Ask Dutchy

My Aunt is Showing Signs of Alz

2008-08-25T07:47:00.000-07:00

A few months ago I heard an unconfirmed rumor. My aunt is showing signs of Alz. After talking to my mother and a few other relatives it was unconfirmed.

I hadn't seen her in over a year. Here is what I noticed

1. Her gait was greatly changed, and she walked with her hands in a funny way. More of a shuffle.

2. Her facial affect had changed greatly. She didn't smile and laugh like she used to.

3. She didn't talk like she used to. She used to be the life of the party and offer tons of new information about everything. This time, nothing!

4. She had a great sentence that people in Alzheimer's care, would refer to as word salad.

I guess time will tell, but it seems pretty obvious to me that she is showing the signs!

A great little article

2008-08-25T07:41:00.000-07:00

About New York; In Twilight World Of Alzheimer's, A Place of Solace

By DOUGLAS MARTIN

Published: July 15, 1989

LEAD: New Yorkers accept confusion and disorientation as a fact of life. For most, things could be worse.

New Yorkers accept confusion and disorientation as a fact of life. For most, things could be worse.

Each weekday, a bus picks up 20 or so people with Alzheimer's disease at their homes in Brooklyn and takes them to the Adult Day Care Program of the Jewish Hospital Medical Center in the Prospect Heights neighborhood.

These people are literally losing their minds. Some can no longer feed themselves. Some cannot go to the toilet alone. And the nature of the disease is that things just keep getting worse. Eventually, Alzheimer's victims forget how to walk, talk and swallow. The shadows darken. Ever so slowly, they die.

But the day-care center is a very happy place. ''We encourage them to have a wonderful day here,'' said Naomi Berger, the director.

And so they seem to do. They sing and dance and make crafts and play games and color pictures and stroke pets and hold one another's hands. They take field trips to Coney Island and the Brooklyn Museum. There are the spring hat show, birthday cakes and Santa Claus.

There is little sense of the biggest loss, the truly irretrievable one.

''We don't have the pain of knowing who they were,'' the assistant director, Cheryl Waldman, said. ''I don't have to look at Morris and think this was once my father.''

The program gives families a huge blessing, temporary escape from the endless strain of monitoring a precarious loved one. ''I love my wife and I'll take care of her at home for as long as I can,'' Bill said. ''Sheila would do the same for me. But it's hard. She needs help with everything, toileting, bathing, dressing, eating. I'd explode if I couldn't get away sometimes.''

To be admitted, applicants have to have diagnoses of Alzheimer's - not an easy call, although 5 percent of the people older than 65 have the disease - and to live within an hour's drive.

Most participants are poor and black. Medicaid pays the bills. A cruel fact is that many people lose out, because small pensions combined with Social Security make them ineligible for Medicaid.

Participants arrive before 10 A.M. The other day, most seemed slightly dazed, but enjoyed cookies and coffee. ''We schmooze with them,'' Ms. Berger said. Then came simple exercises performed while sitting in chairs. This routine - never varied - seemed appreciated for its predictability.

At 10:45 came ''Welcome Time.'' Ms. Berger calls that ''reality orientation.'' The date, season and weather were discussed.

''There are so many wonderful people here!'' Ms. Waldman then exclaimed. She kissed a withered woman who long ago did postgraduate work at Harvard. The woman proceeded to blow kisses to everybody sitting in the circle of chairs. ''I love you all,'' she peeped.

A woman named Virginia was introduced. She boogied to the center of the circle. Some clapped. Others did not seem to see her. ''She's struttin'!'' Ms. Berger shouted. ''Check it out!''

Everybody had their moment, first when introduced and then when introducing another. ''We welcome you to day care,'' Ernestine said to Booker.

Next, all cooperated on a giant crossword puzzle. A clue: ''You can eat it in a cone or a cup. You can lick it off a stick. It is two words. The first begins with ''i.'' Tentatively, several said the right answer.

In truth, all answers are right. After Josephine spelled carousel without the ''u,'' Ms. Waldman said, ''They put a ''u'' in it, but I bet you could spell it either way.''

Just before lunch, records were played. Rock to reggae to rock-a-bye. Some participants shot up to dance. Some were gently pulled to their feet. Some swayed rhythmically in their chairs. Some just sat, frozen.

People shuffled outside for a barbecue, a summer treat. Hot dogs, hamburgers, watermelon, ice cream, the works.

When Ms. Waldman cut food into pieces for those who could not manage, the social worker said she was studying to be a surgeon and needed practice.

After eating, people sat on benches in the sun. They started to sing songs. One contained the line, ''This little light of mine, I'm going to let it shine.'' Another was, ''When I grow too old to dream, I'll have you to remember.''

They then inched back inside, some holding hands, some holding the wall for support.

Time to bowl. Big plastic pins were set on the floor. Frances was first. She knocked down seven pins. Ernestine bent over and laboriously pushed the ball with both hands. It rolled very, very slowly. Strike! Booker then missed everything, but who's counting?

Correction: July 27, 1989, Thursday, Late Edition - Final

A report in About New York on July 15 about a day-care center for people with Alzheimer's disease misidentified the center. It is the JHMCB Center for Nursing and Rehabilitation, not the Jewish Hospital Medical Center, which has changed its name and is not affiliated with the day-care center.

Sleep Apnea

2008-06-11T09:56:00.000-07:00

Since my own father in law had Dementia/ Alzheimer's and Sleep Apnea I found this article very interesting and wanted to pass it along. He didn't believe the CPAP machine did him any good and wouldn't use it. His son, my dear husband also has sleep apnea. He is faithful to use his machine and it has helped him tremendously.

Increases In TST Related To CPAP Treatment Improve Cognition In Alzheimer Patients With OSA

Increases in total sleep time related to the treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) are associated with improvements in cognition in patients with Alzheimer disease, according to a research abstract presented on Tuesday at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by Jana R. Cooke, MD, Sonia Ancoli-Israel, PhD and colleagues from the University of California San Diego, focused on 52 participants with an average age of 77.8 years who had Alzheimer disease and OSA. The participants were randomized to six weeks of therapeutic CPAP or three weeks placebo CPAP followed by three weeks therapeutic CPAP. The participants underwent cognitive testing at baseline, three weeks and six weeks. Sleep was analyzed and scored for sleep stage, total sleep time, amount of time awake during the night, and the amount of oxygen in the blood.

According to the results, when Alzheimer's disease patients with OSA were treated with CPAP, an increase in the total amount of sleep at night, not improvement in oxygen levels, was associated with improvements in cognition.

"This finding implies that the cognitive dysfunction associated with OSA in patients with dementia may be in part an effect of short sleep time rather than a function of low levels of oxygen during sleep," said Dr. Cooke.

OSA is a sleep-related breathing disorder that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. OSA is more common among older adults and among people who are significantly overweight. OSA can increase a person's risk for high blood pressure, strokes, heart disease, and cognitive problems.

Not sleeping well can lead to a number of problems. Older adults who have poor nighttime sleep are more likely to have a depressed mood, attention and memory problems, excessive daytime sleepiness, more nighttime falls and use more over-the-counter or prescription sleep aids. In addition, recent studies associate lack of sleep with serious health problems such as an increased risk of obesity, cardiovascular disease and diabetes.

While most people require seven to eight hours of sleep a night to perform optimally the next day, older adults might find this harder to obtain. Older adults must be more aware of their sleep and maintain good sleep hygiene by following these tips:

Establishing a routine sleep schedule.
Avoiding utilizing bed for activities other than sleep or intimacy.
Avoiding substances that disturb your sleep, like alcohol or caffeine.
Not napping during the day. If you must snooze, limit the time to less than one hour and no later than 3 p.m.
Stick to rituals that help you relax each night before bed. This can include such things as a warm bath, a light snack or a few minutes of reading.
Don't take your worries to bed. Bedtime is a time to relax, not to hash out the stresses of the day.
If you can't fall asleep, leave your bedroom and engage in a quiet activity. Return to bed only when you are tired.
Keep your bedroom dark, quiet and a little cool.

First introduced as a treatment option for sleep apnea in 1981, CPAP is the most common and effective treatment for OSA. CPAP provides a steady stream of pressurized air to patients through a mask that they wear during sleep. This airflow keeps the airway open, preventing the pauses in breathing that characterize sleep apnea and restoring normal oxygen levels.

My Refer Thinks I have Dementia

2008-04-23T11:27:00.000-07:00

Tuesday, June 19, 2007
Doc, My Fridge Thinks I Have Dementia

Filed under: Geriatrics , Medicine

Refrigerators, dishwashers, and doorways diagnosing dementia? Sounds crazy, right, but Dr. Jeffrey Kaye thinks tiny motion sensors strategically placed throughout the home may help doctors diagnose dementia (or chronic alcoholism?) sooner.

Tiny motion sensors are attached to the walls, doorways and even the refrigerator of Elaine Bloomquist's home, tracking the seemingly healthy 86-year-old's daily activity.

It's like spying in the name of science - with her permission - to see if round-the-clock tracking of elderly people's movements can provide early clues of impending Alzheimer's disease.

"Now it takes years to determine if someone's developing dementia," laments Dr. Jeffrey Kaye of Oregon Health & Science University, which is placing the monitors in 300 homes of Portland-area octogenarians as part of a $7 million federally funded project.

The goal: Shave off that time by spotting subtle changes in mobility and behavior that Alzheimer's specialists are convinced precede the disease's telltale memory loss.

Early predictors may be as simple as variations in speed while people walk their hallways, or getting slower at dressing or typing. Also under study are in-home interactive "kiosks" that administer monthly memory and cognition tests, computer keyboards bugged to track typing speed, and pill boxes that record when seniors forget to take their medicines.

Reporting Elder Abuse

2008-04-02T08:52:00.000-07:00

... the Senate Special Committee on Aging estimates that there may be as many as 5 million victims of elder abuse every year.

Signs and symptoms of physical abuse include but are not limited to:

bruises, black eyes, welts, lacerations, and rope marks;
bone fractures, broken bones, and skull fractures;
open wounds, cuts, punctures, untreated injuries in various stages of healing;
sprains, dislocations, and internal injuries/bleeding;
broken eyeglasses/frames, physical signs of being subjected to punishment, and signs of being restrained;
laboratory findings of medication overdose or under utilization of prescribed drugs;
an elder's report of being hit, slapped, kicked, or mistreated;
an elder's sudden change in behavior; and
the caregiver's refusal to allow visitors to see an elder alone.

If you suspect that your loved one may be being abused...

1. If they are in immediate danger, call 911
2. If you have a nagging feeling, that something isn't right, call the department of social and health services.
3. If you feel you need support in your actions, contact the National Center on Elder Abuse.

The National Center on Elder Abuse can be reached at (202) 898-2586 or e-mail them at ncea@nasua.org. While they are unable to provide direct casework or handle individual elder abuse cases, they can put you in touch with those who can help.

National Center on Elder Abuse
1201 15th Street, NW, Suite 350
Washington, DC 20005
Ph: (202) 898-2586
Fax: (202) 898-2583

Here are some more signs of elder abuse

While one sign does not necessarily indicate abuse, some tell-tale signs that there could be a problem are:

Bruises, pressure marks, broken bones, abrasions, and burns may be an indication of physical abuse, neglect, or mistreatment.
Unexplained withdrawal from normal activities, a sudden change in alertness, and unusual depression may be indicators of emotional abuse.
Bruises around the breasts or genital area can occur from sexual abuse.
Sudden changes in financial situations may be the result of exploitation.
Bedsores, unattended medical needs, poor hygiene, and unusual weight loss are indicators of possible neglect.
Behavior such as belittling, threats, and other uses of power and control by spouses are indicators of verbal or emotional abuse.
Strained or tense relationships, frequent arguments between the caregiver and elderly person are also signs. (lists and photo are from the National Center on Elder Abuse's website)

Brain Healthy Diet

2008-03-28T09:05:00.000-07:00

According to the most current research, a brain-healthy diet is one that reduces the risk of heart disease and diabetes, encourages good blood flow to the brain, and is low in fat and cholesterol. Like the heart, the brain needs the right balance of nutrients, including protein and sugar, to function well. A brain-healthy diet is most effective when combined with physical and mental activity and social interaction.

Manage your body weight for overall good health of brain and body. A long-term study of 1,500 adults found that those who were obese in middle age were twice as likely to develop dementia in later life. Those who also had high cholesterol and high blood pressure had six times the risk of dementia. Adopt an overall food lifestyle, rather than a short-term diet, and eat in moderation.

Reduce your intake of foods high in fat and cholesterol. Studies have shown that high intake of saturated fat and cholesterol clogs the arteries and is associated with higher risk for Alzheimer’s disease. However, HDL (or “good”) cholesterol may help protect brain cells. Use mono- and polyunsaturated fats, such as olive oil, for example. Try baking or grilling food instead of frying.

Increase your intake of protective foods. Current research suggests that certain foods may reduce the risk of heart disease and stroke, and appear to protect brain cells.

In general, dark-skinned fruits and vegetables have the highest levels of naturally occurring antioxidant levels. Such vegetables include: kale, spinach, brussels sprouts, alfalfa sprouts, broccoli, beets, red bell pepper, onion, corn and eggplant. Fruits with high antioxidant levels include prunes, raisins, blueberries, blackberries, strawberries, raspberries, plums, oranges, red grapes and cherries.
Cold water fish contain beneficial omega-3 fatty acids: halibut, mackerel, salmon, trout and tuna.
Some nuts can be a useful part of your diet; almonds, pecans and walnuts are a good source of vitamin E, an antioxidant.

Not enough information is available to indicate what quantities of these foods might be most beneficial for brain health. For example, it is not clear how much fruit would have to be consumed to have a detectable benefit. However, a study of elderly women showed that those who ate the most green, leafy and cruciferous vegetables in the group were one to two years younger in mental function than women who ate few of these vegetables.

Vitamins may be helpful. There is some indication that vitamins, such as vitamin E, or vitamins E and C together, vitamin B12 and folate may be important in lowering your risk of developing Alzheimer’s. A brain-healthy diet will help increase your intake of these vitamins and the trace elements necessary for the body to use them effectively.

Stay Mentally Active

2008-03-28T08:58:00.001-07:00

Mental decline as you age appears to be largely due to altered connections among brain cells. But research has found that keeping the brain active seems to increase its vitality and may build its reserves of brain cells and connections. You could even generate new brain cells.

Low levels of education have been found to be related to a higher risk of Alzheimer’s later in life. This may be due to a lower level of life-long mental stimulation. Put another way, higher levels of education appear to be somewhat protective against Alzheimer’s, possibly because brain cells and their connections are stronger. Well-educated individuals can still get Alzheimer’s, but symptoms may appear later because of this protective effect.

You don’t have to turn your life upside down, or make extreme changes to achieve many of these benefits. Start with something small, like a daily walk. After a while, add another small change

Keep your brain active every day:

Stay curious and involved — commit to lifelong learning
Read, write, work crossword or other puzzles
Attend lectures and plays
Enroll in courses at your local adult education center, community college or other community group
Play games
Garden
Try memory exercises

Are you at increased risk for Alzheimer's?

2008-03-28T08:42:00.000-07:00

Yesterday on the news, it was reported that people who have round bellies will have a 4% higher chance of getting Dementia. So I thought I would encourage you all to get out there and walk a bit. ME INCLUDED!

Here are some other tips to keeping your brain healthy!

Think About Your Future.
Maintain Your Brain Today.

When people think about staying fit, they generally think from the neck down. But the health of your brain plays a critical role in almost everything you do: thinking, feeling, remembering, working, and playing – even sleeping.

The good news is that we now know there’s a lot you can do to help keep your brain healthier as you age. These steps might also reduce your risk of Alzheimer’s disease or other dementia.

Simple lifestyle modifications also would have an enormous impact on our nation's public health and the cost of healthcare. If you make brain-healthy lifestyle changes and take action by getting involved, we could realize a future without Alzheimer's disease.

Make brain-healthy life choices

Like other parts of your body, your brain may lose some agility as you get older. It can deteriorate even more if you don’t take care of it. Science is unlocking many of the mysteries of the brain, but we don’t have all the answers yet. You can do everything “right” and still not prevent Alzheimer’s disease. What’s offered here is the best and most up-to-date information available so that you can make your own decisions about your health.

Stay mentally active

Mentally stimulating activities strengthen brain cells and the connections between them, and may even create new nerve cells.

Remain socially active

Social activity not only makes physical and mental activity more enjoyable, it can reduce stress levels, which helps maintain healthy connections among brain cells

Stay physically active

Physical exercise is essential for maintaining good blood flow to the brain as well as to encourage new brain cells. It also can significantly reduce the risk of heart attack, stroke and diabetes, and thereby protect against those risk factors for Alzheimer's and other dementias.

Adopt a brain-healthy diet

Research suggests that high cholesterol may contribute to stroke and brain cell damage. A low fat, low cholesterol diet is advisable. And there is growing evidence that a diet rich in dark vegetables and fruits, which contain antioxidants, may help protect brain cells.

Disease and risk factors you can’t control

Alzheimer’s disease is the most common form of dementia – brain disorders that affect your ability to function effectively in daily living. Well-established risk factors for Alzheimer’s disease are genetics and aging (10 percent of those over age 65 and 50 percent of those over 85 have Alzheimer’s). Unfortunately, aging and genetics are two risk factors you can’t control.

It’s not known what causes Alzheimer’s disease or what role genetics plays in most cases of Alzheimer’s, though having parents or siblings with the disease increases your risk. A small percentage of cases is known to be caused by inherited mutated genes. In other cases, variants of specific genes increase risk, but even people who inherit such variants from both parents still may not get the disease. These risk factors that you cannot change will set a starting point for you, but there is hope that adopting the Maintain Your Brain® life habits might delay or prevent the appearance of Alzheimer’s disease.

It seems like I can't take my mom anywhere!

2008-03-13T11:26:00.000-07:00

Q: I always pick my mom up from her care home and bring her to family get
togethers, , but lately she has been getting so upset. What should I do? I
don’t want to leave mom out.

A:Anything that takes a person with Alzheimer’s out of their daily routine will throw them off track somewhat.

But if you are getting a catastrophic response or a lot negative feed back perhaps you should consider this. There comes a point when a family member needs to ask, is this activity for me or for mom/dad? If your loved one gets agitated at outings perhaps the stimulus is too great for them to deal with.

If you want to have interaction try activities that they are familiar with like, activities from their daily routine, such as talking to them while you are brushing their hair or polishing their nails. I have even found that a lot of my clients enjoy reading a simple children’s book.

With activities like these they get the benefit of a visit without all of the excessive stimuli. They will also get the benefit from touch that they need so much. God bless you in caring for your mom.

Crazy?

2008-03-12T10:53:00.000-07:00

Dementia - Topic Overview

Is this topic for you?

Alzheimer’s disease is the most common cause of dementia. This topic focuses on other conditions that cause dementia. For more information on Alzheimer’s, see the topic Alzheimer's Disease.

What is dementia?

We all forget things as we get older. Many older people have a slight loss of memory that does not affect their daily lives. But memory loss that gets worse may mean that you have dementia.

Dementia is a loss of mental skills that affects your daily life. It can cause problems with your memory and how well you can think and plan. Usually dementia gets worse over time. How long this takes is different for each person. Some people stay the same for years. Others lose skills quickly.

Your chances of having dementia rise as you get older. But this does not mean that everyone will get it. Many older adults never get it. By age 85, about 35 out of 100 people have it.¹ That means that 65 out of 100 people this age do not have dementia. And after age 85, even more people will get dementia.

If you or a loved one has memory loss that is getting worse, see your doctor. It may be nothing to worry about. If it is dementia, treatment may help.

What causes dementia?

Dementia is caused by damage to or changes in the brain. Things that can cause dementia include:

Strokes, tumors, or head injuries. After Alzheimer's disease, strokes are the most common cause of dementia. This type of dementia is called vascular dementia.
Diseases, such as Parkinson's disease, dementia with Lewy bodies, and frontotemporal dementia.

In a few cases, dementia is caused by a problem that can be treated. Examples include having an underactive thyroid gland (hypothyroidism), not getting enough vitamin B12, and fluid buildup in the brain (normal-pressure hydrocephalus). In these cases, treating the problem may cure the dementia.

In some people, depression can cause memory loss that seems like dementia. Depression can be treated.

As you age, medicines may affect you more. Taking some medicines together may cause symptoms that look like dementia. Be sure your doctor knows about all of the medicines you take. This means all prescription medicines and all over-the-counter medicines, herbs, vitamins, and supplements.

What are the symptoms?

Usually the first symptom is memory loss. Often the person who has a memory problem does not notice it, but family and friends do. As dementia gets worse:

You may have more trouble doing things that take planning, like making a list and going shopping.
You may have trouble using or understanding words.
You may get lost in places you know well.

Over time, people with dementia may begin to act very different. They may become scared and strike out at others, or they may become clingy and childlike. They may stop brushing their teeth or bathing.

(Part One)

Terry Pratchett

2008-03-06T14:56:00.000-08:00

Terry Pratchett has addressed an open letter to his fans (on Paul Kidby's Discworld News) with some genuinely awful news -- he has a rare form of early-onset Alzheimer's. His note is incredibly brave and chipper. The man's a real inspiration -- incredibly prolific, brilliant and talented, friendly and clearly as happy as anything with where he's found himself.

Folks,

I would have liked to keep this one quiet for a little while, but because of upcoming conventions and of course the need to keep my publishers informed, it seems to me unfair to withhold the news. I have been diagnosed with a very rare form of early onset Alzheimer's, which lay behind this year's phantom "stroke".

We are taking it fairly philosophically down here and possibly with a mild optimism. For now work is continuing on the completion of Nation and the basic notes are already being laid down for Unseen Academicals. All other things being equal, I expect to meet most current and, as far as possible, future commitments but will discuss things with the various organisers. Frankly, I would prefer it if people kept things cheerful, because I think there's time for at least a few more books yet :o)

Terry Pratchett

PS I would just like to draw attention to everyone reading the above that this should be interpreted as 'I am not dead'. I will, of course, be dead at some future point, as will everybody else. For me, this maybe further off than you think - it's too soon to tell. I know it's a very human thing to say "Is there anything I can do", but in this case I would only entertain offers from very high-end experts in brain chemistry.

I wanted to share this because I thought the PS in this letter was - although sad- a classic/funny response.

Here is some more information on Terry Pratchett

Terence David John Pratchett, OBE (born 28 April 1948) is a British fantasy, science fiction and children's author. He is best known for his popular and long-running Discworld series of comic fantasy novels. Pratchett's first novel, The Carpet People, was published in 1971, and since his first Discworld novel (The Colour of Magic) was published in 1983, he has written two books a year on average. Pratchett is also known for close collaboration on adaptations of his books but has held back from Discworld feature films so far.

Pratchett was the UK's best-selling author of the 1990s,and as of December 2007 has sold more than 55 million books worldwide, with translations made in 33 languages. He is currently the second most-read writer in the UK, and seventh most-read non-US author in the U.S. In 2001 he won the Carnegie Medal for his children's novel The Amazing Maurice and his Educated Rodents.

Despite his popularity, Pratchett is often described as having a ‘cult following’ - a factor seen as having, in the past, hindered his literary recognition. Pratchett, who was named an Officer of the Order of the British Empire "for services to literature" in 1998, holds the record for the most shoplifted books in Britain. Source is Wikipedia.

Reversable Dementia's

2008-03-06T07:42:00.000-08:00

Reversible Dementias

Deteriorating intellectual capacity may be caused by a variety of diseases and disorders in older persons. An illness and/or a reaction to medication may cause a change in mental status. These are sometimes called “pseudodementias.” Detecting the underlying cause of changes through medical evaluation may lead to a determination that the cause is reversible or treatable. Examples of conditions that can cause reversible symptoms of dementia include:

Reactions to medications. Adverse drug reactions are one of the most common reasons older persons experience symptoms that mimic dementia. All medications, prescriptions, over-the-counter pills and herbal remedies should be monitored by a physician to reduce the possibility of side effects.
Endocrine abnormalities. The conditions of low or high thyroid levels, parathyroid disturbances or adrenal abnormalities can cause confusion that mimics dementia.
Metabolic disturbances. Confusion or appetite, sleep and emotional changes can be caused by medical conditions including renal and liver failure, electrolyte imbalances (blood chemistry levels), hypoglycemia (low blood sugar), hypercalcemia (high calcium), and diseases of the liver and pancreas.
Emotional Distress. Depression or major life changes such retirement, divorce or loss of a loved one can affect one’s physical and mental health. A physician should be informed about major stressful life events.
Vision and Hearing. Undetected problems of vision or hearing may result in inappropriate responses and be misinterpreted. Hearing and eye exams should be performed.
Infections. Confusion can be a symptom of an infection and needs to be brought to the attention of the physician.
Nutritional Deficiencies. Deficiencies of B vitamins (folate, niacin, riboflavin and thiamine) can produce cognitive impairment.

If you or your loved one are having difficulties with memory it is best that you consult your doctor and not self diagnose. I wanted to list these as possible causes.

Washington State Adult Family Homes

2008-03-02T12:25:00.000-08:00

As a long-term care consultant for seniors and their families I have visited many different types of facilities. But my favorite type of facility to visit is adult family homes.

There are over 2200 adult family homes in Washington State. Adult family homes have many things in common, but are each unique in their individual decor' and house size. Some are ultra fancy, some are tailored for country type folk, while some are modern and are bursting with color.

Each provider, like the differences you find in the decor of the homes is individual in their personalities. Some are laid back, others are very vivacious, you will find that some are calm, quiet houses, while others team with activity.

When you enter an adult family home the first thing you will notice is that the Adult family home smells wonderful. They take pride in making delicious homemade meals. Often times when you come into the homes you’ll be greeted by the aroma of fresh baked bread, rolls, or muffins, not to mention the varieties of home made soups, baked chicken, roasts or casseroles, whose fragrance fill the air.

Adult family homes do not have overwhelming chemical smells like nursing homes. They have a smaller ratio of clients to serve and clients are cared for in a much timelier manner, reducing odors.

Since caregiver ratio is much smaller than in traditional institutional settings. (The caregiver to client ratio is 1:5 or 1:6) This gives the caregiver and the client much more individualized time together. Careful personalized attention can be given to the individual senior living in this care setting. Bathing, dressing, putting on lotion and powders, not to mention the warmed up bathroom and the occasional dryer warmed towels, for the client are all done in a manner that preserves the seniors dignity. Often times I hear caregivers laughing with their residents while giving them a shower, I have even heard some singing.

Many seniors bring their furniture from home, pictures from their living room walls, bedspreads, photo albums, their own beds even. Having a piece of home with them helps them to feel more at home. I have been in several adult family homes that even paint the rooms the residents’ favorite color. Of coarse the amount of furniture you can bring depends on the size of the room.

Seniors don't have to share rooms in adult family homes. But if they choose to do so, adult family home providers are careful to ensure that there is a good match with the roommate. If you prefer your own private bathroom some adult family homes offer those too.

Activities in the home are individualized to meet each senior’s preferences. Some seniors enjoy more activities and are encouraged to visit the senior centers, go on outings, attend church, or other social clubs, do light cooking and gardening. While other seniors enjoy a good book, watching TV, visiting with the caregivers (there is actually a lot of time for this) or just watching the birds through the kitchen window.

Caregivers have a chance to get to know each client’s individual tastes. If a client doesn't particularly like roast beef, accommodations will be made. You don't find nursing homes that will change a meal based on a single client’s wish. Many adult family homes have their residents help with the menu planning, so everyone gets to participate. Snacks are purchased with the specific individuals in mind. Each aspect of the care is tailored to the individual.

Perhaps the most important thing of all is that caregivers are with your loved one for more than just a shift. There is continuity of care. The person, who manages your loved ones care in the home, is more than likely the one who sleeps in the bedroom right next to them at night. The relationship becomes more personalized. Changes in the clients’ status are detected earlier, because a caregiver has taken time to notice. The staff turnover is very minimal. A senior feels more comfortable confiding health problems with a friend rather than a staff member that he doesn't really know.

I could continue, because there are so many more things that make an adult family home a wonderful choice for long term care. If you have any questions please feel free to contact us.

I hope this helps! ~Dutchy

Nursing homes rake in the money/but provide less care!

2008-03-02T11:25:00.000-08:00

Here is a letter that I received from an adult family home provider in Washington State...I sure wish there were more I could do to help!

Renee,

I came across your article describing AFH's and felt that you painted the correct picture of our industry. I and the other 200 or so Providers here in Eastern WA wish our legislators in Olympia had the same vision of what we do and would be willing to fund us. I'm afraid most AFH's will shut down or stop taking state pay clients all together in the next 2 years because of funding. I have attached a flier for you to look at and ask for your support in contacting the 3 people in long term care funding who will decide if we stay or go.

I received my first AFH license in 1988 as an undergraduate at Gonzaga University and the minimum rate was around $28, today it is at $48. Nursing homes today receive between $160-260 a day with resident to staff ratios of 15:1. I don't have to tell you that between our low ratios of 3.3:1 and the high level of commitment that Providers have in operating a caring and loving home, AFH's are trully a sanctuary for those residents we serve.

With decisions being made in the next few weeks, the time is short for Providers to ask for help. 2 decades of nonfunding from Olympia have left Providers stretched to the breaking point. I have personally spoken to 94 Providers in the last 2 weeks and we are all in the same unfortunate situation.

If you and anyone you know can lend a voice to our cause, all 2200 AFH's would be grateful.

Mark Strahl
AFH Provider
Spokane

Agitation

2008-03-01T10:03:00.000-08:00

A person with Alzheimer's may feel anxious or agitated. He or she may become restless and need to move around or pace. Or the person may become upset in certain places or focused on specific details. He or she may become over-reliant on a certain caregiver for attention and direction.
Causes of agitation

Agitation may be caused by a number of different medical conditions and drug interactions or by any circumstances that worsen the person’s ability to think. Situations that may lead to agitation include:

* Moving to a new residence or nursing home

* Changes in the environment or change in caregiver

* Misperceived threats

* Fear and fatigue resulting from trying to make sense out of a confusing world

Treating agitation

A person with agitation should receive a thorough medical checkup, especially when it comes on suddenly. The treatment of agitation depends on a careful diagnosis, determining the possible causes and the types of agitated behavior the person is experiencing. With proper treatment and intervention, the agitation symptoms can be reduced.

There are two distinct types of treatments for agitation: behavioral interventions and prescription medications. Behavioral treatments should be tried first. In general, steps to managing agitation include (1) identifying the behavior (2) understanding its cause and (3) knowing how to respond.
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Preventing agitation

To prevent or reduce agitation:

* Create a calm environment. Remove stressors, triggers or danger; move person to a safer or quieter place; offer rest or privacy; limit caffeine use; provide opportunity for exercise; develop soothing rituals; and use gentle reminders.

* Avoid environmental triggers. Noise, glare, insecure space and too much background distraction, including television.

* Monitor personal comfort: Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation; ensure a comfortable temperature; be sensitive to fears, misperceived threats and frustration with expressing what is wanted.

* Simplify tasks and routines.

Identify triggers

Identifying what has triggered agitation can often help in choosing the best response to the behavior. Often the trigger is a change in the person’s environment:

* change in caregiver

* change in living arrangements

* travel

* hospitalization

* presence of house guests

* bathing

* being asked to change clothing

How to respond

* Listen to the frustration. Find out what may be causing the agitation, and try to understand

* Provide reassurance. Use calming phrases such "You’re safe here." "I’m sorry that you are upset." "I will stay until you feel better."

* Involve the person in activities. Try using art, music or other activities to help the person relax.

* Modify the environment. Decrease noise and distractions, or move to another place.

* Find outlets for the person's energy. The person may be looking for something to do. Take a walk, or go for a car ride.

* Check yourself. If the person is agitated, do not raise your voice, and do not corner, restrain, criticize, ignore, argue with or shame the person.

Helpful website where I found this information

Alzheimer's is her mission

2008-02-23T06:50:00.000-08:00

Alzheimer's is her mission

There are millions of stories in the vast and growing Alzheimer's universe. Jacqueline Marcell's is just one of them. But what a story it is.

Her best-selling and Book-of-the-Month Club selection Elder Rage: Take My Father ? Please (How To Survive Caring for Aging Parents) is at once blood-curdling and heart-warming, dispiriting and uplifting, a gripping page-turner and well-informed self-help guide. It was prompted by her struggle to help her mother and father, who were both finally diagnosed with Alzheimer's disease but not before more than a decade of heartache that culminated in a hellish year out of her life.

Elder Rage was published in 2001. But it is even more relevant six years later as Alzheimer's and other forms of dementia work their way deeper into the public consciousness while the population ages and Boomers deal with ailing parents and even begin to contract the disease themselves.

Over those six years, Marcell has become nothing less than a force of nurture in the world of Alzheimer's care-giving, a one-woman band dedicated to educating people about how to deal with Alzheimer's and other forms of dementia.

"Education is paramount," she says over the phone from Irvine, Calif., where she lives and practises her new life's work, a totally unintended consequence for the former TV executive and college professor. "We could save the country an enormous amount of money, time, tears, heartaches and absolute misery [by spreading the word about Alzheimer's care and diagnosis]."

Marcell does her considerable bit through a radio program, syndicated column, lectures, TV appearances, blogs and a Web site (www.elderrage.com). More than five million Americans have the disease now and that might grow to 12 million by 2050, by which time it will be costing US$350-billion a year to treat.

Daunting, yes, but not necessarily overwhelming. After all, Marcell says, Elder Rage is about how she made her parents' lives better despite her "rageaholic," Jekyll-and-Hyde father and health and social systems that Kafka might have appreciated.

And some progress is being made as the medical establishment works feverishly on Alzheimer's treatments despite lower funding from government. Only 12 years after the first Alzheimer's drug was introduced, there are 23 new drugs in clinical trials, Marcell says, and a dozen of them show great promise in helping to slow the disease.

But it is still not clear what causes the disease and, barring a major breakthrough on the cure front, diagnosing, treating and care-giving will be where progress must be made.

"It first falls on the spouse," Marcell says. "Then it falls on the adult children. Then they try to find a care-giver. But most people can't afford 24/7 care."

That's where long-term care insurance comes in. She says it's vital. At 57 and knowing her parents' Alzheimer's history, she has the insurance and she eats well and exercises, too.

Yet she is a realist. "I know what to do at the first sign of short-term memory loss. I know what to look for and I know not to delay. I know how to delay the progression of it in all the ways possible. And I know there are doctors to go to."

One major problem in Alzheimer's treatment, though, is a shortage of doctors to go to. Marcell says there are fewer geriatrics specialists practising in the United States now than there were eight years ago when she started looking into Alzheimer's and its treatment.

"Geriatrics is the low-est-paid specialty," she says. "If you're a medical student in your 20s, do you want to deal with bouncing babies or heart disease where you can do something about it? Or do you want to deal with elderly people and their afflictions from head to toe and their siblings and spouses and kids? Every patient you have dies on you no matter what you do. Gee, what would you pick if you were in your 20s?"

Furthermore, though the Boomers have largely stepped up to the plate and taken care of their parents, they can't expect their children to do the same for them. "They have been spoiled since Day 1," she says.

"They have a whole different experience of life. They're not going to be a care-giving generation and they're heading into an era where there are going to be more elderly people than at any other time in history."

Meantime, Marcell says there's still a great deal of denial about Alzheimer's among people who prefer not to recognize its early signs in parents or spouses. "No one gets it till it hits their loved one. Then they start to get it."

Jacqueline Marcell got it when she tackled her parents' problem head-on almost 10 years ago. Today, her mission is to get other people to get it, to make a difference.

"You can do something to delay Alzheimer's. We're blessed to be living when we're living because there are things that can be done."

whanley@nationalpost.com

Click here to find this book

Link to interview with Author of Elder Rage and Author of Into The Mist, When Someone You Love Has Alzheimer's Disease.

Caregivers Firstaid Kit

2008-02-20T07:51:00.000-08:00

Alzheimer's and Dementia is hard to deal with! We like to add a little bit of lighthearted humor to our days. IF we don't laugh sometimes....we cry!

CAREGIVERS FIRST AID KIT

Alzheimer's Book Reviews

2008-02-17T09:04:00.000-08:00

At www.mycarelink.net we have a section for book reviews. You may find some of the comments very helpful. We are always looking for new books to add.
Let us know if you have read one that is helpful.

Thanks!

Heart warming Alzheimer's Story

2008-02-16T06:40:00.000-08:00

This was posted by forum member Cin.

Caregivers are the heroes

By Angela Lunde

I found this article written by a friend and colleague a few years back. As we enter a new year, I thought it would be appropriate to reflect upon some of our true heroes out there ...

Make no mistake: Heroes are good things. But do we stop often enough to think about why certain people are heroes and whether or not we've told them?
We often think of our parents as heroes because of all they've given us that's tangible. Maybe we hear the name of someone famous and are reminded of how their deeds inspire us to be better. I have the good fortune of being able to meet some of my heroes, once a week. They are men and women who are the primary caregivers — the loved ones — of people with Alzheimer's disease.

One of my heroes is a man I'll call Fred. I first met Fred in our men's group about 8 years ago. His wife had been diagnosed with Alzheimer's disease at age 52, and he started coming to our group soon after. Reluctant to join us, Fred had already raised a daughter with special needs and knew full well how many mental health settings often fell short. But somehow we managed to convince Fred that, at the very least, others in the group could benefit from his experiences.

Fred became the truthsayer of our group. He told it like it was. Others might put a cheerful face on their caregiving experience, saying it wasn't so bad, that they were doing fine. Fred said caregiving was *beep*. He admitted to getting frustrated and angry at the things his wife did. He admitted to being scared when she got upset with cooking and threw the skillet at him. He admitted to being worn out when his wife would mistake the clothes in the closet for an intruder and get them both up to check it out, night after night.

But Fred also made others see the humor in caregiving. His story about taking his wife on a trip to Texas is still one of the group's all-time classics. The first night of their driving trip they stopped at a motel somewhere in Indiana. Fred got up in the morning and started packing the car when he realized that his wife wasn't around. Frantically, he checked the room and the parking lot. He was relieved to find her in the motel office until he overheard her telling the clerk that a strange man was trying to abduct her. Fred spent the rest of the morning convincing the police he was her husband and that she had Alzheimer's. It was so ludicrous and frightening that all the men in the group laughed until they cried.

We discovered Fred might have to stop coming to the group because he couldn't leave his wife anymore. Fortunately, we found a program sponsored by our local Area Agency on Aging that trained volunteers to care for people with Alzheimer's in order to allow primary caregivers 16 hours a month respite. Fred arranged four of these hours to be around group time. Fred ended up caring for his wife at home for about six years before he had to place her in an assisted living facility. Only a few months later, she started falling and losing her ability to walk. Her vital signs became irregular, and soon, she died. I went to the funeral. All of the men from the group were there. One of Fred's daughters stood to speak. She said she had not lost her mother that week but had lost her ten years earlier when the disease struck. She said in those ten years, though, she gained something. She discovered how truly incredible her father was. I wept. All the men in the group wept. She said her father was a hero.

Fred came to a few more sessions. He decided to try to go back to a job. He had quit early in his wife's illness to care for her. He planned a trip to Germany.
Jane, from the women's group, is another of my heroes and has a story much like Fred's. Her husband had been a photographer but, at 50, started having trouble finding his words. Two years later — 14 years ago — he was diagnosed with Alzheimer's. Jane quit work four years ago to take care of him full time. She intermittently came to the women's group. When she would come, she would laugh at the silly things that Alzheimer's does to people and their families. Like the time her son thought maybe a dip in the hot tub would relax his father. Once in the water, her husband thought he was in a swimming pool and started diving underwater, bumping into everyone. He then became frantic and stated pulling everyone under with him. Jane just watched and laughed. "What else am I going to do," she said, "cry?"

When Jane would come to the group, she would often say it was hard to get away, even though she knew it was good for her. We told Jane about the Area Agency on Aging volunteer program, but when she first contacted them, no volunteers were available. Then, six months ago, Jane told the group they had finally found a volunteer to stay with her husband. She was relieved it was a man, and even more relieved when he said he understood Alzheimer's because he'd lost his wife to it two years earlier. The volunteer proceeded to look at her husband's photographs with him and to show him pictures of Germany he had brought with him. In no time, they were like long-lost buddies. Jane said the volunteer's name was Fred.

I think heroes come in many forms — a heroic friend or parent or spouse or volunteer. Some heroes show you that even when you think you have done your part, taken your turn, or carried your load, you may have more to give.

When caregiving ends

2008-02-13T10:52:00.000-08:00

I have been a caregiver for 12 years. I have been a burnt out caregiver for the past two years. However, I have constantly found myself falling back into the caregiver postition , pretty much unable to say no whenever I have been asked.

Now that I have a new job as a receptionist in a medical clinic, I find myself having to resist the urge to jump over the counter and open the door for an elderly patient. I still find myself picking out little old ladies in a crowd that I would like to bring home with me.

If you find this hard to believe , just ask my husband and children how many times they have told me no to bringing a "stray" elderly person home.

So I now find myself asking ...what do I do now that care giving has ended? Get on with my life? Focus on my new career opportunities? I disect over and over why I feel this way. Some have suggested a co-dependency type of relationship, while I know that this care giving desire is a feeling that I have deep in my heart. That feeling comes from knowing what it is like to give your life up for someone else. At least for a few moments in time. To know what it is like to be the best at rubbing someone's feet, or to cover them with warm blankets from the dryer, and watch as their face relax. To feel successful when you can re-direct an agitated wandering Alzheimer's patient. To know that you can provide a home for a person who's family doesn't even want to see them. These are the feelings that draw caregivers back to a job care giving. These are the types of feelings that someone has when their hearts have been strengthened by the pain of death yet they continue to seek out this kind of work.

Recently on our forum a woman who's husband passed away told us that she was volunteering for hospice. So I know this...I am not alone in my desire to keep going back into this profession.

2/13/08 I originally began this post a year or so ago. As we speak I am a caregiver again. I am still asking why I find myself again in this role.

I have come to a sort of understanding within my heart that makes sense.

"There But for the Grace of God go I" I don't feel guilty that I am not in there condition...I feel relief...therefore...I must help!

Blessings with Alzheimer's Patients!

2008-02-08T08:17:00.000-08:00

Several years ago my mom’s best friend called to ask if I would take care of her mother who had Alzheimer’s. I felt honored to be asked and was delighted to take on the challenge. It wasn’t long before I was questioning my decision. Hazel was one of the hardest ladies I had ever provided care for.

As I look back on the whole experience I can laugh, but I wasn’t laughing then. She would steal my doilies and put them in her attends, she would go through other residents belongings, she would take all of the scraps from the table and add them to the leftovers and encourage us to make stew for our children with them. She would urinate in her slippers, and get out of bed countless times a night, looking for…. Her bed!

One night was especially crazy. It was later in the evening when she came out of her room, dressed and ready to go visit her brother’s house. She thought he was living across the street. I tried every tactic in the book to talk her out of leaving the house. It was pointless. Quite a while later I was able to convince her to get ready for bed. But she was very upset and kept yelling at me. She even hit me a few times. That little 90-year-old lady could really hit!

I asked my husband to help me lift her into bed. By this time the entire household was disrupted. David tried talking to her. I was standing behind him telling him it wasn’t going to work. She was screaming at the top of her lungs for David to call the police. In her mind I had hit her. After 10 minutes or so David helped me pick her up and put her into bed. Once she was lying down she was a lot calmer. She lay in bed breathing in and out. I could tell she was still very upset. She was whispering a prayer, “ Lord, help me. These people they hit me, they are horrible”

When she was done with her prayer she asked me is she could at least go to the bathroom. “Sure!” I said. Then we proceeded to go through the entire scene again. This time when I asked my husband for help getting her back into bed, he didn’t try talking.

At Christmas time I would always buy my ladies little gifts. I found the perfect gift for Hazel. A little pillow heart ornament. It had the word blessings written across it in gold lettering. I kept that little heart hanging on the knob of her dresser for the entire time I took care of her. It was to remind myself that no matter how difficult the care was, that there was always a blessing…somewhere.

Hazel passed away several years ago; I still keep the heart with me. On days when life seems hard, I find myself looking at the pillow. I remember that the hard times won’t last forever and that one-day I will be able to look back and think of those hard times as blessings.

Here is a picture of her ornament:

This was originally post 3/9/07 I thought it fitting with the heart to place here for Valentines.

Relating with a person who has Alzheimer's

2008-02-06T10:13:00.001-08:00

What person with Alzheimer's wouldn't love to see a baby, a kitten or a puppy? Even some sweet pictures will do.

It is easy to find things to bring for your loved one to see, feel, taste or touch that they will still enjoy.

If they aren't able to express their appreciation for your efforts, it doesn't mean they didn't appreciate them.

The next time you visit a loved one in a nursing home bring something extra...from the outside world that they might enjoy!

Alzheimer's Valentine

2008-02-04T08:46:00.000-08:00

What is one way that you can show someone with Alzheimer's that you love them?

Stop the hustle and bustle for a few minutes and show them that you love them by sitting down and just holding their hand!

Keep your Brain Healthy

2008-02-03T10:52:00.000-08:00

Q:What can we do to help stave off Alzheimer's Disease?

A: Great question. Scientists are constantly asking themselves this question! It seems that while no one really knows what causes Alzheimer's Disease, it is known that there are certain things a person can do to help lower their risk factor for getting the disease. At http://www.mycarelink.net/ we have included a new section called healthy choices. Healthy food choices, excercise, stimulating brain games and supplements.

So, what can we do to keep our brains healthy? What have you done to help maintain a healthy brain?? Anything to help the cause. Visit us and join in the discussion!

Rest and Renewal Tips for Caregivers

2008-01-28T08:33:00.000-08:00

I saw this posted on a website and thought I would just add a few thoughts of my own!

* Hire a sitter or an aide for occasional events or on a regular basis. Once a day would be optimal, but not always practical. Try for once a week. If this isn't available to you, for whatever reason...try and take moments in the day just for yourself!

* Arrange for other family members or friends to provide care. Make a list of phone numbers and keep it by the phone. Write yourself a note at the bottom of the list. (for my sanity!) Let yourself use your list of resources.

* Use a nursing home or assisted living facility for planned vacations of a week or more. If you can't afford to do this, I would check with the department of social services to see if you qualify for relief care. Instead of sending your loved one to a facility consider this...you may be the one that needs to go to a friends house!

* Use a day hospital or adult day care.

* Get a family member or friend to take on some responsibility regularly, such as paying bills, taking your loved one for a daily walk, giving a bath and shampoo. If you are having a hard time finding help, there are many avenues in which to look. I would start with local churches! Ask nurses in your area if they know of someone who could help!

* Change your expectations for yourself: let the housework go more than you like, for example. Letting some of the housework go is ok, but not all of the time. I'd try hiring a housekeeper, having someone take your loved one for a walk so you can focus on cleaning. Or have your loved on stay with you in the room you are cleaning. If you are like most women, letting the house go will make you fell worse!

* Meditate or pray. Stick to prayer!

* Recognize that for some people, nursing homes or assisted living facilities are the best option. If you choose this option-don't beat yourself up!

Helpful website where I found this article