Dementia Care and Stress Reduction

When I first started to care for my mother, it took me a while to realize that when a person cares for a person with dementia, their life is not their own.

I had an epipany one day when I felt the demands of others had taken over my world.

I sat down and figured out that between caring for mom, dad, spouse and two kids--when I divided that hour into 60 minute increments--I basically had only 10 minutes each hour for myself.

There is not much you can do in 10 minutes!

I don't know about you, but for me that was my awakening as a dementia caregiver, or as Oprah woud say, my "A-ha moment."

Another "A-ha" moment happened while I was in my car driving home after two hours of convincing mom to go to a day center and then actually trying to get her there. I just sat in the parking lot and cried.

I know what you are thinking... Nataly, you are exaggerating!

Nope, I'm not. I sat in the parking lot and hysterically cried. I cried for my mother, my children, my family and myself.

Alzheimer's care will break you.

When you are dealing with a person who has any form of dementia there is no "me" time. What you get are stolen moments. And even when you get those stolen moments, somehow they get used for someone or something else.

Alzheimer's Care is 24/7. There is no escaping this fact. Even when you are "off" you're "on."

Dissrupted sleep next to a monitor, clutching your phone like a child's blanket, constantly on red alert for the sound of a foot step, fall, or worse--the chime of a door opening.

Time is the only commodity that can't be bought, sold, traded or bartered for. Time is all we have. And as my mom's symptoms of dementia progressed, and through her various stages of demnetia, there were times where I longed for those precious 10 minutes of time.

Sometimes I found them and others I didn't.

I did the only rational thing I could do: I made lists.

When I made lists, for once, it was about me. Okay, mom was in there too. Her needs, my family's needs, my needs (see I'm still last), but that is what happens when you become an Alzheimer's caregiver.

Forget about spring cleaning, I was time cleaning!

I didn't know it back then, but I learned over time that to be an affective caregver, you have to learn to say NO.

Just like our cluttered homes and lives, as a caregiver sometimes we have to sit back and take stock of our lives. 

Is it possible that we are too connected that we've lost connections?

Over the next few months I will be sharing tips that you can use to make caregiving easier by time cleaning.

As caregivers we can never have enough time on our hands. Send me your time saving ideas and I'll add them to our list.

Dementia and Hiring Home Health Care

I just got a phone call from my client who was sorry to inform me that she has to cancel...again!

Slow down a moment before you rush to judge.

Cancellations are common when you are dealing with anyone going through the many different stages of dementia. Jane's husband, Bob, has Frontal Temporal Lobe Dementia (FTD) and he has become our weather barometer! Anytime the weather changes, so does his mood and behavior.

I started tracking this unusal phenomena when I noticed a pattern of cancelations a few months back. Bob's symptoms of dementia kick into high gear whenever a weather front came through.

Bob is more accurate than my arthritic knee!

And this not only true for Bob, because over the years I've tracked cancelations caused by weather. It seems like the weather has an adverse affect on many who have dementia. Easy going people suddenly become argumentative and non-compliant.

A weather front comes in and so too do the behavioral problems!

And this weather problem brought in more problems for my client. Jane not only missed our scheduled appointment (which we rescheduled to a phone session), but she also couldn't attend a luncheon that she was looking forward to.

Add into the mix that the concert tickets she purchased months back went unused--they never attended the event because of the bad weather.

So, this was a good time to revisit an idea I had suggested to Jane about bringing in a home aide for "Plan B" situations.

There comes a time for every caregiver, depending on the symptoms of dementia, where going out of the house will be a major issue. This is also true depending on the stages of dementia your loved one is in. As a caregiver, if you want to attend an event, there will come a time when you will need to bring in the reinforcements.

Many of my caregivers avoid hiring an aide until the very last moment. This may happen for a myriad of reasons: "I want to be with him," "He won't accept a new person," "I can do it myself" and "He still likes to go places" are just some of the reasons I hear. Again, depending on the stages of dementia, the reasons will vary.

The reality is, for many caregivers, accepting the fact that extra help is needed means also coming to terms with the fact that your loved one's condition is declining. And that is a very difficult idea for many caregivers of Alzheimer's patients to accept.

Another issue is the quality of care. Different stages of dementia will require additional care and support from others to ensure they are successfully cared for safely at home.

For Jane, we discussed adding additional hours with an aide so that the next time she makes plans for the day or evening she will know to have an aide in place.

Emotionally, this was a hard conversation for Jane to have. She finally accepted, though, because as the well spouse it meant she had become what I call, one of the "married-singles." It is a huge transition to attend events without your spouse after many years of marriage.

Jane and I also talked about our "in-and-out rule." When the aide comes in, Jane goes out. When the aide is out with Bob, Jane stays in the house. This way, Jane will be able to go out of the house and not worry as much. Her husband Bob is a wanderer and has walked out of grocery stores, malls and other events. I wrote about ways to stop wandering in an earlier post.

Take it from me: When a caregiver finally gets some hours off duty and is miles away from home, being glued to the phone in case an emergency happens takes all the fun out of the outing.

It's just better to be safe than sorry knowing an aide and your loved one is safely secured at home.

Respite care does not always mean hiring in help. Over the next few weeks I'll be writing about the different types of respite care and how different types of respite care can help you.

Dementia and Jigsaw Puzzles

Growing up I always found gift giving for my parents difficult. Ties, perfume, cologne, perfume...boring!

My parents "oohed" and "ahhed" over my gifts, but the reality was, how many ties did my father need?

So when mom started having symptoms of dementia, the holidays really stumped me!

Bathrobes and slippers were my go to items. They made me feel good, and mom seemed to enjoy the gifts, that is, until I was the one who had to clean out the home and found all of my "wonderful" presents never used!

It appears that I'm not the only one with this problem because I've received several emails over the last few days from caregivers looking for holiday giftsfor their loved ones.

Through the years I've learned some gifts are better than others. The various stages of dementia will call for a little more ingenuity.

As many of us know, dementia affects everyone differently. There are many different symptoms of dementia, and those symptoms will help you pick the right gift. For example, some symptoms restrict activities and other symptoms might make other activities better. The key is to understand what the person with dementia is capable of doing and choosing your activity acccordingly. Different stages of dementia will result in different choices.

I'm constantly on the look out for great activities. Early this year I decided that my go-to gift would be jigsaw puzzles.

A recent article correctly noted that, "Dementia slows down the brain’s function and playing games like crosswords and solving puzzles is good for the affected person." This supports other findings like the one published recently in the Huffington Post where researchers from Germany found individuals who participated in dementia therapy (such as with puzzles) were effective at stopping their dementia from progressing further. The one-year study based on 61 participants also found patients were able to keep doing their everyday tasks. However, patients who only took dementia-slowing drugs had their dementia progress.

In addition to their therapeutic effects, puzzles also make for a great activity to do together.

So I set out to find the perfect puzzle.

The problem I faced was this: All the puzzles I found in nearby Miami stores were either too childlike or had too many pieces. I wanted something that would be age appropriate as the person progressed through their different stages of dementia.

Now, you should know that I'm a sucker for my clients, so it's not uncommon for me to troll the Internet late at night looking for just the right activity. I was searcing for an art book and suddently I stumbled onto a website that physically woke me up....

I found the perfect collection of jigsaw puzzles! These puzzles are based on nostalgic covers of the Saturday Evening Post, a well-treasured publication from the past of many dementia patients. Saturday Evening Post covers are perfect subject matter because they are age appropriate, fun and there are many to choose from.

Truth be told, everything looks great on the Internet, but before I recommend anything to my clients, I have to rigourosly test the product myself. Call me skeptical, but I've been burned too many times. So I contacted the maker to find out more.

It turns out that Karen Miller, the manufacturer of the puzzles, has a passion for the elderly. I learned that in 2007 she saw a show about Alzheimer's, and the show brought back all the memories of her mother. She remembered how her mother had suffered through many strokes and the symptoms of dementia. Karen is not only licensed to use the Saturday Evening Post covers, she was able to bring them back to life in her own unique way. The site describes how Karen came up with the idea:

"Her Mom always liked puzzles and playing cards, both became very difficult for her. Puzzle pieces being too small and puzzles too big were frustrating for her."

Karen also makes memory cards that are great for matching games and terrific for reminicence therapy.

I have personally found that the artwork on these puzzles motivates and stimulates memories, the pieces fit well in hands and they are solidly built. I also find it amazing to listen to patients as they remember their memories of Norman Rockwell and the Saturday Evening Post.

To learn more about these terrific puzzles, visit Karen's website at http://memoryjoggingpuzzles.com

Dementia and the Well Spouse

I can remember it as if it was yesterday. Sitting in my very first support group at Mount Sinai in Miami Beach. My mother had just been diagnosed with dementia and I was told attending a support group would help.

There were six of us in a large, spread out dinning room that felt more like a lecture hall than an intimate table for ten.

A quick scan of the room to see who my seat mates were brought me down to earth. I was 38 years old and caring for my mother. All of the others were much older and caring for a spouse.

I felt like a fish out of water.

People nodded and smiled at me. Being who I am I struck up several conversations only to be paternally struck down. I was too naive and being a newbie I didn't know what others knew....

Caring for a parent is totally different than caring for a spouse

So, innocently I sat through this group listening to the doctor talking about the different stages of dementia and how my mom was going to act and be. I honestly tried to befriend the others in the group who gave me a "knowing" smile and said, "It's different, it's not your wife."

I didn't get it back then because I thought that we are all in this together and going through the different stages of dementia should have been our bond.

Nothing can be further than this truth. Caring for a spouse is different than caring for a parent.

Some things stick with us and make us better caregivers. For me, this lesson hit home, then and now.

Back then, I had no idea that years later I would be a licensed therapist and running the group, not only for the Alzheimer's Association, but for the Alzheimer's Educational program at the Wien Center.

Because of my own experience, I was very sensitive to the needs of each group, children and spouses. Even though both groups will experience many of the same stages of dementia, the reality is that each stages of dementia means something different to each group.

With this in mind, I tried to find a balance for my groups. Spouse, child, friend, culture ... the different stages of dementia were in my mind for each group I ran. Talk about stress!

The reality is that group balance and cohesion depends on many factors. Even with the right mix I still felt like Richard Dawson hosting Family Feud.

So, here are my Dementia Zone top five tips for understanding the differences between spouse and child caregivers:

1- The expectation is different. Adults fall in love and get married, and as spouses they share a dream to spend their lives together. Spouses expect to grow old together and so, despite the imperfections, many tolerate the ups and downs that marriage brings. Even in their wildest dreams, despite vows of "in sickness and in health," few people ever expect or plan for dementia.

2- The intimacy is different. Spouses have sex and sexual needs. Despite what children may want to believe, it's totally natural to have, want and be able to be sexual beings throughout our lives. But when your sexual partner has dementia, it changes the entire dynamic of the relationship.

3-The interaction is different. Couples have their own form of communication. But dementia changes the way we interact and communicate with other people. As a result, spouses become responsible for taking control and being in charge of a person who was once capable on their own. They find themselves directing (or even ordering and pleading) for their spouse to do the most ordinary, everyday things, including bathing and grooming.

4- The role is different. When you are married to a person, there is a written and unwritten "code of roles." For example, (depending on the generation) some couples may subscribe to the idea that "men work on the outside, women work on the inside." Today, both sexes can be equal partners, but every relationship still has roles. Who pays the bills, who cares for the car and lawn, who grocery shops... dementia will change this.

5- The socialization is different. The reality is the wife is usually the one to direct the social functions of the family. Just like Judy McCoy in the "Love Boat." When the wife has dementia, socialization for the spouse slows down or ceases altogether. No matter which spouse has dementia, friends start to fade away and, due to the different stages of dementia, socializing with others becomes very difficult.

If you are caring for a spouse with dementia, you will want to check out The Well Spouse Association, which is dedicated to helping out the spousal caregiver. WSA is filled with great resources, articles and advice that offers spouse specific caregiver support, all helping you through your journey. Go to http://www.wellspouse.org/

In the meantime, if you'd like to talk to me about your caregiving situation, just contact me through this website or call me at (305) 904-9506. I look forward to hearing from you.

 

 

 

 

 

 

 

What You Need to Know About Dementia and Medicare Plans

I don't know about you, but as a caregiver working in the field of dementia, even I can get a little distracted!

With so many demands on my time and energy, it's easy to let the small things slip through the cracks.

Take health insurance for example. Due to an unfortunate situation (my hubby forgot to pay the bill) we were dropped by COBRA. Once I realized we didn't have medical coverage, I started on the hunt for a new policy. It wasn't as simple as it once was. Individual policies are expensive and confusing. Co-pays, deductibles, doctors, medications, in-state, out-of-state....let's just say the entire process was overwhelming, but not nearly as overwhelming as picking a Medicare plan! And I'm a health care professional!

Which leads me to today's topic:

Medicare Plans and Scams

Over the past several weeks I bet you have been getting an awful lot of Medicare Advantage plan information. You're probably not only getting this through your mail, but also in email and text messages on your cellphone too. I, for one, had totally forgot that this is the season for Medicare enrollment!

With only a few days left to go, many unscrupulous insurance agents know if they don't get you to switch and sign up by December 7, they will lose their hefty commissions. So, I'm writing this article today to help you save money on health insurance.

The problem for caregivers of dementia patients is that by saving money you might just lose some of your benefits. Some plan advisers may leave out important details about coverage or outright misrepresent the plan. With so many plans to choose from, depending on the different stages of dementia you're dealing with, many Medicare plan representatives I spoke with were just as confused about what's covered in their policies as I was!

In "Alzheimer's Disease and Other Dementias: The Caregiver's Complete Survival Guide" I talk  about what has happened to several of my clients who did not know or didn't do their Medicare homework. Depending on the stages of dementia your loved one is in, keep in mind they will have drastically different medical needs than people who do not have dementia. Keep the special needs of dementia in mind when you review your Medicare options.

So, before you sign up for a new plan, here are The Dementia Zone's top five tips to make an informed Medicare insurance decision.

1-A Medicare Advantage Plan is not the same as a Medicare supplement. A Medicare Supplement works in addition to your original Medicare coverage and a Medicare Advantage Plan works in place of your original Medicare, and may provide additional features.

2- Ask important questions. Each Medicare Advantage Plan is different. Although all Medicare Advantage Plans must cover at least the medically necessary services, Medicare Advantage Plans can charge different deductibles, offer co-payments (for instance $30 per office visit) or have various co-insurance terms (such as 20% of the procedure cost).

Some Medicare Advantage Plans have a limit on how much you can spend in a year and some plans do not have a spending limit.

Medicare Advantage Plans can also offer additional services like eyecare, dental care, and fitness programs. Consider what you need before you look at plans.

3-Verify before you switch. Ask yourself, what is the true cost? Is your doctor on the plan? Which hospitals will you want to use?

Depending on the symptoms of dementia your loved one is facing, your needs for physical therapy and rehabilitation will change. Be sure you know the plan's  restrictions.

Ask yourself whether you will want to use their service providers, or what you will need to pay if you go outside their plan. Check the rules! Some plans insist you get a referral to specialists or engage in high-cost testing and procedures in certain situations.

4- Check the prescription plan. Are the drugs you are using on the formulary? Know that the drugs you may need in the future might not be on their plan, depending on which stage of dementia your loved one is in.

5-Check additional services. Medicare Advantage Plans also offer additional services like eyecare, dental care, and fitness programs.

Additional services are great, buy only if you actually use them or your doctor is on them. Don't be tempted to join up for somethingn new thinking you might use a fitness club, especially if you hate working out!

6- Never assume. Even if you are with a plan you love, don't automatically re-sign with that plan without checking the details. Plans change, doctors change, medical conditions change. Remember, once you are enrolled, you will be in this plan for one year (unless you appeal). If you are unsure about something, ask questions now or telephone Medicare at 1-800-633-4227 for assistance.

 

Depression and Caregiving

I just got back to Miami last week and I’ve been in a bit of a funk.

I miss being in North Carolina and this time I left the dogs and the hubby behind. For the first time in weeks the sun is actually shining and I have the whole house to myself. It’s every caregivers dream come true, so what’s up with my mood?

If I didn’t know better, I’d say I was depressed. 

The reality is that I have Missing Disease.

I miss my old home in Miami Beach where I cared for mom and the kids, I miss North Carolina, the dogs, the hubby, although not in that order. I miss the chaos of the fun times and having a full house...I miss all the big windows where the light streamed in.

I miss my “normal” life.

The same thing goes for many of my caregivers and people with dementia.

A few months back, a client confided in me that she was depressed. We spoke about the sadness and loss of being a caregiver. This woman is the most active 85-year-old that I know! She still works, exercises, and socializes but the daily strain and worry over her husband with mild dementia has been getting to her. She had tried several anti-depressants over the past year but they didn’t help.

We talked about grief and sadness for the future that has changed.

Hearing so much about the wonders of medication through television advertisements she was convinced that there was a medication for her that would work and she went to see a new psychiatrist.

When I saw her at our next visit she was so much more upbeat that I was curious about which medication the doctor had gaven to her. It turns out the doctor spent time talking with her and then diagnosed her with “Missing Disease”.

According to her doctor, many of the elderly are incorrectly diagnosed with depression because they are feeling sad. My client had every right to feel sad. Her husband has dementia and she's worried about him and their future together. The daily questions and forgetfulness have been getting to her because its been changing her state of “normal”. So the prescription that she got from her doctor was to talk with me!

Unfortunately, the word "depression" has been too over-used in our society. Whenever we are down we automatically think that it’s depression. People look confused when I ask them if they are depressed or sad!

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods of time.

Sadness is a normal process and reaction when we are disappointed. Let’s face it, as dementia caregivers we have a lot to be sad about!

Loss of control, unexpected changes, stressful life events, time demands, increased responsibility, additional expenses, fear, anxiety, worry, contemplating the future.....a total change of our "normal".

There are many remedies for Missing Disorder and none of them involve a trip to the pharmacy. Some of the techniques that work well are talk therapy, aromatherapy, meditation, nature therapy, music and art therapy and lifestyle changes such as diet and exercise. 

Here are your top 5 Dementia Zone tips that you should know about depression

1- True clinical depression is a mood disorder in which feelings of sadness, loss, anger or frustration interfere with everyday life for weeks or longer.

2- Check for a medical condition. Hypothyroidism or underactive thyroid, lack of sleep, heart conditions and drug interactions can cause depression.

3- Medication may be helpful in the short term (and so are placebos). Studies have shown that anti-depressants are most helpful for those who have severe depression.

3- Talk therapy has been shown to be more effective then medication and there are no side effects! Find a good counselor or support group.

4- For many, depression will run its coarse. Despite what you may believe, you may not need to be on medication for the rest of your life. Often times, the reason people feel worse when they go off their medications is due to physical and mental withdrawal symptoms.

5-Check the three S’s- get enough Sleep, get a boost from Sunshine, get a handle on your Stress.

About that client ... I saw her yesterday and she is as happy as can be!

Tune into the next article to find out why. But for now, enjoy the story of Bob and Babs:

 

Fall Driving and Dementia

 

Let’s be honest. Long car trips are boring. Short ones can be too. There are only so many times that you can play car-color bingo or license plate tag. One year, out of desperation to save my sanity and to keep the kids from a major back seat meltdown, I invented a new game:  “Name The Road Kill”.

As macabre as that may sound, driving in Florida--other than the odd possum, armadillo or raccoon--the roads are pretty much clear. 

The kids were occupied for hours. They would spot something from a distance, thinking it might be an animal, only to find out it was a piece of tire.

Times have changed. As a caregiver, I’m changed, but our family tradition lives on. And so, to keep me focused on my drives after license plate tag and car color bingo, I now count the road kill.

This is why on my drive up to North Carolina in late October I noticed there were an awful amount of animals that didn't quite make it to the other side of the highway.

What I thought were tires from a distance turned out to be deer. I’m not talking one or two. I counted over nine deer.  Starting in Georgia, the deer obviously were not crossing at their designated cross walks.

Being a Florida girl, I never experienced or realized this large mammal driving hazard until last spring. That's when I was driving back to Miami and a deer leapt in front of my car at dawn. Another time, a deer and fawn raced across the road in an urban area. I slammed on my brakes and thankfully, no one was behind me.

Unless you have encountered it, having a deer suddenly jump in front of your car is a heart-pounding experience.

No one wants to hit Bambi!

As caregivers, when we think of driving, and early stages of dementia or elderly driving, we typically do not consider wildlife suddenly jumping in front of their cars!

When safely at home I did a quick search and found out that I was not alone.

Deer collisions become more frequent during fall and winter due to deer migration and mating season, which typically occur from October through December. Deers are looking for mates and cars are an afterthought.

According to the National Highway Traffic Safety Administration, there are about 1 million car accidents with deer each year that kill 200 Americans, cause more than 10,000 personal injuries, and result in $1 billion in vehicle damage.

On average, more collisions between cars and deer occur in November than in any other month, according to State Farm Insurance.

For the fifth year in a row, State Farm reported that West Virginia tops the list of states where a driver is most likely to run into a deer. The other states in the top 10 are Iowa, South Dakota, Pennsylvania, Michigan, Montana, Wisconsin, Minnesota, North Dakota and Wyoming.

Over the past several months I’ve had several encounters with deers over the past several in North Carolina that, like my wandering mom, I never reported. 

So, here are my top 5 Dementia Zone tips for Fall Driving:

 1- Reschedule appointments. Some of our loved ones are early birds or late risers. Know that most deer/ car encounters occur between the hours of 6:30-7:30 AM and 4:30-6:30 PM. 

 2- October thru December is peak mating time for deer. They will be out and about. Mating is their concern and not your car.

 3- Deers are herd animals. If you see one, there are others around. Slow down.

 4- When you see a deer crossing sign. Know that you are entering an area where deer will cross. Use special caution in this area.

 5- Hit the deer. Sounds cruel, but when there is a deer on the road, swerving or braking may be your first reaction. The experts say it is safer to hit the deer than to swerve into oncoming traffic or to hit a stationery object, such as a tree, barricade, or another car. 

Uncle Walt coined the term "Twitterpated"- Now I get it!

 

 

 

 

 

 

 

 

 

 

 

 

Alzheimer's Care and Halloween

 

Ah, fall. The air gets crisp, the leaves change and the pumpkin patch becomes the number one family destination for indoor and outdoor decorations. 

I love Halloween not only because it's the official start of the holidays but also because I love everything pumpkin.

Pumpkin pies, cookies, ice cream and coffee. Nothing says loving to me more than pumpkins!

It took a while for me to get over what I now refer to as the "Great Pumpkin Disaster of 2001"

Growing up I had sidewalk envy. We lived on the side of the street where there were no sidewalks. That meant no bike ridding, roller skating or playing hide and go seek around the block unless an adult was around to watch me cross the street.

Being sidewalk deprived was especially hard during Halloween, talk about isolation! As the houses across the street were filled with brightly lit Jack-O-Lanterns and happy kids ringing doorbells our house looked like the haunted mansion in Disney World.

And so I would sit all costumed out with my basket of candy and no one came- other than a few brave teenagers who I'm sure only did on a dare.

In 2001, when I moved with to a street with sidewalks, I vowed that my kids would never suffer the same fate that I did.

Our first Halloween, we went to the local church pumpkin patch and bought three of the biggest pumpkins we could carry and a few small ones to boot. We got out our stencils and carving knives and made the scariest hollowed Jack-O-Lanterns and set them out with candles. I was so excited and couldn't wait to show mom. Her reaction wasn't what I expected. She freaked, panicked and ran back into the house.

And that's when I learned that due to mom's stage of dementia a carved, lit pumpkin was not a harmless decoration in our house.

And neither was the cute battery operated ghost candy dish that grabbed your hand as you reached in for a piece of candy!

It only got worse on October 31st. Hoards of trick or treaters dressed in their scariest costumes visited our home. My kids loved them but mom's dementia couldn't allow her to process why mini Freddy Kruggers were coming to her house! 

Between the doorbell, dogs barking, decorations, dressed up kids as zombies yelling "trick or treat", laughter and screams it became way too much for mom. She was overwhelmed.

Mom also grew up behind a cemetery, think spooky 365 days a year!

Needless to say, I learned a lot about how the most innocent of childhood holidays can be a source of stress and anxiety for a person with dementia.

Here are my 5 Dementia Zone tips for dealing with Halloween.  

1. Keep decorations to a minimum. Any decoration that changes the "normal" look of the house may lead to anxiety and confusion
2. Avoid the fun but scary Halloween doormat, if it scares a 6-year-old, it will scare a person with dementia.
3. Putting out a fake cemetery and hanging goblins from trees may get you in the holiday spirit but don't be surprised when mom refuses to walk in or out of the house. Passing a head stone that reads, "Here lies Fred who choked on bread" can bring up bad memories.
4. Avoid night time use of flashlights and candles, especially in pumpkins. A person with dementia will have visual perception changes and the eerie glow that they cast can lead to high anxiety.
5. Try to stay away from the malls while the little ghosts and goblins are trick or treating. It may be a safer way for the kids to enjoy the holiday but for a person with dementia it will just add to the confusion (and they may later avoid going back to the mall).
6. Put the candy in a safe place. I used to keep our basket of sweets at the front door and there it stayed until the last piece was eaten, until a trip to the doctor revealed that mom was making herself sick on the candy.

Above all, know that Alzheimer's care does not mean not enjoying this holiday. During different stages of dementia, it may be necessary to cut back on the decorations but you can still have a ghoulishly good time watching Herman and his family.

Alzheimer's Care and Dental Health

There must be something in the air or the tooth fairy was working overtime because I've had three separate calls from caregivers about tooth problems and dental problems.

In the first case, the patient was in excruciating mouth pain, the second had an infection and the third had a broken molar.

Last I checked, I am not a dentist...

In fact, I hate going to the dentist for my own personal reasons. Do you recall those commercials where the person is smiling because the dentist gave them a “great check up”? Nope, never happened to me.

My dentist actually smiles with glee when he sees my name on his list! I’ve paid for his swimming pool, vacations and kids college. Yep, he loves me!

Growing up I had the best teeth in town and was pretty much cavity free until I had my first child. After Stephen was born, it was all down hill.

My parents were fanatical when it came to dental care and oral hygiene. My dad pretty much had all his teeth and lived to 99 years. While my Mom also lived a long life, she had all her teeth capped or crowned. She even made me promise to retrieve her “kings ransom” from her mouth before burial.

Last month, my trip to North Carolina was delayed for three days because of a dental problem. I first noticed a problem on Sunday night, including severe tenderness. I thought brushing, flossing and a good treatment with Listerine would cure my problems. On Monday I continued with my good intentions and stoic European background and I even took a few Tylenol to boot. By Tuesday afternoon I realized that my good intentions were getting me nowhere and on Wednesday I finally broke down and called my dentist.

Due to our good relationship, and the fact that one of his kids is now in grad school, they immediately got me in.

As it turned out, I had a severe infection, which explains the past few weeks where I was feeling run down. I needed immediate invasive help and a ton of antibiotics.

Dental Care for Alzheimer's and Dementia Patients

Dental exams and Alzheimer’s disease is not something that you hear about and you should. There are tons of good studies that show that dental hygiene and physical health go hand-in-hand.

Regardless of the stage of dementia, dental care should not stop when a person is diagnosed. As a caregiver, this is a not-to-be-missed step in their care. Often times, family members get so caught up in all of the “other important” appointments,  the dentist gets put on the the back burner.

While dental problems are not a direct cause of dementia, they can cause difficult behaviors and speed up the decline in health and mental functioning. No matter what stage of dementia the person is in, good oral hygiene is a must.

Here are my 5 Dementia Zone tips for good oral hygiene:

1. There are 22 steps to brushing your teeth. The ability to initiate all of these steps can stop a person from being successful. Think about this: You need to pick out YOUR toothbrush, recognize the toothpaste, unscrew the cap, put on the right amount, bring it to your mouth, put the tooth brush in, brush the teeth, spit etc.... it’s confusing!
2. Depending on the stage of dementia, be realistic. If a person is having problems taking their medications or preparing meals or taking a bath, they are probably having problems brushing their teeth.
3. A mouth infection can be the cause of a difficult behavior. During my latest mouth infection I was fatigued and cranky. I didn’t realize that I even had an infection, and a person with dementia won’t either.
4. Keep up the twice-year checks up. As we age, our mouth shrinks and our teeth become loose. This gives plaque and gingivitis a perfect storm for periodontal disease, which will lead to physical health problems.
5. Check the dentures. Many of my clients are not taking them out and cleaning them as they should. Old food will sour and anything they ingest (food or liquid) will taste bad. This can set the stage for dehydration and constipation.

Getting our elders to brush may seem like a job for Jobe, but there is always Mighty Mouse to the rescue

Stages of Dementia: How to Get your Loved One Off the Road

In my last article, I talked about the challenges of Driving with Dementia. As the stages of dementia increase in your loved one, this will become a common issue for many people. One of my readers quickly responded with the following comment: 

"Don't tell me how to track someone who is lost. Give me ways to convince them NOT to drive."

I know how hard this decision is to make. I also know that every family is different. Times have changed, and now driving with Alzheimer’s (or any form of memory loss) is now a major issue.

I can remember the scene as if it was yesterday...

Mom received a visit from one of Miami Beach’s finest--a policeman--and came to the house to deliver the news that another motorist noticed mom's erratic driving, reported it, and now mom would need to take a driving test or surrender her license.

My mother was quite the charmer and tried to dissuade the officer with coy laughter and excellent reasoning. She said that she and a “neighbor” weren't getting along, and this police report was retaliation at its finest. Mom even tried to get the name of the person who reported the incident so she could go personally talk to them. We learned mom had not only been swerving, but had cut the person off!

Needless to say, I was personally thrilled that this anonymous Good Samaritan had reported my mother. Even before the stages of dementia had set in, Mom had been a lousy driver. She often took offense at being the brunt of our jokes. I thought my dad (who also didn’t trust mom’s driving skills and would often call me to be his chauffeur) would be as thrilled as I was that the officer had threatened to take away mom's driving license.

He wasn’t!

The reality was, taking away Mom’s license meant that she would be in the house all day, and that was unacceptable to my father. No matter what I said about mom getting hurt, or both of them getting hurt, or the risk of death to innocent strangers, it all fell on deaf ears.

Dad gave me an ultimatum: Make sure mom passes her driving test or else!

After many heated arguments, I did what most of us do with our parents. I caved in. And so, every day, for two to three hours, I coached my mother through the state's driving exam book. She was not yet diagnosed with Alzheimer's, and we didn't know to be alert for the various stages of dementia. It was a difficult process and I secretly believed mom would flunk the test. After all, she couldn’t even remember what she had for breakfast. There was no way she was going to remember the rules of the road, be able to sit in a car with a stranger and get through the actual road test, right?

So, on the day of the exam, I gladly drove my mom to the testing site and sat inside watching her open the exam. I figured she would give up once she saw the questions and we’d be gone in five minutes.

One hour later, she proudly walked over to the window with her test in hand to be graded. You could have knocked me over with a feather when they said she passed and now would take the driving test.

Whoa! How in God’s name did that happen?!

Well, at least the driving instructor would catch on that she was the worst driver in Dade county and flunk her, right? Even though I didn't know how the stages of dementia were affecting my mother at that time, I trusted the driving test would still be too much for her. With this in mind, I took a deep breath and practiced my condolence speech to her and my dad.

I should have used my time more wisely, because I never got to give that speech. Yep, my mother passed the road test, too.

Seriously.

So, since my Plan A, "Fail the Driving Test" hadn't work, I had to quickly spring into action and put into place: 

• Plan B: Hiding the keys
• Plan C: Flatten a tire
• Plan D: Remove a spark plug
• Plan E: Lock the garage door and take the key with me

Each time I was thwarted by my father, as well meaning and determined as he was. It dawned on me that no matter what I did, my dad would have his own agenda and rationale for wanting mom to drive.

Drastic Times Call for Drastic Measures

At that time, I had just given birth to my daughter, Sloane. She was my parents' only granddaughter. Now, it was my turn for an ultimatum.

"Either mom stays off the road, or I will not bring your granddaughter to the house."

Once again I appealed to their reason and the safety of myself, their grandchildren, society. All to no avail.

When dad would call to ask when I was coming over, I would ask if mom was on the road. She usually was from 10-5pm. So my answer would be, "NO!"

I refused to drive into their area of town, unless I knew for a fact that Mom would be safely off the road. I stuck to my guns, which was very hard, and in about three weeks of me coming over, usually past 7pm with very cold, late meals, my dad eventually caved in. Dad finally took the keys away from mom.

My Lesson: In my family, the way to taking mom’s car keys away was through my father's stomach!

Each Family is Different

If you are like me, and have problems with speaking up to your parents. So here are 7 practical solutions you can use for getting your loved one suffering through the stages of dementia off the road more safely:

1. Have the doctor speak to your loved one about medication and driving.

Doctors carry with them a high level of authority. Ask the doctor to explain how medication can affect reaction time, and that your loved one shouldn’t drive for at least one month, until their medication has stabilized.

2. Have the doctor recommend a professional driving evaluation.

Be firm that your loved one mustn't drive until they get evaluated. Make an appointment and stand firm.

3. Have the doctors office fill out a letter to the state.

Each state has a place where you can download a form for your doctor to report impaired driving. In Florida, the form is located at: http://www.flhsmv.gov/forms/72190.pdf

Reporting impaired driving is mandatory in some states.

4. Report the impaired driving yourself.

Reporting impaired driving can be done anonymously, and the state will send a letter to your loved one requesting a driving exam.

5. Disable the Vehicle.

Depending on the loved one suffering through the stages of dementia, you may try my Plan A-E. Just know that each person is different, and you will need to make sure that you are not endangering them or other drivers. My mom was car safety conscious and would check the air pressure daily. Driving on a flat would not have happened in her case, but for others it will. Consult with other members of your family.

6. Have an off-duty police officer come to the home to speak to your loved one.

7. Tell you loved one that the insurance company cancelled their policy and that you are checking around for new quotes.

Some people will stop driving if their license is taken away, others will forget that they don’t have a licence and will drive no matter what.

Depending on the situation, I reccomend a variety of strategies.

Driving was so much simpler in the Bedrock!

 

What worked for you? Please share or e-mail me. And to Donna, I hope this helps.