The world is no longer as it should be. People use to sit on the front porch and visit one another 1 on 1 or as a group. Where I grew up in the Midwest, people rarely left their house unlocked. You could walk in with out knocking and even help yourself to the fridge if you were hungry!
I am saddened by the number of people who have no one to visit with on a frequent basis. Even worse is the fact that some people enter into care facilities because they are lonely, especially in rural communities. The article that follows was published in 1998. How many people could have lived longer since then if they had been visited more often? Studies are now showing that socializing with others may help to prevent Alzheimer’s Disease or other types of Dementia. We already know that socializing helps to slow the progression down for those that already have it.
Many of the families I work with say that they have lost all of their friends since being diagnosed with Dementia. I believe the reason for this is out of fear. Fear of hurting their own ego or fear of hurting the other persons ego because they may just make some mistakes. Well stay tuned because help is on the way! In my next blog, I will begin to lay out for you some simple concepts of socializing. Interestingly enough, these were the same concepts we were taught in one of my first graduate level classes. How did we get so far from where we were?
One final thought for now. Did you realize that by allowing someone else to help you, you are giving them a gift!
Loneliness Health Hazard for Elderly
NEW YORK (Reuters) — Loneliness can raise the risk of nursing home admission for the elderly, according to a new study.
“Extreme loneliness was a significant predictor of admission to a nursing home among rural older men and women,” conclude researchers at Iowa State University in Ames, Iowa, and the University of Iowa College of Medicine in Iowa City.
Their study, appearing in the current issue of the journal Psychology and Aging, focused on the four-year histories of over 3,000 rural, elderly Iowans averaging 74 years of age at the beginning of the study (1981). The researchers used standard psychological questionnaires to assess levels of loneliness, depression, and social interaction in each of the participants.
Study subjects were then re-assessed once a year over the next four years.
They discovered that “individuals who were the most lonely… at the time of the (original) interviews were more likely to be admitted to a nursing home over the subsequent four-year period,” compared with their less-troubled peers. This effect remained even after the researchers adjusted for the incidence of other known predictors of nursing home care, including age, income, depression, mental and/or physical health status, or extent of social contacts.
The study authors speculate that loneliness might hasten nursing home admission in a variety of ways.
They point to research that suggests that “loneliness may hasten the deterioration of an individual’s health status through its (negative) impact on the immune system.” The Iowa team say chronic loneliness may also help trigger depression, “demoralization and (the) associated effects of neglect of self-care.”
Alternatively, they speculate that nursing homes may offer hope to some of the lonely elderly. Especially in rural areas (where nursing home residents and staff may already be familiar to newcomers), “those who are extremely lonely may enter a nursing home to seek companionship with others,” according to the study authors.
Study senior author Dr. Robert Wallace of the University of Iowa says “interventions to prevent loneliness should be explored in order to keep older people independent.”
He and his colleagues believe that many of elderly living in rural areas need better access to transportation so that they can more easily stay in contact with relatives and friends.
Community groups need to be encouraged as a means of bringing still-independent individuals together. Regular involvement in group activities seems to help ward off a dependence on nursing home care. For example, the investigators discovered that elderly churchgoers experienced much lower rates of nursing home admissions compared with those who did not regularly attend services.
SOURCE: Psychology and Aging (1998;12(4):574-589)
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I am often asked what the first steps are to getting tested if you or a loved one has concerns about memory loss. First of all, be very proactive! You would be surprised at how many times I hear a doctor say “It’s just part of old age” or “She seems fine to me.”
Their are many things that mimic symptoms of Alzheimer’s Disease or other forms of Dementia so the first step is to have your primary care doctor perform a focused physical and order some blood work to determine if anything is out of the ordinary. This lab work must include the following: CBC, Basic metabolic profile, TSH, Vitamin B12, and STS. An abnormal Thyroid condition or Vitamin B12 deficiency may be the underlying cause of memory problems. The doctor should also be given access to a list of all the medications as medication toxicity can cause cognitive impairment.
The doctor will need a complete history from both the patient and other loved ones so insist on being in the room during the visit or bring someone close with you. If the person has a history of brain injury or space occupying lesions, a CT or MRI will be necessary as well.
The Mini Mental Status Examination should always be a part of this visit. The main reason for this short test is to establish a baseline of your cognitive functioning. Be sure and ask for a copy of the test after it has been scored for your own records. The test has five sections: Orientation, Registration, Attention & Calculation, Recall, and Language. A perfect score equals 30 points. A score of less than 21 should be a reason for concern. The test in and of itself is looking for problems in memory both short and long term, language problems, organizational problems, sensory input deficits, and problems with executive functioning. Below, you will see what the test looks like. I do not recommend you give this test to someone whom you believe has memory problems without the primary care physician’s approval.
Mini Mental Status Exam (MMSE)
Name________________________________
Maximum Examinations (1 point per right answer)
ORIENTATION
Ask the patient what (year) (season) (date) (day) (month) it is. 5 Points
Ask the patient where he/she is (province) (country) (town or city) (hospital) (floor). 5 Points
REGISTRATION
Name 3 common objects (e.g., “apple”, “table”, “penny”). Take 1 second to pronounce each word. Then ask the patient to repeat all 3 words. Give one point for each correct answer. Then repeat them until he/she learns all 3. Make a maximum of 6 trials. 3 Points
ATTENTION AND CALCULATION
Ask the patient to subtract 7 from 100 and keep subtracting 7 until you tell him/her to stop. (93, 86, 79, 72, 65)
OR
Ask him/her to spell “WORLD” backwards. The score is the number of letters in correct order (D_L_R_O_W). 5 Points
RECALL
Ask the patient for the 3 objects repeated above. Give 1 point for each correct answer. (Note: Recall cannot be tested if all 3 objects were not remembered during registration.) 3 Points
LANGUAGE
Show the patient a “pencil” and a “watch” and ask him/her to name them. 2 Points
Ask your patient to repeat the following:
« No ifs, ands or buts. » 1 Point
Ask your patient to follow a 3-stage command:
« Take a paper in your right hand, fold it in half, and put it on the floor. » 3 Points
Ask the patient to read and obey the following :
Close your eyes. 1 Point
Write a sentence. 1 Point
Copy the following design. 1 Point
Totals
Initials
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Tips for Better Communication:
¨ Be aware of what you body and face is saying: Smile as much as possible, use slow hand gestures, keep your body relaxed. Try to make normal eye contact.
¨ Be aware of your tone of voice: Avoid yelling, but also be aware that you may be talking to someone with a hearing loss.
¨ Speak slowly and clearly: Alzheimer’s makes it harder to understand many words, this is called Receptive Aphasia. Speaking fast may mean the person you are talking to does not hear all of what you are saying. Set your own agenda aside!
¨ Try not to win arguments: Avoid reasoning or trying to convince them. Often they don’t understand the argument. They can become frustrated by not understanding, or because they are talking to someone who is frustrated.
¨ Limit choice to only a few; (Did you ever wonder why the kid’s menu is this way?) Ask questions which can be answered yes or no. Avoid giving lists or forms to fill out.
¨ Avoid conversations in crowded or loud places; Someone with Alzheimer’s is easily startled. It is harder to focus on one conversation when many others are going on. It is also hard to concentrate when always being startled. The same is true with young children.
¨ Acknowledge what is said: Repeat back key points, and work to let the individual with Alzheimer’s know you heard them.
¨ Agree as often as possible: Stay calm and soothing, and tell them you understand. Avoid using the word “no:” arguing and confrontation.
¨ Know first languages: Alzheimer’s can lead to forgetting second languages. A language spoken since birth can also be comforting when heard.
¨ Rephrase words that are upsetting: Individuals with Alzheimer’s may not recognize or understand words you use. Try to find simpler and more comforting terns or those you are using are upsetting. For example, “day care” often becomes “going to work” or “the [Insert name here] club.”
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1. Corrects treatable causes of memory troubles.
2. Slows the progress of some dementias.
3. Improves medical and hospital care.
4. Reduces risk for accidental injuries.
5. Avoids complications from over-the-counter medications.
6. Allows the parent to organize and safely manage their personal business.
7. Reduces risk of avoidable problems that cause a parent to move from their home.
8. Protects against financial exploitation.
9. Protects against abuse by others.
10. Improves the quality of everyone’s life by reducing anxiety and stress.
The Baby Boomer’s Handbook on Helping Parents Receive Care for Memory Problems
© Richard E. Powers, MD (2007) Bureau of Geriatric Psychiatry/DETA 11/6/07
UAB Alzheimer’s Disease Center
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1. Walk Away- I cannot tell you how often I see this among close friends of someone with Dementia. This includes members of the church congregation, civic clubs, neighbors, business associates and even family members. More often than not, the care giver is in a sense, banished to an unexpected role they did not see coming
This response comes from fear of the disease itself and the fear that you might make a mistake. One of the first things I tell a care giver who is new to this process is that they must embrace the fact that they will make mistakes. Failure is how we learn what not to do!
If you have a friend or family member who has memory problems or has been diagnosed with Dementia, get educated and do the best you can when visiting knowing it is alright to make a mistake. The care giver needs you now more than ever and need people to walk along side them.
2. Assume the person can no longer make decisions for themselves- Mom or dad has been making decisions for themselves for longer than you can remember. Yes, the disease will eventually rob them of thier ability to think rationally however, if it is Alzheimer’s Disease, the decline in functioning will be slow and steady. Of course it depends upon when they are diagnosed and many many other factors. The idea is to meet them where they are at and allow them to participate in as much as they are capable of. Research shows that people with Dementia know they are losing their abilities. This is a frightening experience for the individual and their dignity must be maintained.
3. Sell the Farm- I see this more often than not. The adult children are busy with their own lives and want to have the security in knowing that someone other than them is looking after mom or dad in a facility. As a Gerontologist who specializes in Dementia Care, my goal is to work with the family and the primary care giver to keep mom and or dad in the home as long as possible.
They need to maintain the social network they have spent years to develope. They will remain stable much longer in a familiar, structured, routine environment.
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A few months back, I was taking my kids to school. My son Jonathan is 5 and my daughter Morgan is 9. We live approximately 20 minutes south of Bellingham, which makes for quality time together provided everyone cooperates. Like most parents, I’m always secretly trying to create ways to make things fun and exciting for my kids. This also helps to start my day off right. If I do not do this, they will create something to entertain themselves and this is not always to my liking.
Jonathan made the comment “Hey dad, look at all the volcanoes!” I said to him, “Yes, aren’t they neat. I wonder when they all became volcanoes?” I was ready to launch into an imaginary scene where people a long time ago use to slide down the volcanoes on their way to school instead of driving an automobile. I pictured green slime coming out of the volcanoes and strange creatures that lived inside them. We could have a conversation all the way to school about volcanoes. Except my daughter Morgan busted my ploy! She said, “Those aren’t volcanoes silly, those are mountains!” His moment had ended.
Between the ages of 2 and 7, children are still trying to figure out what’s real and what’s not. They live in the moment! I simply love this age because it is the age of imagination. All one has to do to entertain them is to enter into their sense of reality and support the moment. Yes, there are times when one might say I am lying to my child for doing this. What is wrong with make believe? I know my son just loves it when I play with him on his level and I feel good about it too because I know he is content. We can play for hours on end as long as I stay in his imaginary world. I call this “Gentle Deception”. Now that my daughter is 9, she is starting to get further away from my son’s sense of reality. She is becoming more interested in what is real and what the future holds. Her reality is becoming more like mine and someday, my son’s will too.
By nature, we are driven to grow and improve upon our base of knowledge. People with dementia have grown to their highest level of knowledge and then, they are stricken with this disease that robs them of their ability to learn knew things. They are now going back in time to when they lived life in the moment again. As caregivers, we need to think back to when we had children who lived life for the moment. If we do this often and do it well, it will be much easier to overlook their deficits. When I am working with families, I always encourage them to have fun with this. Some however, have a difficult time with the concept. They feel uncomfortable not telling the truth to their loved one. One client of mine said “ I’ve always been straight with my wife and she expects that of me!” Had I been straight with my 5 year old son, I would of taken away his sense of what he thought was real and insisted he understand what I think is real.
When I work with people who have dementia, I always have to be prepared to get creative. A few weeks ago, I was at a special care facility where only people with moderate to advanced dementia reside. It has a locked door with a keypad next to it. In order to leave, you must know the code and be able to input it correctly. As I entered the code and proceeded to walk through the door I heard a women say, “Where are we going?” Instead of saying, “You don’t belong out here”; I went straight for the plate of cookies sitting in the lobby. I picked up the plate and handed them to her. I then told her I was just getting the cookies so that we could share them with everyone. Even though I did not know this person, I knew that sharing is something she had more than likely learned a long time ago. She was obviously good at sharing, she turned right around and walked back to where her friends were sitting and proceeded to pass out cookies.
I have a client who could no longer drive. He was not safe on the road and he was getting lost more frequently. One of the family members was savvy enough to make the engine in his truck inoperable. Each time I visit my client, he asks me if I could help him get his truck running. My response must accomplish the goal of allowing him to keep his dignity while preventing him from driving his truck. I always use the same response because I know he cannot remember the last time we talked about it. As though I was an old shop buddy from his past I speak directly at him and say “Don’t we know a guy up the street who could fix your truck? Why don’t you give him a call!” I know this man very well and I know he would not be impolite and attempt to call the mechanic while I am there. I have eased his anxiety by giving him a solution to his problem for the moment. He will not remember whom to call after I am gone. This is the blessing in disguise that allows caregivers to master the art of Gentle Deception.
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