Archive for the ‘Alzheimer’s Disease’ Category
Posted on February 3, 2012 - by Nurse Virginia
WHEN THE ELDER WITH ALZHEIMER’S DISEASE NO LONGER RECOGNIZES THEIR FAMILY
WHEN THE ELDER WITH ALZHEIMER’S DISEASE NO LONGER RECOGNIZES THEIR FAMILY
Now it has happened to me my mother doesn’t always recognize me. After visiting my mother Verona in a nursing home, where she has lived for the past 12 years, at times she looks at me with a blank stare. She tries and struggles with the information I give her to try to tweak her memory. But if I turn and talk to anyone else in the room, I have lost her and have to start all over. “Hi, Mom, it’s Ginny,” always said with a big smile.
Sometimes she will smile as though this is the first she has seen me, having forgotten already that I have been sitting next to her for the last hour talking, singing and reading to her. It is like I just walked in, and this is the first she saw me, and we start all over trying to remember who I am.
(Book excerpt from: Please Get To Know Me – Aging with Dignity and Relevance)
It was a winter’s afternoon, and I felt the need for a little sugar rush to get me through the rest of the day. I went down to the vending area in the employee cafeteria. There sat the son of one of our elders, who was a frequent visitor. I asked if he was coming or going.
“I’m trying to come,” he said.
It seemed as though every time he visited, he had to go to the cafeteria for a few minutes and emotionally ready himself for the visit with his mother, whom he loved dearly. “She’s in the late stage of Alzheimer’s disease and no longer recognizes me,” he said. It was obvious that hurt him deeply.
Many books have been written about the long, painful loss of a person to Alzheimer’s disease. But while that is certainly true, it is also true that during this time of loss the ongoing life of the person continues. Visiting with a person afflicted with Alzheimer’s disease becomes more of a connection than a “visit.”
Even elders in the late stage of dementia can usually recognize someone as a friend. Make eye contact, get on the same level as the elder, and speak the person’s name and smile while you communicate. Even something as simple as touching the elder’s hand while you talk can bring his or her attention to the speaker.
While communicating, incorporate as many senses as you can; hearing, seeing, and touching will make a connection even in the late stages of the disease. Although the elder may no longer recognize you as a spouse or child, your body language will communicate to the elder that she knows you. (End of book excerpt)
I find myself more and more grateful for the wonderful staff that take care of my Mom. The people, who say her name, tell her who they are and what they are going to do to help her. The staff that always smile at her and give her the comfort of knowing that she is with people who know her.
One day a couple of years ago when she was having trouble remembering something, out of the blue she turned to me and said, “I’ll never forget you, Ginny”
But there is one she never forgets. Just say the name of “Jesus” to her, and the staff will tell you, Verona remembers.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 16, 2012 - by Nurse Virginia
EARLY STAGE DEMENTIA – LOSS OF JUDGEMENT AND REASONING
Part I
“It’s an American Eskimo,” Ray said with a big smile as he showed his daughter the new puppy he had just bought. “I know Dad, that’s what Sugar was, the dog I had growing up, I know all about that dog.” Ray’s expression turned blank, as his daughter realized that Ray no longer remembered the family dog.
Ray had been giving signals to his wife that he was thinking of getting a dog. Beth had tried to have a conversation with Ray about the kind of dog he might want Ray had been retired now for 11 years, since he was fifty-seven. Beth thought a dog would be a good idea for Ray and over the last months she had suggested several options.
Beth still worked full-time and thought a dog would be good company for Ray and give him a reason to get out of bed and take a walk every day. Beth looked into adopting a “war Dog.” She thought a mature dog who had served the country would be just perfect for the very patriotic Ray, who had never had the chance to serve himself. No, Ray said that’s not what he wanted. Ray started getting dog magazines and spent considerable time poring over these magazines.
Whenever Beth asked what kind of dog Ray was thinking of, Ray would shut her down with his usual, “It’s none of your business, and I’ll do what I want.” Now here he was with his impulse purchase because he went to a pet store and saw this dog that looked “just like a wolf.” He thought it would be great to have a dog that looked like a wolf, and even named it “wolf.” Completely forgetting that family dog, that also had “looked just like a wolf.”
Ray’s daughter reminded him that this was a very energetic dog. This was a dog for a young family with a lot of energy to match the dog’s needs. That this was the breed of dog that had been so hard to train that she became a junior dog trainer when she was just thirteen because of all the time she spent, working with this breed of dog. She told Ray that November was a bad time to buy a puppy in the Midwest, that this puppy would need regular trips outside during the winter months to housebreak.
Ray was no longer able to use reason or logic in this life changing purchase. All he could say was, how this dog looked just like a wolf, and that seemed to be enough for him.
Ray missed going to his daughter’s out of state for Thanksgiving a week later, because he had forgotten all about the trip, and how that daughter’s family had allergies and could not have pets. He also missed going there several weeks later for the Christmas holiday
Ray is no longer able or interested in learning about his new pet. He is just in the moment, while he is trying to understand why the dog seems nervous and unable to sit still, always wanting to go somewhere, and now dragging Ray behind.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on January 4, 2012 - by Nurse Virginia
MALNUTRITION IN THE ELDERLY – ESPECIALLY IN THOSE WITH ALZHEIMER’S DISEASE
“I never lived so well,” said Grace as dinner was served in her assisted living facility. Fortunately, there are some elderly who feel this way. But they seem to be the in the minority, the vast majority of the elderly have signs of malnutrition for a variety or reasons. As people age, the risk of malnutrition increases. Signs of malnutrition are: weight loss, nausea, illness, muscle wasting which results in frequent falls, dizziness and fatigue.
The causes of malnutrition can involve a large range of challenges for the elder especially the confused elder.
- They may have a loss of appetite sometimes due to medication or lack of exercise.
- Food may no longer taste good to them because of a loss in the ability to taste or smell.
- Their metabolism has slowed down and they just aren’t hungry.
- They may no longer have the equipment to make the food they like.
- They may not have the money to buy the food they like.
- They may not have the strength or transportation to go get the food they like.
- They start to develop poor eating habits related to these issues.
Encouraging an elder to eat can be at times a challenge. The best approach is to address these issues in the reverse. Make sure the elder does get some exercise everyday, so they can build up an appetite. Provide a balanced diet with foods that are familiar and that are favorites of the elder. Make sure the foods are easy to chew and that the elder chews food well to aid in digestion.
Provide a pleasant dining experience. Even the simplest meal can seem a treat when served on the “good” dishes with relaxing music. Assist the elder in the purchase of food, remembering that the confused elder may be having difficulty using money, transportation and equipment.
Bon Appétit!
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on December 20, 2011 - by Nurse Virginia
GOING TO HOLIDAY CHURCH SERVICES WITH THE ELDER WHO HAS ALZHEIMER’S DISEASE
ELDERLY CHRISTIANS WITH ALZHEIMER’S DISEASE STILL HAVE EXACTLY THE ABILITIES THEY NEED TO PARTICIPATE AT CHURCH
Carl, an elderly member of the congregation for 92 years, is no longer attending because of behaviors related to his dementia. Just when he and his family need the support of their church family the most, someone thinks Carl shouldn’t be there.
Elderly with Alzheimer’s disease have abilities for church
The truth is that Carl, like many other seniors with Alzheimer’s disease, actually continues to have the very abilities he needs to be an active part of the congregation’s worship.
The universal ability to recognize facial expressions and body language continues in a person with Alzheimer’s disease. In any country you visit, a smile is greeted with a smile, a frown is recognized as a frown and the person with Alzheimer’s disease is able to read positive or negative facial expressions as well. But because the elder with Alzheimer’s disease is so aware of their confusion and of making mistakes, the need for a smiling welcome is more important than ever.
The response to touch is universal. When someone is touched, a chemical is released in the brain that is referred to as the “care and connection” transmitter. This transmitter makes us feel comfortable and open to each other. Indeed, that old friend at Church with the warm handshake is just the medicine Carl needs now.
Music, (and we all know how much Christians love to sing), is the most recognized of universal languages. Music triggers reminiscing and creates a sense of comfort and feelings of well-being for the elder with Alzheimer’s disease. Music, unlike language skills is located in several parts of the brain. Elderly who have lost their words will often continue to be able to sing. I remember a woman who, in her last days, when she was no longer able to recognized her family or herself in a mirror and was in need of total care, continued to sing “Jesus Loves Me” every day. Singing together with the congregation produces feelings of being connected to others and the ability to enjoy music continues throughout life regardless of the dementing illness.
Help elderly with Alzheimer’s disease with environmental cues
What Carl needs now is cues to help him understand what is going on. Coming into Church after the music has started will help provide the environmental cue he needs to recognize that he is in a familiar place of worship. This worshipful atmosphere with the organ playing should help with unwanted behaviors. Having Carl wear a name tag that says “Hi, my name is Carl” can help cue other people to smile and greet Carl by name, creating a warm and comfortable environment for him.
Beverly wanted to continue worshipping with her husband John, who had Alzheimer’s disease. Every time the congregation would stand John would exit the pew. Beverly wanted to give him a cue as to when it was time to go. She told him to watch her purse and when she picked up the purse they would go. Well of course John kept a keen eye on that purse, and when Beverly picked up her purse, John was the first one down that isle. But that cue helped him continue to be part of the congregation worship service for some time.
They are calling the aging of America “The Silver Tsunami”, but coupled with that will be another wave – the “Dementia Tsunami.” As congregations, the time is now to educate the flock while encouraging your families with confused elders to continue to come to church and give the congregation the opportunity to be part of keeping the faith.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on November 2, 2011 - by Nurse Virginia
WHAT IS THE DIFFERENCE BETWEEN DEMENTIA AND ALZHEIMER’S DISEASE?
What really is dementia? Is dementia the same as Alzheimer’s disease? The easiest way to remember is, Alzheimer’s is the disease and dementia is one of the symptoms.
Just the way a Ford is a car, but not all cars are Fords. There are Toyotas, Chevys, Hondas, Mercedes they are all cars just like the Ford is a car. But all of those cars are not Fords; just a Ford is a Ford.
So also we have many diseases that have as one of their symptoms, dementia. But everyone who has dementia doesn’t have Alzheimer’s disease. They may have some dementia as a result of a stroke, Parkinson’s disease, Pick’s disease and many other disease processes. But having dementia is not a clinical diagnosis of Alzheimer’s disease.
Dementia is defined as a decline in the ability to think and reason – something unusual happens and the person is no longer able to think it through and come up with an alternative solution. A decline in memory especially the ability to store recent memories. However this depends on what was usual for the individual in the past. If you are a person who never could remember a name or face the fact that you can’t remember now, isn’t significant.
Dementia would eventually be the loss of the ability to handle money and maybe not even recognize coins and dollar amounts or be able to calculate anymore. A person with dementia will get very literal and no longer be able to think in the abstract.
A diagnosis of “Dementia” really doesn’t say anything, what you need is the disease. Dementia, of the Alzheimer’s type, or dementia as related to Parkinson’s disease, and so forth. People routinely think of Alzheimer’s disease and dementia as being one and the same because the largest amount of people who have dementia, have it of the Alzheimer’s type.
Just as saying you have a car – doesn’t really tell anyone the whole story as would, “I just bought a new car, it’s a Ford,” tells so much more.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on October 11, 2011 - by Nurse Virginia
WHEN THE CONFUSED ELDER WITH ALZHEIMER’S DISEASE GOES TO THE HOSPITAL
THINGS TO DO BEFORE GOING TO THE HOSPITAL:
Write a brief description of the type of dementia the elder suffers from. Include all the elder’s abilities as well as their needs. Always keep in mind that the elder will most likely decline in his/her abilities due to the change in environment, medical condition and not having caregivers who really know him/her.
- Arrange transportation
- Arrange for at least two people to accompany the elder – one person to handle any admission paper work while the other remains with the elder.
- Arrange for someone to take care of plants and animals
- Arrange for someone to pick up the mail and go through it for important bills to pass on to family or designated friends.
- Arrange for someone to pick up the newspaper so the house doesn’t look vacant
- Arrange for someone to go to the house before the return to clean old food out of the refrigerator and stock with new items.
WHAT TO BRING TO THE HOSPITAL:
- All insurance cards.
- Personal items – soap, toothbrush and toothpaste, comb, brush etc.
- Several sets of underwear – the hospital doesn’t launder patient’s personal laundry so you have to bring several sets with you for a long stay and have someone take them home to launder.
- Clothes that are easy to get on and off.
- Things for the elder and the visitor to do at bedside – phone and address book, pack of cards, books, magazines, TV Guide, crafts (knitting, sewing etc) as well as things for children to do if they are expected as visitors.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 28, 2011 - by Nurse Virginia
HERE COME THE HOLIDY CATALOGS – AND A SPECIAL ONE FOR THE ELDERLY WITH ALZHEIMER’S DISEASE
It is that time of year again, the time we all start receiving specialty catalogs, but the one that came today is really special. The Best Alzheimer’s Products Catalog (www.bestalzheimersproducts.com) makes a statement right from the start with its beautiful art work on the cover. Then it gently leads you to the page where you can learn some background on art therapy for the elder with Alzheimer’s disease. As well as order art kits – everything from painting with water, to water colors.
John and Holly have included so much meaningful information and education in their catalog, like the article on “The Power of Activity”:
[Catalog excerpt]
A person with any progressive dementia will go through stages that are similar to those that a growing child experiences, but in reverse order. Not just memories but cognitive as well as social abilities are slowly lost as the disease spreads through the brain. We like to think about it in this way: As the disease progresses the person with Alzheimer’s regains those childlike (not childish) qualities that allow children to see the world as a magical place.
What a lovely thought, that the confused elder is enjoying a magical place. A place where there are activities on many levels, one just right for you.
Every activity has a handy code to identify where in the disease process the person might be in, who would benefit from this item. The code is described on the inside of the front cover, with a simplified description of the stages of Alzheimer’s disease.
The catalog continues to carry several versions of my favorite, the “Twiddle Muff.” Hint, hint, if anyone is looking for a little something for me. J
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 13, 2011 - by Nurse Virginia
THE TRAIN JOURNEY – UNDERSTANDING HOW IT FEELS TO HAVE ALZHEIMER’S DISEASE
I am going on a long journey by train. As I begin the journey the city skyscrapers and the landscape looks familiar. As I continue my journey, the view reminds me of times gone by and I feel relaxed and comfortable. The other passengers appear to feel the same way and I enjoy pleasant conversation with them.
However as the journey progresses, things begin to look different. The buildings have odd shapes and the trees don’t look quite the way I remember them. I know they are buildings and trees, but something about them is not quite right. Maybe it’s a different country with different architecture and plant life. It feels a bit strange even unnerving.
I decide to ask the other passengers about the strangeness I feel, but notice they seem unperturbed. They seem to hardly be taking any notice of the passing scenery. Maybe they have been here before. I ask them questions but they don’t seem to notice the changes. I wonder if my mind is playing tricks on me. I decide to act as if everything looks all right, but because it does not, I have to be on my guard. This places some tension on me, but I believe I can tolerate it for the rest of the trip. I find myself so preoccupied with appearing alright that I am very distracted and don’t notice the passing scenery.
After some time I look out the window again and this time I know something is wrong. Everything looks strange and unfamiliar. There is no similarity to anything I can recall from the past. I think I must do something and try to talk to the other passengers about the strangeness I feel but they look at me dumbfounded. They talk in a new language. Why won’t they talk in English to me? They look at me knowingly and with sympathy. I want to know what is going on so I keep after them trying to get them to tell me where the train is going. The only answers I get are in a strange language and then even when I talk my words sound strange to me. Now I am truly frightened.
I realize that I am going to have to get off the train and find my own way home and then I get up to leave. I don’t get very far as the other passengers stop me and take me back to my seat. It seems that they want me to stay on the train whether I like it or not. I try to explain but they just talk in a strange language.
I realize that I will never find my way home if I don’t get off that train. I get ready to jump when hands suddenly appear from nowhere and grab me from behind. I try to fight them off, but I feel them pulling me back onto the train. I will never get home.
How sad I feel. I did not say goodbye to my friends or my children. The passengers look sympathetic, but they do not know how sad I feel. Maybe if they knew they would let me off the train.
I have no choice now. I have to go along with the passengers because they seem to know where the journey will end. Maybe they will get me there safely. I wish that I had never started out on this journey but I know I cannot go back.
This story has been written and re-written many times over the years. The original author is unknown, but the words ring true. This remains the biggest fear of the elderly; no one wants a ticket on this train.
Virginia Garberding R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on September 6, 2011 - by Nurse Virginia
ART – A GREAT ACTIVITY FOR THE CONFUSED ELDER
Carl never really studied art, but that doesn’t hold him back these days from painting. Sometimes he paints for hours, over and over on the same tree, grass, sky or clouds. He is so engrossed that he rarely speaks and forgets to eat as well. His wife Barb just interrupts with the suggestion of a meal. Because Carl is very confused now, it is much simpler to say “How would you like some meat loaf?” than “What would you like to eat Carl?” Giving a suggestion is so much more effective that expecting Carl to come up with an idea on his own.
Barb doesn’t want Carl to come out of that “place” he goes to when he paints. So Barb tries not to stress him with too many questions or choices. Participating in art is an opportunity to do something that is neither right or wrong. It just is, you may like it or not. This makes it a perfect activity for someone who is confused or has early dementia. You can’t be wrong.
Art nurtures the well-being of the confused elder, and in many cases brings to the elder a connection with the past. Over the years school districts have added or reduced art programs depending on the districts budget. But for the elders of today, they would have had some instruction in art in grade school.
Instead of this being a totally new experience the elder is really relearning a pleasant activity from the past. Relearning is so much easier for an elder, especially an elder who is also confused, than learning an activity that is brand new to them.
Painting doesn’t make Carl more appropriate in social situations, or in any way fit in better in group conversations. At a recent family event, as people were discussing an afghan someone had just made. Carl joined in with “that blue is in my picture.” When the group knows what Carl’s challenges are, his observations are very much welcomed.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
Posted on August 31, 2011 - by Nurse Virginia
WHEN WATCHING TV IS GOOD OR HARMFUL FOR THE CONFUSED ELDER
TV THAT IS HARMFUL
Natural disasters, tornados, hurricanes, flooding, drought, extreme heat, wildfires, blizzard and more tornadoes, 2011 has really been something and it’s not over yet. Roads and highways that have all but disappeared, being broken up by flood waters. People stranded, and now whole communities stranded with roads and towns that have become lakes.
That isn’t even counting all the news footage of terrorist strikes, marches, angry crowds, war, revolutions – and we get to see it all on TV, on some stations all day long.
Even a little of this is too much for the confused elder. The confused person cannot tell that what is being televised could be hundreds if not thousands of miles away, or right outside the door. When people are hurt the confused elder could think it is a family member being hurt or that the danger is to them.
Negative TV, negative news and dramas of killing, danger and mayhem need to be avoided by the elder who is having a problem telling the difference between the TV and their present situation.
TV THAT IS ENTERTAINING AND NOT HARMFUL FOR THE CONFUSED ELDER
Good TV for the confused elder? The current trend towards competitions- the best singer, the best dancer, how much do you think this costs – are shows the confused person can enjoy with the rest of the family. The elder can give their opinion if the singer/juggler/dancer is good or bad. The confused person can laugh along with the family even if they don’t always know what the joke is.
These shows are in the moment right with the elder. No need to remember a plot, or characters or follow a story line. Just sit back have a little snack and enjoy the show.
Virginia Garberding, R.N.
Director of Education, The Wealshire, Lincolnshire, Illinois
Author: Please Get To Know Me – Aging with Dignity and Relevance
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