1994 my mother was diagnosed with Alzheimers Disease.



At that time she had been demonstrating memory deficits for at least two years. My career had always been in the field of Geriatrics, the care of the elderly. I had worked with countless families in caring for their elder family members at home, in Assisted Living Facilties and in Nursing Homes.

My least favorite patient type was the Dementia

patient. I know now that why I felt that way was

because I had never really walked in the shoes

of the dementia patient.

In caring for my mother I have come to appreciate her uniqueness. Watching her struggle with her losses and struggling myself to come up with ideas to keep her moving and feeling good about herself has really helped me to see dementia through new eyes.

It is like caring for a child in reverse order. With a child we wait with anticipation as they grow through new stages. We watch for them to sit up, then take their first steps, potty train, talk, ride their first bike, and on and on.

Well, with aging and dementia, it really is the

same process in reverse. Watch carefully for the subtle changes (losses) and then make the necessary adjustments in the environment and in ourselves.

For most elderly, as age advances so does the

collecting of chronic conditions.

Chronic Conditions:

to name a few arthritis, heart disease, high blood pressure, diabetes, poor vision, reduced hearing,

reduced hearing and reduced muscle strength.

Chronic diseases must be managed and it takes

willingness on the part of the elder and often the

family, to learn about the disease, treatment

and limitations.

Physical Changes :

Aging happens over time, gradually over years.

Abilities decline and needs increase.

The ability to clean house, do the laundry,do yard work, grocery shop, participate in hobbies, entertain in the home, prepare fancy meals, handle finances,and to drive.

Physical changes often progress to personal care deficits fear of falling in the shower, they stop showering,walking distances that they were able to handle previously, toileting themseves without accidents, stop going out especially for social events.

A variety of reasons will often emerge if asked why they stopped doing something. Rarely will the whole truth be told. Denial is very strong due to the fear of being dependent on others and fear of being remove from their home. As the adult children we are obligated to watch carefully for these changes in our parents.

Cognitive Changes:

When it comes to cognitive changes things do not get any easier. Approximatly 50% of 85 year old have dementia. Their symptoms usually have been present a few years before diagnosis. Please read that again, 50% of 85 year olds have dementia. So many family members ignore the symptoms (they also suffer from denial) Your elder usually needs help long before he or she is getting the necessary support.

Elders with dementia have often lost the ability

to reason, to react logically or correctly interpret

their surroundings. Often unhealthy or irrational decisions are made frequently related to safety and medications.

One of the common things I hear is, "She is not my mother anymore" or "I do not know this person." You have to get past that to be helpful to your parent.

I am sure you had times in your child raising years

where you felt the same, the terrible two's,teen

years, college years,or even into the adult years,

where you said to youself," I do not know this person anymore."

It is a process of accepting your children at the

stage they are at, knowing that you are doing your best. Well, it is not any different with your parent. Your parent will always be your parent. They just act differently as they become more frail, more vulnerable, and child like.

I often look at my mother and see a three year

old or a five year old and it makes me feel good

to know that no matter what age (stage) she is today

I will care for her and love her as she is.

Behavioral Issues: Behavior is not intentional in Dementia.

SOLUTIONS:

Always look to the basics: hungry, thirsty,cold, toileting needs. Pain-80% of the frail elderly have chronic pain that goes untreated.

Keep your phrases short and simple,"do you want apple juice or orange juice?" Ask questions requiring a yes/no response. Allow LOTS of time for a response.

Allow choices as often as possible. Choices must be appropriate to their level.

We do not ask the three year old if he wants to go to bed. We take him to bed. Choices like, "Would you like to wear blue or yellow today?" "Would you like tomato soup or chicken noodle soup?" These are an example of stage appropriate choice I would give my mother.

Avoid statements such as, "Do you want to eat?" "Do you need to go to the bathroom?" "Are you ready for your shower?" Those are given tasks not options.

Do not ask if they want to go to the doctor, hairdresser,etc. Just take them. Allow plenty of time for appointments. Dementia patients will never move on your time table. Lots of extra time must be

allotted to get ready.

Dementia patients do much better with a fixed routine (just like your kids.) Regular meal and snack times. (do not forget fluids.) Regular shower time at their best time of the day. Regular bedtime. Avoid mentioning an appointment ahead of time. Some people will stress on that and ask repeated questions.

Use distraction to change a behavior. My mother has a habit of clapping her hands loudly and repeatedly if she is not busy with somethng. Sometimes just asking her a question breaks the pattern. At other times having her fold clothes, play cards, look through a magazine, or singing a song will also break the pattern.Activities are a must. Some communities have a senior center with activites or adult day care centers that often do a great job with activities.

Find activities that your parent enjoys,walks, folding laundry, washing dishes, playing cards,etc. Be creative. "Remember Times" I learned all sorts of family history and fun stuff when my mother was in

her earlier years of dementia. We would do "remember time."

We would talk about family, how she meet my father, their first date, hobbies, jobs, vacations, WWII, the Depression era, etc. Today, my mother is in her 12th year of Alzheimer's and she does not remember the past. Now she likes us to tell her the family stories.

THINGS TO AVOID

Do not try to reason with the dementia person. They are unable to reason. Do not take their behavior personally. They are not doing it to you, they are just doing it. Do not confront or correct. Leave the room if you have too.

Do not argue. You are arguing to a blank wall!

Do not talk about your parent in front of them.

Do not ask them or expect them to have recent memory.

Statements like, "I just answered that question"

or, "don't you remember? Remember the "blank wall"!

Remember, between you and your parent, YOU are the one that has to change, accept, grow, and love them through to the end.

When all is said and done you will never regret

this time spent caring for your elder. Allow this time to be as fun as possible-find your humor and use it in the daily activities of caregiving. And yes, it is a very difficult job caring for your parent.

Arm yourself with support groups and learn all you can about your parent's dementia. Do not become the " Lone Ranger". Rreach out, ask for help, hire a babysitter, etc. Just like you did for your kids, you can do this.