Posts
This is the second in a series of six dealing with the symptoms that may signal the start of the process known as dementia. The symptoms are taken from the Johns Hopkins free Guide to Understanding Dementia, and will be taken in parts and related to personal events experienced by the family of Lib, who is the subject of this blog. All symptoms taken from The Guide will be italicized for clarity of origin.
HANDLING COMPLEX TASKS
has trouble with previously familiar activities, like balancing a checkbook, cooking a meal, or other tasks that require a complex train of thought.
Our mother was a bookkeeper by profession. She loved keeping orderly books for a large highway construction company and did this for twenty-two years. Prior to that, she kept books for the gins our parents operated. Not only did she keep books as her vocation, but she seemed to enjoy it as an avocation too. She kept meticulous books of all personal expenditures and her small cattle operation. She was active in other ways, but spent a good deal of time inputting all information by hand, using a small adding machine, a ledger, and a pencil to perfect results. Finding a penny error could consume a day at work, and she couldn't understand a child of hers who could never balance a checkbook.
The change we noted was subtle at first. But she must have noticed it before we were aware of it as she asked her youngest daughter, who also kept books for their business, to take over her taxes, and later, her checkbook. During the investigative phase by her daughter, magazine subscriptions were found to have been paid over and over, five or six years in advance, because they kept sending bills.
Fortunately, because her financial health was so important to her, she let go of that control sooner than she did in other areas. Her daughter Jan would go to the house and pay her bills, work on taxes and get her to sign checks. That was in the early phases.
Eventually she could not even sign her name.
The other more baffling symptom was in the area of food preparation. My sisters had come for a visit once to find her panting on the couch, fanning her face. She had just put out a grease fire in a skillet on the gas stove. The phone distracted her, and she simply forgot she was cooking.
We had noted that she had begun to leave her foodstuffs out on the counter, but mistakenly thought it was just too much trouble to put it all up. The truth was that it took too much effort to find it.
We engaged a friend to bring meals about two to three times a week at this point, and my sister paid her. However, mother thought she was doing too much, not knowing that she was being paid, and we couldn't tell her because she wouldn't think it was necessary for meals to be brought to her. So that help eventually had to be discontinued.
Thus began weekly trips by my sisters and brothers-in-law to buy groceries and take food.they had prepared. As often as I could, I would go and cook a lot of food and freeze it for her to eat. She could still at that time barely manage the microwave. Never having been technologically savvy, it was difficult to maintain that ability as her symptoms progressed.
We were still in the early phases of the dementia, in approximately years 3 and 4. She was, unbelievably, still driving and still managing in many areas, but the damage was beginning to be apparent. We saw her life change, watched the slow melting of the candle, and hoped we'd realize when the hot wax spilled out, and we had to act. quickly.
DEMENTIA HINT: Labeling cabinets might help at this stage.
Writing out directions for using coffee pot, microwave, etc. helped.
Contact your local Meals on Wheels and/or local meal service which are sometimes operated in your community
*Let me make one note. We were trying to honor our mother's wishes to stay in her own home. I want to be clear in this. She was extremely independent and was in one sense difficult to help because in her estimation she needed no help.
Families who have a parent who reasonably makes a plan to go into assisted living or independent living before they become so mentally and/or physically disabled are fortunate. This blog will probably make more sense to families who are walking a tightrope with an extremely strong and independent parent.
Monday, December 28, 2009
Friday, December 18, 2009
VASCULAR DEMENTIA IN THE ELDERLY: IS IT DEMENTIA?
While dementia today is not considered a disease by itself, it is rather a set of symptoms resulting from different sources.
These next six posts will explore individually 6 problem areas in functioning that suggest that a person should be evaluated for dementia, along with examples from our own experience. Part of the post will delineate the intellectual component of the symptom; the second part will explore the practical and emotional aspect of the symptom.
The symptoms are taken from the Johns Hopkins Guide for Understanding Dementia, and in their booklet, they list these as guidelines published by the Agency for Health Care Policy and Research.
I. LEARNING AND RETAINING NEW INFORMATION:
REGULARLY MISPLACES OBJECTS-did I mention my mother's hearing aid? For about a year, we had something to do about the hearing aid every two months or so. It would be that the battery had gone down and thus she was not using it. The battery had been jammed in the wrong way, so we had to take it to the audiology office for repair. She couldn't remember if it went in the right or left ear, so would have it in the wrong ear. Sometimes, she forgot which way it fit into her ear (and we were little help in that regard-some sort of familial mechanical deficiency)
And during the time we were not working on these issues, we were looking for the tiny thing. My older sister could often find it when no one else could. We found it in her purse, in the closet, in the pocket of clothes she had worn, in the car, under the bed, under magazines on the bedside table, and behind a bookshelf in the kitchen---for starters.
HAS TROUBLE REMEMBERING APPOINTMENTS-remember that we noted in an earlier post that at the very beginning, when symptoms were first appearing,our mother forgot birthdays for the first time in her life. It was one of the earliest signs that something was wrong.
HAS TROUBLE REMEMBERING RECENT CONVERSATIONS-at the beginning of the emergence of the symptoms, we noted that she couldn't remember which of her four children had told her things. She would repeat something to one of us as though we didn't know, when we were the one who told her. (I know, I know, many of you are saying "I do that", and I am saying "I do that"), but it is not as often, and it is not consistenly so, and probably when you are tired, overworked or stressed. For the person with dementia, this trouble remembering occurs regardless of external factors.
On a lighter note, I decided one day on a two hour car trip that I could make the trip pleasant by using the fact that my mother couldn't remember our conversation. She still was able to "get" jokes, so I told the same joke about six times during the trip, and she laughed and thoroughly enjoyed it each time. We had a pleasant trip, and I only had to know one joke. Minimized frustration.
Another comical day was the summer of 2004, and the repetition was fairly pronounced by this time. I noted she had stopped talking as much overall which was sad, but she still liked to tell stories. Our future son-in-law made himself a card carrying member of the family on this day.
Mother wanted to tell him about his soon-to-be wife, her granddaughter, and had a particular story in mind from when our daughter was three years old. She told it at dinner on Tuesday night, again during the morning on Wednesday, and when we were seated for lunch, she said "Oh, I can tell you a story about K", and started out again.
Four of us at the table either laughed or giggled; our very kind future son-in-law turned to the side, leaned slightly down and put his head down. His face became so red he looked like he might explode. But he did not laugh. What kindness. Meanwhile, Mother happily joined in the laughter. Every day was a good day for her, as always. We were fortunate.
REPETITIVE IN CONVERSATION-several notes here. We noted this in her conversation, and on good days, I would listen to stories over and over. On my bad days, I tried to change the subject, as did we all.
There seemed to be a marked increase in this after the death of her younger brother in 2000.
She felt a great love for him, and he was twelve years younger than she. At his death, she became the only remaining sibling of her original family. At his memorial service, it seemed that she repeated to each new person that she met that she had loved him as a baby and that she had pushed him in a baby carriage when he was tiny. That was all. She pushed him in a baby carriage.
That day was key for us in realizing the change in her. Not a word of his chidhood, adulthood, how she adored him. Just pushing him in a baby carriage. It seemed odd. to us. But it was her new way of coping.
AND WE WOULD ALL JUST HAVE TO ADJUST!
DEMENTIA HINT: This is for family and friends. If you don't have patience and a sense of humor, you probably ought to get some and find one or this phase could be harder on you than it has to be. And it will be hard enough-guaranteed!
These next six posts will explore individually 6 problem areas in functioning that suggest that a person should be evaluated for dementia, along with examples from our own experience. Part of the post will delineate the intellectual component of the symptom; the second part will explore the practical and emotional aspect of the symptom.
The symptoms are taken from the Johns Hopkins Guide for Understanding Dementia, and in their booklet, they list these as guidelines published by the Agency for Health Care Policy and Research.
I. LEARNING AND RETAINING NEW INFORMATION:
REGULARLY MISPLACES OBJECTS-did I mention my mother's hearing aid? For about a year, we had something to do about the hearing aid every two months or so. It would be that the battery had gone down and thus she was not using it. The battery had been jammed in the wrong way, so we had to take it to the audiology office for repair. She couldn't remember if it went in the right or left ear, so would have it in the wrong ear. Sometimes, she forgot which way it fit into her ear (and we were little help in that regard-some sort of familial mechanical deficiency)
And during the time we were not working on these issues, we were looking for the tiny thing. My older sister could often find it when no one else could. We found it in her purse, in the closet, in the pocket of clothes she had worn, in the car, under the bed, under magazines on the bedside table, and behind a bookshelf in the kitchen---for starters.
HAS TROUBLE REMEMBERING APPOINTMENTS-remember that we noted in an earlier post that at the very beginning, when symptoms were first appearing,our mother forgot birthdays for the first time in her life. It was one of the earliest signs that something was wrong.
HAS TROUBLE REMEMBERING RECENT CONVERSATIONS-at the beginning of the emergence of the symptoms, we noted that she couldn't remember which of her four children had told her things. She would repeat something to one of us as though we didn't know, when we were the one who told her. (I know, I know, many of you are saying "I do that", and I am saying "I do that"), but it is not as often, and it is not consistenly so, and probably when you are tired, overworked or stressed. For the person with dementia, this trouble remembering occurs regardless of external factors.
On a lighter note, I decided one day on a two hour car trip that I could make the trip pleasant by using the fact that my mother couldn't remember our conversation. She still was able to "get" jokes, so I told the same joke about six times during the trip, and she laughed and thoroughly enjoyed it each time. We had a pleasant trip, and I only had to know one joke. Minimized frustration.
Another comical day was the summer of 2004, and the repetition was fairly pronounced by this time. I noted she had stopped talking as much overall which was sad, but she still liked to tell stories. Our future son-in-law made himself a card carrying member of the family on this day.
Mother wanted to tell him about his soon-to-be wife, her granddaughter, and had a particular story in mind from when our daughter was three years old. She told it at dinner on Tuesday night, again during the morning on Wednesday, and when we were seated for lunch, she said "Oh, I can tell you a story about K", and started out again.
Four of us at the table either laughed or giggled; our very kind future son-in-law turned to the side, leaned slightly down and put his head down. His face became so red he looked like he might explode. But he did not laugh. What kindness. Meanwhile, Mother happily joined in the laughter. Every day was a good day for her, as always. We were fortunate.
REPETITIVE IN CONVERSATION-several notes here. We noted this in her conversation, and on good days, I would listen to stories over and over. On my bad days, I tried to change the subject, as did we all.
There seemed to be a marked increase in this after the death of her younger brother in 2000.
She felt a great love for him, and he was twelve years younger than she. At his death, she became the only remaining sibling of her original family. At his memorial service, it seemed that she repeated to each new person that she met that she had loved him as a baby and that she had pushed him in a baby carriage when he was tiny. That was all. She pushed him in a baby carriage.
That day was key for us in realizing the change in her. Not a word of his chidhood, adulthood, how she adored him. Just pushing him in a baby carriage. It seemed odd. to us. But it was her new way of coping.
AND WE WOULD ALL JUST HAVE TO ADJUST!
DEMENTIA HINT: This is for family and friends. If you don't have patience and a sense of humor, you probably ought to get some and find one or this phase could be harder on you than it has to be. And it will be hard enough-guaranteed!
Monday, December 14, 2009
VASCULAR DEMENTIA IN THE ELDERLY: ELDER ABUSE INFORMATION CONTINUED
ELDERLY PEOPLE ARE AT INCREASED RISK OF BEING TARGETED BY PREDATORS
BE AWARE OF STRANGERS
Two incidents that happened while my mother was visiting at my house further emphasize the fact that there are predators attracted by evidence of aging. Two different times, as my mother sat on our porch enjoying the day, people appeared as if from nowhere to talk with her. We lived on a highway in a small town, but the driveway was long and uphill and people rarely ventured there by accident.
On one of the days, I was in the yard but concealed by some trees, and catching a glimpse of movement, I looked up to see a young woman approaching my mother. By the time I got to the porch, I could hear her soliciting money for her young daughter who supposedly was going to be in a beauty pageant. Again, my mother's old habits somehow rose to the surface and she was largely ignoring the woman. It was clear she was not local, and extremely doubtful she had a daughter involved in beauty pageants. She appeared to be walking by, possibly looking for victims. She didn't find one that day.
Another day, and this seemed more sinister, a second "near" incident occurred. I returned from church and noted a very rough character walking, nearing the driveway. Forgive me if it seems I judged him strictly by appearance. I walked in the back door, met the caregiver who had left Mother briefly on the front porch, and she left through the backdoor as I walked immediately to the front. I decided to bring my mother inside as I was so alarmed by the appearance of the man I had seen on the street.
As I got her with some difficulty to the front door, my cellphone rang. It was the caregiver telling me that she had seen a very roughlooking man near the driveway. In fact, so alarmed was she by his appearance that she had turned around and come back, only to see him entering the driveway. I looked behind Mother as I closed the door, my heart pounding fast, and the man was at the edge of the yard. He saw me and started off through the yard returning to the street. It seemed that day as I reflected on those events that perhaps white hair actually works as a magnet for predators.
BE AWARE OF THOSE WHO SUDDENLY WANT TO SPEND TIME WITH THE ELDERLY
Elderly in high crime neighborhoods are often targeted for robbery or worse. Their kindness can be mistaken for weakness. My 98 year-old friend had a young woman who showed a sudden interest in her and drove her wherever she wanted to go. She took my friend to a local store and ended up getting a credit card in her name and loading it up with charges. A man in one town where we lived gave a ride to a young man to assist him, and the young man murdered him for his kindness. Unfortunately, the elderly need to become more self-protective as they age. Almost as we teach children to stay away from strangers, we need to reinforce that idea with our elderly loved ones. And they need to be aware of others with whom they interact also.
USE ESTABLISHED BUSINESSES FOR LAWNCARE, HOME REPAIR, AND CAREGIVING
Family should use established businesses or people they know well for lawncare. For repairs done inside the house, family members should be present if at all possible. Always use reputable companies.
Caregivers used should have established references or be affiliated with a business that does background checks. A caregiver that spends a lot of time with the elderly person needs to be in contact with the family. Family should call several times per week at a minimum. If the caregiver restricts access or tries to isolate the person from the family, run, don't walk to the home and see what's going on.
Those who care about the elderly and those with dementia need to "listen with the third ear" to see what is going on around the person.
FAMILY MEMBERS WHO TAKE ADVANTAGE FINANCIALLY
LESS TALKED ABOUT, BUT A SERIOUS PROBLEM is the abuse of the elderly or those with dementia, by family members, particularly in the financial arena. As the person with dementia weakens, they are sometimes unable to say no as they have in the past. They may be approached by family members who want to ask for certain items or want to borrow money. This can happen with "outsiders" too as evidenced by the egregious case featured in Dallas, Texas on December 12, 2009 on ABC 20/20 (http://www.abc.com/).
The person may have been able to withstand requests in the past, or their weakening may have emboldened persons who want things that they have. At any rate, it will take vigilance in this area also. It may be necessary for the family member with the power of attorney to intervene. A parent's having dementia can stress the relationships in a family as there becomes disagreement over decisions.
PSYCHOSOCIAL STRESSORS ON THE FAMILY AS THE LOVED ONE DETERIORATES
I believe that the interim time before the parent with dementia is incompetent to make decisions is a dangerous time financially. The parent may be clinging to the power to make decisions, but is unable to make good ones. At this precipitous time, certain family members or others may obtain access to their finances that can seriously jeopardize their future.
As the situation changes, some family members are unable to adjust to the reality that their mother/father is no longer able to make significant decisions about his/her own life.
A piece by Dana Kelley headlined "Defining Reality" stated "A firm grasp of reality is essential to good self-governance. From the mortgage crisis to healthcare to education and a host of other public policy issues,it's easy to demagogue according to 'what should be'.Much harder, but most essential, is actually managing 'what is' and 'what can be'".
The psychosocial aspects of the deterioration of a parent's mental status can tax family relationships, and it is the wise family that recognizes that change is not optional; it is mandatory. They can be drug kicking and screaming through the changes or become part of an orderly process for achieving the goals that will best serve the person with dementia.
There are several questions to ask in regard to financial decisions : 1)what is best for the person with dementia, 2) will these decisions preserve their assets or deplete them without providing for care 3) are the costs associated with direct care or necessities 4) would you be comfortable telling a judge why you spent this money and what it paid for 5) is there a clear record of expenditures
These are just some thoughts about the financial aspects of the development of dementia. It is essential that people develop a durable power or attorney. Do it SOONER rather than later.
DEMENTIA HINT: Be aware of the ways that life is changing for the person with dementia symptoms. Work on your own feelings so that you can accept the "what is" and leave the "what was".
BE AWARE OF STRANGERS
Two incidents that happened while my mother was visiting at my house further emphasize the fact that there are predators attracted by evidence of aging. Two different times, as my mother sat on our porch enjoying the day, people appeared as if from nowhere to talk with her. We lived on a highway in a small town, but the driveway was long and uphill and people rarely ventured there by accident.
On one of the days, I was in the yard but concealed by some trees, and catching a glimpse of movement, I looked up to see a young woman approaching my mother. By the time I got to the porch, I could hear her soliciting money for her young daughter who supposedly was going to be in a beauty pageant. Again, my mother's old habits somehow rose to the surface and she was largely ignoring the woman. It was clear she was not local, and extremely doubtful she had a daughter involved in beauty pageants. She appeared to be walking by, possibly looking for victims. She didn't find one that day.
Another day, and this seemed more sinister, a second "near" incident occurred. I returned from church and noted a very rough character walking, nearing the driveway. Forgive me if it seems I judged him strictly by appearance. I walked in the back door, met the caregiver who had left Mother briefly on the front porch, and she left through the backdoor as I walked immediately to the front. I decided to bring my mother inside as I was so alarmed by the appearance of the man I had seen on the street.
As I got her with some difficulty to the front door, my cellphone rang. It was the caregiver telling me that she had seen a very roughlooking man near the driveway. In fact, so alarmed was she by his appearance that she had turned around and come back, only to see him entering the driveway. I looked behind Mother as I closed the door, my heart pounding fast, and the man was at the edge of the yard. He saw me and started off through the yard returning to the street. It seemed that day as I reflected on those events that perhaps white hair actually works as a magnet for predators.
BE AWARE OF THOSE WHO SUDDENLY WANT TO SPEND TIME WITH THE ELDERLY
Elderly in high crime neighborhoods are often targeted for robbery or worse. Their kindness can be mistaken for weakness. My 98 year-old friend had a young woman who showed a sudden interest in her and drove her wherever she wanted to go. She took my friend to a local store and ended up getting a credit card in her name and loading it up with charges. A man in one town where we lived gave a ride to a young man to assist him, and the young man murdered him for his kindness. Unfortunately, the elderly need to become more self-protective as they age. Almost as we teach children to stay away from strangers, we need to reinforce that idea with our elderly loved ones. And they need to be aware of others with whom they interact also.
USE ESTABLISHED BUSINESSES FOR LAWNCARE, HOME REPAIR, AND CAREGIVING
Family should use established businesses or people they know well for lawncare. For repairs done inside the house, family members should be present if at all possible. Always use reputable companies.
Caregivers used should have established references or be affiliated with a business that does background checks. A caregiver that spends a lot of time with the elderly person needs to be in contact with the family. Family should call several times per week at a minimum. If the caregiver restricts access or tries to isolate the person from the family, run, don't walk to the home and see what's going on.
Those who care about the elderly and those with dementia need to "listen with the third ear" to see what is going on around the person.
FAMILY MEMBERS WHO TAKE ADVANTAGE FINANCIALLY
LESS TALKED ABOUT, BUT A SERIOUS PROBLEM is the abuse of the elderly or those with dementia, by family members, particularly in the financial arena. As the person with dementia weakens, they are sometimes unable to say no as they have in the past. They may be approached by family members who want to ask for certain items or want to borrow money. This can happen with "outsiders" too as evidenced by the egregious case featured in Dallas, Texas on December 12, 2009 on ABC 20/20 (http://www.abc.com/).
The person may have been able to withstand requests in the past, or their weakening may have emboldened persons who want things that they have. At any rate, it will take vigilance in this area also. It may be necessary for the family member with the power of attorney to intervene. A parent's having dementia can stress the relationships in a family as there becomes disagreement over decisions.
PSYCHOSOCIAL STRESSORS ON THE FAMILY AS THE LOVED ONE DETERIORATES
I believe that the interim time before the parent with dementia is incompetent to make decisions is a dangerous time financially. The parent may be clinging to the power to make decisions, but is unable to make good ones. At this precipitous time, certain family members or others may obtain access to their finances that can seriously jeopardize their future.
As the situation changes, some family members are unable to adjust to the reality that their mother/father is no longer able to make significant decisions about his/her own life.
A piece by Dana Kelley headlined "Defining Reality" stated "A firm grasp of reality is essential to good self-governance. From the mortgage crisis to healthcare to education and a host of other public policy issues,it's easy to demagogue according to 'what should be'.Much harder, but most essential, is actually managing 'what is' and 'what can be'".
The psychosocial aspects of the deterioration of a parent's mental status can tax family relationships, and it is the wise family that recognizes that change is not optional; it is mandatory. They can be drug kicking and screaming through the changes or become part of an orderly process for achieving the goals that will best serve the person with dementia.
There are several questions to ask in regard to financial decisions : 1)what is best for the person with dementia, 2) will these decisions preserve their assets or deplete them without providing for care 3) are the costs associated with direct care or necessities 4) would you be comfortable telling a judge why you spent this money and what it paid for 5) is there a clear record of expenditures
These are just some thoughts about the financial aspects of the development of dementia. It is essential that people develop a durable power or attorney. Do it SOONER rather than later.
DEMENTIA HINT: Be aware of the ways that life is changing for the person with dementia symptoms. Work on your own feelings so that you can accept the "what is" and leave the "what was".
Friday, December 11, 2009
VASCULAR DEMENTIA IN THE ELDERLY: ELDER ABUSE DEFLECTED
The animal world recognizes when one of its own weakens. Raising parakeets in captivity demonstrated to me the perils of becoming physically inferior, as birds were often pecked to death once they showed the first sign of vulnerability. Lions and cheetahs lie in wait until the weakest of the waterbuffalo herd is isolated because it can't keep up, then they attack. Elder abuse is too familiar to us now as it makes headlines. When your loved one starts to show signs of dementia, you must increase your vigilance on their behalf.
As a person shows signs of frailty, it is not unusual to find that they attract the attention of predators. It's not that they seek this attention; it simply comes to them as they can't keep up and are "separated from the herd".
1) BE AWARE, especially if the elderly person is still living alone, OF PEOPLE WHO SHOW A SUDDEN INTEREST IN THEM. Once, while talking on the phone with my mother in the early evening after dark when she had just started to show early signs of memory loss, she had to leave the phone to answer the door. She mentioned that it was the back door. When she returned to the phone a few minutes later, she said it was a young man who had been in a lot of trouble with the law, and he wanted to move some things in her yard, with remuneration, of course. She still had the judgment to refuse his offer, and he didn't come back, but it was a scary moment.
2) OF REPAIR SCAMS - this story could have been tragic, but actually is funny. Mother called to tell us that she had gotten some asphalt on her driveway because a truck came to her house, which by anyone's estimate is WAY out in the country, not on the way to anywhere. The truck, allegedly, had extra asphalt left after a restaurant in town refused the load. (I later checked this out, and it was patently untrue). It panicked me, and I asked what she had paid, fearing it would be thousands and that the asphalt would be inferior quality and poorly spread. Later, when I saw it myself, I started laughing. It looked pretty good. I pictured two frustrated scammers, outfoxed by an 80 something who had always squeezed pennies and who had not lost that ability, even with the advent of dementia symptoms. The driveway had a nice coat of asphalt (that has held up well for many years), and she said the guy sure didn't want to take the amount she paid, which was well under a thousand dollars, but finally agreed to do the job for that amount. "He acted like he wanted to cry", she said, "but I stuck to my dollar amount".
3) DOOR TO DOOR SOLICITATION, PHONE AND MAGAZINE SUBSCRIPTIONS- This is an area that is hard to control and can be extremely frustrating.
A person who had taken an unsolicited picture of mother's property from the air and wanted $100 for the picture had stopped by the house. Penny wise, Mother talked her down to $60 and bought the picture, which really was quite good. Definitely worth the $60, possibly the $100 the photographer didn't get.
We found in going through her mail, which my younger sister primarily took over at this juncture, numerous promises to various charity organizations. Some were paid, but others had to be called and told that she should be taken off their list. Magazines likewise had to be called or letters written to stop their sending bills. She had paid some bills so many times that the magazines were paid up to five years ahead.
The three items above represent a fractional part of the ways the elderly can be taken advantage of by the lions and cheetahs of the world. More sinister and serious abuses can take place. Family members can help by 1)being vigilant, 2) asking questions, and 3)going through mail on a regular basis. As long as the person remains in their own home without assistance, you may not be able to stop everything, but you may be able to mitigate the damage or prevent additional issues from developing.
DEMENTIA HINT: Put your loved one on the "do not call" list.
As a person shows signs of frailty, it is not unusual to find that they attract the attention of predators. It's not that they seek this attention; it simply comes to them as they can't keep up and are "separated from the herd".
1) BE AWARE, especially if the elderly person is still living alone, OF PEOPLE WHO SHOW A SUDDEN INTEREST IN THEM. Once, while talking on the phone with my mother in the early evening after dark when she had just started to show early signs of memory loss, she had to leave the phone to answer the door. She mentioned that it was the back door. When she returned to the phone a few minutes later, she said it was a young man who had been in a lot of trouble with the law, and he wanted to move some things in her yard, with remuneration, of course. She still had the judgment to refuse his offer, and he didn't come back, but it was a scary moment.
2) OF REPAIR SCAMS - this story could have been tragic, but actually is funny. Mother called to tell us that she had gotten some asphalt on her driveway because a truck came to her house, which by anyone's estimate is WAY out in the country, not on the way to anywhere. The truck, allegedly, had extra asphalt left after a restaurant in town refused the load. (I later checked this out, and it was patently untrue). It panicked me, and I asked what she had paid, fearing it would be thousands and that the asphalt would be inferior quality and poorly spread. Later, when I saw it myself, I started laughing. It looked pretty good. I pictured two frustrated scammers, outfoxed by an 80 something who had always squeezed pennies and who had not lost that ability, even with the advent of dementia symptoms. The driveway had a nice coat of asphalt (that has held up well for many years), and she said the guy sure didn't want to take the amount she paid, which was well under a thousand dollars, but finally agreed to do the job for that amount. "He acted like he wanted to cry", she said, "but I stuck to my dollar amount".
3) DOOR TO DOOR SOLICITATION, PHONE AND MAGAZINE SUBSCRIPTIONS- This is an area that is hard to control and can be extremely frustrating.
A person who had taken an unsolicited picture of mother's property from the air and wanted $100 for the picture had stopped by the house. Penny wise, Mother talked her down to $60 and bought the picture, which really was quite good. Definitely worth the $60, possibly the $100 the photographer didn't get.
We found in going through her mail, which my younger sister primarily took over at this juncture, numerous promises to various charity organizations. Some were paid, but others had to be called and told that she should be taken off their list. Magazines likewise had to be called or letters written to stop their sending bills. She had paid some bills so many times that the magazines were paid up to five years ahead.
The three items above represent a fractional part of the ways the elderly can be taken advantage of by the lions and cheetahs of the world. More sinister and serious abuses can take place. Family members can help by 1)being vigilant, 2) asking questions, and 3)going through mail on a regular basis. As long as the person remains in their own home without assistance, you may not be able to stop everything, but you may be able to mitigate the damage or prevent additional issues from developing.
DEMENTIA HINT: Put your loved one on the "do not call" list.
Monday, December 7, 2009
VASCULAR DEMENTIA IN THE ELDERLY: 5 SELF-ASSESSMENT QUESTIONS FOR CAREGIVERS
On a scale of 1-5 with 1 being the least and 5 being the most, rank your assessments of these questions.
1. How big a jolt was learning that your loved one had this diagnosis?
1 2 3 4 5
2. How sad have you felt over learning of the diagnosis?
1 2 3 4 5
3. How much has this disease changed your family life?
1 2 3 4 5
4. How worried are you about the financial effects of the disease for the future?
1 2 3 4 5
5. What level of support will you have from extended family?
1 2 3 4 5
These questions are for information only and do not substitute for medical advice or psychological counseling.
JACK
Following is a sensitive and poignant poem written by Jane Ray about a person she admires who is representative of the population with dementia and Alzheimer's.
JACK
Sitting in the place you now call home
What do you see?
What do you hear?
Who do you know?
Family comes, you smile.
Music plays, you dance.
Sitting in a place called church
What do you see?
What do you hear?
Who do you know?
Scripture is read, you remember.
Hymns are played, you sing.
Sitting at the Thanksgiving table
What do you see?
What do you hear?
Who do you know?
People talk, you listen.
Heads bow, you pray.
Looking at Jack
What do we see?
What do we hear?
Who do we know?
We see our Dad, our Papaw, and a Precious Child of God.
We hear voices of the past. Words of wisdom; words of prayer; words of love.
We know a man filled with the grace of God. A man who leads by example.
A man called Dad, Papaw and Precious Child of God.
And God knows Jack and holds him in the palm of his hand.
author Jane Ray
JACK
Sitting in the place you now call home
What do you see?
What do you hear?
Who do you know?
Family comes, you smile.
Music plays, you dance.
Sitting in a place called church
What do you see?
What do you hear?
Who do you know?
Scripture is read, you remember.
Hymns are played, you sing.
Sitting at the Thanksgiving table
What do you see?
What do you hear?
Who do you know?
People talk, you listen.
Heads bow, you pray.
Looking at Jack
What do we see?
What do we hear?
Who do we know?
We see our Dad, our Papaw, and a Precious Child of God.
We hear voices of the past. Words of wisdom; words of prayer; words of love.
We know a man filled with the grace of God. A man who leads by example.
A man called Dad, Papaw and Precious Child of God.
And God knows Jack and holds him in the palm of his hand.
author Jane Ray
Thursday, December 3, 2009
VASCULAR DEMENTIA IN THE ELDERLY: Where Is My Hearing Aid-for the next 8 years?
Vascular Dementia, is, after Alzheimer's Disease, "the most common cause of memory loss", according to a special report from JohnsHopkinsHealthAlerts.com. This same report attributes that this disorder often results " from a series of tiny strokes that destroy brain cells." Eventually, the strokes cause so much brain tissue destruction that functional abilities are affected.
Dementia--deprived of mind--the definition itself is cruel. Our mother began to show the symptoms of vascular dementia, which later became her diagnosis, but unbelievably (it is, however, true), she had not had a family doctor in over 25 years. She was the IRON WOMAN, and to go with that, she had an IRON WILL, which effectively prevented our convincing her to go to a doctor until the progress of the symptoms had advanced much further.
She loved language, insisted on proper usage of language, and was an avid reader. One son-in-law later commented that it seemed particularly sad for her to lose so much of her mental acuity since she had always been overtly interested in things involving the exercise of the mind.
Mother never liked wearing a hearing aid, but had, in her later years agreed to wear it, at least when family was visiting. In October 2001, I received an email from my older sister Neila, who had begun to go down to check on mother more frequently.
Exerpts of the email follow indicating the further deterioration of the situation, but we had not yet assumed the role of her parent. In fact, it would be several more years before we began to insist on substantive changes as she clung fiercely to her independence.
The email: "While we were at KMart, (left her car to have the oil changed), I lost Mother for a little while in housewares. Found her in Halloween candy a little later. We returned home just in time to meet a nice man with a load of our cows in a big trailer.They had been away visiting, and he was kind enough to return them. I raced to the end of the pasture behind the house to close the gate, just in the nick of time. They unloaded them behind the house and they stampeded toward the gate by the barn, but I locked the second gate just before they got there. They joined their sisters, three other cows that another neightbor brought home three days ago. " Note: (I believe it was during this time that my brother was working away, so he was not there to take care of all matters "cow".)
The email continues..........."Then we continued the hunt for the lost hearing aid. I wish it had one of those little answering beepers like my car keys have;otherwise I'd still be in the parking lot at Northpark in Dallas. But, we did not find the hearing aid. Finally, I took Mother (and another relative) back to KMart, (our third trip there actually), to get Mother's car. Finally, going maybe 7 mph, Mother creeps out of the parking lot, and I pray God got home safely............ And what did you do on this lovely day?"
The search for the hearing aid continued for the next eight years. It was found on sinks, behind bookcases, in her purse, and myriad other locations. Looking back, we should have gotten a large, bright colored bag and put it in there to help her remember.
Managing our elderly parents is never easy, and each of us has to decide at each step how we will proceed. At this juncture, we began to deal with four main issues: 1) the cow issue 2) getting food on a weekly basis as she pretty much stopped shopping 3) lost essentials like the hearing aid 4) maintenance of the car
We recognize that we were lucky, as symptoms of the dementia started so late in her life (age 81) and she was able to maintain her independence for so long.
DEMENTIA HINT: One suggestion is to get large, brightly colored bags for essential items like hearing aids and eyeglasses or to get bags that are embroidered with the name of the item. They should be hung in a special place. (One note is that we didn't DO this, so hope it doesn't seem hypocritical to suggest it, but looking back, it would have helped-not forever, but for a while).
Dementia--deprived of mind--the definition itself is cruel. Our mother began to show the symptoms of vascular dementia, which later became her diagnosis, but unbelievably (it is, however, true), she had not had a family doctor in over 25 years. She was the IRON WOMAN, and to go with that, she had an IRON WILL, which effectively prevented our convincing her to go to a doctor until the progress of the symptoms had advanced much further.
She loved language, insisted on proper usage of language, and was an avid reader. One son-in-law later commented that it seemed particularly sad for her to lose so much of her mental acuity since she had always been overtly interested in things involving the exercise of the mind.
Mother never liked wearing a hearing aid, but had, in her later years agreed to wear it, at least when family was visiting. In October 2001, I received an email from my older sister Neila, who had begun to go down to check on mother more frequently.
Exerpts of the email follow indicating the further deterioration of the situation, but we had not yet assumed the role of her parent. In fact, it would be several more years before we began to insist on substantive changes as she clung fiercely to her independence.
The email: "While we were at KMart, (left her car to have the oil changed), I lost Mother for a little while in housewares. Found her in Halloween candy a little later. We returned home just in time to meet a nice man with a load of our cows in a big trailer.They had been away visiting, and he was kind enough to return them. I raced to the end of the pasture behind the house to close the gate, just in the nick of time. They unloaded them behind the house and they stampeded toward the gate by the barn, but I locked the second gate just before they got there. They joined their sisters, three other cows that another neightbor brought home three days ago. " Note: (I believe it was during this time that my brother was working away, so he was not there to take care of all matters "cow".)
The email continues..........."Then we continued the hunt for the lost hearing aid. I wish it had one of those little answering beepers like my car keys have;otherwise I'd still be in the parking lot at Northpark in Dallas. But, we did not find the hearing aid. Finally, I took Mother (and another relative) back to KMart, (our third trip there actually), to get Mother's car. Finally, going maybe 7 mph, Mother creeps out of the parking lot, and I pray God got home safely............ And what did you do on this lovely day?"
The search for the hearing aid continued for the next eight years. It was found on sinks, behind bookcases, in her purse, and myriad other locations. Looking back, we should have gotten a large, bright colored bag and put it in there to help her remember.
Managing our elderly parents is never easy, and each of us has to decide at each step how we will proceed. At this juncture, we began to deal with four main issues: 1) the cow issue 2) getting food on a weekly basis as she pretty much stopped shopping 3) lost essentials like the hearing aid 4) maintenance of the car
We recognize that we were lucky, as symptoms of the dementia started so late in her life (age 81) and she was able to maintain her independence for so long.
DEMENTIA HINT: One suggestion is to get large, brightly colored bags for essential items like hearing aids and eyeglasses or to get bags that are embroidered with the name of the item. They should be hung in a special place. (One note is that we didn't DO this, so hope it doesn't seem hypocritical to suggest it, but looking back, it would have helped-not forever, but for a while).
Wednesday, December 2, 2009
VASCULAR DEMENTIA IN THE ELDERLY: What Is This and What Do You Do With It?
According to Johns Hopkins Health Alerts special report Guide to Understanding Dementia, in normal age-related forgetfulness a person "sometimes misplaces" items. Those with dementia "forget what an item is used for".
October 2000 We as an extended family made some adjustments. Everyone knew that we needed to check on Mother more often. My brother, who lived just across the country road from her, was often at her home daily. We felt we had the pulse of the situation, but my sisters started coming from Dallas about every two weeks or more often if needed. I lived about 8 hours away, so came as often as I could.
On a visit that month, I noticed that there was an odd smell when I was near Mother, and I thought it was coming from her hair. Her hair looked clean, though, and because I spent several days at a time with her, I was aware of her hygiene habits, and I noted that she was still taking regular showers every morning. Not wanting to offend her, I came up with a plan. I offered to help her wash and set her hair, hoping that this would allow me to find the source of the offending odor. When we got ready to wash her hair, I told Mother to bring the shampoo to the sink. She arrived, handed me the bottle, and the issue was solved. She handed me a bottle of conditioner, and on checking, that was all she had in the shower where she usually washed her hair. It wasn't her eyesight. Her vision at that time was still pretty good. We replaced the conditioner with shampoo and that particular problem was solved. Ten more problems took its place in the next six months, but for the time being we were handling one problem at a time.
DEMENTIA HINT: Assist your loved one by simplifying the number of items they use for each activity of daily living and placing the items where they are easily accessible in the area where that activity takes place.
October 2000 We as an extended family made some adjustments. Everyone knew that we needed to check on Mother more often. My brother, who lived just across the country road from her, was often at her home daily. We felt we had the pulse of the situation, but my sisters started coming from Dallas about every two weeks or more often if needed. I lived about 8 hours away, so came as often as I could.
On a visit that month, I noticed that there was an odd smell when I was near Mother, and I thought it was coming from her hair. Her hair looked clean, though, and because I spent several days at a time with her, I was aware of her hygiene habits, and I noted that she was still taking regular showers every morning. Not wanting to offend her, I came up with a plan. I offered to help her wash and set her hair, hoping that this would allow me to find the source of the offending odor. When we got ready to wash her hair, I told Mother to bring the shampoo to the sink. She arrived, handed me the bottle, and the issue was solved. She handed me a bottle of conditioner, and on checking, that was all she had in the shower where she usually washed her hair. It wasn't her eyesight. Her vision at that time was still pretty good. We replaced the conditioner with shampoo and that particular problem was solved. Ten more problems took its place in the next six months, but for the time being we were handling one problem at a time.
DEMENTIA HINT: Assist your loved one by simplifying the number of items they use for each activity of daily living and placing the items where they are easily accessible in the area where that activity takes place.
Sunday, November 29, 2009
VASCULAR DEMENTIA IN THE ELDERLY: COWS BEAUTIFUL COWS
Cows had been part of my mother's life since 1959. Actually, she and my dad owned cows even before that, but it was in 1959 that she moved right into the middle of a pasture filled with herefords. She always said she had been a tomboy, and after that move we all believed it. She was comfortable living in a house where cows summoned you out of bed with their bawling "give me some hay" cries. They scratched themselves on the boards of the house, and left organic gifts in the driveway and yard.
From the large picture window in the living room of the ranch style house, a style popular in the late 50s and early 60s, one could view the whole herd, eating hay, playing, stomping the earth, bumping into one another like the rudest of shoppers at a firesale, and running with no apparent goal in sight. Large mama cows, and in the spring, cavorting babies, running and chasing each other in the bright green grass under the oak trees near the pond, or tank, as Texans label such bodies of water. And observing it all with a stern eye, the sultan ruling his harem, stood the bull.
When she was younger and raising a family, the cows provided extra money. They also made for a lot of extra work. Saturdays, after she had worked all week at her bookkeeping job for a highway construction company, were often spent eartagging, branding, and treating cattle for grubworm. It was the only time to do it, and she actually enjoyed it. Further proof of her "tomboyishness", or perhaps her love for her husband.
After being widowed at age 58, we (her daughters) thought she would likely give up the cattle. Our brother and she agreed on a business arrangement, and she kept them.
When she retired at age 62, we (again, her daughters) thought she would give up the cows. She did not. She started talking at age 65 about giving them up at age 70; at age 70, she talked about giving them up at 75. After 75, she stopped talking about giving them up. Our brother still did the heavy work, and they still had a business arrangement, but she never gave them up. One day in 2006, when she could no longer live alone, she simply had to leave them.
DEMENTIA HINT: Be sure that your parent has a durable power of attorney in place many years before it is needed. It may be necessary to take over aspects of their financial dealings, and having the legal authority given before your parent shows any signs of dementia makes things much easier.
From the large picture window in the living room of the ranch style house, a style popular in the late 50s and early 60s, one could view the whole herd, eating hay, playing, stomping the earth, bumping into one another like the rudest of shoppers at a firesale, and running with no apparent goal in sight. Large mama cows, and in the spring, cavorting babies, running and chasing each other in the bright green grass under the oak trees near the pond, or tank, as Texans label such bodies of water. And observing it all with a stern eye, the sultan ruling his harem, stood the bull.
When she was younger and raising a family, the cows provided extra money. They also made for a lot of extra work. Saturdays, after she had worked all week at her bookkeeping job for a highway construction company, were often spent eartagging, branding, and treating cattle for grubworm. It was the only time to do it, and she actually enjoyed it. Further proof of her "tomboyishness", or perhaps her love for her husband.
After being widowed at age 58, we (her daughters) thought she would likely give up the cattle. Our brother and she agreed on a business arrangement, and she kept them.
When she retired at age 62, we (again, her daughters) thought she would give up the cows. She did not. She started talking at age 65 about giving them up at age 70; at age 70, she talked about giving them up at 75. After 75, she stopped talking about giving them up. Our brother still did the heavy work, and they still had a business arrangement, but she never gave them up. One day in 2006, when she could no longer live alone, she simply had to leave them.
DEMENTIA HINT: Be sure that your parent has a durable power of attorney in place many years before it is needed. It may be necessary to take over aspects of their financial dealings, and having the legal authority given before your parent shows any signs of dementia makes things much easier.
Tuesday, November 24, 2009
VASCULAR DEMENTIA IN THE ELDERLY: Insidious Onset
Guide to Dementia published by Johns Hopkins Health Alerts comnpares factors of normal age-related forgetfulness and dementia. In the former, a person "may forget an event from the distant past" while with dementia, the person "has serious impairment of short-term memory," and "has difficulty learning and remembering new information."
My mother was 31 when I was born in 1950, the fifth of six children. Each year, once we had moved away from home, she faithfully called each adult child, and later, her grandchildren, on their birthdays. In her best singing voice, she gave a splendid rendition of "Happy Birthday To You" via the phone. If no one was home when she called, undeterred, she sang to the ubiquitous answering machines.
In June 2000, we had just moved to another city, where I was busy unpacking and getting settled. My birthday came around, and even though it should have been one of the seminal birthdays, the 50th, I had little time to think about it. It was several days afterward that I realized with a jolt that I had not heard from my mother.
She had not called, nor had she left a message in song on the answering machine. When I called to tease her, she didn't immediately realize what I was talking about. Then she apologized profusely for forgetting my birthday.
Unfortunately, others in the family would mention when we got together later in the year that she had also forgotten their birthdays. It was one of the first symptoms of the dementia that would take more and more from her and from our family.
She never remembered another birthday by calling and singing, though she did get a calendar and began to use it to record birthdays and other important dates, so she would sometimes remember to send a card.
Dementia onset is usually between ages 60-75 , but our mother was 81 before her symptoms appeared.
DEMENTIA HINT: If you note significant changes in functioning, even if they seem small, get a calendar and keep track so that you can note the frequency and severity of symptoms.
br />
My mother was 31 when I was born in 1950, the fifth of six children. Each year, once we had moved away from home, she faithfully called each adult child, and later, her grandchildren, on their birthdays. In her best singing voice, she gave a splendid rendition of "Happy Birthday To You" via the phone. If no one was home when she called, undeterred, she sang to the ubiquitous answering machines.
In June 2000, we had just moved to another city, where I was busy unpacking and getting settled. My birthday came around, and even though it should have been one of the seminal birthdays, the 50th, I had little time to think about it. It was several days afterward that I realized with a jolt that I had not heard from my mother.
She had not called, nor had she left a message in song on the answering machine. When I called to tease her, she didn't immediately realize what I was talking about. Then she apologized profusely for forgetting my birthday.
Unfortunately, others in the family would mention when we got together later in the year that she had also forgotten their birthdays. It was one of the first symptoms of the dementia that would take more and more from her and from our family.
She never remembered another birthday by calling and singing, though she did get a calendar and began to use it to record birthdays and other important dates, so she would sometimes remember to send a card.
Dementia onset is usually between ages 60-75 , but our mother was 81 before her symptoms appeared.
DEMENTIA HINT: If you note significant changes in functioning, even if they seem small, get a calendar and keep track so that you can note the frequency and severity of symptoms.
br />
VASCULAR DEMENTIA IN THE ELDERLY: You're Saying I'm Losing It.
According to a report by Johns Hopkins Health Alerts called Guide To Understanding Dementia, one of the differences between normal age-related forgetfulness and dementia in regard to memory loss is that the person with age-related forgetfulness "jokes about memory loss" while the person with dementia "may have little or no awareness of cognitive problems."
Late in the summer of 2000, Mother came to visit. She was frugal to a fault, and there were certain things she just would not spend money on. One of these was long distance services. In the years that I was in college, one of the things that I sometimes verballly chastised my parents for was the fact that they never called me. My whining changed nothing. They still did not call me.
Long distance was for emergencies only, at least that continued to be my mother's view. Costs had gone down considerably since my college days in the late 60s, but that didn't seem to factor in to her thinking.
Today, she held in her hand a telephone bill. She wanted me to look at it because there was a charge of $15 for a long distance call, and she believed one of my daughters had made the call when she was visiting her the month prior. After looking at the bill, I remembered that I had called Mother on that exact date, left a message, and been very surprised when she called me back and talked for a long while. Usually, I called her on either the landline or my cellphone, but since I had moved that summer and now lived 8 hours away, I had the sense that day she had made an exception because she would be seeing me less than in the past and wanted to talk.
Although I thoroughly explained this to her, reminded her of the call, etc. she was unconvinced and continued to complain about the bill. I finally told her I would give her $15, but that I just wanted to know if she understood what I was saying (i.e. that my daughter had not made an unauthorized call on her phone. She had her own cellphone for long distance). Mother answered a little bitterly, uncharacteristic for her, "Yes. I know what you're saying. You're saying I'm losing it."
She was still living alone, driving, teaching a class at her church, going to various activities and functioning well as far as we could all tell, but her words were prophetic.
DEMENTIA HINT: Pay careful attention when your loved one says something uncharacteristic about themselves even if it doesn't appear to be true at that time. There may be an embedded message for you there.
Late in the summer of 2000, Mother came to visit. She was frugal to a fault, and there were certain things she just would not spend money on. One of these was long distance services. In the years that I was in college, one of the things that I sometimes verballly chastised my parents for was the fact that they never called me. My whining changed nothing. They still did not call me.
Long distance was for emergencies only, at least that continued to be my mother's view. Costs had gone down considerably since my college days in the late 60s, but that didn't seem to factor in to her thinking.
Today, she held in her hand a telephone bill. She wanted me to look at it because there was a charge of $15 for a long distance call, and she believed one of my daughters had made the call when she was visiting her the month prior. After looking at the bill, I remembered that I had called Mother on that exact date, left a message, and been very surprised when she called me back and talked for a long while. Usually, I called her on either the landline or my cellphone, but since I had moved that summer and now lived 8 hours away, I had the sense that day she had made an exception because she would be seeing me less than in the past and wanted to talk.
Although I thoroughly explained this to her, reminded her of the call, etc. she was unconvinced and continued to complain about the bill. I finally told her I would give her $15, but that I just wanted to know if she understood what I was saying (i.e. that my daughter had not made an unauthorized call on her phone. She had her own cellphone for long distance). Mother answered a little bitterly, uncharacteristic for her, "Yes. I know what you're saying. You're saying I'm losing it."
She was still living alone, driving, teaching a class at her church, going to various activities and functioning well as far as we could all tell, but her words were prophetic.
DEMENTIA HINT: Pay careful attention when your loved one says something uncharacteristic about themselves even if it doesn't appear to be true at that time. There may be an embedded message for you there.
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