A Brain is a Beautiful Thing

By Patty Hagen

When it comes to reversing memory decline and rejuvenating your brain, take heart! There’s hope for us, regardless of age. That’s the central message of a “Remember This” seminar recently held at Charles E. Smith Life Communities, where I’m the director of Dementia Programs.

In “How to Boost Your Memory and Brain Performance – at Any Age,” Majid Fotuhi, MD, PhD laid out solid information and important, easy-to-follow advice that boils down to sticking to a physical exercise regime, finding ways to stimulate your mind, and following doctors’ orders  to improve serious medical conditions. Dr. Fotuhi is considered one of the world’s leading brain experts and an authority in the field of memory and aging. Starting with some basic physiology, Dr. Fotuhi explained that with aging, the brain’s hippocampus – shaped like a small sea horse and responsible for short-term memory – shrinks by about 0.5% per year after age 50. That’s hardly an insignificant loss when added up over a decade or more. Factors that can contribute to shrinkage are:

• Diabetes and hypertension, uncontrolled
• Obesity
• Stroke
• Sleep Apnea, uncontrolled
• Stress
• Concussion
• Depression

What steps can we take to improve blood flow to the brain and help prevent or reverse this shrinkage? Dr. Fotuhi advises taking clear – and doable – steps, with some examples, to turn things around. While these tips will not reverse memory loss caused by Alzheimer’s disease, they can help make our brains “younger:”

1. Get fit. Walking a mile a day five times per week can make a positive difference in just a few weeks. If knees hurt, try walking in a swimming pool.
2. Tease your memory. Memorize things; for example, learn one or two names a day. Study something new.
3. Eat well and add DHA, specifically omega-3 fatty acid, to your diet. Eat a heart-healthy diet to increase blood flow to the brain.
4. Sleep. A full night of rest every night works miracles.
5. Relax your mind. Stress can be toxic and rarely solves problems. Try meditation.

“The brain is forgiving and can bounce back, “says Dr. Fotuhi encouragingly. Never say you’re too old to make changes; be positive and show confidence!

Snow, Ice, & Frigid Winds Heap New Challenges on Caregivers

The perils and discomfort of winter weather are fodder for the nightly news, but they present a whole different issue for caregivers of individuals with dementia. The caregiver’s task of having to come up with activities to fill the day now becomes one of limiting activities to those done indoors. An often resultant malady called cabin fever, courtesy of snow and ice, can make the day feel endless.

The Alzheimer’s Association has a few tips to help caregivers weather the storms:

1. When planning activities, think about how the person for whom you are caring historically enjoyed spending his or her time.
2. Adjust these activities so they are doable and safe, while also meaningful for the person with dementia and caregiver alike.
3. It is important not to infantilize the person by asking  them to do activities which may be below their current level of functioning.
4. When engaging in an activity, minimize distractions. Turn off the television and your cell phone.
5. Be present with the person during the activity. Give  the person you’re caring for your undivided attention, which will feel good for you both.

The Internet, of course, provides innumerable suggestions for indoor activity, but I just found a site, Elder One Stop, that offers ideas that go beyond “the usual.” Check it out at http://www.elder-one-stop.com/dementia-activities.html.

Posted by Patty Hagen, Director of Memory Care Programs, Charles E. Smith Life Communities

Caregiver Tips for Special Family Events Throughout the Year

With just a few weeks left to the 2013 holiday season, there may be a few more special occasions for families who have a loved one living with dementia to gather together. We’ve discovered a list of tips from the Alzheimer’s Association to make these occasions successful and happy, but since they are as relevant to any family celebration at any point in the year as they are to traditional year-end events, we felt it would be worthwhile to share with readers.

1. Adjust your expectations of yourself, the caregiver. Only agree to take on what you can reasonably manage, and ask for help. Holidays, birthdays, and anniversaries often come with traditions and expectations from family members, but try to ask for people to be flexible. Perhaps you can ask someone else to host the holiday gathering this year.
2. Let family and friends know what to expect. If they haven’t seen the person with dementia in a few months or a year, make sure they know.
3. If a family gathering is large, assign a friend or relative (or two) to be a “buddy” to the person with dementia. The buddies can take turns guiding the person with dementia through what is expected at the gathering and making sure the person with dementia’s needs are being met.
4. Involve the person with the diagnosis in tasks that they can succeed in. Maybe he or she can no longer prepare the entire meal, but perhaps the person can rinse the vegetables, set the table or clean silverware and still feel included in the preparation.
5. Try to schedule only one activity or outing a day. Allow the person to rest either before or after the event. If you have an especially busy day, plan for the next day to be one of rest and relaxation for both the person with dementia and you.
6. Take time for yourself. If you have a holiday tradition that is important to you, such as attending a musical performance with your grandchildren, arrange for home care so you can continue to enjoy the things you love.

Visit the Alzheimer Association website for a fuller list of holiday season tips as well as tips for winter and spring enjoyment.

Leader in Advancing Alzheimer’s Research Reviews Challenges Ahead

Dr. Neil Buckholtz, National Institute on Aging

Dr. Neil Buckholtz, director of the Division of Neuroscience at the National Institute on Aging (NIH), explains that a long, difficult journey lies ahead for researchers worldwide striving to understand Alzheimer’s disease, develop better treatments to slow its progress and ultimately find a cure. Eventually, he says, “we hope to be able to delay the onset or prevent Alzheimer’s disease entirely.”

In a recent fascinating interview, Dr. Buckholtz lays out with precision the achievements to date and the goals and challenges for research professionals in academia, government and industry. Go to http://1.usa.gov/17PLIJM to read or hear “A conversation with… Dr. Neil Buckholtz.”

Readers may be interested in learning that Dr. Buckholtz participated in the May 2013 “Remember This” Symposium sponsored by the Hurwitz Lecture Fund at the Charles E. Smith Life Communities. The topic: Alzheimer’s Disease: Current Understanding and New Directions.

“The new national push on Alzheimer’s has re-energized all of us, I think, and has elevated research on Alzheimer’s in the national conversation about aging and health.”

Caregiver Guilt: What to Do If You Feel It

If I had to name the one emotion I hear about most frequently from family caregivers who assist loved ones living with dementia, its guilt. In fact these caregivers are pained just to have to admit this and share their thoughts with me.

Here’s what’s overwhelming: the unremitting stress that comes with the reality of their situation, their heavy responsibilities and the difficulty they face in juggling care with everything else in their lives, e.g., children, husband, job, and their own personal and mental health needs. Where does guilt come in? When, no matter how exhausted you are, “there are most likely times when you tell yourself that you could do better,” says Dr. Alexis Abramson on her blog, The Dr. Alexis Blog.

I’ve recently come across one of her posts, “10 Tips to Help You Say Goodbye to Caregiver Guilt,” which constructively addresses the guilt dilemma. Here are the tips, but I suggest you go to the actual blog itself for full elaboration, insights and suggestions. By the way, you’ll find other excellent advice on the blog…as well as a link to obtaining Dr. Abramson’s book, The Caregiver’s Survival Handbook.

1. Acknowledge your feelings.
2. Think quality, not quantity
3. Establish priorities
4. Set limits
5. Redefine your concept of caring.
6. Act from love, not from a sense of debt.
7. Forgive and seek forgiveness.
8. Foster their independence.
9. Face the facts.
10. Don’t succumb to peer pressure.

A Day for Awareness…and Beyond

September 21, 2013 is Alzheimer’s Action Day, but in truth every day in every year is an opportunity to sharpen awareness of a disease that “affects families across the United States and the world,” according to the Alzheimer’s Association.

Since the January 2013 opening of Cohen-Rosen House, our state-of-the-art memory care residence, Charles E. Smith Life Communities has taken major steps to share our expertise in the care of individuals living with Alzheimer’s and dementia with the broader community. To this end, I’d like to highlight two upcoming events:

October 10:   “Allen Cognitive Levels: A Best-Abilities Approach to Dementia Care” 

This is our final program in the 2013 “Remember This!” seminar series. Learn more and register at http://bit.ly/14SlwXG.

October 2 – November 20:  8-Week Memory Loss Support Group

In partnership with the Alzheimer’s Association of the National Capital Area, Charles E. Smith Life Communities is pleased to present a series of eight informative sessions for families who have a loved one experiencing memory loss or dementia. The sessions are open to caregivers and families in the community as well as those with ties to our campus. They will be conducted by Kara Genderson, a volunteer from the Alzheimer’s Association.

Dates & Topics:

October 2 –  “Defining Dementia”

October 9 –  “Caregiver Burnout”

October 16 –  “Coping Skills and Self-esteem”

October 23 –  “Understanding Behavior Issues”

October 30 –  “The Grieving Process”

November 6 –  “The Changing Family Dynamics”

November 13 – “Resources in the Community”

November 20 – “Future Planning and Strength Building.

• Time:  Each session starts at 7 p.m.
• Location:  Wasserman Residence Conservatory, located at 6121 Montrose Road, Rockville, MD 20852
• Cost:  Free
• RSVP: Email Patty Hagen, Director of Memory Care Programs at Charles E. Smith LIfe Communities, or call her at 301.770.8408.
• Note:  Group size is limited. 

Your Second Caregiver Responsibility: Take Care of Yourself!

As director of memory care programs at Charles E. Smith Life Communities, I assist in developing stimulating programming for residents living with memory care issues. Recently, I was chatting with the family member of one of these residents and suddenly refocused the conversation to the gentleman’s own wellbeing by asking, “So what are you doing for yourself today?”

He scratched his head and had difficulty coming up with a quick answer. Why? Well, he had never considered himself in the equation of care. Finally he replied that he was not coming back that evening and in fact had just decided to decrease his visits to mornings only.

We started to discuss his typical day. Every morning and afternoon he attends synagogue services. He then tries to arrive at our residence around 9 a.m. to be with his wife; he stays to have lunch with her and finally leaves around 1 p.m. Back at his home, he attends to personal affairs. That’s it. As far as doing anything for himself that might be fun, interesting, stimulating, or nourishing to body and soul—all in an effort to relieve stress and prevent caregiver burnout, he has nothing on the schedule.

If this describes your life as a caregiver, there’s abundant practical advice out there to help you help yourself. To start the ball rolling, go to the Mayo Clinic website to read “Caregiver stress: Tips for taking care of yourself.” http://www.mayoclinic.com/health/caregiver-stress/MY01231.

Can Dementia Complicate Travel Plans? You Bet!

“When you are caring for someone with dementia, the thought of a vacation may be wonderful, but the actual reality of the experience can be stressful and complicated.”

I’d like to know what caregiver for an individual living with dementia doesn’t relate to this observation. The sentence – which I quote because I couldn’t have expressed it better – comes from a Hebrew Senior Life blog (ReAge) written by Tara Fleming Caruso, MA, LMHC. Ms. Caruso does more than just sigh or commiserate; she lays out plenty of helpful suggestions regarding preparation and strategy to make the coming, going, and stay successful. Here’s one example:

Schedule a dress rehearsal. Go for a day trip that includes traveling, activities and meals. This will give you an opportunity to practice some of the challenges you may face on your actual trip.

So, if you’re contemplating a trip in the remaining weeks of summer—or, of course, any other time —you really do need to read Ms. Caruso’s article in full at http://bit.ly/16jsaau.  

NOTE: If you have suggestions from your own experiences, please share with us!

Let’s Get Past the Stigma of Dementia

Photo of President Ronald Reagan and Margaret Thatcher by Gerald Penny/Associated Press

Paula Span, in a recent article for her insightful New York Times blog, The New Old Age, considers the terrible stigma attached to dementia: “Alzheimer’s and other forms of dementia, to this day, carry a stigma that most other diseases—heart failure, for example—do not.”

To pursue her point, Span compares how the families of President Ronald Reagan and Britain’s Margaret Thatcher revealed diagnosis of the condition in both world leaders to the public. In Reagan’s case, the disclosure was contained in an open handwritten letter; Thatcher’s family, on the other hand, chose to avoid using the term dementia.

In my work at Charles E. Smith Life Communities, I continually observe how families differ in how they share the reality of a loved one’s dementia with friends and relatives. They seem to feel uncomfortable, embarrassed or pressed to explain why this has happened to someone long recognized for being so smart, vital, and competent.  

But, Span hits the nail on the head when she writes this: “We know that dementia will become an increasingly common condition in coming years, that it’s a terminal disease which doesn’t respect the public stature or intellectual accomplishments of its victims (our emphasis), that it can cause families to grieve for the people they’ve lost long before they die.”

My advice is to be honest, willing to discuss the diagnosis with friends and relatives, and ready to shift the focus to the lasting abilities, not disabilities. As a society, this is what we must do.

Read “A Singular Life, an All Too Common End” by Paula Span at http://nyti.ms/1bCIDuM .

Summertime — With Adjusted Expectations

Family gatherings, reunions, vacations, and visits from friends can all be special times for folks to sit around the living room for some chitchat and catching up. For most families and friends, these occasions are filled with opportunities for togetherness, laughter and memories, but they can also be filled with stress, frustration and sadness for those touched by Alzheimer’s disease or a related dementia.

Here are some tips that may help to make these seasonal gatherings happy and upbeat for everyone.

• Arrange a face-to-face meeting or long-distance phone call with family and friends to discuss the upcoming gathering. Make sure that everyone understands your caregiving situation and has realistic expectations about what you can and cannot do.
• When hosting, give yourself permission to do only what you can reasonably manage. If having company for an entire week is more than you can handle, consider making the visit a little shorter, or send a list of suggested alternative accommodations nearby.
• When visiting, request any necessary preparations in advance, such as having certain foods in the refrigerator and bedroom space set up. If it would be helpful, ask your hosts to label important areas, like the bathroom and bedroom, with signs.
• Stay as close to a normal routine as possible. For example, bathing and eating times should be on a similar schedule to what they are at home. Eating in familiar settings, such as a dining room table, may be less confusing than eating at a crowded, noisy restaurant.

Familiarize others with your situation by writing a letter or email. Here are some ways to phrase your concerns:

• I’m writing this letter to let you know how things are going at our house. While we’re looking forward to your visit, we thought it might be helpful if you understood our current situation before you arrive.
• You may notice that ___ has changed since you last saw him/her. Among the changes you may notice are ___. I’ve enclosed a picture so you know how ___ looks now.
• Because ___ sometimes has problems remembering and thinking clearly, his/her behavior is a little unpredictable.
• Please understand that ___ may not remember who you are and may confuse you with someone else. Please don’t feel offended by this. He/she appreciates your being with us and so do I.
• Please treat ___ as you would any person. A warm smile and a gentle touch on ___ the shoulder or hand will be appreciated more than you know.
• I would ask that you call before you come to visit or when you’re nearby so we can prepare for your arrival.

Involve the person with dementia

Involve the person in safe, manageable family gatherings and activities. Begin slowly by asking the person to help you set the table, wrap packages, prepare food, or hand you decorations.  (Avoid using candies, artificial fruits/vegetables or other edibles as decorations. Blinking lights may confuse or scare the person.)

Maintain the person’s normal routine so that preparations don’t become disruptive or confusing. Taking on too many tasks can be stressful for you and the person with dementia.

Try to be flexible

Consider celebrating with lunch or brunch, rather than an evening meal, to work around the evening confusion. 

Think of positive ways to modify favorite family traditions or even start new ones. 

Allow time to de-stress

Try to work in downtime between activities to avoid the feeling of non-stop frenzy.

Prepare for a post-gathering letdown. Arrange for in-home care through a company like Home Care Solutions (http://bit.ly/12ExdyC). You, as the caregiver, can enjoy a movie or lunch with a friend and reduce post-gathering stress.

Family celebrations are opportunities to share time with the people you love. Try to make these events easy on yourself and the person with Alzheimer’s disease so you can concentrate on enjoying your time together.