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.

Manage Stress to Alleviate Dementia Symptoms

David R. Larsen, MFHD

We know from evidence that unremitting stress heightens the risk of developing dementia, but what may be less obvious is the fact that once someone has actually been diagnosed with this unforgiving illness, meditation as a stress management tool can help to alleviate behavioral symptoms that include aggression, banging, yelling and anxiety.

I’ve had the privilege of meeting Alzheimer’s researcher David R. Larsen, MFHD, whose career has been devoted to studying and sharing insights about stress and brain health. He has impressed upon me the value of “meditation, mindfulness and other forms of autogenic relaxation” in making individuals living with dementia more comfortable. As a result, I’m working with the massage therapist at the Hebrew Home of Greater Washington and Cohen-Rosen House, our memory care residence, on ways to incorporate these approaches to stress management into the care of our residents. Here are some easy meditation instructions offered by Mr. Larsen in his newsletter Brain Health News for June 2013 that you also might find useful:

Start by finding a soft comfortable chair and then do some tensing and releasing (or stretching) of muscle groups, taking three slow, deep breaths (much like yawning). Count to 4 as you breathe in and to 5 as you breathe out.

Next, repeat to yourself silently and 3 times the following self-statements:

• I feel quite quiet. . . I am easily relaxed.
• My right arm feels heavy and relaxed. . . My left arm feels heavy and relaxed. . . My arms feel heavy and relaxed.
• My right leg feels heavy and relaxed. . . My left leg feels heavy and relaxed. . . My arms and legs feel heavy and relaxed.
• My hips and stomach are quiet and relaxed. . . My shoulders are heavy and relaxed.
• My breathing is calm and regular . . . My face is smooth and quiet.
• I am beginning to feel quite relaxed.

Say the phrases in a quiet, thoughtful way. Pause and notice how you feel. Focus on your feelings for two or three breaths. Practice each statement until you feel their full relaxing effect.

If you have time, it will also help if you can then vividly imagine yourself in some quiet, peaceful place or vacation site, in rich sensory detail.

The more often you return your body to this state of restfulness, the easier and faster the process will become, and the more energy and self-control you will experience. It is suggested that you do this exercise at least twice a day.

Mr. Larson invites readers to email him at DavidRJL@aol.com for a copy of his newsletter.

Tailoring Communication to Meet a New Reality

Most of us take for granted the natural ability to converse. Unfortunately, dementia is a game changer, in this regard; it alters forever the ease of communication for the individual living with cognitive decline…and the caregivers who are striving to maintain a meaningful relationship.

As director of memory care programs at Charles E. Smith Life Communities, I spend significant time strategizing ways to communicate more effectively with each resident and then conveying my insights to family members who want to scale a communication wall to connect with their loved one. I have an interesting article to share on this point titled, When Communicating with Someone Who Lives with Dementia: Wait.

“Wait at least 90 seconds for someone who lives with dementia to answer or respond. Do not ask again, do not suggest, just patiently, wait,” advises author Megan Hannan as she describes her effort to elicit an opinion from an elderly woman regarding what she likes best in her “dementia specific” residence. The clock ticked away until the woman finally answered. “It’s quiet here.” After another 60 seconds, she added, “the space.”

That calm, undemanding interchange created a comfort level leading to the woman’s preference that Hannan herself be the one to escort the resident to the dining room.

Bottom line: To adjust to communication limitations imposed by dementia, be patient, relaxed, soft-spoken, and, above all else, sensitive.

Read the full article at http://bit.ly/16l5M4P.

Patricia Hagen is director of Memory Care Programs at Charles E. Smith Life Communities, located in Rockville, Maryland.

Spring Fever

Regardless of the time of year, it can be a challenge to come up with meaningful activities to do with a person living with dementia. Now that spring has arrived (and summer is around the corner), it’s a great time to explore the outdoors and take advantage of the warmer weather.

When choosing activities, try to identify things the person you are caring for has historically enjoyed, while focusing on his or her abilities and modifying the activity based on their stage of disease. Here are some random tips:

1. Work in the garden together. Sometimes just repotting plants is easy and fun to do.
2. Grab an ice cream cone as a cooling treat.
3. Toss a ball in the yard or park to get some outdoor exercise.
4. Play with pets or visit a zoo.
5. Take a trip to a botanical garden.
6. String Cheerios to hang outside for birds.
7. Have an afternoon tea party outside.
8. Feed the ducks. 

By the way, just because it’s spring doesn’t mean you have to go outside. Simple Indoor activities can be worthwhile too. Consider these ideas:

1. Do some spring cleaning together.
2. Dance!
3. Make homemade lemonade.
4. Look at family photographs.
5. Make a scrapbook.
6. Work on a puzzle together.

Finally, it may be helpful to have activities ready in different rooms of the home so you always have engaging ways to spend time together right at your fingertips.

If your loved one happens to live in a memory care residence, ask staff about their activity schedule so you can arrange your time to visit when something that interests you is happening.

Triggering Memory – Courtesy of a Lemon Pound Cake

“Memories, imagination, old sentiments, and associations are more readily reached through the sense of smell than through the other channels.” ~ Former Chief Justice of the Supreme Court Oliver Wendell Holmes

Sweet memories count amongst our most precious possessions. For individuals diagnosed with dementia, anything that triggers these memories – seemingly faded into the mists of time – is a powerful tool. A recent experience in our new memory care residence drove home this point for me.

Seated comfortably in the living room by a warm fireplace, an elderly resident, her family members and staff, including myself, were suddenly entranced by the pleasing smell of freshly baked lemon pound cake wafting from the kitchen. Here’s the conversation that ensued:

“Have you seen my father?” asked the resident. “Where do you think he went?” replied a therapist. “Maybe to the store,” said the resident. “Do you think he knows what to get?” asked the therapist. “Well, not if it relates to cooking!” answered the resident. We all started laughing, but now let’s guess what happened.

Sensory stimulation, prompted by an irrestible aroma, aroused memories from the resident’s childhood—perhaps of a mom who was a sensational cook, a dad who, for whatever reason, would rarely be sent on a mission to the grocery store, special family gatherings, delicious home-cooking, and probably more. These memories led to the sharing of a unique moment in the resident’s current reality, and most important, this occurred within a non-judgmental setting filled with love, humor and support. We all felt uplifted and enriched.

Caregivers and professional healthcare providers working with patients living with dementia will find these two relevant articles that address memory retrieval of particular interest:

“Reminiscence and Alzheimer’s Disease” – http://bit.ly/14yRFsh 

“Smell stimulates memories for seniors with Alzheimer’s disease or other dementias” – http://bit.ly/10kvlAY  

The Power & Magic of Music

Music lifts the spirit—even for individuals living with dementia. I recently came upon a striking video — http://bit.ly/YM9I9G — that shows an expressive arts therapist helping an elderly couple rediscover the joy of music and the intrinsic pleasure of shared moments, despite their both having lost an ability to communicate verbally. As the jaunty music plays, the therapist joins their hands and leads them through simple arm movements in an easy, lighthearted manner. To witness a happy husband and wife relaxed and re-engaged with one another in such an upbeat and beautiful way is nothing short of inspiring. Try using music with your loved one who may be living with dementia and let us know how it goes.

Celebrating & Coping at Holiday Time

When a loved one is living with dementia, it may feel like everything is a challenge for caregivers. That’s certainly the case at holiday time. While your natural desire is to embrace warm traditions and think back fondly on cherished memories associated with past celebrations, it can be difficult, sad, and even overwhelming coping with a reality that was never anticipated. The Alzheimer’s Association offers excellent advice to support you and your family at this time. Go to  http://bit.ly/13j7zGy and learn how to make necessary adjustments.

When a Garden is More Than a Garden

  I just had a great conversation with residents at Cohen-Rosen House about the approach of spring and upcoming plans for our garden.

“What should we grow in our garden?” I asked. “What did you grow in your garden?  Fruits, vegetables, herbs?” I explained that everything we grow here can be used in the Cohen-Rosen kitchen and this was greeted with surprise and delight.

The conversation moved on to tomatoes. “Are they a vegetable or fruit?  And what about eggplants: vegetable or fruit?”

This is an encouraging example of how interest and anticipation can arise from a simple discussion of a life-long pleasure.

Caregivers might enjoy reading “Gardens for People with Dementia” at http://bit.ly/Zm7c6a.

The Beauty of Art…as Therapy

   A fascinating article titled Art Therapy Innovation, written by art therapist Erin Partridge, supports what I regularly witness in my work: “Living with dementia does not mean an end to expression and innovation.” Partridge describes a creative project that should be a solid dose of inspiration for anyone – professionals and family members alike – who provides daily care for individuals experiencing cognitive decline. I plan to share this with my own recreation specialists. Check it out at http://bit.ly/12XFP9l.

Affects of Hospitalization on Cognitive Ability: It’s Not What You Think

We’re happy to share the following superb article by Dr. Edward L. Schneider, which appeared in a publication of the Los Angeles Jewish Home and is reprinted with their permission.

For most of us, it is an inescapable result of aging: Faced with conditions that require treatment or repair, we are admitted into the hospital, whether for an outpatient procedure or a longer-term stay. No matter the duration, hospitalization can present a variety of physical and emotional challenges for anyone – and for seniors, those challenges are particularly acute. One of the most pernicious, says Dr. Edward Schneider, a senior advisor for special projects at the Jewish Home and a professor at the Keck School of Medicine of USC, is a condition known as delirium.

Characterized by a short-term onset of problems with memory, disorientation and judgment, delirium, Schneider says, “does not last; this is not dementia, although people with early to moderate Alzheimer’s disease are more susceptible.” Delirium has a broad range of contributing factors, Schneider continues. “People are in a new environment, and are often receiving powerful drugs they haven’t taken before.” In addition, they experience changes in electrolyte balance and metabolism that can also serve as a trigger.

Fortunately, delirium usually passes within several days or weeks of leaving the hospital – the time horizon is different for everyone – and patients make a full recovery. However, while the prognosis is excellent, it does not necessarily translate to the return of robust mental health. Once they are discharged, Schneider says, “patients typically go back to their baseline.” In other words, the delirium recedes, but any preexisting cognitive impairment remains.
Whether someone is fighting delirium or trying to prevent it in the first place, Schneider points out that the prescription is the same. “You are much less likely to develop delirium, and are much more likely to recover from it, if you have a family member or friend present in the hospital.” The reason, Schneider says: “Being surrounded by people you know offers a sense of continuity and reassurance.” To that end, many hospitals send volunteers to sit with elderly patients; they become acquainted, and the patients feel more at ease.

If delirium does set in, it is important to alert the patient’s doctor to the change in behavior. And to the greatest extent possible, caregivers should avoid taking steps that can make the condition worse, such as the use of wrist or ankle restraints. “If a patient is already confused and feeling like he is in a foreign place, you can imagine how much more threatened he will become if he finds his movement restricted,” Schneider says.
The bottom line, according to Schneider, is that heightened awareness and compassionate treatment can go a long way toward staving off the condition. For countless seniors and their loved ones, that is good news, indeed.

Dr. Edward L. Schneider headed the largest private center for research and education on aging, the Andrus Gerontology Center of the University of Southern California, from 1986 to 2004. He is now Dean Emeritus of the Leonard Davis School of Gerontology and Professor of Medicine at the USC Keck School of Medicine. Dr. Schneider has written or co-written 14 books, including Ageless: Take Control of Your Age & Stay Youthful for Life, and published more than 180 scientific articles on topics related to aging.