I'm often asked about examples of challenging behaviors that I noticed in my mother—behaviors that helped me to finally realize she was sinking into dementia. The list below may help you to evaluate what is happening to your loved one.
For Mom, it started slowly with just a few of these behaviors attracting my attention. I just passed them off to normal aging. Gradually, it reached the tipping point where I could no longer ignore what was happening. There was an emergency a day.
I lived 1500 miles North of Mom, trying to run a business. Every day in the middle of some crisis at work came a phone call about some calamity in Florida. Sometimes from Mom, sometimes about Mom.
Up to 30% of my time was being consumed as a long distance caregiver and decision maker—often without the facts I needed to make correct, emotion free, objective decisions. Frequent air travel to check things out became another costly requirement. Here’s some of what I had to deal with:
• NUTRITION: She was not eating well. Things in her refrigerator were scary: ie: partly eaten fruits and cheeses with lots of mold.
• CLEANLINESS: Her house was dirty (she had been a meticulous housekeeper).
• HOUSEHOLD ORGANIZATION: There was clutter everywhere. This was not my mother!
• FIRE SAFETY: She was storing plastic bags in the oven. Then, forgetting, she was turning the oven on.
• REALITY ISSUES: Hallucinations about mice were occurring with increasing frequency.
• HEALTH ISSUES: Many health issues were threatening her well-being. Hospitalizations for pneumonia, arthritis, etc., were becoming more frequent.
• DRUG COMPLIANCE: She was non-compliant with medications with the result that her blood pressure was out of control and other health conditions were not receiving prescribed therapy.
• MEDICAL CARE: She changed doctors (and HMO's) several times each year. Continuity of care suffered and I could not build a useful relationship with her physicians.
• INTERPERSONAL RELATIONSHIPS: She was isolating herself—alienating friends and family with harsh, judgmental personality changes.
• FALLING: She fell in her room, sustained a serious head injury and no one found her for 2 days
• FINANCIAL MANAGEMENT: She was messing up her finances and making other poor judgments.
• HOUSING: She became a housing hopper: In a 2 year period she went from her Florida house to a Florida condo to a furnished condo in Michigan back to her Florida condo to senior apartment to assisted living in Florida back to assisted living in Michigan. She had trouble settling in anywhere.
• DRIVING: Her driving became a daily nightmare with multiple fender benders and traffic violations.
Sound familiar? Are any or all of these things happening to your mom, dad, spouse or significant other? I hope not, but if they are, it may be time to seek a professional geriatric evaluation.
Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com
Wednesday, August 13, 2008
Tuesday, August 5, 2008
Is Your Mom/Dad/Spouse Ill—Or Just Being Difficult?
I'm often asked the following questions:
• When did I first realize that my mother was ill and not just being difficult?
• What are some examples of her challenging behavior?
• How did I try to cope?
For this post, I will focus on the first question: when did I finally understand that what I was seeing was illness and not nastiness? While I cannot pinpoint the exact moment with any accuracy, suddenly I knew—the light bulb flashed on and it was not a happy moment.
All her life, Mom had been a well organized, high energy person. She ran my father's manufacturing business and, when she retired, she became a dedicated community oriented leader, an organizational volunteer and chapter president, a local library board member, and a worker for all sorts of charitable organizations too numerous to mention here.
My mother grew up in Brooklyn, New York, and lived there until retiring to Florida at around age 60 with my father. Dad died suddenly while shopping in a Sears store. He just collapsed with Mom shopping beside him. He was 83. Mom was 77 and, of course, was totally traumatized.
I was to learn that dementia is something that happens gradually; quietly altering a person's skills and behavior until it becomes so obvious something is wrong that it can't be ignored. After my father died, I suddenly realized that Mom had been slipping emotionally and cognitively for some time. I just hadn't noticed before because Dad had been covering for her.
Mom's behavior was becoming eccentric and embarrassing. At first, not suspecting illness, I felt angry and guilty but, as I say, dementia kind of creeps up on you. I gradually realized that something was wrong. Something very serious.
She was ultimately diagnosed with a progressive dementia, not Alzheimer's, rather a multi-infarct (mini-stroke) vascular dementia. And her only son (me), who lived 1400 miles away, was to become her primary caregiver.
Next time, I'll report on question two: Examples of Mom's behavior alerting me to the fact that something dreadful was happening.
Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com
• When did I first realize that my mother was ill and not just being difficult?
• What are some examples of her challenging behavior?
• How did I try to cope?
For this post, I will focus on the first question: when did I finally understand that what I was seeing was illness and not nastiness? While I cannot pinpoint the exact moment with any accuracy, suddenly I knew—the light bulb flashed on and it was not a happy moment.
All her life, Mom had been a well organized, high energy person. She ran my father's manufacturing business and, when she retired, she became a dedicated community oriented leader, an organizational volunteer and chapter president, a local library board member, and a worker for all sorts of charitable organizations too numerous to mention here.
My mother grew up in Brooklyn, New York, and lived there until retiring to Florida at around age 60 with my father. Dad died suddenly while shopping in a Sears store. He just collapsed with Mom shopping beside him. He was 83. Mom was 77 and, of course, was totally traumatized.
I was to learn that dementia is something that happens gradually; quietly altering a person's skills and behavior until it becomes so obvious something is wrong that it can't be ignored. After my father died, I suddenly realized that Mom had been slipping emotionally and cognitively for some time. I just hadn't noticed before because Dad had been covering for her.
Mom's behavior was becoming eccentric and embarrassing. At first, not suspecting illness, I felt angry and guilty but, as I say, dementia kind of creeps up on you. I gradually realized that something was wrong. Something very serious.
She was ultimately diagnosed with a progressive dementia, not Alzheimer's, rather a multi-infarct (mini-stroke) vascular dementia. And her only son (me), who lived 1400 miles away, was to become her primary caregiver.
Next time, I'll report on question two: Examples of Mom's behavior alerting me to the fact that something dreadful was happening.
Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
http://www.dementia-diary.com
Wednesday, July 30, 2008
Is It Alzheimer's?
Or is it one of the many other kinds of dementia that slowly rob our loved ones of their identities? It matters not which dementia they have. The effect is pretty much the same.
So I finally “got it.” Maybe you have too. But, if not, consider this: Chances are your loved one would be embarrassed to death if his earlier, healthy, self could see him now.
It’s up to us as caregivers to recognize that Mom or Dad (or spouse) are not being difficult on purpose, and to forgive them—daily if necessary. They just can’t help themselves.
DEMENTIA CAREGIVERS OFTEN FEEL ISOLATED
They need lots of caregiver support. For a very long time, I felt TOTALLY ISOLATED—like I was the only one in the whole world carrying the burden of caring for an aging parent. I bet you sometimes do too.
Be good to yourself. Seek dementia support services wherever and whenever you can.
That’s what I did and gradually I realized that I WAS NOT ALONE! Thousands of people were experiencing exactly what I was—dealing with memory loss and unpleasant behavior in a loved one, every moment of every day.
KNOWING THIS MADE ALL THE DIFFERENCE
Bob Tell
Author, "Dementia Diary, A Caregiver's Journal"
http://www.dementia-diary.com
So I finally “got it.” Maybe you have too. But, if not, consider this: Chances are your loved one would be embarrassed to death if his earlier, healthy, self could see him now.
It’s up to us as caregivers to recognize that Mom or Dad (or spouse) are not being difficult on purpose, and to forgive them—daily if necessary. They just can’t help themselves.
DEMENTIA CAREGIVERS OFTEN FEEL ISOLATED
They need lots of caregiver support. For a very long time, I felt TOTALLY ISOLATED—like I was the only one in the whole world carrying the burden of caring for an aging parent. I bet you sometimes do too.
Be good to yourself. Seek dementia support services wherever and whenever you can.
That’s what I did and gradually I realized that I WAS NOT ALONE! Thousands of people were experiencing exactly what I was—dealing with memory loss and unpleasant behavior in a loved one, every moment of every day.
KNOWING THIS MADE ALL THE DIFFERENCE
Bob Tell
Author, "Dementia Diary, A Caregiver's Journal"
http://www.dementia-diary.com
Tuesday, July 29, 2008
COULD IT BE THE DEMENTIA?
I couldn’t tell. I was too close to it. I got mad every time she lashed out at me…or else I felt embarrassed whenever her target was someone else (usually in public places)—or when she over-ate without remembering that she had just eaten—or when she asked the same question over and over and over—or she was physically aggressive—or (you can fill in the blanks with other things that make you crazy).
Every time Mom did something socially unacceptable (I won’t catalogue these things—you know what they are), my anger raged. Afterwards, of course, I felt guilty for getting angry. Well, I didn’t have to feel this way…and neither do you.
Here’s what the social worker told me:
“DEMENTIA IS A DISEASE PROCESS”
“Cool it buddy!” she said. “It’s not about you. It’s about her. It’s a disease process—an illness.” So recognize the wisdom of the social worker’s advice.
Learn to ignore the bizarre behaviors of your loved one and to accept them as “normal” symptoms of dementia disease (and to not take them personally even when they seem to be personal). You’ll be a much happier person and a much better caregiver.
Remember: Your Mom can’t control her dementia symptoms any more than if it were pneumonia, or heart disease, or cancer. Things are happening in her brain that make her do the things that upset you.
IS IT ALZHEIMER'S?
(The Answer Next Time)
Bob Tell,
Author "Dementia Diary, A Caregivers Journal"
http://www.dementia-diary.com
Every time Mom did something socially unacceptable (I won’t catalogue these things—you know what they are), my anger raged. Afterwards, of course, I felt guilty for getting angry. Well, I didn’t have to feel this way…and neither do you.
Here’s what the social worker told me:
“DEMENTIA IS A DISEASE PROCESS”
“Cool it buddy!” she said. “It’s not about you. It’s about her. It’s a disease process—an illness.” So recognize the wisdom of the social worker’s advice.
Learn to ignore the bizarre behaviors of your loved one and to accept them as “normal” symptoms of dementia disease (and to not take them personally even when they seem to be personal). You’ll be a much happier person and a much better caregiver.
Remember: Your Mom can’t control her dementia symptoms any more than if it were pneumonia, or heart disease, or cancer. Things are happening in her brain that make her do the things that upset you.
IS IT ALZHEIMER'S?
(The Answer Next Time)
Bob Tell,
Author "Dementia Diary, A Caregivers Journal"
http://www.dementia-diary.com
Monday, July 28, 2008
IS THIS THE ROAD TO CAREGIVER BURNOUT?
It’s the middle of the night and you want to scream:
You’re angry!
You’re embarrassed!
Your Mom…Dad…Life Partner is acting strangely…
You ask yourself: Who is this person? …and…
What is going on here?
You are experiencing caregiver burnout. I know how you feel. Just like you, I’ve “been there and done that.” And I can now say: IT’S NOT ABOUT YOU and IT’S NOT ABOUT ME!!!
It took me forever to understand this. The woman who birthed me, raised me, nurtured me, and loved me…MY MOTHER…had become a new person—and not a very lovable one at that. Sound familiar?
At around age 77, she changed. Gradually, but noticeably. After a lifetime of kindness and consideration. She changed and, suddenly, I needed eldercare guidance...desperately!
Could this be my mother—this woman who went out of her way to insult and demean others…including me…and who rejected all of my efforts to help her? Or......
COULD IT BE THE DEMENTIA?
(The Answer Next Time)
Bob Tell
Author, "Dementia Diary, A Caregiver's Journal"
http://www.dementia-diary.com
You’re angry!
You’re embarrassed!
Your Mom…Dad…Life Partner is acting strangely…
You ask yourself: Who is this person? …and…
What is going on here?
You are experiencing caregiver burnout. I know how you feel. Just like you, I’ve “been there and done that.” And I can now say: IT’S NOT ABOUT YOU and IT’S NOT ABOUT ME!!!
It took me forever to understand this. The woman who birthed me, raised me, nurtured me, and loved me…MY MOTHER…had become a new person—and not a very lovable one at that. Sound familiar?
At around age 77, she changed. Gradually, but noticeably. After a lifetime of kindness and consideration. She changed and, suddenly, I needed eldercare guidance...desperately!
Could this be my mother—this woman who went out of her way to insult and demean others…including me…and who rejected all of my efforts to help her? Or......
COULD IT BE THE DEMENTIA?
(The Answer Next Time)
Bob Tell
Author, "Dementia Diary, A Caregiver's Journal"
http://www.dementia-diary.com
Friday, July 18, 2008
IS "PRE-NEED" REALLY NEEDED?
There is a product that is growing in popularity among seniors and is being merchandised aggressively by funeral parlors. This product is known euphemistically as “Pre-Need.” It is sold by funeral directors, of which there are very many. Retirement communities breed undertakers and cemeteries in the same way that young family suburbs grow childcare centers and elementary schools.
Morticians have discovered an undeniable truth about merchandising their wares. It is very difficult to return a cemetery plot or coffin, especially after it has been used. This gives the death business an advantage that has to be the envy of merchants selling more mundane wares.
So what, exactly, is Pre-Need? The idea, which is attractive to many retirees, is that they can make decisions concerning their deaths while still alive and vigorous. Purchasers of Pre-Need packages hope that all will go smoothly when they die, and that they will be sparing their loved ones the turmoil and trauma of having to make all sorts of tough choices under time and emotional pressures.
By arranging all of these things, and paying for them in advance, the theory goes, the temptation to buy the most expensive casket and services (because nothing is too good for “Dad”) can be avoided.
The cynical view is that Pre-Need is a clever scheme that greedy funeral parlor owners have invented to lock in their customers, and to obtain up-front capital on which to earn interest. They can sell the “product,” usually on an installment contract basis, with high, if not usurious, interest rates.
The buyer thus loses the investment interest that would have been earned by the dollars spent on the Pre-Need contract. It is the mortician that now earns the investment interest—and, to make the deal even sweeter, the buyer gets to pay credit interest to the mortician for the privilege of deferring final payment.
Not bad (for the funeral parlor, that is)!
In addition, the mortician is assured that the mortuary’s investment for cemetery land is quickly returned to the business, along with a nice margin of profit, long before it’s actually needed for the purpose for which its sold. No wonder so many entrepreneurs are dying to get into this business.
The truth is that Pre-Need can be a win-win in many situations. If the funeral parlor and cemetery deliver what is promised in the contract; if they don’t use the moments after death to impose the old “bait and switch” technique on guilt ridden survivors in an effort to sell higher priced product than chosen by the deceased; and if the terms of a fair and honorable agreement reached with the deceased long before the moment of need are observed, then the Pre-Need agreement may actually provide a bona fide value to the purchaser and to his or her loved ones; and a reasonable and fair business profit to the seller as well.
It is the ultimate layaway plan!
Bob Tell
Author
Dementia Diary, A Caregiver's Journal
http://dementia-diary.com
Morticians have discovered an undeniable truth about merchandising their wares. It is very difficult to return a cemetery plot or coffin, especially after it has been used. This gives the death business an advantage that has to be the envy of merchants selling more mundane wares.
So what, exactly, is Pre-Need? The idea, which is attractive to many retirees, is that they can make decisions concerning their deaths while still alive and vigorous. Purchasers of Pre-Need packages hope that all will go smoothly when they die, and that they will be sparing their loved ones the turmoil and trauma of having to make all sorts of tough choices under time and emotional pressures.
By arranging all of these things, and paying for them in advance, the theory goes, the temptation to buy the most expensive casket and services (because nothing is too good for “Dad”) can be avoided.
The cynical view is that Pre-Need is a clever scheme that greedy funeral parlor owners have invented to lock in their customers, and to obtain up-front capital on which to earn interest. They can sell the “product,” usually on an installment contract basis, with high, if not usurious, interest rates.
The buyer thus loses the investment interest that would have been earned by the dollars spent on the Pre-Need contract. It is the mortician that now earns the investment interest—and, to make the deal even sweeter, the buyer gets to pay credit interest to the mortician for the privilege of deferring final payment.
Not bad (for the funeral parlor, that is)!
In addition, the mortician is assured that the mortuary’s investment for cemetery land is quickly returned to the business, along with a nice margin of profit, long before it’s actually needed for the purpose for which its sold. No wonder so many entrepreneurs are dying to get into this business.
The truth is that Pre-Need can be a win-win in many situations. If the funeral parlor and cemetery deliver what is promised in the contract; if they don’t use the moments after death to impose the old “bait and switch” technique on guilt ridden survivors in an effort to sell higher priced product than chosen by the deceased; and if the terms of a fair and honorable agreement reached with the deceased long before the moment of need are observed, then the Pre-Need agreement may actually provide a bona fide value to the purchaser and to his or her loved ones; and a reasonable and fair business profit to the seller as well.
It is the ultimate layaway plan!
Bob Tell
Author
Dementia Diary, A Caregiver's Journal
http://dementia-diary.com
Monday, July 14, 2008
Memory loss- Key things to Remember
Just a few tips for the alert caregiver to consider when observing memory loss in a loved one:
* Be alert - document signs of memory loss and circumstances
* Notice if the memory loss is affecting activities of daily living such as planning, organizing and making decisions about every day functions.
* If there is a memory decline/loss be sure to be evaluated by physician
* Keep record of all medications including prescriptions, over the counter, herbs, and vitamins
* Understand the difference between delirium and dementia
* Learn to identify and manage stressful situations
These tips were provided by Jean Bandos, MSN, RN, GCNS-BC Research Director at "My Health Care Manager," a national company that helps seniors and their families manage the complexities of older adult life.
Bob Tell
Author, Dementia Diary, A Caregiver's Journal
http://www.dementia-diary.com
* Be alert - document signs of memory loss and circumstances
* Notice if the memory loss is affecting activities of daily living such as planning, organizing and making decisions about every day functions.
* If there is a memory decline/loss be sure to be evaluated by physician
* Keep record of all medications including prescriptions, over the counter, herbs, and vitamins
* Understand the difference between delirium and dementia
* Learn to identify and manage stressful situations
These tips were provided by Jean Bandos, MSN, RN, GCNS-BC Research Director at "My Health Care Manager," a national company that helps seniors and their families manage the complexities of older adult life.
Bob Tell
Author, Dementia Diary, A Caregiver's Journal
http://www.dementia-diary.com
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