DEMENTIA FROM ALCOHOL AND THE FAMILY IN DENIAL

Long before experiencing dementia from alcohol, the alcoholic has spent a life time trying to hide his alcoholism from family, friends and even medical professionals. So when the illness progresses to the dementing stage the  family who is in denial, now takes over not only the feelings of guilt and shame the alcoholic experienced. But also the active role of concealing the real cause of the dementia.  Dementia from alcohol doesn’t come on rapidly, but after a long time of alcohol abuse.

During those years of alcohol abuse the family maintains a code of secrecy, looking away and in so doing gives the abuser little reason to seek help. Family and friends are referred to as “co-alcoholics” due to their role in maintaining the alcoholic’s excuses, thereby promoting continued abuse.

Enabling, references the families efforts to protect the alcoholic from the consequences of their drinking. Supporting statements of needing “something to unwind,” ignoring odd or inappropriate behavior, and not identifying times when the alcoholic is not physically or emotionally available, are ways in which families protect the drinker. By not addressing the abuse the family gives the alcoholic little reason to seek help.

The alcoholic most likely, because he is enabled, will not seek help until he hits rock bottom. However more often than not, the abuser experiences dementia from alcohol and long term placement becomes necessary before he has the opportunity to make that choice. Once in long term placement the family and friends then continue the charade by finding a diagnosis of Alzheimer’s disease more acceptable than dementia from alcohol abuse.

The true numbers of persons with dementia from alcohol will most likely never be know because of the family continuing their role of “co-alcoholics.”  While healthcare professionals avoid questions about alcohol consumption so they are not seen as being “intrusive.”

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHAT DOES THE PERSON WITH DEMENTIA NEED?

The person with dementia needs to feel safe, but not in a way that they feel restricted. The person with dementia has a need to understand. The person with dementia has a need to be understood. The person with dementia has a need to be healthy and physically fit. The person with dementia has a need to be spoken to like an adult.

The need to feel safe, means feeling comfortable and accepted. Many times when a person with dementia moves into a nursing home, they will talk about “going home.” Home is where you are comfortable, accepted and you will not be forced into doing something. In the nursing home setting it takes about a month for many to no longer ask to go home. It is not that they are now resigned to being in the nursing home. It is that they finally feel that acceptance and feel at home.

The need to understand, and be understood. Persons with dementia have lost their normal forms of communication. They no longer can communicate verbally or non-verbally their needs. Even the person who still has words has trouble expressing their thoughts and feelings. Misinterpretation of their environment causes more misunderstanding and results in fear.

The person with dementia has a need for nutritious food and exercise.  Nutritious meals, no junk food, supplement with B vitamins for stress and brain health, fresh air and exercise results in better sleep. (B vitamins should only be taken in the morning so they do not disrupt sleep)

The person with dementia needs to be included in conversations. They need to be addressed by their preferred name or title.

The person with dementia struggles all day long to understand their world and make their needs known.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

GETTING LOST IN THE COMMUNITY – WHY DO PEOPLE WITH DEMENTIA WANT TO WALK AWAY?

Harry was out to dinner with his family, and stood up saying he had to go to the bathroom. Soon it was noticed that Harry hadn’t returned. When a member of the family went to look for Harry they discovered he was no longer in the building. Two hours later, and after a search of the neighborhood, Harry was located wandering the neighborhood streets confused and unable to state why he had left the building. Harry has early dementia and had just walked away. Leaving a dinner party and even a restaurant unaccompanied is not a problem unless you are a child or are confused. Harry was confused, alone and quickly became lost in the community.

Current statistics tell us that about 60% of people with dementia will get lost in the community at some point. This includes people living in the community as well as those living in institutions.

Harry might not have been able to locate the restroom, or may have seen the exit and just thought to go home. Perhaps he used the restroom and then forgetting his family having dinner, just walked out the door. However it happened, after wandering the neighborhood for two hours, being tired and scared, he was not in condition once found to state what his actions were.

In this case, Harry was just confused and walked away. Many with dementia who become lost do so because they are actively trying to meet a social, emotional or physical need. As in the case of the woman who always feels her children are needing her, or the man who must get to his job.

Many years ago when Harry and his wife had young children, they had ID bracelets made for their children in case they would ever get lost. Now Harry is wearing his own ID bracelet for the very same reason.

The Alzheimer’s Association sponsors the  “Medic Alert – Safe Return” bracelet.  This  bracelet offers a 24 hour service, national data base and coordination of local support services. Well worth the price, in peace of mind.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHY A GUIDE FOR VISITING IN THE NURSING HOME?

The statistics are in, 60% of Nursing Home residents never get a visitor. These elderly are the new orphans in society. What is so difficult about visiting in the nursing home?

  • When you observe so many visiting families, they just don’t seem to know what to do. Families will arrive with young children and nothing for them to eat, drink, or do. The children end up chasing each other up and down the halls and then being told to be quiet and sit down.
  • Family members will come in, stand around the elder, looking down at her saying how “good” she looks. And they soon are searching for something to say, especially with an elder who doesn’t respond.
  • The family may not have visited for some time, but once there, they spend their precious time questioning the elder. If the elder has short term memory problems they can’t answer these question, yet the elder does realize somehow they are letting down the questioner.

I have observed a very caring family come into a nursing home for the first time, to visit their mother following a very debilitating stroke. Their mom had been living independently and just within a week was unable to speak, walk, and take care of the most basic of self care. The family stood around the woman’s bed, looking down at her, as a group. After about 10 minutes of small talk about how she looks, the conversation changed to where they would be going together for lunch.

Just a week earlier, this woman would have been included in lunch talk, or maybe they would all have gathered at her apartment. Now, in this short span of time she was an onlooker, not a participant and they were now visiting her in a nursing home.

No doubt it is very physically and emotionally draining to visit a loved one in a Nursing Home. The answer comes from being prepared for the visit, and in many cases creating a new normal for your visit. Planning can change what is just visiting in a nursing home, to a new connection and for children even good memories.

Please download the free gift: “Come in – the door’s open”

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

WHY DOES AN ELDERLY PERSON NEED A NURSING HOME/REHAB FACILITY?

Why do people need to go to nursing home or rehab facility?

  • they need nursing help with bathing, eating, dressing, or walking
  • they have just come out of the hospital and are not ready to go home
  • they are unsafe and can no longer take care of themselves
  • they have dementia and and forget how to take care of themselves

Why do these people need so much assistance?

It may be for a medical condition that they are recovering from, or the nursing facility has the equipment or human assistance they need to recover. It can be that they are recovering from an infection and need medications better delivered at a nursing facility. It maybe that they are just too weak to live independently, or they are frail due to advanced age. The elder with poor vision can have a hard time shaving, dressing, even difficulty eating independently much less shopping for food and meal preparation.

The elder with dementia may not even remember how take care of himself, even how to brush his teeth:

  • he may not remember that he needs to brush his teeth
  • not remember that he hasn’t brushed his teeth
  • not remember what equipment he needs to brush his teeth
  • not remember how to brush his teeth, what to do first and what to do next – the entire process of brushing teeth

How much should you help a person with dementia?

“Why do you make my wife brush her own hair?” a husband asks the nursing assistant. “Isn’t that your job?”

  • the confused elder feels better about themselves if they do as much of their own care as is possible
  • the elder who participate in their own care remain healthier and stronger
  • the job of the nursing staff is to teach the confused elder how to take care of themselves
  • it is the responsibility of everyone in a nursing community to help their patients be as independent as possible
  • always support ability not disability, provide just as much assistance as the person needs

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

DEMENTIA – BAD BEHAVIOR AND HOLIDAYS

Children act out in the days leading up to holidays and parents shake their heads and say ” he has had too much sugar.” That may very well be true, yet children are certainly impacted by the hustle and bustle of holidays. And just as children are overwhelmed by the activities and anticipation, even more so is the elder with dementia.

However when the elder with dementia becomes angry and uncooperative, no one says “he has just had too much sugar.” And very often the solution proposed is some form of isolation, where what the elder may need is just the opposite. The elder with dementia may push family away with angry behaviors such as yelling, screaming, even pushing and at times throwing things.

There are also behaviors that are not as physical but equally as troubling such as, pacing, complaining, repeating themselves and general restlessness. What is important to remember is that the elder with dementia is not acting this way on purpose. The elder with dementia is always trying to understand his environment. Where he is, who is there, what is going on and most of all what might be expected of him.

While holidays are great is so many ways for the person with dementia, the music, colors, food, smells and decorations reinforce what is happening. The increase in  people, excitement, noise can push an already stressed elder over the edge. This is a good time for old fashion remedies. Activities that are calm, quiet and one on one.

  • a hand massage helps with anxiety, worry, sadness, and fearfulness
  • the old fashion back rub works wonderfully for those  in chronic pain or exhibiting irritability and anger
  • a foot massage provides calming for those with hyperactive behaviors, restlessness and pacing
  • massaging the forehead, temples and scalp help with tension and headaches

Added to the calming effect of the physical-therapeutic touch, some light smelling aroma, and you might be giving the best gift.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

HOLIDAYS A GOOD TIME TO HAVE THAT FAMILY TALK ABOUT GRANDPA’S DEMENTIA

Grandpa still lives alone in the family home and his daughters keep in constant communication with him by phone. Getting ready for the family holiday get together, required several phone calls to Grandpa to remind him of where and when they were meeting. After the big event , the daughters used their time with Grandpa to compare notes on how well their Dad is still able to function.

What they found:

  • Dad needed those frequent phone reminders – he had a 15 minute chat with the oldest daughter and the next day didn’t remember she had called
  • Dad had been mentioning that neither of his 2 hearing aids still worked, yet he was wearing both
  • Dad was now making strange and inappropriate comments to strangers, he asked a man in a restaurant if the design on his shirt was Nazi swastikas
  • Dad’s personal hygiene was in question, even though the holiday event was for an entire weekend at a hotel, Dad was wearing exactly the same clothes every day and on arrival it was apparent that Dad hadn’t bathed for some time
  • When asked what he has been eating, even though the daughters kept him well supplied with grocery delivery, he was choosing to eat all of his meals at the local fast food carry out
  • Dad had been asked to bring his latest report from his physician, after reviewing the doctor’s findings and recommendations, it was clear that Dad not only had no intention of following the doctor’s advise but didn’t understand most recommendations
  • Dad asked one of his daughters for a type of first alert button – in case he was taken to a hospital he could push the button and an ambulance or “someone” would come and take him out of the hospital

On the positive side, all of the daughters are on the same page, that Dad has dementia and needs their monitoring any changes. It is terribly hurtful and lonely to be the  only member of a family seeing signs of dementia. When even some of the family members are in denial of signs of confusion, it delays solutions. These daughters are realistic and pro-active trying to get ahead of future problems and support for their Dad.

Now after this holiday, they know that Dad might be needing some house help if the reason he doesn’t make meals is that he no longer can put a meal together. Some home help might be also needed for hygiene. One of the daughters needs to get involved in going with Dad to have his hearing aids taken care of as well as accompany him to his physician.  Dad probably would benefit by having a calendar to write down appointments and events. This way the daughters could check, just by calling and asking Dad what he has written down for a certain date.

The daughters know that as Dad continues to decline, (and they realize he will) he will be a candidate for an assistive living facility. When that day comes they will have to be united, it really helps to start now.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

LEARNING COMPASSION IN THIS ELECTION SEASON FROM A DONKEY

While some psycholigists are recommending deep breathing exerises and other suggest binge watching comedies on NetFlix, try a book about a donkey. Saving Simon is the moving story of a donkey rescue. But Simon turns out to be so much more than the tragically abused animal you meet in the first chapters. As Simon begins to heal and the author, his caregiver, begin to bond the true meaning of compassion is explored.

“It’s so easy to help an animal in need, especially if the animal is cute or nice, or amenable to being helped, or shows affection and what we like to call gratitude. People tell me how grateful Simon seems to me, how appreciative.”

“As I thought about it, I realized that I was pretty careful in my choice of compassionate opportunities. I didn’t feel too much compassion for snakes, coyotes, cows or rabid raccoons and skunks.  I wondered how much compassion I would hve felt for Simon had he been ill-tempered or resistant to treatment.”

“While I tended to be compassionate to people and animals I liked and who liked me, I found it hard to be compassionate or emphatic to people whose beliefs and actions were offensive or disturbing to me.”

“When I look at the news, I saw little compassion mirrored back at me. In fact, whenever I looked at news from Washington, I saw none. Our world is not very compassionate. I wonder sometimes if anyone apart from the Dalai Lama can be deeply and consistently compassionate.”

“Compassion is not really about our personal interior world but the exterior one. It extends to living things beyond our yards and pastures.  It extends to people as well as animals, encompassing things we don’t like as well as things we do: animals that are not cute and endearing, but are simply suffering and in need.”

“Many of our leaders do not seem to be able to put themselves in another’s shoes; instead they relentlessly attack and demonize the people standing in front of them.”

For a really good read this November as we go through this election season and ready ourselves for Thanksgiving, give Saving Simon a look. Even better yet, make this your go to book when you need a gift for friends, in this very unfriendly election season. Please click on icon below for Saving Simon on Amazon.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

NEVER TOO OLD TO BE CURED OF ECZEMA

Joyce didn’t think too often about eczema, the scourge of her youth, anymore. That is just how it is when something that once ruled your life is long gone, you rarely think about it. But the magazine article brought it all back, the discomfort and often pain, embarrassment,  and the never ending search for the right product that would help. Joyce remembered as a child going to her mother’s dermatologist, yes, Joyce’s mom also had eczema.

Hard to believe today, but those many years ago the dermatologist had Joyce, in her pre-teen years start on Valium for her condition. And on Valium she stayed for many years, until she and her mother finally received relief with the new wonder drug cortisone. And that is what Joyce and her mom believed for many years, that they would have to use gentle scent free cleansers, special moisturizers, oatmeal baths and of course the powerful cortisone.

Now the magazine article brought it all rushing back, and the crushing news that they estimated there are 30 million people still suffering. And the heartbreak that many of them are children. Joyce remembered how it was to suffer from that itch that couldn’t be stopped. She hadn’t found her cure until she was an adult and her mom was in a nursing home.

Joyce had started to reading about food intolerance’s and decided  to eliminate some food items and see how she felt. When she eliminated all citrus fruit from her diet, to her great surprise her skin stopped itching. She had always loved citrus, especially oranges. Her mom had always made sure that she had oranges and grapefruit available for her family, while Joyce was growing up. Joyce had continued that tradition with her own family, fortunately her daughters didn’t take after her the way she had taken after her mother.

Joyce couldn’t believe it, that after all those years, it had always been oranges? So, Joyce experimented by re-introducing small amounts of citrus fruit back into her diet. She soon found that she could tolerate lemons but even the smallest amount of oranges or grapefruit brought her skin condition roaring back.

Joyce arranged meetings at her mother’s nursing home with the dietitian and nursing director. She impressed upon them the seriousness of restricting her mother’s diet and removing any citrus products. Over the next weeks seeing the red angry spots on her mother’s arms disappear and her no longer stressed by that constant itch was such a relief.

For those 30 million still suffering, the answer may not be citrus, but most likely the cause is lurking in the kitchen. And the cure won’t be found in a pill or lotion just as it wasn’t for Joyce.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

PERSON CENTERED CAREGIVING, MEANS HAVING A RELATIONSHIP

Person centered care means not only knowing an elderly person you are taking care of but knowing them so well that you have a relationship. When two people are in a relationship they know so many small things about the other. What are the elder’s favorite foods, drinks, as well as what does she really dislike. What are her favorite activities and what activities can she live without. Who are her favorite people and having easy access to these people so that you can always reach them for her.

Person centered care-giving means the control, is always with the elder. Having control, means giving the elder choices all day long. At every interaction, whether choosing what to wear in the morning, what to have for breakfast or where to go for a walk. Letting the elder know that you take their concerns first over any chore or task you need to do.

Knowing the elder’s usual routine, is she an early riser or likes to sleep in, makes all the difference. I took care of Carl who was difficult to say the least. He seemed to wake up grumpy and stayed that way all day. I was just about ready to give up, when his daughter shared that her mother had brought Carl a cup of coffee in bed every morning all their married life. Knowing this was the definition of, person centered care for Carl.

Bringing Carl his cup of coffee in bed made all the difference to him. This now was his routine, and he started the day happy, gone was grumpy Carl. The family is always the bridge between the elder and the caregiver. The family knows those seemingly small things that make up person centered care, that don’t turn out to be small at all.

Letting someone know that they are more important, and spending time with them is more important than any chore, is empowering to the elder. It puts me in mind of a poem found on stitched samplers and framed in babe’s rooms. It starts out “cleaning and scrubbing can wait till tomorrow – quiet down cobwebs, dust go to sleep”, (my tweak) Grandma needs me now and Grandma won’t keep.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing