EARLY SIGN OF DEMENTIA – GRANDPA WEARS SWEAT SUIT TO HOLIDAY DINNER

Where is grand-pa? All the family were comparing notes, before dinner, on Thanksgiving. “Did you talk to Dad?” “Did he seem to understand where to go and what time?”  And so the conversation went, while the sisters were getting ready to put the dinner on the table. Then right before dinner time, there was the door bell, and the sound of Grandpa letting himself in.

There was Grandpa, smiling, joking and also sporting his old grey sweat suit. On closer inspection he hadn’t shaved, his hair looked greasy, and he was covered in dog hair. When asked by one of his son-in-laws why he was wearing a sweat suit for Thanksgiving, he gave his now customary response. “This is so comfortable,” “This is so warm,” and ” I am afraid of catching cold.”

When asked why he didn’t go to church that morning, it became clear that it was just too hard to get out of that sweat suit, too much trouble. Once again it is just too comfortable, and warm.

Once dressed the confused elder has a sense of security, feeling put together. And more mentally together as well, as the favorite outfit now becomes a security blanket. And what could be more secure than the feel of  fleece, the feel of a sweat suit. So the confused elder then begins to resist bathing, getting into pajamas or even changing that sweat suit for a clean one.

This chosen outfit is then worn everyday, to eat in, sleep in, work in, relax in, for every season, and on every occasion. Grand-pa doesn’t know that he is wearing his confusion out there, for everyone to see.

So for this family as well as for many families during the holidays, the private conversations turn to “how bad is Dad?” “Should we be doing something?” “Is it time for him to go to a nursing home?”

No, its not time yet. Grand-pa drove himself over, seems to only drive with-in a few miles of his home, and has had no accidents. He is able to monitor his gas, and maintain his very old car. He appears well fed, so he must still be able to get his own food.

What can be done now, is to keep in close touch with him. Get in the habit of calling frequently, asking what he has eaten, where he has gone, and what he is doing. Make sure that he is able to use his telephone and that it is user friendly. Go to his house and make sure he has an adequate amount of fire alarms, especially one in the kitchen and by the clothes drier. Get in a schedule of checking the batteries for those alarms. Look at his kitchen items for any signs of burning.

Look carefully around the house for tripping hazards and move furniture to create clear walk ways. If clutter is beginning to be a problem, ask for some of the things instead of suggesting throwing things away.

Get more people involved. Start having food delivered, especially grocery staples. Start having a cleaning service come in  on a regular schedule. The important thing is to start these services, so the confused elder gets used to having these people around. Then, over time, these services can be increased as needed.

As annoying as the Thanksgiving sweat suit can be, it is really just a sign of things to come, and a sign it is time to plan.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

THE ANGRY AND AGGRESSIVE CONFUSED ELDER

Many an angry confused old man goes to live in a nursing facility because the caregiver can no longer manage the aggressive behaviors. And in many cases the caregiver might even be frightened and concerned that they may get hurt. The elder who becomes physically aggressive, hostile and combative puts everyone including himself in harms way.

Sometimes the behavior follows a pattern and you can see the anger building until there is an act of aggression.  But for some the aggressive act comes suddenly, almost from nowhere.

Ed, was the suddenly aggressive type. Ed married late in life and he and his wife never had children. Ed became the favorite uncle to his nieces and nephew.  He was the one who tirelessly pushed them around the block on their bikes until they got the hang of balance, and could take off on their own. Yes, Ed was known as a very kind, thoughtful, and quiet man. Well, respected in his community.

Now he was confused, diagnosed with mid-stage Alzheimer’s Disease and living in a nursing community. The first thing the family did when Ed moved into the community, was to inform the nursing staff that Ed could become physically aggressive. They realized that when Ed was asked to do something he no longer could do, he would quickly become frustrated and then angry.

They told the staff that what worked very well with Ed was to use courtesy, say “please” when giving directions. Words that were inclusive worked well, “Walk with me to the dining room,” “Lets get dressed, its almost time for breakfast.” Using specific, concrete, and positive words, while avoiding negative words like “No,” or “Don’t.”

When a confused elder shows signs of getting annoyed, uncomfortable and uneasy in a situation, the caregiver can use humor. If the elder, like Ed, looks like he is struggling with putting his shirt on, turn the focus to the caregiver. Blame yourself. “Oh no, what did I do now, did I give you that shirt inside out?” Then laughing say you don’t know what you are doing, it is a crazy day.

Give the elder that gift of preserving their dignity, by not pointing out mistakes. Ed knows he is making mistakes, his day is full of them. And when he is frustrated and angry, he is really angry at himself.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA 101 – DISEASES THAT CAUSE DEMENTIA

Dementia is not a disease. The word dementia refers to a number of symptoms such as a decline in the ability to reason, remember, and even focus and think. There are many diseases that cause dementia and because each disease affects the brain in different ways, the word “dementia” is a broad term.

The most prominent disease is Alzheimer’s because it affects so many more people than Parkinson’s, Huntington’s, even stroke. Not only do the diseases resulting in dementia, affect the brain in many different ways, the cause and rate at which the dementia progresses is also variable.

In Alzheimer’s disease the outer layers of the brain are most affected resulting in the loss of memory and language. Other diseases such as Parkinson’s, and Hydrocephalus (fluid on the brain), affect the inner parts of the brain. This results in a decrease in the speed of thinking and an inability to initiate movement. Many times a person with Parkinson’s will actually get “stuck” in place while walking. They had a sudden inability to move and need to take a step backwards before they can once again go forward.

Dementia can also be the result of a severe trauma to the brain. Head injury resulting in blood clots can cause dementia. Brain tumors, a Vitamin B-12 deficiency, hypothyroidism, and of course multiple strokes may result in dementia.

As in all conditions what you are looking for is a change. If a person never could remember names, and they run into someone at the mall that they haven’t seen for years, and don’t know their name, it doesn’t mean they have Alzheimer’s disease. But when something is different and unusual for the person, especially if it has come on quickly, that requires a visit to the doctor for testing. Testing to rule out infection, drug interactions, depression, nutritional deficiencies, all of those things that can make a person appear to have Alzheimer’s disease.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

Dementia 101 – The First Case of Alzheimer’s Disease

Auguste Deter was born in 1850, and met Dr. Alzheimer in 1901 at the Institute for the Mentally Ill, Frankfurt, Germany. Dr Alzheimer was a psychiatrist and neuropathologist at the institute. This is Auguste’s story.

Auguste was married to Karl Deter, and was a housewife.  At the time Karl sought help at the institute, Auguste; had no sense of time/or place, and she wasn’t sleeping at night. During the day she was dragging sheets all over the house, she was very paranoid and was constantly accusing Karl of having affairs. She was having trouble with language and writing, as well as having signs of anxiety, mistrust and withdrawal, and oh yes, Auguste would also scream for hours.

Auguste was a danger to herself, especially in the kitchen using knives. She was recorded as saying repeatedly “I have lost myself.” Even though the institute was a scary place, known to the locals as the “Castle of the Insane,” her husband had no choice but to bring her there.  Karl was a middle aged man who had to work and no one else was able to care for her.

For thousands of years when the elderly had symptoms of memory loss doctors thought this was just normal aging.  Auguste Deter on the other hand wasn’t elderly, she was only 51 when she first met Dr. Alzheimer. He worked with her documenting her behaviors, memory problems, lose of her words, anger issues and constant paranoia. And later when he left the institute he requested that on her death Auguste’s brain be sent to him.

Auguste died at the age of 55, and her brain was sent to Dr. Alzheimer. Dr. Alzheimer had a very famous friend at that time, Carl Zeiss who had just invented the first distortion free microscope. Dr. Alzheimer took Auguste’s brain tissue, froze it and then sliced and stained the tissue. Putting it under the microscope, magnified 100’s of times he saw for the first time the plaques and tangles later to be known as Alzheimer’s disease.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology

DEMENTIA 101 – WHAT IS DEMENTIA?

Many people use “dementia” and “Alzheimer’s disease” interchangeably as though they are one and the same. Dementia is not a disease in itself, it is a combination of symptoms, which may accompany a disease.  Those symptoms are; the ability to reason, think, remember and often a change in behavior. There are many diseases that can cause dementia. Diseases such as Parkinson’s, Huntington’s, Pick’s, stroke, Creutzfeld-Jakob, as well as many physical conditions result in dementia.

Symptoms of dementia:

The ability to reason. Grace was in her late 70’s, living alone and coping just fine. That is until her local  grocery store decided to remodel. They relocated all of their products, moving them about all over the store. While Grace was in a routine, she had been able to locate all of her frequently purchased items, and she functioned well.

But this drastic change caused Grace to walk the store for hours a day, not buying anything. Grace was no longer able to reason and figure out for herself where new locations would be, nor was she able to ask for assistance. Very soon her daughter noticed that Grace was losing weight, and taking a closer look at her mother’s life, found out about the store re-model and her mother’s problem with reasoning.

The ability to think. In the early stages the person may have times when he appears confused, perplexed or is struggling to organize his thoughts. He may appear as if in a dream world and fail to respond to questions. He may report strange thoughts or be unable to think of the date or time.  He may be having trouble participating in small talk with friends or participate in activities.

The ability to remember. In normal aging memory loss, the elderly person has been distracted and failed to form a memory. As in those infamous lost keys, cell phone, pen, all of those things that everyone misplaces daily. As people age they begin to have distraction problems. If two older people  walk into a department store and they are talking, they may be distracted. When they leave they might not remember where they parked the car, because they never laid down that memory, due to distraction.

In Alzheimer’s disease this memory loss is not particularly worrisome for the elder. The elder with normal memory loss will be concerned about it, and just take a little longer to access memories. If given a few clues or reminders they will be able to retrieve those memories. For the person with Alzheimer’s disease the memory is just gone.

The public is more aware of Alzheimer’s disease because it is the most common cause of dementia. While many other diseases and conditions cause dementia, the most often source is Alzheimer’s disease.

Virginia Garberding R.N.

Certified in Gerontology and Restorative Nursing