Away From the Mind

Don't Regret

2011-12-21T07:38:00.003-05:00

This is a good read.

Top 5 Regrets of the Dying

Something to keep in mind as we converse with the ill and elderly.

Dementia CE in Virginia

2011-12-01T07:29:00.004-05:00

Need any last minute CEUs??

I will be giving two seminars in Virginia next week. 6 hours credit and I promise it will be an enjoyable and worthwhile day :-)

Here is the Richmond registration on Wednesday 12/7/2011.

And registration info for Roanoke on Thursday 12/8/2011.

See you there!!

Thankful

2011-11-24T07:09:00.007-05:00

A survey of THANKFULNESS as told by the elderly...

The girls (aka, nurse aids) who work hard
Happy times
A great birthday party earlier this month
New hearing aids, to better hear all of the gossip
Kids, Grandkids, Greatgrandkids, Spouses, Brothers, and Sisters
Fun we have upstairs (therapy gym) with that boy (the token male in our dept)
Unannounced visits from family
Late sleeping days, at that age no one HAS to wake early unless by choice
Not being confined to a wheelchair
Eating delicious food
Styled and washed hair
Still having a good mind at 91

There were a few others, as I learned I am a best friend, the ability to obtain oatmeal creme pies and cheesy puffs becomes invaluable, and even something as simple as seeing a smile from a caregiver gives our elderly patients a reason to be thankful.

Don't sweat the small stuff. Don't get bogged down by the big stuff. It appears that everything SIMPLIFIES in the end.

Seminar Time VA & MD

2011-10-18T06:58:00.002-04:00

Year end is approaching quickly.

Come on out and see me if you still need some CE credits. 6 hours approved for SLP, OT, PT, nurses, administrators, and other boards. Message me if you need details.

Fairfax, VA on Wednesday 10-18-2011
Baltimore, MD on Thursday 10-19-2011

www.summit-education.com to register & walk in registration accepted.

See you there :-)

Where are the Words?

2011-07-08T07:49:00.006-04:00

Word finding is one of the most frustrating language symptoms of aphasia related to dementia. It comes about early in the process of the disease, and it exacerbates as the dementia progresses.

I could explain and describe, but I think this short video says it all. Link below.
"Forgetting words. I'm trying to think of it..."

So leave space for the person to think.

Provide time as the words may come slowly.

The video's example of a multi-sensory experience is ideal, the senses of touching, feeling, tasting, hearing, seeing, and smelling will work together and help elicit the verbal response.

Ask one question at a time and WAIT. Bombarding the system with information to comprehend without ample time to process and formulate a response will not be the most effective strategy.

Don't forget that words may not be the most important part. While losing language and memory is devastating it is not the only way in which people experience the world.

Skilled Dementia Care Coming to New England

2011-06-16T07:13:00.006-04:00

Next week I'm hitting the road. 3 days of age related cognitive decline, dementia, & providing comprehensive assessment, treatment, & so much more!! The course is for therapists of any discipline, but I have had many family members or people in early stages of dementia come as well & they all have good things to say about the information covered during the day. Come talk with me & learn!!

Tuesday 6/21/2011 Portland, Maine.

Wednesday 6/22/2011 Manchester, New Hampshire.

Thursday 6/23/2011 South Burlington, Vermont.

To register click below
https://cart.summit-education.com/cart/jsp/course.jsp?categoryId=10011&courseId=GDEMEB.3

Can't wait to see your smiling faces :-)

Ain't No Empty Chair

2011-06-15T07:09:00.003-04:00

I spent some time with my extended family recently. They are full of life, tons of fun, and boiling over with jokes and one-liners. My favorite crack of the visit came about when one of the oldest members of the family was asked about her husband's health. He has had some small strokes and TIAs, and is left with physical impairments, but he really is in good shape given all he has been through, as evidenced by his skills at playing corn hole! At one point the question arose, "How is he doing these days" to which his wife responded "Ain't no empty chair". Translation for those of you who don't speak sarcasm or Appalachian... He is alive, he is here, and what more could we ask for.

My personal thought, and professional one as well is that we can ask for a lot more!! In fact when I see people who have dealt with illness, strokes, falls, health problems in general keep on moving through life, being active, staying social, it makes me so very happy. Quality of life means a lot, and throughout the long weekend with my family I heard them talk about bowling, traveling, parties and gatherings with their friends. I watched some bike, take walks or run. Some played games, cards, or shot pool. Some chased and wrestled with the little ones, there was singing and storytelling galore, and let's not forget the hysterical belly laughing that occurred on a frequent basis. In this microcosm of the Cooks I saw that QUALITY of life was in the forefront of every single moment, interaction, and decision made despite the fact that the words, if taken literally and out of context, pointed to a less fulfilled existence.

I have always been inspired by the way my family has lived, and their boisterous approach to the world and their lives. Each and every single family member is just a blast to be around. This visit I was in awe of the energy that continues throughout their aging. What I know from spending time with my fabulous people is that we have an advantage. We value the fun, the joy, the happiness created through experiences we choose. How lucky I am to have such wonderful role models for aging. So even if you ask how I'm doing and my response is "Ain't no empty chair" know that in actuality I am probably dancing on the chair and smiling because I know there is just more good to come!

Why Therapy?

2011-06-06T21:16:00.003-04:00

Right now my blog posts are sparse, and this is because the thoughts around the chosen topic of awayfromthemind are few and far between. I am so overwhelmed with the logistics of providing therapy these days. By that I mean, minutes, RUGS, case-mix, skilled service justification, third party payers, medicare cut-backs, productivity, blah, blah, blah, blah, blah. I am normally much more positive, an idealist, a therapist who will fight for what she believes in, but right now elder-care (at least in my world) kind of sucks.

Now this doesn't mean I love my patients any less, or provide less effective therapy, in fact the contact with the people, the patients, those moments where I feel like I have made a difference in function or quality of life are the ones that keep me plugging along. Sound like burnout? I'd say it's a strong possibility!

For now, I'll laugh at the jokes made by my favorite seniors, try to help keep communication and swallowing up to par, and smile when they remember my name but have no idea where they are. I will know that long after the billing systems are revamped, the documentation standards are modified again and again and again, and the things that make therapy stink right now are sorted out, I will be left with a compassion for humanity, a love for the elderly, and the desire to make their lives as fulfilling as possible.

Ahhhhh. There it is. I found the optimist again :-)

At Any Age...DO YOU!!

2011-04-08T06:53:00.003-04:00

I hear her sing “If o’er sea or land I roam, still I think of happy home, and the friends among those West Virginia Hills.” I smile at the sound of her voice and the echo of a song so eloquently illustrating her pride and love for her home state of West Virginia. She tells me that she wanted to give a word of thanks to all that helped her pull the event together, but was afraid she would cry because it turned out so beautifully.

This Wednesday was the completion of a project that Annabelle worked on for over a month. One day she noticed that the nursing home did not have a state flag. The wheels began turning and as she says “consequently I decided that we should have one so people could enjoy and know more about the state.” Planning started, pricing the flags and poles, talking with administrative staff, arranging the purchase, and determining where the flag would go. It was all orchestrated by Annabelle, and that was just the tip of the iceberg. Annabelle spent time recording from her memory, researching, and writing facts of importance about our state, and even designed brochures to be given to people who attended the flag dedication. The day itself was an eventful one, filled with blue and gold décor, clothes and hairstyles were even coordinated to reflect the pride of West Virginia. There was a ceremony with a speech, cake, punch, piano playing, singing, and plenty of photo ops to capture Annabelle doing what she does best, inspiring all of us to strive for bettering our community no matter what our age.

Annabelle is in her mid eighties. She has always been very active and continues to be today. When we talked about the flag dedication day she told me that she was no stranger to event planning, as she was responsible for many ceremonies, dinners, and gatherings in her years spent as a community leader in Pocahontas County. I asked her what she enjoyed the most about the organizing process and she explained that she “learned a great deal about the history of our state through her research and had always loved to write so it was a pleasure to write Jud Worth’s (the facility administrator) key points for his speech.

I enjoyed the day as much as anyone. What I delighted in the most was catching a glimpse of this lovely woman shining, being exactly who she has always been in her life - a lovely lady with the ability to lead others, gather people for a cause, and pull off one classy event without a hitch. I like to think of this flag and its dedication ceremony as an accomplishment for the nursing home and Annabelle, but a gift for the rest of us. A reminder that we ALWAYS have the ability to be who we are, do what we do best, and make a positive impact on our community and those around us.

Thank You Annabelle!!

Language: An Expanded View

2011-02-19T15:44:00.004-05:00

Off the wall, not your typical awayfromthemind post, maybe so, but I had to share. Listening to Deepak Chopra sparked a thought, then a series of ideas, hence the blog. Hope you will find his words as thought provoking as I do.

“Language is the maker of reality…material reality”

When you think of language, do you immediately go to words, images, verbalizations, writing? I would imagine this is the first concept most people have, words comprise language, but that is really a very narrow view. Verbal language is only a piece of whole picture. Preverbal language exists, and more importantly, serves as the basis for the more common concept of language, words, ideas, insights communicated with one another. All living things have preverbal language abilities, which consist of information, sound, energy, and vibration. So, wouldn’t it be true that with sharper sensory perception skills, preverbals may be sufficient for some interaction and exchange? In my experience the answer is yes. More is often said in the absence of words, the look in a person’s eyes, the movement of their body, a small sound, a sigh or a moan can say it all.

Now what I am wondering is how this can impact the people in our world who have lost their verbal language. How can we as caregivers, therapists, and family members of those aging reframe our idea of language and communication? Would it be beneficial to more astutely observe a person, watching, listening, and feeling to find preverbal communications? Would it be helpful for a daughter caring for her mother in the end stages of dementia to have someone tell her that yes language as she has always known it is gone, but in a broader sense there may be more to the dying parent’s interaction than meets the less-aware eye?

Preverbal together with verbal language create the experiences of our human reality. As the aged veer further and further away from words it is up to us to move into their reality and look towards the energy and information conveyed in so many other ways so that interaction continues and thrives as long as life does.

Aging and Eating

2011-02-03T17:28:00.002-05:00

If you have met me, heard a seminar, or read something I have written you know that I am a big proponent of keeping a thorough check on the nutrition of my elderly patients. What are they eating? Is it just caloric intake, or quality caloric intake? Vitamin deficiencies cause issues with clarity in thinking, mental speed, focus, concentration, just to name a few. The risk exists for the average person whose diet is not generally filled with all of the nutrition needed, but it’s even greater for the geriatric population. Watch out for the most common B12 and D.

So what can be done when the elderly person starts losing weight, begins eating less and less?

· Don’t try to change an elderly person’s eating habits completely. This will often be met with strong resistance.

· Work with nutritive supplements in between meals, and hope that “real food” intake will also increase once overall health improves.

· Provide small meals with few items. A huge amount of food presented in one setting can seem overwhelming.

Eat with the person who is having trouble. We all like to have a nice meal with the ones we care about.

Last, but most certainly not least, I have to say it... keep quality of life in mind. Make sure the supplements you give taste great! If you wouldn’t drink or eat it don’t expect them to.

Staying After The Stroke

2011-01-04T07:46:00.003-05:00

Why do families fall apart after a CVA? Strokes devastate those around them, not just the person suffering from this trauma, but the entire family. Each person plays a role in the dynamics of a family, and when suddenly one member changes, without discussion, warning, or preparation, overwhelming effects occur. In 1994, the US Department of Health and Human Services, as part of the National Health Interview Survey, found a 7.6 increase in the rate of divorce in adults with acquired disabilities. I have seen quite a few marriages and relationships crumble after a stroke. It is hurtful for all involved, makes depression even more likely, and to be honest until faced with the situation we don’t know if our relationships could survive such a drastic change.

Back to my question: why does the breakdown of relationship happen? I have a few speculations. After a stroke the person recovering will be more dependent on caregivers. They will often need assistance with even the basic tasks of living, like getting dressed, feeding themselves, and even once they recover function for these tasks there may be some residual impact, leaving the spouse different in personality. Even when my husband has a cold or the flu, the change in our interactions can be frustrating. The caretaker of our home, the man who is active, full of life and love for his art becomes lethargic, instead of being out on the snow taking photographs, or in his studio painting, he is in his recliner with tissues around, covered in blankets. I can deal, his illness is limited, but if there were no end in sight I imagine it could be quite the scary prospect for a marriage’s future. On another note, emotional support may be altered. The unwavering wife, the rock of the family, now has episodes of uncontrolled crying, and where does that leave her husband who used to lean on her? One of the most crucial aspects of change that contributes to the breakdown of relationship following a stroke is altered communication. Aphasia is very common, and so even the simplest words, phrases can’t be spoken, not to mention the fact that understanding of questions or conversation becomes difficult. Think about trying to talk to your husband, he just keeps repeating the same word, it seems like nonsense, and you can see that he is clearly trying to get a point across. Frustrating, right?

Now the question moves to what do we do with this situation. The problems outlined all contribute to a collapse of the family unit after suffering a stroke. Part of the problem lies on our inability to step out of traditional roles with our loved ones. Recognizing that the essence of the relationship has shifted is essential. Lack of communication can also must be dealt with by reframing, watching for gestures, facial expressions, and body language. The nonverbals will often tell you more than the jumbled words could ever convey, and communication is crucial to allowing parties adjust to a new relationship. The person who had the stroke has changed. Personality, characteristics that often define a person, may no longer apply. If the goal is survival of partnership then the mindset of all parties has to change, and preconceived expectations must be released. The advice I like to give is that a path less traveled has appeared. Do you navigate your way through the changing terrain, the rocks and boulders, to find the beautiful sunset at the peak of the mountain? There is no right answer for dealing with these devastating situations, but I have seen the most amazing couples emerge, maybe a little shaken, but stronger nonetheless, and not regretful for extending their love to encompass a different concept of what marriage can be. Are you a person who has taken on a great challenge such as this? Or do you know someone who has? Let’s talk. How did you/they cope?

Dementia: Coping with the Change

2010-12-14T07:04:00.008-05:00

This is a beautiful film. Nic Askew and his Soul Biographies blow me away time and time again. "A Life Beyond" is so relevant to the changes we are coping with today. I may even say it showcases humanity at its finest. It is short, 7 minutes, and well worth your time. Click, watch, and listen. Be prepared for a transforming perspective.

I speak to this concept quite often, to families, therapists, nurses, any caregiver. A change of outlook can make everything we do when caring for someone with dementia much different, less burdensome, more joyful, and the shift happens not just for us but also for the person we love who has this horrible disease.

One of my favorite phrases about the work I do is "my patients give me so much more than I could ever give them". So true when the viewpoint is one of an exchange with this person you hold dear and not just the load of care-taking. This is a valuable angle that should be shared.

Thank you to Soul Biographies and Nic Askew for such meaningful films.

Keeping the Memories

2010-12-11T10:35:00.004-05:00

Today will be a day filled with a riot of reminiscing. I'm with my family in Virginia, "The Cooks" for our holiday celebration. This will be a few hours together with my mother, stepfather, aunts, uncles, and cousins. All of us together for a day. We really don't have any elderly left in the family, but the memories of the are abundant. This year I am going with the flow, but throughout the next year I am going to send some time capturing a piece of this family's story. It's too important to lose.

Most of the time is spent during our gatherings is for visiting, talking about our lives today, remembering the past, and what amazing memories they are. I love hearing Mom talk about growing up with 10 other siblings. When she gets together with all of the brothers and sisters it's like they speak a different language. They have code talk, and these key phrases are hilarious to them, but indecipherable to others. Sometimes they explain the story behind the phrase and it all makes sense then. This was a huge part of my childhood, and I wonder if the next generation of kids in our family will know any of the "Cookisms" because it doesn't really translate without the entire story told. I am thinking I'll capture these tales.

I know all families have their own allegory, and I see no better way to honor our elders than to acknowledge the importance of that history and record their narrative. Everyone should have the chance for future generations to hear their own "familyisms". It is so important that we collect memories that make us laugh, or smiles, or cry, or even take us back to that special moment. Let's commemorate!

Will you have some special time with your loved ones this season? I am sure remembering will be a part of the time sent with your loved ones. So rise to the challenge. Use these tools, make he memories last beyond this lifetime.

To converse and record with the person with memory loss...

http://storycorps.org/initiatives/mli/

For anyone...

http://nationaldayoflistening.org/participate

Aging or Living

2010-12-07T23:06:00.001-05:00

A few hours ago I spoke with a friend on the phone. We had a great conversation about healthy living, our belief systems about our bodies, our abilities at any age, and the power our minds hold over changing the way we live.

Somehow our society cultivates a belief that once we reach a certain age, our capabilities diminish. Mental capacity, physical agility, as we age, everything about our being changes. Working in a medical setting I know that some of this is true, but I also realize that we are largely responsible for the vitality or arrest of ourselves. Who makes these rules anyway? I know there is some science to back up symptoms of aging. On the other hand, I have encountered 70 year olds who are very fit, and 30 year olds who are on the verge of heart failure. Honestly, I live a much healthier life now than I did at 21. There are exceptions to every rule. So, who are the anomalies and what make them go against the norm?

I saw a patient in therapy a couple of years ago who was in her 90s. She could no longer swallow. She was weak, has been ill, had a feeding tube, and stayed in bed most of the day. She was asking for water, food, typical things that would be missed if after nearly a century they were suddenly taken away. I was the swallowing specialist; so, what could it hurt if I tried? Her family had no hope, but this woman told me from day one that she was sure she could eat and drink if someone would just give her a chance. Disheartened by her horrible quality of life I decided to give therapy a shot. We worked together, she began drinking water again, then food came. She refused to accept that 90 was the age for her to give up. She believed that she could do it again, and with a little help she did.

Wouldn't it be nice if we could reframe our view of what aging should be? Should it include losing something as basic as food and water? Wouldn't it be nice if everyone had the philosophy of being able to do anything you set your mind to. We could look at each year of life as an opportunity to outdo our previous selves. I would love to see us serve as inspiration to those aging around us to thrive, and live their most fulfilled life right now. Seriously, we aren't kidding anyone. We are all "aging." Maybe it would be better stated as we are all "living". It is really that simple.

If we believe we are getting older then guess what, old it is. If we hold the perception that our bodies, our brains are breaking down then guess what happens. Just like my patient who knew that path was not the one for her. She believed she could change direction, so her last years were more pleasant and fulfilling. We can do the same. Imagine if every person on this Earth chose to "live" instead of "age" what a different world it could be. Do we simply grow old, or do we live amazing adventures and make the most of each day, month, year, decade? They pass by quickly. You make the choice.

Travel Time

2010-12-01T19:54:00.003-05:00

Airplanes, airports, flight schedules, delays, and diversions; they all make for interesting traveling. As I sat in the airport last night I watched an elderly couple make their way through the madness.

We enter the security checkpoint at approximately the same time. I am in no rush, so behind the couple I stay, watching as they fumble around with their bags. I have it down to a science now, so it baffles me when others enter with no clue. The wife removes liquids and proceeds to dig through her purse taking out some makeup items. She can't maneuver her luggage. Pulling the bag is ok, but when it's time to lift, her companion takes over. Good thing he's there with the muscle I think to myself. The husband removes some items, and to his dismay he has to ditch the Sam's Club size Barbasol. Then their bags go through the scanner, they move one duffle type bag forward and back, repeat, call another agent over to look. Coins are the culprit. One gallon size zip-lock storage bag and one quart size, filled to the brim with coins. Off to the corner searching station they go and I lose sight for a moment, but can hear the man exclaiming that he can't possibly comprehend why coins pose a problem. Ok, so now I'm thinking that confusion with the whole security process could happen to anyone, but I am keeping my eyes and ears peeled in case they run into problems. These seniors aren't too savvy in the traveling department.

Delays and cancellations keep arising. I see the couple sitting at another gate. By this time the lady is sitting, her husband is pacing. He walks to the monitors, back to his wife, and to the monitors again. There are no attendants at the counter. Status change announcements blare over the intercom. Out of desperation the man walks my direction. I suppose I appear elderly friendly. He can't understand what is happening or what's going to come of his itinerary. They need to get to a larger airport and with the delays he won't make his connection. So he shows me the tickets, and when I begin to explain he asks that I talk to his wife as well. We venture across the room, and I launch into a discussion of time zones, standby lists, etc. I am fortunate that the wife understands fully. Her husband is relying on her reasoning skills to make this trip happen.

All flights were cancelled last night, so they went home to rest, while I tried not to think about the possibility that they were driving around in the foggy, dark, stormy weather. I imagine he drove & she navigated. The brawn and the brains had to work as a team. This morning I didn't see them, but hopefully with improving weather this man and wife will experience a flawless trip, much like myself.

So this brings me to my point. We take for granted the ease at which we can problem solve, shift gears and come up with an alternative. Airports can be pretty unfriendly, and I have seen some moments of terrible customer service when flying. I wonder how many elderly would report that flying is difficult for them? What might make it a more pleasant event? What services could benefit the aging population in the industry of travel?

Moments of Clarity

2010-11-29T14:18:00.001-05:00

If you have participated in my presentations/courses you know that I am most often the last to give up hope. I am the one who says over and over again that we need to look for the moments of lucidity, and take full advantage of the times when our patients and loved ones with dementia are a resemblance of their former self. So today I saw it, again, firsthand. A woman who I’d basically written off, told her family she was not going to regain any of her thinking skills, and told all of the staff that the compensation system we had in place was all we could do, proved me wrong.

I saw her spark come back a couple of weeks ago, and to my dismay that light remains consistent even now. A few months ago, when I first met her, she told me that if I just gave her time she would feel better and recover. I persisted with therapy then, and I failed. She was correct. Now, it seems like she has shed about 10 years. Today we had a wonderful conversation. She laughed, smiled, and discussed her life with a precision and simplicity that made me know this was improvement. She also gave me some insight that was very valuable. Listen to your patients. Sometimes even when they seem off base and confused if we can listen to what they are truly saying, and realize that our goals and our time frame is not always what best suits them.

By leaving my preconceived notions behind and remembering that we all know ourselves better than any medical professional could, I am able to see the value in reading beyond the uncertainty of dementia. We have a responsibility to help our people live their best lives for as long as possible. How can we possibly begin to do that if we don’t use what they know to our advantage? Use their moments of clarity, find some resolution for yourself, and consider what we are here for. Reflect on our purpose of helping the elderly exist in a way that makes keeps life normal.

Seniors and Holiday Woe

2010-11-28T08:10:00.009-05:00

The holiday season can be extremely hard for many. I know that I tend to remember holidays of years past, long to be with my family, and miss loved ones who have passed on. I also have a real distaste for the commercial aspect and the mass amount of consumerism that plays into the holiday season in our culture. Not to mention that we lose focus on taking care of our physical self as we spend time running here to there, shopping, visiting, and experiencing the hustle and bustle. While I know that many people are inspired by the sights, the sounds, and the aromas. You have to admit that the amplified energy levels this time of year creates can be difficult, even for the most avid holiday enthusiast. Many factors come into play, sadness, loneliness, financial stress, time crunches, or sensory overload and they all take a toll.

Seniors are very susceptible to depression associated with the holidays. Just think about it from their perspective…

An elderly widow, we’ll call her Sue, lives at home alone and her children and grandchildren are coming to visit. This year Sue has been feeling less motivated to get prepared than ever. Maybe it’s because she is coming very close to that 80 year mark, or maybe it is just because she has recently stopped driving. Sue is worried that she won’t have all of the necessary food, presents, and amenities that her family is used to when they arrive for their traditional 4 day visit, but what could she have done, she has to rely on neighbors for a ride to the store, or she has to use the senior bus, and it is not easy to be prepared and remember all you need on the occasional bus trip. Plus the stores are so crowded and big that she can’t find anything. Her kids are bringing the dinner, they tell her not to worry about anything, but this makes Sue feel inadequate. Do they think she is not capable? What will be next, if she can’t drive and can’t cook dinner when will they decide she is too feeble to be alone? The last thing Sue wants is to have to move into one of those places for old people. They arrive, her kids, grandkids, a pet dog, they bring presents and food. Sue’s entire routine is changed. Sue is so grateful to have her family with her, happy they are willing to travel and share their time, but she is exhausted before they even arrive, and by the end of the visit, she feels like she could fall over from fatigue. Can you see how this might lead to the holiday blues? Can you see how Sue might have conflicted feelings as she is appreciative and thankful to have this time with her family, but she also is so out of her own routine that she begins to sense anxiousness and worry?

So what do we do?

The Mayo Clinic reports the top 3 triggers for holiday stress are relationships, finances, and physical demands. Sue is burdened by all of these. Many seniors are in this position, and even if they have no issues with money, even if their family takes care of every aspect of the physical load, everyone has to cope with the relationships (or lack thereof) which is an undercurrent of the season. So we need to simplify the whole process. Slow down. Focus on contact, interaction, and connection. Make the seniors in your life realize just how much love surrounds them during this holiday season.

Photo Courtesy of Mimi_K http://www.flickr.com/photos/mimk/2117234691/

November 16th: National Memory Screening Day

2010-11-14T07:20:00.003-05:00

The Alzheimer’s Foundation of America is holding its annual National Memory Screening Day this upcoming Tuesday.

A screening is not a diagnosis, or in-depth testing, but a systematic way to look at areas of concern and determine if you or your loved one is at risk for dementia. It is also a great way to examine memory right now. Even if you are not having trouble the screen is helpful for future comparisons.

More than 2,000 locations nationally will provide the opportunity on Tuesday, November 16th for memory screening. Click on the link below for more detials.

http://nationalmemoryscreening.org/index.php

Take this opportunity and screen your parents’ memory, your grandparents’, and your memory. This valuable service could help for earlier diagnosis of dementia, and guess what…the medical treatment available right now for Alzheimer’s and other types of dementias is MOST EFFECTIVE in early stages. So why wait?

Too Old??

2010-10-27T17:03:00.003-04:00

You are never too old to try something new…

A concept proven today as I watched a group of elderly men and women experience their first “Mexican Meal”. We planned for days, talked about the different foods served in Mexico, and all of my senior friends said that they were unsure of how it would turn out, but were willing to give it a shot. They filed in, with Pandora pumping mariachi music, and spirits high, the lunch preparation began. We had a blast stuffing tortillas and faces alike. Everyone loved their lunch and 75% of the people had never tried this type of cuisine. The comments ranged from “better than I thought it would be” to “a real treat”. My personal favorite was when I asked one person who happened to be hard of hearing if she was ready for a Mexican dance, and was met with the exclamation of “I don’t want any man, Mexican or not”. Hahaha. The laughs kept coming, our bellies were full, and we all thought the fiesta was a success!

New experiences keep us fresh. We all get stuck in the same old patterns, but let’s take a lesson from these kids and remember that you never know until you try.

Way to Go Grey's

2010-10-26T16:08:00.004-04:00

I love seeing the movement go mainstream!

McDreamy & Meredith are making waves in the right direction :)

http://abc.go.com/shows/greys-anatomy/video-detail/featured/leading-the-fight-against-alzheimers/pl_PL5520968/vd_VD5593036

Perils of Presenting

2010-09-29T09:48:00.002-04:00

I did a guest lecture last night at Marshall University. My talk centered on dementia and the SLP’s role. A day later, it is interesting to reflect on that brief time I spent with the class. A little nervousness came over me, far different from my typical experience presenting. I am rarely nervous for an 8 hour day and room full of therapists, but this hour lecture to a few graduate students caused me to loose the timing and fluency that I have worked hard to perfect.

So after sleeping on it I realized what my deal was. I had a room full of people who were seemingly eager to hear what I had to say. Not your standard CE course with texting, passing notes to one another, (both distractors I have learned to tune out completely), but now I had the full attention of 25ish speech-language pathologists in the making. A very different audience that my norm. They were all fully aware, took notes diligently, and the amount of motivation in that room was overwhelming. That is a different sort of pressure than I am used to. The ladies’ passion and desire to take in all of the information they possibly could was refreshing, but also a bit nerve-racking.

I did however enjoy my time with that class and their eagerness was what I appreciated most. They had a look in their eyes, apparent excitement to learn, and thoughtful questioning. Their questions were more frank and to the point than I anticipated. I talked about dementia, how we can provide services throughout the stages, as well some of the reasons I love working with this population. As I started to wrap things up, two unanticipated questions came barreling at me. The first student asked if “I felt prepared for the work I do when I started in the field”, and I answered with honesty. Maybe I even laughing a little at the thought of feeling completely equipped at any phase, new grad or seasoned professional. I didn’t and still can’t be prepared for everything I encounter. The next student asked me if “I wanted to leave them with one thing what would that be?” Now this was the question I had not thought about, and I completely veered off topic. I told students not to box themselves in, not to underestimate what they can achieve, or how their skills might provide service. She probably wanted to know the gold standard for dementia treatment, but if you know me I tend to go beyond, and wanted to bestow a grander knowledge for life fulfillment J

It’s remarkable that we ended on such a note. I was completely out of my element for the evening, and feeling less than confident about it. My guidance to these students was to push the boundaries, and believe in their abilities. You know what? I think that is sound advice. I operate that way in my clinical practice, in my life, and my career. Hopefully the students saw it that way as well, and know that there is no cookbook, there is no right way to do it, or wrong way to do it. Life, work, treating patients, we just have to take what we know and apply it to the reality at that moment.

As Memories Slip Away

2010-08-27T16:28:00.003-04:00

Just in case you missed NPR's Morning Edition this morning. I thought I'd share a link to the StoryCorps clip aired. This clip was recorded as part of the Memory Loss Initiative.

http://www.npr.org/templates/story/story.php?storyId=129454463

The Patterson's share what they have learned about living with Alzheimer's, and really living in the present moment. They hit on a key point for sure. Like Eleanor Roosevelt said...

Yesterday is history, tomorrow is a mystery, and today is a gift; that's why they call it the present.

Listening and Loving

2010-08-27T07:57:00.003-04:00

Many of you may know of the work I am currently doing with StoryCorps. There will be many exciting projects to come, but today something special will happen. NPR will be airing a beautiful clip that was recorded as part of the Memory Loss Initiative.

This morning at 8:20 on NPR's Morning Edition tune in to hear why I think StoryCorps is so wonderful, and its value with those we care for suffering from memory loss or dementia.

I hope you will listen and let me know what you think.

Past and Present

2010-07-20T07:49:00.002-04:00

Each day I work with people who have dementia. I talk with them. I ask them to communicate and converse. I ask them to remember. So many of my interactions with these people begin with observation, and more often than not they are unoccupied until I initiate contact. Once dementia gets to a certain point, the person appears to be “living in the past”, and their reality shifts away from the one in which we live. No wonder they seem disengaged, they are not living in the same realm as you and I. As their disease worsens, remembering becomes increasingly difficult. At this point, we often focus with our elders, on examining the memories still left intact. Precisely recalling life’s history is valuable, but let’s consider another perspective…
The most important piece of the puzzle may be that by talking about the past we are actually helping the person with dementia be present. They are in the moment, actively engaged in narrating their life. For a person with loss of thinking and communicating abilities, the act of interacting is more valuable than remembering accurate details of life. It is an amazing gift to provide this opportunity for a person who often lives within the confines of their own world/head. Take a moment and speak those you know who don’t remember well, who can’t converse easily, and remember that the success is in the experience not the result.

Jan's Story

2010-06-24T22:21:00.005-04:00

Last night I check my email to find a note from a person who attended one of my seminars. She referred me to last week's CBS Sunday Morning show, and simply stated that there was a segment I should see that was wonderfully done. I watched this video and was very touched. Barry Petersen when out on a limb, creating a relevant piece that is absolutely worth sharing.

Take a moment, click the link, scroll down, watch the video, and share your thoughts.

What if Jan's story was your family's?

http://www.cbsnews.com/stories/2010/06/20/sunday/main6600364.shtml?tag=cbsnewsTwoColUpperPromoArea

10 Mountains 10 Years

2010-04-29T21:13:00.006-04:00

They may not be moving mountains, but pretty close to it…

The Mountains
A small group of ordinary people, “ The Regulars” as they call themselves, are breaking new ground in awareness for Alzheimer’s and Parkinson’s Disease. Enzo Simone and his team of climbers are anything but regular. They are on a quest to summit 10 of the world’s most challenging and amazing mountains. Not only will they conquer the mountains, but also bring a level of unprecedented awareness to 2 horrible diseases afflicting over 92 million families in our country.

The Movie
10 Mountains 10 Years is a documentary feature film by Back Light Productions which chronicles the summit of Kilimanjaro with this group. The climbers make their way up the mountain and along the way receive inspiration, reading letters written by caregivers for those with Alzheimer’s or Parkinson’s. The film intertwines their climbing journey with medicinal accomplishments in fighting these diseases. All proceeds from the film go to medical research and caregiver programs. Check out the trailer. It is phenomenal!!

10 Mountains 10 Years Movie Trailer from Vancan Design Studio on Vimeo.

The Motivation
Optimism and inspiration resonate in Jennifer Yee’s (writer/director/producer) voice when she talks about the movie. She calls it an “underdog journey” which began with her friend’s project of climbing mountains to bring attention to Alzheimer’s and Parkinson’s, and with a “giant leap of faith” became 10 Mountains 10 Years. Their desire for the film is worldwide distribution, but not for the reason you may think. The motivation for staying with the movie for the long haul is according to Yee, “to make a difference with people, so they see there are others out there fighting for them…there is hope when maybe they have lost hope”

A few with a dream CAN make a difference…
Thank you to Back Light Productions and “The Regulars”, keep up the battle.

Reminisce Resurrect

2010-04-04T09:59:00.006-04:00

Easter Sunday, brings us to see our elders, a family dinner, baskets, eggs, church, a new dress or a nice suit. Easter sparks many memories for the neurotypical person like one of us. For instance, I can recall the exact shade of pink in the stripes on my dress one Easter, the scratchy knee socks, and the bright sun shining on my face while I posed for Easter photos in the nicely manicured lawn with my cousins. The patient with dementia will not have these memorable details easily accessible. So asking the person with memory and cognitive impairment about their favorite Easter, or what their Easter traditions are may be a great way to begin a conversation, without very fruitful discussion.

What we know about memory is that short term recall is the first to disappear, and then long term recall slips away more slowly. It manifests like this in the early stages…The person with dementia gets up and dressed in their Sunday’s best, the family leaves for church and no slip up yet. They go to service, sing the songs, read the scripture, and then time for family dinner. But this year family dinner is at the granddaughter’s home, and the driver is relying on the one with dementia to give directions, as he is in from another town. Travel there is not so easy, despite many visits prior to this one, wrong turns are made, even pulling into the wrong home, but thankfully noticing another family in the drive. Talking about the sermon this date is impossible, even though the person with dementia was present and participated during the service, no recollection of information so new exists. So, with a lack of interaction regarding current happenings, the family begins to dig back into days past. Reminiscing about the year that one lost egg from the hunt wasn’t found for a week, and only did the stench of the decorated egg lead them to find it. The person with dementia may remember this humorous event. Perhaps they break out the photo album. The senior with memory loss sees a photo of their children 20 years ago, outside the church after Easter, and with a quick comment from the daughter regarding the fun had that day, comments flow easily and memories though long lost begin surfacing.
Now how can we make this Easter, and everyday special? How do we help preserve memories and interactions in life while dementia is trying to take those skills away? Stick with tradition, and keep the events of the holiday as recognizable as possible. People with dementia will remember the familiar, and function optimally when provided with stimulation that is not constantly changing. Memory loss will often not attack the prayers that were repeated throughout life, the common routine of cooking the same recipe for the Easter ham will be intact, and even knowledge of the normal attire, or typical events of the day are tools to use to help the person with dementia live life as normally as possible. When it comes to remembering and conversing, use items and pictures from the past to elicit recall, and keep the demand simple. Allow the senior to recall what they easily can and keep the conversation flowing by feeding in missing details. Familiar smells, tastes, places, routines, and providing stimulus with emotional content will retrieve memories from places hidden.

Not only this Easter, or on special holidays, but everyday, we can draw from this knowledge to help those we love with memory loss have meaningful interactions. Keep routine intact, use familiar ritual, and pull in concrete items to stimulate memories and conversation. Fill the day with success driven interactions. We can tap into emotions, feelings of love, joy, and peace to promote pleasant contact with the senior suffering from dementia, and through these moments preserve quality of life in the face of a terrible disease.

Happy Easter!

End of Life: So Many Questions

2010-04-01T21:26:00.005-04:00

For years I have known the devastation that comes about when making decisions regarding death and planning for end of life care. When do you opt for treatment? When is it time to just live the rest of your life? When do we as clinicians, nurses, doctors, stop fighting to fix the problem, and resolve to lend a hand for finding peace? Throughout personal experience, encounters with families, and interactions with dying patients I have come to realize that there is no consistency in ensuring that a dying person’s wishes are conveyed and carried out. Extreme variability exists in discussions about dying and one’s end of life wishes. Talk about death is complicated, dealing with death is difficult, and when you add in factors such as multiple medical conditions that take away communication, thinking, or weaken the patient to a point of compromise, it becomes essential to start the dialogue long before the disease takes over.

In the last year or so this specific notion of dealing with death has crept into my life time and time again. First in multiple encounters of working with elderly patients with dementia, or some other illness, who did not “have their ducks in a row” so to speak, left families with critical choices on their plate. Many times a person will have laid out the basics, but when critical moments arise it is much more complicated, emotions of family member take over, not wanting to “lose” their loved one, etc. Resuscitate or don’t? Ventilator or none? Feeding tube or pneumonia? So many intricate questions crop up. Also, I have spent time talking with friends and members of my own family who don’t work in the medical field and they have dealt with similar issues. They ask for guidance from medical professionals, but find it lacking. All of these end of life determinations in the midst of an emotionally trying time. Hoping they will know the right thing to do, while keeping with the wishes of their loved one.

Wouldn’t it be nice if we talked about these decisions with the one who really is responsible for making the call long before the time comes?

The following is a guide designed to be used in conjunction with Bill Moyers’ PBS series On Our Own Terms.

http://www.pbs.org/wnet/onourownterms/community/pdf/discussionguide.pdf

Use with the series is beneficial, but the guide alone also serves as an superb resource for topics of conversation, decisions to be considered, suggestions for dealing with death, and even how to make sure our needs are thoroughly document so no confusion arises.

Initiate the conversations and listen intently. Learn how your parents, grandparents, spouses, and patients what to live out their last months and days, and how they want to die. In spite of a distressful event, you won’t be sorry.

Healthcare Reform

2010-03-26T18:10:00.005-04:00

No matter which side of the fence you fall on, it is important to attempt to get some unbiased knowledge about just what health reform will mean. So much of what we hear in the media is distorted. With the important issue of obtaining health care for elderly loved ones, our families of all ages, and ourselves, it is absolutely necessary to find some objectivity and review the facts.

http://www.kff.org/

The Kaiser Family Foundation does a nice job of reporting information without inserting opinion. This type of resource is hard to locate regarding a topic which holds so much political charge. KFF also provides updates frequently so you may want to bookmark this site as well.

95 and Counting

2010-03-17T06:26:00.004-04:00

We started the conversation talking about specific memories this elderly woman wanted to share. She prefaces our discussion with a statement that, in her mind, sums it up. With a high pitched voice, and rich Appalachian dialect Mary tells me, “Things just don’t come back to you like you’d think they would. Ain’t got much memory. I’ve about forgot it all.” Then she defies all she just said and remembers her story. Detailing life as a young woman, a wife, a mother, a farmer, she talks of days in her life before the nursing home, days before, as she says “my bones started to give out”. This petite elderly lady with long, wavy, barely gray hair holds the information of what life has been like for nearly a century. I am fortunate enough to get a slight glimpse into the mind of a woman who has experienced nearly a 100 years of change, and hear her talk about the transformation and the constant aspects of life over the years.

Mary tells me “I remember the milk cows, sheep, goats, hogs, a team of horses, and things like that. That is what took up my time. That is what I know. I knowed how to plant corn, potatoes, all kinds of little things in the garden. That is what took up your days.” She recalls more in-depth stories of tending her garden, helping her animals, herding them in to shelter when weather turned bad, and staying up into the midnight hours to make sure the baby animals, lambs in particular, were saved from the fate of freezing to death. She tells me of her childhood as an orphan, as her parents died and left 9 children, to “manage the best they could”, when Mary was not yet a teenager. She can’t recall her exact age, but tells me that she was pampered as she was not one of the oldest. Her face and words reveal shock when I tell her that average life expectancy in the United States is 77.7 years. Her family did not live this long and she feels like she is the exception.

Speaking easily of the days of past she recounts events in her life, but tells me that around the time her great-grandchildren came along there “must have been something happened to my mind”. She explains that currently, “It is hard to concentrate and sometimes I get scared because I am confused about where I am.” This happens most often when she wakes up at night, and she is able to “get straightened out” once she fully wakes. She regretfully tells me “If you’ll notice, I can’t tell you anything of benefit.” But what Mary fails to realize is that her presence, her story, the wisdom gained in her years are of benefit to us all.

What I see when talking to Mary is a person whose brain is in very good shape after 95 years of hard work, living, and thinking. She has normal age related memory change. Precise details are decreased, and the particulars of events happening in present day tend to fade more quickly. When I ask her to let me in on the secret to living such a long and fruitful life she explains how she took care of her body, working hard and walking a lot. I learn that they never called it exercise, as activity was just a way of life. I posed a question to Mary that required a bit of thought on her part, as it would for anyone. I wanted to know the best and worst thing about being a woman 95 years of age. The best, she tells me, is being able to “eat all you want because nobody pays attention if you need to trim up”. This statement, coming from the smallest woman I’ve ever met, reveals a great deal about how some components of our belief system and self image, deeply ingrained, carry throughout the span of our lives. The worst thing is a concept she can’t quite put her finger on. She simply states “I’ve lived through it all and there’s not much use to try and sort it all out, I am just here and that matters.”

Mary is very kind, beautiful, and grounded. When speaking of tomorrow she tells me in a quiet voice “The future will take care of itself. I like to be where I am and not waste the day with worrying about tomorrow.” This is how she has lived her 95 years. Her story is intact, the important parts, her ties to the past remain, but today is where she stays.

Cheers to Mary.

Meds and Memory Improvement

2010-03-14T12:04:00.004-04:00

A body of evidence exists discussing a positive secondary effect of antidepressant use. Hippocampus cell growth is the result which comes as a byproduct. The hippocampus is a structure within the brain which stores memories systematically. Typically examined in those with long term depression, studies show that with use of antidepressants over extended periods of time, hippocampus cells proliferate and increase in plasticity. If the hippocampus cells are generating, or even if the plasticity is allowing new information to be stored and retrieved, then implications could be profound.

The use of antidepressants can be very beneficial for the elderly and those with dementia, for decreasing depression, but perhaps there is an additional benefit. Wouldn’t it be amazing if we could kills two birds with one stone, or at least slow down the migrating flight of memory loss throughout the fragile brains of those with dementia, Alzheimer’s, or normal age related memory impairment.

Now I have to say that doctors do not prescribe antidepressants for this purpose, and research is virtually nonexistent in hippocampus volume increase with the population whose diagnosis is that of a memory disease such as Alzheimer’s. What’s available is the promise of clinical trials related to this concept. Here is a link to one such trial, and this site will provide a tool to find other trials as well that may benefit our patients and loved ones with dementia.
http://clinicaltrials.gov/ct2/show/NCT00702780?term=Alzheimer%27s+and+antidepressant&rank=12

More than a clinical trial, the promise or hope that perhaps a treatment we use for one symptom, depression, will change the brain with memory loss in a positive way may provide solace in the face of a very challenging disease.

Photo By: Tom Varco

Here's the Way to Grow Old Together

2010-02-26T19:17:00.002-05:00

I love this! This is how we should age. It warms my soul to watch this couple. Now I just have to convince my husband to practice a routine of some sort so we can perform together. I'm leaning towards dancing. Enjoy.

http://www.youtube.com/watch?v=RI-l0tK8Ok0

Lesson Learned

2010-02-23T06:30:00.001-05:00

Sometimes we find a new outlook in an unexpected place.

I had a recent bout with the drug Topamax, a seizure medicine used to manage migraines in adults. This medication made me completely stupid. The neurologist said “it might cause some mild problems with word finding”. Obviously this doctor had never taken Topamax. In the beginning it felt as if I was living in a fog, it was very difficult to process information. Side effects forced me to adapt and cope, all in hopes that the head pain, the dizziness, nausea, and sickness, would go away if I used the medicine. The worst part was the long lasting result of word finding difficulties. As a speech pathologist I rely on my words. I teach people to talk and give seminars for a living. Seriously, words have to come quickly, flow easily, and nothing less is tolerable. My patients have these symptoms, not me. The meds were in my system for almost 4 months, and then I decided the side effects were too much. I was fortunate to have the luxury of being allowed to make that decision. My patients do not have the ability to stop their symptoms.

I stumbled upon an abundance of insight because of this experience. Even in the midst of my migraine and medication provoked stupor I gained a new understanding for the people I encounter each day. These people have dementia often in early stages, some highly aware of the tribulations they face, others beyond that awareness, but at times, still frustrated with changes in their thinking, slowed cognition, lack of ability to express themselves. For the first time I held a fresh perspective. The embarrassment, the lack of desire to speak, the tendency to avoid specific situations, was a problem I now faced. I love being a presenter, but I dreaded every seminar I had to give, certain there would come a time during the day long event that I would make a joke about my lack of appropriate word retrieval. I am lucky to be able to make these symptoms go away. Just stop taking a pill. Dementia does not forgive so easily. The people I meet, do therapy with, and talk to, tell me that the symptoms are relentless, frustrating, and almost impossible to deal with.

The journey of Topamax allowed for a shift to occur in me. I’ve always believed that dementia was a terrible disease but now I had a small taste, very small, not even comparable, off its manifestations. I did not like it, and could not accept it. A deeper respect for those suffering from dementia lies in me now, and I wonder what life will be like as I age.

Please feel free to comment about your own experiences that occur regarding aging, or other thoughts you may have.

Just a Phone Call Away

2010-02-11T10:56:00.003-05:00

Last week I conducted a seminar in Tucson, AZ and had a great conversation with a course participant. This lady spoke with me about some of her greatest concerns caring for her elderly parents. She told me that the mother was in her late 80s and father in his 90s. They live at home and their children assist with their care. The adult children want their parents to have as much independence as possible, consistent with the aging in place movement we are in the midst of.

The lady expressed concern with use of the phone. What comes to mind initially? Large buttons due to eyesight problems, poor hearing interfering with comprehension of the conversation, both possibilities, but neither fit the bill. The main worry was the automated system that we all encounter. Even those of us whose brains are in our prime experience frustration, and at times just want to push 0. We hope that a person, a real live voice will help us with the problem. Think about the tribulations that may complicate the automated system phone task even further. Poor working memory… by the time “push option 7 for billing questions” comes along, the elderly person with memory loss will forget what assistance “option 2” might provide. Then they try to get the operator, instinctively touching the 0 button on the phone, and what do they hear “this is an invalid option, goodbye”, and back to square one.

In our world of evolving technology where paper bills are a thing of the past, customer support provided by a human being becoming obsolete, and the first thing we hear when calling customer service is redirection to a website, we must consider the generation who is not familiar with this system. How about a default option, 0 for operator, required for all customer service centers? Although the companies would have to employ more people increasing their costs, certainly it would be less expensive than providing services for the elderly at home to assist in maintaining personal finances. Perhaps someone could start a customer service company, a call center, and its primary function would be to service the aging population. They could then contract to utility companies and customers over a certain age would receive an alternate number to call, the ones who most need help would now have a better option. I don’t know of a quick fix. I think we have to look at changing the system on this one, but what a difference a simplified version of the complex customer service phone methods could make in the lives of our elderly and their caregivers.

Depression: Let’s Consider the Impact

2010-01-24T14:56:00.010-05:00

My lunchtime routine goes something like this; consume food and beverage, visit with co-workers or seminar participants, and then the multi-tasking begins, I check email, TMZ updates (a guilty pleasure I know), and Medscape updates for new articles. This past Thursday in the midst of my daily ritual, a title catches me off guard. “Patients With Newly Diagnosed Dementia May Become Suicidal” are the black, bold type words that make me look twice. My first thought, not one of shock or surprise because I know depression is an expected reaction to a diagnosis of dementia, if one knows anything about the disease. Problem was, I had not seen it in such stark terms, suicidal, newly diagnosed, and suicidal in early stages of dementia. I keep thinking. These are people functioning at a high level, able to execute the suicidal plan if not treated and if so desired. So, I touch the link, read the summary provided by Medscape, research and read the entire article.

Here is the abstract for you to read if you wish.
http://www.alzheimersanddementia.com/article/S1552-5260(09)00104-6/abstract

Basically, a literature review identifying patterns of increased suicidal thought reports and requests for euthanasia in patients with a recent diagnosis of dementia. The article suggests that protocols be established to identify, treat and monitor for significant depression and suicidal risk. They also suggest modifying thought patterns of the medical community and the concept that depression of this severity, with this population, is not a concern.

Depression is significant, and diagnosis can be difficult in a patient with dementia for many reasons. Overlap exists in behavioral changes seen with progression of dementia and depression, i.e. loss of appetite, weight increase or decrease, varying sleep patterns, poor concentration, loss of interests, apathy, decreased concentration and attention, indecisiveness, fatigue, loss of energy, restlessness. Difficult or not, diagnosis is important or as we just read, effects are significant. If everyday, people with dementia walk around thinking of suicide, and request to be euthanized we have to alter our view on depression and be more aggressive with its identification.

Regardless of the cause of dementia there is self-awareness in the onset of the disease of functional abilities changing, and the core of that person shifting. Initial awareness of difference and decline is a key factor. Depression is likely to occur. As the patient looses the ability to recognize their own decline, depression may or may not lessen. I am a big believer that awareness and orientation is inconsistent. We do not know specifically which parts of the brain have been destroyed or preserved, so we have to be cautious. When I talk with people who have dementia it is likely, at times, a moment of clarity will shine through. I see that person searching and grasping for reality and knowing that they are not living in it. That must be a scary place in which depression hides in the corner and waits for that prime moment to assault. The person with dementia will have difficulty grasping the abstract concept of depression as their disease worsens, and describing it as language breaks down. I mean, even the normal, non-cognitively impaired person often has a hard time putting their symptoms of depression into words, and understanding why they are experiencing the behavioral changes that occur with depression.

Let’s all begin to pay closer attention to those we care about who have dementia. At the beginning, recognize the fragility of mental state, know that essentially this person’s concept of what life would be like in old age has, in an instant, changed forever. As deterioration occurs, keep in mind that the dementia may cause behavioral symptoms, but depression can exacerbate these. Depression is not just possible, but probable. Talking to physicians, openly, about concerns as soon as they occur, and looking at all options to manage depression will make a difference. I am taking a proactive approach with the people I know who have or care for someone with dementia. I am going to warn them of the severity of depression’s impact on well being, especially when life already presents the challenge of dealing with dementia. I will advocate for quick diagnosis of depression which left untreated, may likely have devastating effects.

Photo by Chalmers Butterfield

What is it?

2010-01-19T21:04:00.000-05:00

Dementia, not a pretty picture… Typical progression of the disease includes a decline in cognitive function, memory, communication, physical abilities, to the point that the person living with dementia is unable to care for themselves. So, first we see the thinking fade away, recent memories, then those from days past, problem solving skills, attention, and communication. Then this horrific disease attacks a person’s physical being. As if the war on their mind was not enough, they lose coordination, vision disturbances occur, senses change. In the end, it all goes, the person with dementia cannot tell you want they want and need, cannot remember who they are or where they are, cannot walk, feed themselves, use the bathroom on their own, and then goes the ability to swallow, something as basic as eating and drinking become physically impossible. As I said, it is not a pretty picture.
What I know, and see everyday, is that people are living with dementia. The CDC says that as many as 5.3 million American’s are living with dementia caused by Alzheimer’s disease (which is responsible for over half of the cases of dementia). What I also know is that our population is aging, and these numbers are growing exponentially. Now the question is what do we do with this fact? How will we care for all of these people as they age? How will we prepare their families to cope with dementia? We need to start the conversation now. Knowledge is power. The more people know about this disease the more empowered they (or we) will be to kick it!