Don't Regret

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

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

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

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?

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

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

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?

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 :-)

Language: An Expanded View

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

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

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?