How to Survive Caring for a "Challenging" Elder and Recognize the Early Signs of Dementia! Part III

Guest blog by Jacqueline Marcell
Author of Elder Rage, or Take My Father... Please! How To Survive Caring For Aging Parents
Watch her interview on The Woman's Connection YouTube Vlog

Elder-Proof the House to Reduce Frustrations

There are things you can do to make navigation in the home easier for elders.

1. Even out the ridge on the floor in front of a doorway to make it easier for a wheelchair to get over.
2.Strategically placed grab-bars (even in the shower) will help to reduce falls.
3. Remove throw rugs as they are a hazard and easily tripped on.
4. Put glow tape around the perimeter of doorways so they are visible at night.
5. Place motion-sensing night-lights on the floor of their bedroom.
6. Put colored tape on the edges of stairs so they can be clearly seen. Adult Day Care is the Answer

Relying on the professionals at an Adult Day Care turned out to be the answer to getting my parents out of bed 23 hours a day "waiting to die," and giving them social, physical and intellectual stimulation during the day, so they'd sleep through the night. Yes, it was no small feat to get my father to go, but gradually, once he got into the swing of it, he really enjoyed it. Then, you can spend quality time with them in the evenings and on weekends and you will not be so burdened with their care 24 hrs a day.

Hiring Caregivers

When your loved one needs more care than you can provide, it is time to hire a caregiver.

Questions to ask when hiring a caregiver:

1. Does the person live close by; have a car, a valid driver's license, and current insurance?
2. Has he or she had elder care experience and can you call several references?
3. Is the person willing to be photographed and fingerprinted so you can do a search on his or her background?
4. If you're hiring through an agency, is that agency a member of state and national organizations that you can call to check on them?
5.What kind of background checks does the agency do? (If they refuse to give this information to you in writing, they probably have not done any background checks.)

A Success Story

A year later, after turning around a seemingly impossible situation, I knew it was all worth the horror and heartache to hear my father say he loved me again.

I felt so compelled by what I had lived through, I wrote a book so that others won't have to struggle as I did to figure out how to manage their elderly loved ones. The result: Elder Rage, or Take My Father… Please! How To Survive Caring For Aging Parents.

It's written with humor and I guarantee laughter out loud, as you learn everything you never wanted to know about eldercare but were afraid to ask. After the success story I include 70 pages of self-help, answers to the toughest questions, valuable resources and a renowned dementia specialist's chapter on medications. I'm honored to have 40+ prestigious endorsements including: Hugh Downs, Regis Philbin, the late Steve Allen, Dr. Dean Edell, Robert Stack, Dr. Bernie Siegel, Dr. Nancy Snyderman/ABC News, Duke University Center for Aging, Johns Hopkins Memory Clinic, Dr. Eric Tangalos/Mayo Clinic, Dr. Rudy Tanzi/Harvard Medical School .

How to Survive Caring for a "Challenging" Elder and Recognize the Early Signs of Dementia! Part II

The 10 Warning Signs of Dementia

1. Recent memory loss -- your loved one may ask you the same question over and over, look at a beloved granddaughter and ask her name, or forget that they just told you that story and tell you again.
2. Difficulty performing familiar tasks -- such as tying a necktie or shoelaces, or being unable to do the knitting they have enjoyed for many years.
3. Problems with language - using the wrong word or unable to remember the right word to use.
4. Disorientation of time and place -- mistaking a time period of hours for days, or giving incorrect directions in the town they have lived in for many years.
5. Poor or decreased judgment - for example, while babysitting they may completely forget about the child they are supposed to be watching.

6. Problems with abstract thinking -- inability to balance a checkbook, adding becomes difficult or they may insist that a one-dollar bill is a 20-dollar bill.
7. Inappropriate misplacing of things -- you might find the wristwatch in the sugar bowl, the iron in the microwave, or a hat in the freezer.
8. Rapid mood swings -- switching from tears to anger for no apparent reason.
9 Changes in personality -- you may notice a tendency toward fear and paranoia.
10. Loss of initiative -- your loved one may not want to get out of bed, withdraws socially or says they don't want to live anymore. Behavior Modification Techniques
Once the brain chemistry is properly balanced for the dementia, often-present depression and possible aggression, you will be able to start behavior modification techniques on a challenging elder if they are still in the very earliest stage of dementia.

As amazing as it sounds, the use of tough love coupled with rewards and consequences worked to turn around the most obstinate man on the planet: my father, even with the onset of dementia. By being 100% consistent, never rewarding his bad behavior and using lots of praise to encourage good behavior, he finally changed his negative life-long behavior pattern of screaming and yelling to get his way. He learned that he could (as Mom would say), "catch more flies with honey than vinegar."

How to Survive Caring for a "Challenging" Elder and Recognize the Early Signs of Dementia!

Guest blog by Jacquelie Marcell
Author of Elder Rage, or Take My Father... Please! How To Survive Caring For Aging Parents
Watch her interview on The Woman's Connection YouTube Vlog

Caring for a "challenging" elder can be one of the hardest things you'll ever do. I know -- I went through a year of hell before I figured it out.

I had been the light of my father's life -- but with the onset of dementia he turned on me, doing and saying things that I would have never believed he could do. Having no experience with elder care, I just didn't get it. I thought it was just due to his bad temper of a lifetime and his need to control, which it was, but it was also the very beginning of dementia that intermittently made his actions even more illogical and irrational than ever before.

When he threw two little dilapidated hand towels at me, screaming and swearing at me for throwing them out, I was stunned and sobbed my heart out. With the knowledge I have now I'd say, "This seems illogical, this seems irrational. Red flag -- it is!" And I'd haul him off kicking and screaming to the Alzheimer's Association's best recommendation for a geriatric dementia specialist to be evaluated right away. I'd know not to waste time with his regular doctor who didn't specialize in dementia.

Recognizing Dementia Symptoms Before It's Too Late
The stereotype of a person with dementia (Alzheimer's is just one of many types) is that of someone who doesn't know what they are doing. That's Stage Three, but there is a long road before one gets there.

Dementia starts very intermittently and is generally ignored by families who think that these strange behaviors are just a normal part of aging: Stage One lasts two to four years; Stage Two lasts two to ten years; and Stage Three lasts one to three years. In the beginning, your loved one may have a raging temper tantrum and then suddenly be as sweet as pie. Because there are usually long periods of normalcy in-between, the tendency is to want to forget about the irrational incident instead of seeking treatment immediately.

Statistically families wait four years before they reach out for help -- usually after a crisis. By that time, however, the person has gone through Stage One and is starting into Stage Two already, which usually requires full-time care.

Getting medication for your loved one as soon as you recognize the early warning signs of dementia can slow its progress for two to four years doctors say, saving your family a lot of heartache and money. It will also save our society the burden of caring for so many elders who have progressed into Stage Two sooner than need be.

Consult a geriatric dementia specialist for the medications that may slow the progression of the dementia: Aricept, Exelon, and Reminyl.

Warning Signs: Passing the turkey and the torch. What to look for when you go home for the Holidays.

Guest blog by Jody Gasfriends,VP Senior Care,

As the holidays approach, I want to share a story with you. It’s the story of a friend of mine, Noreen*-a typical sandwich-generation mom and daughter who had many people and priorities to juggle. But it was at Thanksgiving last year when she realized something needed to change. 

Noreen left home for college 30 years ago. After graduation, she got married, had two sons, and settled into a life in a small town north of Boston. But her roots, along with her aging parents, were still in Western Massachusetts. Among her three siblings, Noreen lived the closest to her folks and was the most worried. Her brother, Tom lived on the west coast and typically chalked up Mom’s forgetfulness and Dad’s driving mishaps as part of getting older. Pam, the youngest, had her hands full with a rebellious teenager and a recent divorce. She had no room on her plate to worry about Mom and Dad. 

So, as Noreen drove – or crawled -- along the highway last Thanksgiving, she wistfully remembered Thanksgivings past. Mom’s famous pecan chocolate chip pie, Dad’s careful carving of the turkey and the children’s delight at watching the Macy’s Thanksgiving Day parade in their pajamas seemed like scenes out of a Norman Rockwell painting. Noreen also recalled the fractious squabbles that sometimes erupted amidst the merriment. Those tensions seemed far less weighty than the anxiety she now felt about her parent’s safety and welfare, and her siblings’ apparent dismissal of her fears. 

Arriving at her parents’ home, Noreen couldn’t help but stare at the peeling paint and the unkempt lawn. Years ago, she suggested her folks sell the house and find a place to live that was more senior-friendly. Dispelling her concerns, Noreen’s parents quickly dismissed the idea. Noreen, unsupported by her siblings, let the issue drop. Now, she regretted that decision. She opened the front door and got a whiff of something burnt. Turns out it was the turkey. Noreen’s mother was apologetic. She had gotten distracted by the excitement of the holiday. Tom and Pam were busy ordering take out Chinese food and seemed un-phased by the Thanksgiving turkey that had already been tossed. Mom had always been a consummate cook. Now, no one seemed to care that she ruined the holiday meal centerpiece. Noreen also worried about her Dad who seemed unsteady and frail. She asked how he was feeling and he replied “under the weather” but hadn’t seen the doctor in months. As the day progressed, Noreen grew increasingly more concerned. She saw a stack of bills on the kitchen counter, some of them dating back months. She observed Mom forgetting simple things and got frazzled easily. While Noreen did not want to worry excessively or make a scene, things seemed out of sorts and she could no longer pretend otherwise.

Holidays are a time when emotions get stirred up. Like Thanksgiving cranberry sauce and stuffing, our emotions are a mixture of ingredients: Excitement, joy, sadness and stress can all be part of the family recipe. Many adult children, like Noreen, must face a changing reality and confront their own anxiety and grief as their parents lose their strength and independence. These changes are often more prominent around holiday time, particularly for adult children who live at a distance. It is easy to overreact when we see, as Noreen did, bills piling up or a home not properly cared for. At the same time, it is important to differentiate changes in behavior. A newfound tendency to let the house go a bit can be part of normal aging, or it can represent illness and decline. When I later met Noreen for coffee, she told me she worried that the burnt turkey was an ominous sign. I assured her that one burnt turkey does not foreshadow disaster, but a pattern of uncharacteristic behaviors, is more of a concern. 

Holidays can be incredibly stressful. In the midst of all the activity and eating, they can also provide an opportunity to observe our parents as they age. So this season, here is what to look for to determine if your worries are justified and whether there are real concerns about your parent’s wellbeing and safety that need to be addressed. 

• Change in eating habits/weight loss
• Forgetfulness-out of the ordinary
• Neglected personal hygiene and cleanliness
• Decrease in socialization and activity level
• Significant mood changes
• Unexplained dents in the car
• Misuse of prescribed medications
• Mishandling finances

Like Noreen, so many adult children feel they shoulder the burden of worry on their own. Getting siblings on the same page, whenever possible is a good place to start. Sharing perspectives on Mom’s increasing forgetfulness or Dad’s unsteady gait can shed new light on your understanding of the problem. Has it been an ongoing progressive decline or an intermittent reaction to stress or illness? Gathering information, as objectively as possible is the first step toward being an effective caregiver. Unlike Noreen, you don’t have to go it alone. Getting the support and information you need early on can help you navigate the unexpected twists and turns along the caregiving journey.

Empowering Women Caregivers: 6 Steps to Reclaim Your Life and Relationships

Guest post by  Diana B. Denholm, PhD, LMHC
Author of The Caregiving Wife's Handbook: Caring for Your Seriously Ill Husband, Caring for Yourself

Terminal illness shatters lives and marriages. Fortunately, by following simple strategies you can learn to solve problems and quickly discover that your life and your marriage are not over! In The Caregiving Wife’s Handbook, you learn how to bring your marriage back--to uncover the love and caring you once experienced--as you discover options and choices to reclaim the closeness--and your loving bond. Learned communication is the key to these options and choices. It isn’t just talk!

Wives avoid discussing difficult issues with their husbands because they feel guilty, they're afraid it will upset them, they think it won't make any difference, or because they simply don't know how to do it! And that’s where the problems begin.

Do you experience common caregiver concerns? Mary and Mark are a very attractive retired couple. Mark is dying of Parkinson’s, and their advancing age makes it hard to handle the many unexpected changes that come their way. Watching her husband decline is incredibly difficult, yet she also has to deal with numerous concerns common to most caregivers. These include the day-to-day matters of her role in his care, her previous roles, her self-care, their ongoing lives, household management, sleep, sex and intimacy--all of which put strains on her marriage. Hygiene and appearance concern Mary, as they do many caregivers. Mark has lost a lot of weight, and his Parkinson’s caused his posture to deteriorate. Mary is concerned that others might think she’s failing in her “wifely duties” because he looks unkempt. So, she criticizes him, in front of others, saying he looks like he’s slouching in his suits. Mark, and everyone present, is deeply embarrassed--for both of them. Instead of having a private discussion, she inadvertently and repeatedly, breaks their intimate and loving bond. 

Using learned communication methods resolves concerns. Noticing other people’s reactions and realizing what she was doing, Mary decided she had to make some changes. Using my book, she learned the Six Step Communication and Resolution Strategy allowing her to compassionately and effectively communicate with Mark. Here are the six steps: 

Step 1. Bring it all out into the open--with yourself. Mary began with the 24-Question Planning Guide and wrote down, for her eyes only and without censoring herself, every concern or complaint she had about any area of her life. A typical list may include topics ranging from minor annoyances (Your ostomy bag smells bad. I can't take your complaining), to fears (How will I pay the bills after you're gone? You'll fall down if you don't use the walker), and everything in between (I'm sad we can't make love anymore. I wish I could get a break. I'm mad that you're still sneaking cigarettes. Your family takes me for granted).

Step 2. Choose your discussion topics. Next, Mary learned to organize her concerns so she could decide which things she would talk about with Mark. Four categories were all she needed: A--things I want to say but don't expect a response to; B--things I want to say but won't, because it won't make a difference; C--things I want to say but should only share with a friend; D--things I really need to talk about, know about, have resolved, or make a decision about. Category D are the topics you will discuss with your husband. 

No topic is off limits, but the wording you use and the way you express yourself will determine the proper category. For instance, saying, “You really stink and I can’t stand being around you”, isn’t off limits, but would go into C--only to share with a friend or confidant. However, saying “I’m concerned about your hygiene” is fine for Category D and sharing with your spouse.

Step 3. Familiarize yourself with easy tips that make communication more effective. Here are a few simple tips and techniques Mary learned: not asking "why" (you really don’t want to know why your husband leaves the toilet seat up, you just want him to change his behavior and put it down.); letting him keep his opinion, while changing his behavior (It’s all right if he hates his medicine, as long as he takes it.); reflective listening, where you repeat back to him what he just said, instead of interpreting (If you interpret what he says, it will stop a conversation dead in its tracks); using "I" statements (It’s more effective if you don’t presume something about another person by using the inclusive “we”); speaking his language, which means structuring your statements in the way he will most easily understand them (If he's very reason- and logic-oriented, for example, you might ask him what he "thinks" about something, rather than how he feels.). 

Step 4. Make a "talking date" with your husband. Using her new tips and tools, Mary set up a “talking date” with Mark. Rather than saying “We need to talk”–the phrase most men dread and which causes an immediate shutdown–Mary began, “Mark, I have some concerns about your appearance. I know I’m not handling that very well, so I’d like to talk about it. Would this evening be good, or would tomorrow morning at breakfast be better?” She used an “I” statement because, it wasn’t Mark’s desire to talk. Then rather than demanding the discussion on the spot, she gave two closed-end options, knowing that just asking Mark when they could talk probably would have been answered with, “Never! 

Knowing that some settings are more conducive to good conversation than others, Mary picked a lovely location for their discussion. Depending on your loved one’s condition, you may need to choose a place such as your living room or the hospital chapel or solarium rather than going to a park or out for a boat ride.

Step 5. Prepare for the "big talk." Before you have your discussion, you need to complete one more step. Take some time for yourself, look at your topic list, and briefly run the discussion through your mind—focusing on ways to encourage mutual respect. Remember that this is not an adversarial activity. Instead, you and your husband are going to collaborate to resolve issues and problems, or to plan a course of action. Then put away your list and notes. Make yourself as calm as possible. Pray, meditate, or just sit quietly. Avoid caffeine, cigarettes, and sugar which can make you hyper, and alcohol or drugs, which can cloud your thinking. 

Step 6. Have your talk, and create agreements. Having employed mutual respect and compassion in their discussion, Mary and Mark came up with several agreements about expectations for themselves and others. Agreements can be written down to include who will do what and when. This is particularly helpful with issues about family visits—“From now on, my family will only visit on Sundays, and only if we invite them." Occasionally, partners hit an impasse and have the option to agree to disagree on a topic in order to reestablish peace in the home. This is much healthier than continuing to argue over something that won’t change.

Now Mary has taken all the important steps on the path–the path to making life easier, and making her life and marriage work. She and Mark could now reclaim their loving bond.