Another good article in the most recent Right at Home Newsletter
While some people with dementia can still drive safely for a time, nearly all people with dementia will eventually have to give up driving," said lead guideline author Donald J. Iverson, MD, of the Humboldt Neurological Medical Group in Eurkeka, CA, who is a Fellow of the American Academy of Neurology.
Iverson adds, "It's important for doctors to discuss this with patients and caregivers soon after the diagnosis, since restricted driving will affect the patient's quality of life and may lead to other health concerns, such as depression."
The guideline recommends that doctors use the Clinical Dementia Rating (CDR) scale to identify people with dementia who are at an increased risk of unsafe driving. The CDR provides a tool for clinicians to integrate information from caregivers and from direct examination of the patient to develop a comprehensive view of the dementia severity.
Evidence shows that driving skills deteriorate with increasing dementia severity. "While patients with mild dementia, as a group, are higher-risk drivers, more recent studies report that as many as 76% are still able to pass an on-road driving test and can safely drive," said Iverson. "Faced with these facts, we needed to provide guidelines for doctors to identify those people at higher risk of unsafe driving, without unnecessarily restricting those who are safe drivers."
Family caregivers may be an accurate judge of loved one's driving abilities.
The guidelines also confirm that caregivers should trust their instincts. A study found that caregivers who rate a patient's driving as "marginal" or "unsafe" were often proven correct when the patient took an on-road driving test. On the other hand, patients who deemed their own driving as "safe" were not necessarily accurate in their own assessments.
Caregivers and family members play a role in identifying warning signs from unsafe drivers with dementia. These include:
Collisions;
Moving violations; and,
Aggressive or impulsive personality traits.
"It is important that the decision to stop driving be directed by a doctor who is trained and experienced in working with people with dementia and their families," Iverson said. "Doctors should be aware that assessing driving ability is a complex process. More than one source of information is needed to make a judgment. In some situations, a dementia specialist may be needed."
Doctors, patients and caregivers must also know their state laws, since some states require that doctors report any medical conditions that may impact a patient's ability to drive safely.
This guideline was published in a recent issue of Neurology, the medical journal of the American Academy of Neurology, which is dedicated to promoting the highest quality patient-centered neurologic care. Visit the AAN website for consumer information on dementia, Parkinson's disease, stroke, and other neurological disorders.
Wednesday, July 28, 2010
Tuesday, July 27, 2010
Marriage and Alzheimer's
An Alzheimer diagnosis of a spouse is a life crisis. Life is irrevocably altered. When one is sick, two need care. The healthy spouse is grieving the loss of his or her other half. Roles change, identity as a husband or wife changes, and there is more often than not a social change. People shy away from inviting you as a couple, perhaps fearing looking at the change, or embarrassed around the ill friend.
Sexuality changes; sometimes spouses withdraw from the diagnosed spouse and feel that sexual expression now is inappropriate or distasteful. There are hygiene issues, fear that the partner will forget who their partner is.
If a couple can preserve aspects of their sexual relationship, there is still a sense of 'couple'. Other times passion is relabeled compassion. There may be lonliness within the relationship; the relationship now defined by loyalty, not necessarily love. If less attracted to the mate, there is guilt around rejecting advances. Males may wonder if sex is still consentual, and don't make advances. Couples need help accepting the many losses in their marriage when a diagnosis of Alzheimer's is given. They must learn other ways of communicating caring.
The couples I've coached over the years mostly talk about the loss of relationship; little conversation or one sided, the well spouse carrying the conversation.
I'd love to hear from spouses and what you've discovered in your experience and how you've found solutions.
Sexuality changes; sometimes spouses withdraw from the diagnosed spouse and feel that sexual expression now is inappropriate or distasteful. There are hygiene issues, fear that the partner will forget who their partner is.
If a couple can preserve aspects of their sexual relationship, there is still a sense of 'couple'. Other times passion is relabeled compassion. There may be lonliness within the relationship; the relationship now defined by loyalty, not necessarily love. If less attracted to the mate, there is guilt around rejecting advances. Males may wonder if sex is still consentual, and don't make advances. Couples need help accepting the many losses in their marriage when a diagnosis of Alzheimer's is given. They must learn other ways of communicating caring.
The couples I've coached over the years mostly talk about the loss of relationship; little conversation or one sided, the well spouse carrying the conversation.
I'd love to hear from spouses and what you've discovered in your experience and how you've found solutions.
Friday, July 23, 2010
The Seasons of Caregiving
When I was very little my mother introduced me as her little nurse. Did that have anything to do with my choice of professions? I’ve focused my last 32 years in the mental health field. I thought about this question “Why that population; the mentally ill and now the cognitively impaired and their caregivers?”.
I grew up hearing about my uncle Harold who was hospitalized when he was 27 for acting in a bizarre harmful way towards his mother. He spent the next 50 years in mental institutions. I visited him once when I was a student nurse on rotation at Medfield State Hospital and talked with a mild mannered pleasant man who looked just like his sister,my mother. I started to think how terrible for him to have had a psychotic break before the advent of psychotropic drugs. He missed out on 50 years of family life and perhaps years of pursuing and enjoying his dream of teaching. Today he would be treated with medications and probably released within a week or two….if his insurance company allowed that long.
The helper’s journey goes through seasons as I see it. First comes the spring; an awakening of a need of a person or population. There is the gathering of tools; information, education, and skill building.
As the skills needed to help are developed and refined, the summer brings confidence in oneself as helper. There may be a broadening or narrowing of the area in which we see we can best be effective. This may be grant writing, lobbying, directing, speaking,or teaching for the professional or hands on care. We find out what brings us satisfaction.
When I asked an audience in an assisted living residence to look at the satisfaction factor, we found some realized it in bringing comfort to the elder, others in teaching them easier ways of caring for themselves, others in advocating for services. The helper sees “This is how I can make a difference and feel satisfied doing it”
As caregiving continues there is a fall season in which there is ‘more of the same’, or little improvement in spite of our best efforts. There is a danger here of despair or burnout. This is the time when affirmation of what has been accomplished by our efforts becomes important. New ideas get generated as one reaches out to others for help in continuing.
Winter is a season of endings; perhaps that of a career, a program or an area of compassionate work. I underestimated the grief I felt 3 years ago when a program I developed and worked at for seven years waned as budget crunches emerged and finally ended for me when I was laid off. This is a time of new beginnings as well as endings.
And so we continue our individual journeys, learning about ourselves along the way, learning more about how to work with others in a team, and perhaps learning to let go when a caregiving area ends.
During all these seasons, the gift of appreciation and validation of work a person does cannot be overstated. We can each care for our team members who are helpers in their own unique way. An attitude of gratitude and appreciation among workers spreads like wildfire the same as an attitude of complaining and blaming can. We can choose the attitude of gratitude and carry on with our journey and support others in theirs.
I grew up hearing about my uncle Harold who was hospitalized when he was 27 for acting in a bizarre harmful way towards his mother. He spent the next 50 years in mental institutions. I visited him once when I was a student nurse on rotation at Medfield State Hospital and talked with a mild mannered pleasant man who looked just like his sister,my mother. I started to think how terrible for him to have had a psychotic break before the advent of psychotropic drugs. He missed out on 50 years of family life and perhaps years of pursuing and enjoying his dream of teaching. Today he would be treated with medications and probably released within a week or two….if his insurance company allowed that long.
The helper’s journey goes through seasons as I see it. First comes the spring; an awakening of a need of a person or population. There is the gathering of tools; information, education, and skill building.
As the skills needed to help are developed and refined, the summer brings confidence in oneself as helper. There may be a broadening or narrowing of the area in which we see we can best be effective. This may be grant writing, lobbying, directing, speaking,or teaching for the professional or hands on care. We find out what brings us satisfaction.
When I asked an audience in an assisted living residence to look at the satisfaction factor, we found some realized it in bringing comfort to the elder, others in teaching them easier ways of caring for themselves, others in advocating for services. The helper sees “This is how I can make a difference and feel satisfied doing it”
As caregiving continues there is a fall season in which there is ‘more of the same’, or little improvement in spite of our best efforts. There is a danger here of despair or burnout. This is the time when affirmation of what has been accomplished by our efforts becomes important. New ideas get generated as one reaches out to others for help in continuing.
Winter is a season of endings; perhaps that of a career, a program or an area of compassionate work. I underestimated the grief I felt 3 years ago when a program I developed and worked at for seven years waned as budget crunches emerged and finally ended for me when I was laid off. This is a time of new beginnings as well as endings.
And so we continue our individual journeys, learning about ourselves along the way, learning more about how to work with others in a team, and perhaps learning to let go when a caregiving area ends.
During all these seasons, the gift of appreciation and validation of work a person does cannot be overstated. We can each care for our team members who are helpers in their own unique way. An attitude of gratitude and appreciation among workers spreads like wildfire the same as an attitude of complaining and blaming can. We can choose the attitude of gratitude and carry on with our journey and support others in theirs.
Wednesday, July 21, 2010
A Matter of her mind...and my Heart
I'm beginning a new book about my Alzheimer caregiving journey, sometimes peaceful, sometimes not, with my mother in law, Bette. This is the opening paragraph. I'm hoping it helps others to read it as it did me to write it.
I should call this Confessions of an Alzheimer Coach. As I read back on the last 10 years of caring for Bette, I am aware of how much I’ve learned since the beginning, when I thought I knew a lot about Alzheimer care. It was after my father in law died of Alzheimer’s in 1996, that I realized Bette would require more attention. I didn’t know then just how much attention she would need and how little of what she needed she’d be wanting or accept. I confess I was a very reluctant caregiver, only agreeing to become primary caregiver to relieve my husband of a job he was ill-equipped to handle mainly because he loved her too much. His sister, although living nearby her mother, didn’t drive due to low vision and had limited knowledge of Alzheimer’s and the medical systems her mother would need. And so I accepted the position that would prove very challenging, frustrating, frightening in its impact on my marriage, my caring for my own mother and my feeling of emotional well being.
I’m writing this for one reason only; so caregivers can console themselves for the mistakes, the failures in care and the lack of heart for the job of caregiving. And, now one year after her death at 99 years of age, I can stand back and assess what kind of caregivers we were. As a professional, a nurse and owning a business coaching Alzheimer caregivers, I can adopt the professional stance when working with families. I often look very smart and an expert on Alzheimer’s. I have studied a great deal about the disease and caring with Habilitation Therapy approaches. I don’t really believe there are any experts on Alzheimer’s disease; just people who specialize in it. We learn very quickly there is no Alzheimer archetype to go by; no concrete model or typical patient. Each person is unique as he should be. A person expresses this crazy disease out of his experience coping with the world and its challenges. Whatever worked in the past to make a person feel as if they could relate in the world will be magnified in their response to the disease.
Probably the most difficult person to care for who has Alzheimer’s or any related dementia is the independent strong minded person who never felt they needed anybody. They handled life the way they saw it; they coped well, or perhaps sometimes not so well by others’ viewpoint, without adopting anyone else’s way but their own. I coached a man once whose wife had many difficult to manage behaviors. She resisted care, wandered, refused to wear protective underwear for her incontinence, and became belligerent when bathed or dressed. I asked him on our last coaching visit, “Is there anything in this that is positive for you?” “Oh, yes.” He exclaimed, “She needs me. She’s never needed me before, always so competent. It’s the first time in our 48 years of marriage that I feel essential. That feels good!”
My mother in law was such a woman.
I should call this Confessions of an Alzheimer Coach. As I read back on the last 10 years of caring for Bette, I am aware of how much I’ve learned since the beginning, when I thought I knew a lot about Alzheimer care. It was after my father in law died of Alzheimer’s in 1996, that I realized Bette would require more attention. I didn’t know then just how much attention she would need and how little of what she needed she’d be wanting or accept. I confess I was a very reluctant caregiver, only agreeing to become primary caregiver to relieve my husband of a job he was ill-equipped to handle mainly because he loved her too much. His sister, although living nearby her mother, didn’t drive due to low vision and had limited knowledge of Alzheimer’s and the medical systems her mother would need. And so I accepted the position that would prove very challenging, frustrating, frightening in its impact on my marriage, my caring for my own mother and my feeling of emotional well being.
I’m writing this for one reason only; so caregivers can console themselves for the mistakes, the failures in care and the lack of heart for the job of caregiving. And, now one year after her death at 99 years of age, I can stand back and assess what kind of caregivers we were. As a professional, a nurse and owning a business coaching Alzheimer caregivers, I can adopt the professional stance when working with families. I often look very smart and an expert on Alzheimer’s. I have studied a great deal about the disease and caring with Habilitation Therapy approaches. I don’t really believe there are any experts on Alzheimer’s disease; just people who specialize in it. We learn very quickly there is no Alzheimer archetype to go by; no concrete model or typical patient. Each person is unique as he should be. A person expresses this crazy disease out of his experience coping with the world and its challenges. Whatever worked in the past to make a person feel as if they could relate in the world will be magnified in their response to the disease.
Probably the most difficult person to care for who has Alzheimer’s or any related dementia is the independent strong minded person who never felt they needed anybody. They handled life the way they saw it; they coped well, or perhaps sometimes not so well by others’ viewpoint, without adopting anyone else’s way but their own. I coached a man once whose wife had many difficult to manage behaviors. She resisted care, wandered, refused to wear protective underwear for her incontinence, and became belligerent when bathed or dressed. I asked him on our last coaching visit, “Is there anything in this that is positive for you?” “Oh, yes.” He exclaimed, “She needs me. She’s never needed me before, always so competent. It’s the first time in our 48 years of marriage that I feel essential. That feels good!”
My mother in law was such a woman.
Friday, July 9, 2010
A Patriotic Break
Instead of working today I attended a birthday celebration of our city's John Quincy Adams at the Church of the Presidents where John Adams, Abigail Adams, John Quincy Adams and Catherine Adams are incrypted. There was a Navy honor guard with a laying of a commemorative wreath about 3 feet in diameter. The church was packed including our US Senator Scott Brown, our mayor Thomas Koch and past mayors and other dignitaries. The music was rousing and evoked tears as we sang America the Beautiful. America is beautiful and although many things she does are wrong (one big wrong is ridding everything American of God) she is still the best place to live. Let us be grateful.
Deliuium in hospitalization of dementia patients
AN INTERVENTION INTEGRATED INTO DAILY CLINICAL PRACTICE REDUCES THE INCIDENCE OF DELIRIUM DURING HOSPITALIZATION IN ELDERLY PATIENTS, VIDAN M, SANCHEZ E, ET AL. JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2009: 57 (NOVEMBER): 2029-2036
OBJECTIVES: To analyze the effectiveness of a multicomponent intervention integrated into daily practice for the prevention of in-hospital delirium in elderly patients.
DESIGN: Controlled study comparing an intervention in a geriatric unit (GI) with usual care in two internalmedicine services (UC).
SETTING: University Hospital in Madrid, Spain.
PARTICIPANTS: Five hundred forty-two consecutive patients (170 GI, 372 UC), aged 70 and older, with any of the risk criteria for delirium (cognitive impairment, visual impairment, acute disease severity, dehydration).
INTERVENTION: Educational measures and specific actions in seven risk areas (orientation, sensory impairment, sleep, mobilization, hydration, nutrition, drug use). Daily monitoring of adherence.
MEASUREMENTS: Baseline characteristics, risk factors for delirium, and quality care indicators were analyzed. The primary endpoint was incidence of delirium assessed daily. The secondary endpoint was functional decline, defined as loss of independence in any of the activities of daily living. The intervention effect was evaluated using logistic regression analysis.
RESULTS: Delirium affected 11.7% of the GI group and 18.5% of the UC group (P=.04). After adjustment for confounders, the intervention was associated with lower incidence of delirium (odds ratio=0.4, 95% confidence interval=0.24–0.77; P=.005). In the patients who experienced delirium, severity, length, and recurrence of episodes were similar in both groups. Adherence to the intervention protocols was 75.7%. The intervention reduced the rate of functional decline (45.5% in GI vs 56.3% in UC, P=.03) and improved other quality indicators (e.g., mobilization and physical restraints reduction).
CONCLUSION: A multicomponent, nonpharmacological intervention integrated into routine practice reduces delirium during hospitalization in older patients, improves quality of care, and can be implemented without additional resources in a public healthcare system.
KEVIN’S COMMENTS: Delirium is a common and serious geriatric problem that affects a high percentage of older adults admitted to hospitals. Delirium may persist for weeks and is very common in persons transferred from hospitals to nursing homes and assisted living communities. It is associated with considerable morbidity and mortality. Recognition is important in order to look for reversible causes such as drugs, electrolyte disturbances, infections, etc. This study demonstrates that delirium is a preventable problem and does not require additional resources. Several interventions aimed at reducing well-recognized risk factors for delirium (such as sensory deprivation, sleep disturbance, dehydration, and inappropriate drug use) markedly reduced the incidence of delirium in the study group. By Dr. Kevin O'Neil
OBJECTIVES: To analyze the effectiveness of a multicomponent intervention integrated into daily practice for the prevention of in-hospital delirium in elderly patients.
DESIGN: Controlled study comparing an intervention in a geriatric unit (GI) with usual care in two internalmedicine services (UC).
SETTING: University Hospital in Madrid, Spain.
PARTICIPANTS: Five hundred forty-two consecutive patients (170 GI, 372 UC), aged 70 and older, with any of the risk criteria for delirium (cognitive impairment, visual impairment, acute disease severity, dehydration).
INTERVENTION: Educational measures and specific actions in seven risk areas (orientation, sensory impairment, sleep, mobilization, hydration, nutrition, drug use). Daily monitoring of adherence.
MEASUREMENTS: Baseline characteristics, risk factors for delirium, and quality care indicators were analyzed. The primary endpoint was incidence of delirium assessed daily. The secondary endpoint was functional decline, defined as loss of independence in any of the activities of daily living. The intervention effect was evaluated using logistic regression analysis.
RESULTS: Delirium affected 11.7% of the GI group and 18.5% of the UC group (P=.04). After adjustment for confounders, the intervention was associated with lower incidence of delirium (odds ratio=0.4, 95% confidence interval=0.24–0.77; P=.005). In the patients who experienced delirium, severity, length, and recurrence of episodes were similar in both groups. Adherence to the intervention protocols was 75.7%. The intervention reduced the rate of functional decline (45.5% in GI vs 56.3% in UC, P=.03) and improved other quality indicators (e.g., mobilization and physical restraints reduction).
CONCLUSION: A multicomponent, nonpharmacological intervention integrated into routine practice reduces delirium during hospitalization in older patients, improves quality of care, and can be implemented without additional resources in a public healthcare system.
KEVIN’S COMMENTS: Delirium is a common and serious geriatric problem that affects a high percentage of older adults admitted to hospitals. Delirium may persist for weeks and is very common in persons transferred from hospitals to nursing homes and assisted living communities. It is associated with considerable morbidity and mortality. Recognition is important in order to look for reversible causes such as drugs, electrolyte disturbances, infections, etc. This study demonstrates that delirium is a preventable problem and does not require additional resources. Several interventions aimed at reducing well-recognized risk factors for delirium (such as sensory deprivation, sleep disturbance, dehydration, and inappropriate drug use) markedly reduced the incidence of delirium in the study group. By Dr. Kevin O'Neil
Wednesday, July 7, 2010
Balancing Caregiving and Work
Recently at a workshop for employers about caregiving and work productivity, a new word was introduced; ‘presenteeism’. This term describes an employee who is present bodily at work but not emotionally due to concerns about an elder at home. Work productivity starts to decline; the employee himself is often the first to notice. They come in late due to duties at home, perhaps getting mother to a day program, phone calls are made, to check in at home to be sure everything is ok or perhaps to follow up on a doctor’s suggestions for medication and treatments. Many caregivers do not recognize the stress they feel is due to caregiving responsibilities at all, and continue to handle everything themselves; home care, family obligations and work. Their attention to their personal needs takes a back seat, adding to the stress. Physical and emotional illness may exacerbate the strain of the balancing act, or be the result.
Caregivers generally experience an incremental increase in responsibility for an elder, not identifying themselves as caregivers at all. They may first help handling the bills, then help with the shopping, perhaps later accompany their family member on doctors’ appointments or pick up medications. They may start to notice the elder is not nourished adequately, preferring to eat simple sweets and tea rather than prepare a meal. So they stop in more frequently to deliver or prepare and share meals. The caregiver may finally realize that they need help. “Where do I go to find what help is available?” “Am I doing the right thing by mom?” “Is this the right decision?” Finally, “I can’t do this alone anymore.”
When the elder has Alzheimer’s which affects memory, reason and judgment, the responsibilities of the caregiver increase significantly. Safety and well being become a major concern. Alzheimer’s, a progressive cognitive illness, presents the caregiver with a long term commitment. This realization alone can be overwhelming. There is a comparison made that someone caring for a person with Alzheimer’s experiences the same stress as a soldier in combat; both are on duty 24/7, hyper-vigilant, waiting for the next emergency to appear, and not knowing when it will happen.
Many employees, I learned at the conference, do not access their Employee Assistance Program. Perhaps they fear being seen as weak and will eventually lose their job if they reveal the struggle balancing work and caregiving. Many are unaware of the wealth of information to be gained about resources for caregivers through their employer. Instead, they continue to muddle along alone.
It is the job of the Employee Assistance Program to research resources for their employees; it is unfortunate that caregivers don’t access help from their EAP sooner. Resources for caregivers can also be accessed at the local council on aging and, in Massachusetts, at one of the 27 Aging Service Access Point agencies that provide numerous services to elders and their caregivers. Each ASAP, funded and overseen by the Executive Office of Elder Affairs, has a care management program for income eligible seniors over 60. Elders served under the care management program receive services like nutritional meals, housekeeping, laundry and shopping services, companionship and personal care. Their caregiver programs offer help for those family members caring for elders. Caregiver programs offer a variety of services including respite funds for in home helpers or a few days at a local day program for seniors, as well as an array of other services to ensure safety. There are also grant funded programs and scholarships to further help caregivers.
Another helpful resource is a caregiver support group. These groups help minimize the feeling of being alone; caregivers find others who, like them, need information and support in the caregiving role. Support groups on site at work, perhaps during the lunch hour, ease the employee attending one after work hours. A list of groups specific for Alzheimer’s can be found on the Alzheimer’s Association website www.alz.org/manh serving Massachusetts and New Hampshire.
It is essential that the caregiver is educated about Alzheimer’s disease and behavior changes to expect. There are always significant behavior changes if it is a memory disorder. Learning how to relate to someone with Alzheimer’s is important to gain their cooperation. Education and support significantly reduce the perceived burden of care. Research shows that telephone support for the Alzheimer caregiver can reduce the perceived burden of care. Recognizing their limits, learning about resources and asking for help, the caregiver finds relief in the care partnering role. Coping skills are improved as the care is shared, and work productivity is enhanced.
Beverly Moore is owner of StilMee™ The leader in Alzheimer coaching, a company exclusively dedicated to educating, empowering and supporting care partners through Alzheimer caregiving. StilMee coaches are available for in home coaching in Massachusetts including Cape Cod, and northern Rhode Island. Telephonic coaching is available anywhere in the United States. Look for the website www.StilMee.com for information. Beverly is also author of the book Matters of the Mind…and the Heart, Meeting the challenges of Alzheimer care, published July 2009. Go to her blog www.StilMeeCoach.blogspot.com
Caregivers generally experience an incremental increase in responsibility for an elder, not identifying themselves as caregivers at all. They may first help handling the bills, then help with the shopping, perhaps later accompany their family member on doctors’ appointments or pick up medications. They may start to notice the elder is not nourished adequately, preferring to eat simple sweets and tea rather than prepare a meal. So they stop in more frequently to deliver or prepare and share meals. The caregiver may finally realize that they need help. “Where do I go to find what help is available?” “Am I doing the right thing by mom?” “Is this the right decision?” Finally, “I can’t do this alone anymore.”
When the elder has Alzheimer’s which affects memory, reason and judgment, the responsibilities of the caregiver increase significantly. Safety and well being become a major concern. Alzheimer’s, a progressive cognitive illness, presents the caregiver with a long term commitment. This realization alone can be overwhelming. There is a comparison made that someone caring for a person with Alzheimer’s experiences the same stress as a soldier in combat; both are on duty 24/7, hyper-vigilant, waiting for the next emergency to appear, and not knowing when it will happen.
Many employees, I learned at the conference, do not access their Employee Assistance Program. Perhaps they fear being seen as weak and will eventually lose their job if they reveal the struggle balancing work and caregiving. Many are unaware of the wealth of information to be gained about resources for caregivers through their employer. Instead, they continue to muddle along alone.
It is the job of the Employee Assistance Program to research resources for their employees; it is unfortunate that caregivers don’t access help from their EAP sooner. Resources for caregivers can also be accessed at the local council on aging and, in Massachusetts, at one of the 27 Aging Service Access Point agencies that provide numerous services to elders and their caregivers. Each ASAP, funded and overseen by the Executive Office of Elder Affairs, has a care management program for income eligible seniors over 60. Elders served under the care management program receive services like nutritional meals, housekeeping, laundry and shopping services, companionship and personal care. Their caregiver programs offer help for those family members caring for elders. Caregiver programs offer a variety of services including respite funds for in home helpers or a few days at a local day program for seniors, as well as an array of other services to ensure safety. There are also grant funded programs and scholarships to further help caregivers.
Another helpful resource is a caregiver support group. These groups help minimize the feeling of being alone; caregivers find others who, like them, need information and support in the caregiving role. Support groups on site at work, perhaps during the lunch hour, ease the employee attending one after work hours. A list of groups specific for Alzheimer’s can be found on the Alzheimer’s Association website www.alz.org/manh serving Massachusetts and New Hampshire.
It is essential that the caregiver is educated about Alzheimer’s disease and behavior changes to expect. There are always significant behavior changes if it is a memory disorder. Learning how to relate to someone with Alzheimer’s is important to gain their cooperation. Education and support significantly reduce the perceived burden of care. Research shows that telephone support for the Alzheimer caregiver can reduce the perceived burden of care. Recognizing their limits, learning about resources and asking for help, the caregiver finds relief in the care partnering role. Coping skills are improved as the care is shared, and work productivity is enhanced.
Beverly Moore is owner of StilMee™ The leader in Alzheimer coaching, a company exclusively dedicated to educating, empowering and supporting care partners through Alzheimer caregiving. StilMee coaches are available for in home coaching in Massachusetts including Cape Cod, and northern Rhode Island. Telephonic coaching is available anywhere in the United States. Look for the website www.StilMee.com for information. Beverly is also author of the book Matters of the Mind…and the Heart, Meeting the challenges of Alzheimer care, published July 2009. Go to her blog www.StilMeeCoach.blogspot.com
Monday, July 5, 2010
Five Facts every caregiver must know
FIVE FACTS EVERY ALZHEIMER CAREGIVER MUST KNOW
1. THE PERSON WITH ALZHEIMER'S IS STILL A FULL PERSON; RELATE TO HIS PERSON
2. THE PERSON WITH ALZHEIMER'S CAN LEARN; WHEN GIVEN TIME AND LOW FRUSTRATION LEVEL,
HE CAN LEARN NEW THINGS AND ENJOY IT. GO TO WWW.SERPERMETHOD.COM FOR MORE.
3. THE PERSON WITH ALZHEIMER'S HAS MORE BRAIN POWER LEFT THAN IS GONE; TAP INTO
WHAT IS REMAINING AND ENJOY HIM.
4. THE PERSON WITH ALZHEIMER'S HAS A FUTURE (MAYBE MORE THAN YOU OR I HAVE).
MAKE IT A MEANINGFUL FUTURE.
5. AN ALZHEIMER CAREGIVER CANNOT DO IT ALONE; ASK AND ACCEPT HELP.
1. THE PERSON WITH ALZHEIMER'S IS STILL A FULL PERSON; RELATE TO HIS PERSON
2. THE PERSON WITH ALZHEIMER'S CAN LEARN; WHEN GIVEN TIME AND LOW FRUSTRATION LEVEL,
HE CAN LEARN NEW THINGS AND ENJOY IT. GO TO WWW.SERPERMETHOD.COM FOR MORE.
3. THE PERSON WITH ALZHEIMER'S HAS MORE BRAIN POWER LEFT THAN IS GONE; TAP INTO
WHAT IS REMAINING AND ENJOY HIM.
4. THE PERSON WITH ALZHEIMER'S HAS A FUTURE (MAYBE MORE THAN YOU OR I HAVE).
MAKE IT A MEANINGFUL FUTURE.
5. AN ALZHEIMER CAREGIVER CANNOT DO IT ALONE; ASK AND ACCEPT HELP.
Friday, July 2, 2010
Driving and the elderly
I attended an Alzheimer partnership meeting last week. Dr. Bob Stern from BUAD Research Center gave an update on driving and elders. Privilege to drive means INDEPENDENCE. For this reason, it is hard to terminate one's own driving never mind have to terminate another's. Most elders today are more self monitoring and stop driving when they feel their vision, hearing, strength, flexibility and ability to be attentive to their surroundings is impaired.
Driving and dementia is another story. People are often unaware of their deficits and continue to drive. However, many impairments in dementia make this hazardous. Slow intake and processing of information in the environment, insigtht, judgment, ability to attend to a task, spatial skills, contrast sensitivity, problem solving etc are all challenged in Alzheimer's. Seventy percent of people with Alzheimer's live in the community and twenty percent live alone. The question is, Who is driving?
Dr. Stern reviewed the testing that is done both real and simulated. All had their flaws. His team is working on devising a simple short tool that could be used in an office that would help determine the safety of a person continuing to drive. The team is looking for 55-95 year olds with and without memory loss who would be subjects in this study. It requires testing at the Center and an on the road driving evaluation. We all need to promote research participation to develop this tool.
He added that the law just passed to address the driving and elder challenge is not much different from what is already practiced in Massachusetts. People 75 don't need to be retested as suggested, AARP was against any age descrimination at all, and eye exams were all that would be required every five years as is already the case.
The talk generated much discussion and questions.
I'm in a study at BUADRC; the HOPE program, trying to see what normal cognitive changes in aging are and which are signs of cognitive decline.
Driving and dementia is another story. People are often unaware of their deficits and continue to drive. However, many impairments in dementia make this hazardous. Slow intake and processing of information in the environment, insigtht, judgment, ability to attend to a task, spatial skills, contrast sensitivity, problem solving etc are all challenged in Alzheimer's. Seventy percent of people with Alzheimer's live in the community and twenty percent live alone. The question is, Who is driving?
Dr. Stern reviewed the testing that is done both real and simulated. All had their flaws. His team is working on devising a simple short tool that could be used in an office that would help determine the safety of a person continuing to drive. The team is looking for 55-95 year olds with and without memory loss who would be subjects in this study. It requires testing at the Center and an on the road driving evaluation. We all need to promote research participation to develop this tool.
He added that the law just passed to address the driving and elder challenge is not much different from what is already practiced in Massachusetts. People 75 don't need to be retested as suggested, AARP was against any age descrimination at all, and eye exams were all that would be required every five years as is already the case.
The talk generated much discussion and questions.
I'm in a study at BUADRC; the HOPE program, trying to see what normal cognitive changes in aging are and which are signs of cognitive decline.
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