Caregivers Need a Break

Family caregivers, especially adult children caring for aging parents, need a break.

We've known for years that caregivers have a higher rate of illness - even death - than the person in their care. We know that caregiving is stressful physically, emotionally and psychologically.

We know that high blood pressure, sleepless nights, colds and depression are common problems among caregivers.

Now, another study of baby boomer adults caring for parents reaffirms these impressions, finding that "helping a parent results in a downward trajectory of health and well-being for the child." ("Routine Caregiver Duties Create Overload," Times of the Internet, Sept. 26, 2008)

Among the issues are the challenges of balancing many roles. Most baby boomer generation family caregivers are also working, managing their own household and caring for kids or even grandkids. They have parent-teacher conferences with their children, and then rush to their parent's home for caregiver meetings.

They are sandwich generation people, pressed down and put on the grill.

Giving caregivers a break may be as simple as giving them access to tools to help them cope. It may be offering support in terms of training for their role, so that as they face caregiving issues with their aging parents they know how to respond.

Knowledge, after all, can be one of the greatest stress relievers of all. And providing support in the form of access to training is something that can be done by anyone, from anywhere.

If you know of family caregivers that need a break, consider ways to help them gain access to caregiver training and resources. Contact us - we'll help.

Preventing Memory Loss - It's Easier than you Think

Most people who have a loved one with memory loss from Alzheimer's or another disease affecting the brain have a fear running through the back of their minds:

"Will I lose my ability to remember and reason? Will I get Alzheimer's disease, too?"

We do know that many forms of Alzheimer's disease have a genetic component, but we also know another thing that is a little more of a secret:

You can take steps NOW to prevent your own memory loss. These simple steps are incredibly effective, and easy to incorporate into your daily life, starting right now.

Don't believe me? Consider this information, taken from the long-running Nun Study in Minnesota, where an entire group of nuns have committed to participating in a study of aging and memory loss, including autopsy after death. Among the nuns are women whose brains, upon autopsy, looked like typical Alzheimer's brains but whose functioning was essential normal throughout their lives. Their secret? They diligently incorporated some of the very steps you can take today.

1. Exercise. No doubt about it: exercise will preserve good health and improve poor or marginal health. Many instances of memory loss are caused by small strokes in the brain. Best prevention for stroke? Exercise. It doesn't have to be in the gym; it doesn't need to be intense. It just needs to be regular and of long enough intensity and duration to make your heart work a little harder and cause just a little glow of sweat. Good rule of thumb? 30 minutes every single day of vigorous walking, dancing, swimming or whatever you enjoy doing.
2. Eat Right. Again, nothing you're not hearing from many sources today. But something most of us could improve on. Two food choices can make a significant difference in your brain health: variety and color. Try for as broad a variety as possible in your meals, especially in the fruit and vegetable department, and go for foods that are intensely colored: beets, berries and peppers, for example. Make those two changes and you've done quite a lot for your future brain health.
3. Keep learning. Read the paper and news magazines. Listen to talk shows that are on the opposite spectrum as your usual way of thinking. Then find someone to talk to about what you're learning, hearing and thinking. If that's too argumentative for you, join a class. Learn to play the piano, speak Spanish, or cook vegetarian. Free or inexpensive classes for adults abound in this country. Consider volunteering in student tutoring or teach a class yourself. Keep learning and keep your brain active and healthy.
   
4. Nourish friendships and stay socially involved. Staying socially active is important for overall life happiness as well as brain health. That doesn't mean you need to have a circle of 50 friends; a few close friends who make you laugh and enjoy life are just as effective. But don't lose touch, and do reach out to make new friends from time to time.

Four easy things that you're probably already doing in one form or another. But focusing on these four vital areas can help you preserve your brain health as long as possible.

What's Happening to Mom? - Taking the First Step

Carrie has a full-time job and two kids still at home. When her dad became ill and passed away unexpectedly, Carrie spent a lot of time with her mother, talking to her about what she would be doing with her life now.

Carrie worried about depression becoming a problem for her mom, and her mother being alone, but what she discovered was that her mother seemed unable to manage even the simplest daily tasks. Cooking seemed to be completely beyond her; even daily dressing, bathing and grooming tasks seemed overwhelming.

In just a few days, Carrie began to suspect that her mother had been experiencing a decline in mental functioning for a long time – her father had been “filling in the blanks,” and no one in the family had even noticed her mother’s failing. Carrie needs to figure out what to do to be the most helpful to her mother right now – at the same time she’s coping with the loss of her father, as well as her own full-time work and family demands.


Figuring out how to face this challenge in addition to your own life demands is the first step you’ll need to take. Learning to cope with your loved one’s needs without losing your mind is your biggest challenge, however!

The First Step

Get a diagnosis. This is the first step you need to take, and the sooner you take it the better. You may wish to go directly to a research center that specializes in Alzheimer’s disease (most university hospitals have these kinds of programs). Or, you may need to start with a family doctor, and go from there for further tests, if necessary.

A visit to the doctor for a thorough check-up is the first important step.

You may hear, “There’s nothing wrong with me – I’m not going to the doctor.” Right off the mark, you need to learn some new skills.

Start with this one: Reassurance. “Dad, I’ll go with you, and I’ll stay with you the whole time – it’s no big deal.”

If that doesn’t work, try bargaining. “Mom, if you’ll just do this for me, we can go to lunch together afterward and have a nice, long chat at your favorite restaurant.”

If that still doesn’t work, try diversion: “Honey, I need you to go to the doctor so the kids will stop nagging me. I’m getting sick and tired of the nagging – it’s up to you to get those kids off my back.”

These are skills you’ll develop and learn to use like a pro over time. You’ll find that you need a whole new set of skills to be most helpful to your loved one, and keep your own sanity intact.

The least useful approach both now and in the future is argument. You might also call this debate, persuasion, or explanation. Whatever you call it, it won’t work! When the brain functioning is impaired, even slightly, a factual presentation is likely to be futile. Logic is frequently one of the first brain functions to diminish, so no matter how grounded in facts your arguments may be, you just won’t win. Try some of the other “tools” for accomplishing necessary goals.

Janice had tried every logical approach she could think of to get her husband Mac to agree to go to the doctor for testing. Each time she brought it up, Mac simply refused to go. “I’m perfectly fine,” he’d say.

Finally, at her wits end, Janice said, “I promised the kids that we’d both get to the doctor for a check-up. I’ll go first if you’ll go after me.” Reluctantly, Mac agreed to go. Janice got a same day appointment, and took Mac in before he was able to change his mind and refuse again.

Once you get an agreement to go to the doctor, you’ll want to consider the following things:

• Accompany your loved one to the doctor – all the way in. Don’t send him or her into the examining room alone.

• Make notes about what you’ve observed – details and facts, suspicions and observations. Take your notes with you, and don’t hesitate to read them to the doctor, or simply give them to the doctor. Can you do this in front of your loved one? Try it – you may be surprised how accepting your loved one is with the facts you present, especially if you word them as facts. For example, “Dad got lost coming home from the store last week. It was kind of scary for us both.” If you just can’t read your notes in front of your loved one, simply hand them to the doctor or nurse to read. Be prepared for your loved one to become suspicious about what you might have to say “behind my back,” and make an effort to include your loved one in your discussions with the doctor if at all possible. Most individuals with early stage memory loss are keenly aware of what they are losing, and this is distressing to them as well. Talking about it openly can actually be very freeing for both of you. Whispering about things tends to reinforce our society’s stigmatizing of diseases causing dementia. Choosing to openly discuss all of the facets of memory loss and dementia can help both you and your loved one face this disease rather than feel that it needs to stay “hidden.”

• Ask for tests. If your loved one has just suffered a significant loss – from a spouse to a beloved pet – be aware that depression could be the problem. Untreated, lingering depression can cause a person to act like they have dementia or another brain impairment. With appropriate medication and perhaps a “friendly visitor” program or brief talking therapy, your loved one may be able to work through the depression and re-gain complete mental functioning. Other physical problems like bladder infections, pneumonia, or vision or hearing losses can look on the surface like Alzheimer’s disease. These problems are generally completely treatable, and what looks like dementia can be totally reversed if the underlying health problems are addressed. Be aware that simple things like drug interactions, dehydration and malnutrition – fairly common problems for the elderly person living home alone – can cause the appearance of dementia. Ask the doctor to test for these and similar treatable physical ailments before you both assume that your loved one has dementia.
  

• Expect your loved one to be much more lucid at the doctor’s office than what you’ve observed. This can drive you nuts, especially if the doctor is not experienced in diagnosing dementia, and looks at you like you’re the one with the problem! This is so common that, fortunately, the medical community is beginning to catch on, and educate doctors to look beyond the “perfectly normal” presentation in the office. Be prepared that your loved one may even be able to ace the “mental status exam” that a physician can complete in 2 minutes during an office visit. If this happens, ask for a referral to a neurologist, or seek out an Alzheimer’s diagnostic center at a nearby University or teaching hospital. Don’t let this distress you. Take a deep breath, and know that what you’re going through is very common and normal. Keep at it until you find a doctor who is really able to see what you’ve been seeing, and help you find an appropriate treatment plan.

• Ask about medications. Once the physician has ruled out treatable problems, and has determined that your loved one likely has a disease like Alzheimer’s, ask about medications. The drugs currently available to “treat” Alzheimer’s disease and other dementias work best during the earliest stages of the disease. During this time, medications can be truly helpful, and can help your loved one regain some functioning, and, barring that, can delay significantly the progression of the disease. Imagine giving your loved one a year or two of extra independence, and what a difference that can make to him or her, both personally and financially. Ask about those medications!

What's Happening to Mom? - what to do when you first discover - or just suspect - your loved one has Alzheimer's disease

You’re reeling from the diagnosis the doctor gave you. Your loved one has dementia – what is that? What does it mean for him (or her) – and for you?

You’ve come to visit your loved one after being away for a while – and something clearly is not right. Is it Alzheimer’s disease? Is it something else – or just you?

You’ve just lost a parent, and the surviving parent seems to be totally unable to cope. You’re dealing with your own sense of loss, and struggling to make sense of what’s happening to your surviving parent at the same time. You need help!

You’re one of the millions of family members who is forced to face the daily consequences of the diseases causing memory loss and dementia, and figuring out what to do now is your first – and most important – challenge.

The Discovery

Typically, the discovery of a disease causing memory loss and dementia comes on slowly. You may be able to look back and realize that there were hints for months, maybe even years, before the moment when you came to the conclusion that Mom or Dad was not just become more and more “eccentric.” Some professionals refer to this period before the discovery as a period of “denial” when family members simply refuse to accept that something is really wrong.

More often, however, family members just don’t put all the clues together until something happens to bring the concerns to the forefront. That could be one pivotal event – Dad went out for a drive and got lost for hours before coming back home.

Or, even more commonly, the discovery comes on slowly, as, over time, you notice more and more signs of a change in your loved one.

Perhaps you realize that bills are not getting paid. Perhaps you notice that your obsessively neat parent forgot to shave for 2 or 3 days in a row, or neglected to change clothes for several days. Perhaps you notice a change in behavior – a use of language that seems out of character; a need for continual contact or reassurance that is unusual.

Perhaps your loved one looks at you with no recognition – or asks you why you never come to visit when you were just there yesterday.

Perhaps your loved one turns on you and threatens to call the police and report you for stealing money, wallets or possessions.

If you’re like millions of other family members facing this moment of discovery, your first reaction may be dismay, especially if you have other responsibilities in your life.

What now?

How on earth do I cope with this, in addition to my regular, busy, full-time life?

We'll explore these questions, and begin answering them, in future articles. Join us!

Families Need Support, too

This evening we're going to participate in the family support group sponsored by our local hospital.

We'll be talking about ways families can get support while they're busy providing care to their loved ones. One of the pieces we'll talk about is holding a family council or a family meeting. Based on our experiences we'll share ideas on when, where and how to get the whole family involved in the process of providing care - or at least supportive of those family members that do the direct work.

Families can be torn apart when caregiving decisions become difficult. When to get help ("Our Mom needs help? Are you sure?"); how to get help ("I hope you're not going to ask me to help pay for it!"); and heaven-forbid, the discussion about moving mom or dad out of the family home into a retirement center, assisted living community or nursing home ("I promised Mom she'd never have to leave home").

But you probably know exactly how this goes. The child living furthest away, doing the least amount of daily work, is still the saint, while the busiest child, helping every day with tasks big and small, is rarely the most valued and appreciated by the aging parent.

So tonight we'll go meet with some families who are right in the middle of this situation, and who come together, leaving their warm, cozy homes to venture out at night, for a little support and encouragement.

Sometimes all we can give is a little help. But sometimes that's all that's needed.

If you'd like a copy of our booklet titled "Holding a Family Council: A Guide to Family Decision-Making about Long Term Care Issues" email me at Sharon@aquiretraining.com.

Stuck in the Middle, but Still Smiling

Stuck in the Middle, but Still Smiling

Where it all began, May, 2005: After years of teaching about, counseling with and writing about them, I've become one. One of the people stuck in the middle - the "sandwich generation," we so fancifully call them.

In addition to the challenges we face raising three teenage daughters, my husband and I are now helping BOTH of our parents make a well-considered change in their living circumstances - hopefully before something happens that forces this change.

Both my husband's and my parents are getting to the point where if one little thing happens, staying in their own homes will not be an option. You know them - the people who, at age 92, are still "several years" away from needing to move from their home. We're encouraging them both to move into a retirement community that offers them all the benefits that they don't have in their isolated lives at home.

Of course, they've been balking - big time. We decided to use a little psychology – always a good thing when you’re the ones plastered in the middle – and we convinced each set of parents that we needed their help getting the other set of parents to agree to a move. Each set thinks the other “really needs to move!”

When we finally got both sets of folks to agree to tour – together - a beautiful, new retirement community close to our home, it took about a month to set a date convenient to all - and that's after two cancellations. Then, when we arrived, both my mother and mother-in-law stood there with jaw set, saying, "No way are we moving in here with these old people!"

By the end of the tour (three hours later), they had softened, and realized that this could actually be fun - a good thing!

Of course now they want to tour several other communities to comparison shop, and of course, they want us to come with them. We, who have SO much extra time in our lives!

Then there are the kids: our eldest away at college, still needing her mom and dad to help her through the challenges she's facing being away from home for the first time in her life. The middle daughter, who calmly cruises along - until the high school pressure builds up, at which point we have major DRAMA, as the girls like to say. And then there's the youngest one, who's determined to chart her own course in life, and not follow in her older sisters' footprints, no matter what it takes!

And we're stuck in the middle. No peanut butter and jelly on this "sandwich" - just lots of time-consuming, emotion-draining listening, coaching and guiding.

But last Mother's Day, as we made the round of the parents, we saw in their eyes a new energy, and an excitement for a new phase in their lives. They couldn't stop talking about what it's going to take to get their homes ready to sell, or what they should do with all their (tons and tons and tons) of belongings.

The Mother's Day cards I got brought tears to my eyes, and even had me sobbing out loud (thank-you again, daughter #1).

And just for a day, I thought what a blessing it is to be surrounded by family, even when the pressure is coming from both sides. Being "smushed in the middle" isn't such a bad thing after all.