Don’t Just Blame Dementia

Don’t Just Blame Dementia

BLOGGER: Michael B. Friedman, LMSW

After a person has been diagnosed with Alzheimer’s disease or other dementia, subsequent emotional, mental, cognitive, and behavioral problems are usually blamed on the disease.  Other possible reasons including behavioral disorders such as depression, anxiety, or substance abuse or ordinary human reactions to tough realities are very often ignored.

“Grandma seems terribly sad.”
“  Of course, she has Alzheimer’s”
“Grandpa has been nasty lately“.
“It’s the Alzheimer’s.
“  Uncle John doesn’t enjoy life anymore.”
“  Who would?  He has dementia.”
“  Mom isn’t eating much or isn’t taking her pills or isn’t getting any exercise.”
“It must be the Alzheimer’s”.

Not necessarily.  In fact, blaming dementia very often gets in the way of understanding what is really going on and doing something about it that will help.

If there were a pill that would reverse, stop, or — better yet — cure Alzheimer’s, it might be useful to understand the emotional and behavioral problems of people with dementia solely in terms of the disease.  But the best pills available now only delay the unavoidable decline in memory and other cognitive functions.  That’s worth doing, of course, for the people for whom the pills work.  But counting on the doctor to come up with medicine that will make a big difference usually is disappointing.

People with dementia experience many of the same emotions as people without dementia, but they are at higher risk than older adults without dementia for diagnosable mood and anxiety disorders, both of which can result in declines in cognitive functioning that are similar to the decline associated with dementia.

Unlike dementia, however, depression and anxiety can be treated effectively; and if they are, the loss of cognitive functioning that is caused by these disorders can be reversed.  To be clear, treating depression and/or anxiety does not reverse dementia and the loss of cognitive functioning caused by dementia.  But effective treatment for mood or anxiety disorders can result in overall improvement of functioning that can make a very big difference in a person’s life.

These days, of course, the first line of response to depression and anxiety is medication.  However wise that is for people without dementia, it is unwise for those with dementia.  Medication can be helpful, but it can also be dangerous.  At the very least, doses must usually be lower than for younger adults.

Better is to begin with interventions that do not rely on medications.  Some formal psychotherapies can be helpful, such as “cognitive-behavior” and “interpersonal” therapy.  Exercise, interesting activities, and social contact with people they enjoy can also be extremely helpful.

Most important is to understand (1) that people with dementia are adults with meaningful life histories, personal interests, individual desires, and a need for dignity and respect and (2) that behavioral “problems” are to a significant extent in the eye of the beholder.  People with greater understanding and tolerance of behavior, that most people find trying, are generally better able to help people with dementia to get the most out of life.

I don’t mean to make this sound easy.  Some people with dementia are so profoundly sad and lost in themselves that they may be impossible to reach.  Some people are “scared to death” by the slightest change in routine.  Some people completely deny that they have any need for help.  Some people are abusive towards anyone who tries to help them, evoking responses in kind from many — if not most — of us.

But many people could be helped to overcome emotional problems that co-occur with, but are not caused by, dementia.

In an ideal world everyone with dementia would be able to get a sophisticated assessment to distinguish between the effects of dementia and other disorders and then to get the treatment that would be most likely to be effective.  But in the real world there is a terrible shortage of physicians who understand the subtle differences between dementia and depression and other disorders.  In the real world there is a terrible shortage of geriatric psychiatrists and other mental health professionals.  And in the real world, paid and family caregivers usually do not get training and support to help them be more skillful with and tolerant of the people they care for.

Our nation needs major changes in policy to address these shortfalls.  In the meantime, however, we need to understand that there are ordinary emotional causes for the sadness, disengagement, and anger experienced by so many people with dementia and that we caregivers can do much to meet human needs often neglected because of a frightening diagnosis.

Grandma is sad?  Grandpa is nasty?  Maybe they are clinically depressed and could benefit from treatment.  Maybe she’s lonely and he feels he’s being treated like a child.  Maybe it’s something else.  But be careful not to jump to the conclusion that it’s because of the dementia.

 

Is Melancholy an Inevitable Outcome of Getting Old?

Elderly Depression: Is Melancholy an Inevitable Outcome of Getting Old?

BLOGGERS: Michael B. Friedman, LMSW and Lisa Furst, LMSW

Depression is dangerous and one of the most significant impediments to aging well.

People with depression[i] usually experience a profound sadness and sense of hopelessness that goes far beyond ordinary unhappiness.  They often experience terrible psychic pain, which some people report is harder to bear than severe physical pain.

People with depression often experience a profound disinterest in life.  What has made them happy and kept them vibrant no longer does.  Life may have no meaning for them.

People with depression often find it difficult to carry on ordinary life functions.  They may have trouble sleeping or sleep too much.  They may have no interest in food or may stuff themselves in futile efforts to counter their bad mood.  They may find it difficult to concentrate on work, day-to-day tasks, or social interaction.  They may ruminate about relatively minor matters and be unable to make a decision or forgive themselves for errors or discourtesies.  They may feel that doing anything takes too great an effort.  They may always expect the worst and give up without trying.  They may be angry much of the time, easily irritated by small aggravations.  They may often think about death, even about taking their own lives.

People with depression have lower life expectancy than those without.  The combination of depression and a serious, chronic physical illness, such as diabetes and heart disease, results in greater risks for disability and premature death than for people with the same physical conditions without depression.[ii]

People with depression are also more likely to be socially isolated and caught in a vicious cycle in which depression feeds isolation and isolation feeds depression[iii].

Most people who complete suicide are depressed.[iv] And the sense of hopelessness inherent in depression makes many people reluctant to seek or accept help.

Obviously, depression makes it hard to live well at any age, including old age.

The good news for older adults is that, contrary to common belief, depression is not a normal or inevitable outcome of aging.  But the ageist expectation that it is frequently results in failure to take steps to overcome it.  ”There’s nothing to be done.  They’re just old.”  This attitude too often robs older people of opportunities to enjoy life.

In fact, each year major depressive disorder affects fewer than 5 percent of adults 65 or older who live in the community.[v] The rate is higher among older adults with serious chronic health conditions, those who need home health care and those who are institutionalized.

A much higher proportion of older adults who live in the community — perhaps 20 percent — experience symptoms and forms of mood disorders, such as dysthymia or sub-syndromal depression[vi], that are not as severe as major depressive disorder but may have nearly as much negative impact[vii].

So, a significant proportion of older adults suffers from depression.  But, it is important to note, 75 to 80 percent of older adults do not experience depression in any given year.  Depression — to say it again — is not normal in old age, an encouraging fact for those who may feel hopeless about their lives.

Depression often can be treated effectively or overcome through other means such as meaningful relationships, activities, or spiritual experience.  Unfortunately, it often goes unrecognized.

One reason for this is that it may not look like “depression”.  Frequently, it is expressed through physical symptoms such as headaches, “stomach” problems, aches and pains, fatigue or insomnia.

Depression also can be hard to recognize because it does not necessarily involve having a depressed mood.  There are two “cardinal” symptoms of major depressive disorder — profound sadness for two weeks or more and loss of interest and pleasure in activities that have had the greatest personal meaning.  It is necessary to have one, but not both, of these symptoms to be diagnosed with major depression.  It may seem strange, but there is depression without sadness[viii].

In older adults, depression may be missed because it involves cognitive difficulties that get diagnosed as dementia.  This common misdiagnosis is terribly unfortunate because successful treatment of depression can restore cognitive capacities that have been lost due to depression — even in people with dementia.[ix]

Finally, depression can be hard to spot because many people with depression are able to hide it.  From the outside they may seem unchanged, even though they may be suffering terribly on the inside.

So depression is dangerous, and it often goes unrecognized and untreated, depriving older adults of opportunities to get the most out of life.  What can be done about this?  We will address this question in our next post.

In the meantime, if you or someone you care about needs help, call 1-800-273-TALK.

And to find a geriatric psychiatrist in your area, refer to the website of the Geriatric Mental Health Foundation, http://www.gmhfonline.org/gmhf/find.asp.

This article was co-authored with Lisa Furst, L.M.S.W., Director of the Training and Technical Assistance Center of The Geriatric Mental Health Alliance of New York and co-author of  Depressed Older Adults: Education and Screening

“Eat Your Vegetables!” mother said…

BLOGGER:  JULIE WEBSTER

Did she really have all the information we do today or was this just instinct? What we really should eat hasn’t changed that much for a very long time. It is what we DO eat that has created the current health crisis. Not only have we gone away from real food and towards predominately eating processed food but the decrease in consumption of fruits and (especially) vegetables has increased tremendously!

More and more research is coming to the forefront about the importance of having fruits and vegetables as the major portion of our diets. According to the Center for Disease Control and Prevention, “At least one-third of annual cancer deaths in the United States are related to dietary factors. Increased fruit and vegetable consumption can reduce cancer risk, but less than one-third of U.S. adults eat the recommended servings of fruit and vegetables every day.” Yet, the idea is not new. Books have been written for years on this subject. Some say the concept goes back as far as Hippocrates!

So what exactly is the big deal? Why are these foods so much better for us?

To begin, fruits and vegetables are high in vitamins, minerals and fiber. They are loaded with antioxidants which keep our cells from being broken down so easily by free radicals. They are nutrient dense. In other words they are loaded with lots of healthful ingredients and low in calories so you can eat a ton of them, be completely satisfied and still be way lower in calories than when eating other foods. Best of all, they provide your tissues with an alkaline environment.

Alkaline environment… what does that mean? When foods are metabolized or broken down by the body, they provide the body with energy and leave behind ash. That ash can either be alkaline-forming or acid-forming; based on the mineral content of the foods. The alkaline forming minerals are calcium, magnesium, sodium, potassium, iron, and manganese. The acid forming minerals are phosphorous, sulfur, chlorine, iodine, bromine, fluorine, copper and silicon. So, those foods that are high in alkaline-forming ash will provide your body with a healthier environment.

If you consume too many foods that are acid-forming, it can wreak havoc on you. As said by Dr. Theodore A. Baroody, author of Alkalize or Die,” in my opinion, acid wastes literally attack the joints, tissues, muscles, organs and glands causing minor to major dysfunction. If they attack the muscles, you could possibly end up with myofibrosis (aching muscles). If they attack the organs and glands, a myriad of illnesses could occur.”

Amongst the biggest culprits for acid-forming ash are fast foods, processed foods, refined sugars, drugs, and chemicals. Proteins such as meat, dairy, and fish are also acid-forming and yet are important in the diet when taken in proper amounts. Grains and legumes are also acid-forming. Too many of any of these substances consequently leads to an acid environment in the body and can result in disease, infections and especially inflammatory conditions such as arthritis.

In addition, we need to have an alkaline reserve in our body for other situations. Lack of exercise can be acid-forming for exercise helps to regulate the acid/alkaline balance via respiration. Stress is a big acid-forming condition. If we are stressed out or angry, our bodies produce large amounts of acid-forming ash. Since this is quite prevalent in today’s society, offering your body more of the alkaline-forming foods is that much more important.

As you can see, there is a fine balance. This balance is referred to as pH or the measure of concentration of hydrogen in the body. A pH above 7 is alkaline. Theories vary as to how alkaline our body (ash) needs to be and yet the range is narrow. Most say a pH of around 7.4 is ideal. Based on what I’ve read that number can vary slightly and how to measure your precise pH (in your body) is actually quite difficult to determine. Having said all this, we do need to be on the alkaline side of the chart and this is mostly determined by what we eat.

Before we get into the foods themselves, let us look at one other major factor – an acid called hydrochloric acid or HCL. This is the only acid our body actually produces and it is essential to life. It is the first substance in the stomach that breaks down our foods. Lack of it and our foods would just be a mass of undigested waste. Along with water and enzymes, HCL digests protein into the eight essential amino acids vital to life. Without it, we would not be able to absorb B12 or folic acid. In addition, this strong acid kills most bacteria that enters into our body with the food we eat. Last, it keeps us alive by maintaining the proper alkaline/acid balance and becomes alkaline itself after doing its job.

Lack of or excess amounts of hydrochloric acid have the same symptoms – heartburn, burning sensation in the stomach. Most times, people think it is ‘too much acid’ rather than not enough and end up taking anti-acid tablets, thus decreasing the amount of HCL even further. It is more common that there is not enough HCL. Hydrochloric acid production starts to decline around the age of 40. If you suffer from heartburn, are over 40 or have eaten poorly for an extended number of years, you might consider consulting with a nutritionist about taking a HCL supplement.

So now that we know all this, how are we supposed to eat? To begin, let us look at the side of food that is confusing. One of the greatest alkaline-forming foods is the lemon. We often think of a lemon as being very acid in nature and yet the end result is the opposite. Lemons produce a very alkaline-forming ash due to their mineral content. As mentioned before, the minerals calcium, magnesium, sodium, potassium, iron, and manganese all end up creating an alkaline-forming ash. Well, lemons happen to be high in potassium, calcium and magnesium! See how it works?

Generally all fruits and vegetables are alkaline-forming while all other foods are acid-forming.  To maintain a healthy body, it is suggested that your diet is a minimum of 70% alkaline and 30% acid-forming foods.  This ratio is even better at 80% to 20% respectively.  If you suffer from any type of disease, inflammatory condition or have a great deal of stress in your life, you might consider upping the ratio to 90% and 10% respectively.  Also, based on the degree of alkalinity to acidity (for example some foods have a greater degree of alkaline or acid), you can play with what you eat.  I have provided a chart showing you most foods.  Simply download this pdf and keep it on your refrigerator.  Last, to make it easy when you are eating out, think about your plate being 70-90% full of vegetables and fruits with the rest of the plate being filled with protein.  You may think this is impossible but just ask.  I often ask for steamed spinach or extra vegetables instead of the bread or pasta they offer.  Usually they are glad to accommodate you.  (For thoughts on grains, listen to this podcast.)

For many of you this might be a new concept and very different way of eating. I strongly suggest you start slowly. Gradually add in more fruits and vegetables, with vegetables being the major addition. At the same time start decreasing the worst of the acid-forming foods first – such as junk food, fast food, processed food, and sugar. Give yourself several months to make the changes. Over time you will be amazed how much better you feel and how much more energy you have!

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website: www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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Why Healthy Posture is So Important!

BLOGGER:  JULIE WEBSTER

Let us look at this in greater depth. The body is designed to work at an optimal level within gravity. Joints, bones and ligaments are stacked in such a way to use the least amount of energy to hold us upright, to be able to stand or sit effortlessly.

Have you ever watched a young child sit? Do you notice they don’t typically lean back in the chair but rather naturally sit quite straight with no effort? What happens as we go through life that we start to rely on that chair back to hold us up? Or that we stand in such a way as to put more pressure on our entire being? These are some of the questions that started to arise as I became professionally involved in health.

To begin, posture plays a large role in how we approach life. If we are hunched over or in pain from poor posture, it shows. We give off signs of lack of self confidence, lack of intelligence, being overly tired, shyness, and more. In addition, if our posture isn’t optimal, the amount of energy it takes to go through daily life increases exponentially. No longer can we rely on the structural body to hold us up but rather our muscles now must be recruited to fight gravity, causing us to expend a great deal of energy. Our entire being is compromised and energy that should be used to enjoy life is used just to hold us up, literally.

So what really happens? To start, we have become a sedentary society. No longer do most of us make our living by working in the fields, walking long distances, carrying packages, and so forth. Instead we spend long periods of time sitting at a desk followed all too often by sitting in front of the computer or television when we get home. Our bodies have become lazy. Some muscles hardly have to work much at all in these situations. Not only do they not have to engage but, allow them to be in a shortened position for a long enough period of time and they will stay shorten indefinitely. Other muscles, at the same time, will be in an elongated position with some working overtime and others just becoming weaker. All this results in our muscles being imbalanced and our joints compromised. Along with these changes, we can experience pain, burning, numbness, weakness, tingling and more. Depending on the situation, nerves can be compressed and lead to syndromes such as Thoracic Outlet Syndrome and Carpal Tunnel. Low back pain, which is all too common, is often a result of poor posture and muscular imbalance. Consequently the typical answer to these complaints, often result in surgery or pain medications. Although this might be necessary under certain circumstances, they should never be the first choice of treatment.

Let’s start with looking at the head and neck. Under normal circumstances, the head should sit right on top of the shoulders, with the correct position being the ear vertically in alignment with the shoulder joint. Unfortunately all too often the head starts to jut forward. Some of the common reasons for this are from slouching, trying to read something that is too small (so you lean forward to read it), lack of lumbar support while sitting or from improper positioning of a computer screen. Our head typically weighs between 12 – 15 pounds; a lot of weight when you think about it and yet if sitting as it should, effortless for the muscles. Take it out of that ideal position however and multiple problems can arise. Dr. Rene Cailliet says that for every inch the head is forward of its’ ideal position adds 30 pounds of pressure onto the posterior neck muscles! In addition, this position can result in:

• Added pressure to the facet joints of the vertebrae which have a great deal of pain receptors, thus causing pain perception to increase
• Constriction of blood flow to the muscles, resulting in unhealthy muscles that become prone to injury
• Tight muscles that tend to refer pain to the head, resulting in headaches
• The health of the temporomandibular joint causing TMJ dysfunction
• Carpal tunnel symptoms

Let us move on to the shoulders. Typically the upper back has a slight convex curve. When in this position, the vertebrae are stacked properly and the ligaments on either side of the vertebrae maintain this position. As we start to slouch forward, the shoulders tend to round inward. The muscles in the upper back are in an overstretched position and are now having to work hard to keep you from falling over forward. The muscles in the front of the chest are becoming shorter with the potential to compress the nerves that innervate the arms. One of the most common results is known as Thoracic Outlet Syndrome. In addition, the following complaints can arise:

• Burning between the shoulder blades
• Chest pain
• Shoulder pain
• Carpal Tunnel syndrome
• Arm pain
• Inability to take a full deep breath

Next is one of the most common areas of complaint – the lower back. A great deal of work has been missed in our country from low back pain and much of it can be avoided. To begin, we will look at the role sitting plays. When sitting for a long period of time, the muscles in the front of the hips, known as the hip flexors, are in a very short position. They are used a great deal during walking so they do not tend to get weak, as the upper back muscles, but they do become very short. This results in changing the normal position of the pelvis and creating what is known as an anterior pelvic tilt. A small degree of anterior pelvic positioning is normal for women whereas men’s pelvis should stay neutral. The issues arise when this position is exaggerated. The pressure tends to be moved posterior to the discs, putting a great deal of pressure on the facet joints. Remember as mentioned earlier, facet joints are loaded with pain receptors.

In addition to sitting, the pelvis can end up in an anterior position due to being overweight, especially when we carry our fat in our bellies. Belly fat puts a great deal of added weight in front of the body. The only way to compensate for this added weight is to shift the positioning of the pelvis into that exaggerated anterior pelvic position, once again causing an increase in low back pain.

Along with general pain complaints from the low back, the following issues can arise:

• Sciatica
• Hip pain
• Neurological complaints in the legs

So what do we do about all this? It would be great if we could move away from sitting for extended periods of time but this is unlikely. Rather we need to work within the parameters of our society. The following is a list of ideas that can have a positive impact on our posture thus decreasing or eliminating the negative results of poor posture:

Movement or regular exercise: By getting the blood to flow throughout the entire body, the muscles are receiving fresh nutrients and eliminating waste products. These waste products in and of themselves can cause pain. Also by moving, we are taking the muscles through a greater range of motion which can be a start to add length and strength to the muscles.

Stretching: Working to lengthen the shortened muscles before strengthening the elongated weaker muscles will aid in realignment of the skeletal system. It is important that specific stretches are given in order to lengthen the appropriate muscles.

Strengthening: Once the shortened muscles are working towards being longer, it is then time to add in exercises to strengthen those muscles on the elongated side of the joint. This is important to allow the body to regain a healthy posture where the joints and ligaments are able to do their job thus decreasing the amount of energy it takes to remain upright in gravity.

Ergonomics: Assessing the position of the person to the height of the desk, the relationship to the chair, the positioning of the computer and so forth is a key. Only focusing on ergonomics will not change the posture by itself but rather help to maintain the healthier posture with the aforementioned suggestions.

Diet: Although not directly involved in posture, it does play a large role in the health of the muscles. Eliminating fast food, sugar, refined foods, soda, excess caffeine and more will enable the muscles to receive the nutrients need for maintaining health. A healthy diet will also decrease constriction of blood flow thus allowing the entire body to process waste products at a healthier rate.

These are just some suggestions to creating a healthier posture. Remember posture is much more than just looking good. By having a body that is fully supported by the appropriate joints and ligaments, we will have more time and energy to enjoy all aspects of life and to live it to its’ fullest. Isn’t it time to take a good look at your body?

Julie Webster is a Certified Massage Therapist and Certified Health Counselor. She provides health education online and through seminars. In addition she has written a book titled “Regaining Good Posture” which is available as an ebook, with videos performing each of the stretches, through her website: www.julie-webster.com Julie is also available for presentations on posture and various health topics to corporations. To reach her visit her website or email her at info@julie-webster.com

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Coping with Dementia: A Caregiver’s Guide

Coping With Dementia: A Caregiver’s Guide

BLOGGERS: MARY A. LANGUIRAND, PHD

ROBERT F. BORNSTEIN, PHD

Many people who have experienced a loved one’s dementia have said that given the choice, they’d rather deal with almost any other ailment, no matter how painful or debilitating.  Medical science has gotten pretty good at alleviating pain or restoring physical function—hearts can be made to beat properly, lost limbs can be accommodated with prosthetic devices, failed organs can be replaced via transplant.  However, there’s almost nothing we can do to fix the deterioration of memory, communication skills, and reasoning that dementia steals away.  Some recent experimental drugs hold promise, but at this point most of those medications are just that: experimental.  And few experiences are as frustrating as watching a once-vibrant, intelligent, witty person deteriorate into a confused stranger.

There are numerous forms of dementia, and great differences from person to person in how dementia symptoms are expressed.  However, all forms of dementia have certain common features.  These include:

• loss of memory and impairment in reasoning abilities
• changes in the ability to produce and/or understand verbal, written, and symbolic language
• deterioration in everyday practical skills

In the early stages of dementia, the person usually knows that ‘something is wrong’.  She may realize that she is having difficulty remembering names, balancing a checkbook, or figuring out how to use the microwave.  Some people acknowledge their problems openly and voice frustration, fear, or embarrassment about them.  While this response may provoke worry in you, it’s actually pretty adaptive: It’s an opportunity to discuss the problems openly, and work on ways to address them.

Things get trickier when your loved one goes to great lengths to hide or deny their difficulties.  They may offer plausible explanations and excuses.  “I read perfectly well—I just need new glasses!”  “The buttons on that remote are too small!”  “I know exactly where I left my bag!  It’s not there—somebody must have taken it!”

At first you will probably respond with problem-solving suggestions and helpful gestures, arranging eye appointments, buying new remotes, and so forth.  You’ll eventually find that most of these efforts don’t actually solve the problems (even if they help temporarily).  Worse, over time your efforts may be met with angry rejection, recriminations, or even abuse: Dementia is frightening to the person who has it (even if they deny it), and they’re likely to lash out at the nearest moving target.  That’s you.

You may both get pretty frustrated and angry with one another during this period, and the relationship may become quite fraught.  You feel that you are always encountering an angry, frightened, edgy person who is quick to attack you for their problems.  The care-receiver feels that they’re being patronized, marginalized, or discounted.

As the disease progresses, the capacity for realizing that there are problems fades, and the person with dementia becomes less aware of her behavior and its impact.  At this point, the patient is often blessed with ‘pleasant confusion,’ especially if their environment can anticipate and meet most of their needs successfully.  They may not be able to tell you who’s president, name their grandchildren, or recall how to cook a favorite meal, but as long as they can be physically comfortable, they tend to accept whatever is happening without question.  Some skills and pieces of information may be preserved pretty well—they may be able to knit with great skill, or recite baseball statistics from games they watched 30 years ago with total accuracy.  Often, they will construct a sort of “Reader’s Digest” version of their life experiences and beliefs, which will be presented as indisputable fact.  When the story is reasonably accurate and presents all the players in a favorable light, it can be a pretty good construct (so leave it alone).  Problems arise when significant distortions or hard-to-hear criticisms of yourself or those you love get incorporated into the narrative.  Hearing one parent criticize the other, or advise new acquaintances that your spouse is a real loser hurts, even if there’s some truth to the observation.  Worse, you (and everyone else) will hear it over and over.  The temptation to argue, correct, or defend may be very strong.  Sadly, facts and logic usually get you nowhere.

So, what do you do?  Some responses tend to work better than others.

First, remain calm. Answering the same question 20 times in one afternoon or hearing your loved one recite a totally skewed account of events for the hundredth time can make you want to scream.  Losing your cool helps nobody.  Your loved one did not develop dementia in order to annoy you, they’re not doing it on purpose, and they can’t help it.  So change the subject.  Suggest that you go out on the patio and look at the flowers.  Take a break.  If all else fails, leave—do something that will help you regain control.  Take a walk, grab a cup or tea, call a friend, pray.

Distraction sometimes works. Some realities will not change however much you discuss them, rendering the interaction upsetting and pointless.  “Re-direction” is the formal term for moving from a hot topic to something more neutral.  It’s harder to do than it sounds, especially with people with dementia, who can be surprisingly stubborn in their focus on a given topic.  However, persistence can sometimes pay off.  “Why can’t I go home with you tonight?”  can be countered with “They’re going to be showing your favorite movie in the dining room after dinner.  Remember how great Bogart was in Casablanca?”

Keep problem-solving efforts reasonable. When Mom complains that the telephone buttons are too small, buy her a phone with bigger numbers.  When she complains that there are ‘too many numbers to dial,’ program the speed dial function, and leave a note explaining how to use it.  However, when she complains that she can’t actually reach anybody on the phone in spite of all these efforts, what are you supposed to do?  That one’s a trap, so you may want to respond with a vague reply about ‘how busy people are these days,’ and change the topic.  You cannot ‘solve’ dementia—know when to quit.

Here’s a key one: Try to acknowledge feeling, rather than content.  “I want to go home” may actually mean “I miss the way things were,” “I’m frightened,” “I hate being sick,” or all of the above.  You know your loved one well, and can probably make a pretty good guess about the feelings associated with many of the things she says.  In this area the research findings are clear: Addressing the underlying feeling is more effective than arguing the logic.

That’s our best advice, but we’d like to hear from you as well.  What are your experiences in coping with a loved one’s dementia.  What has worked for you?

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press (2009). Here’s the link: http://www.newmarketpress.com/title.asp?id=901

To find out more about Robert Bornstein, click his photo.

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