5-Step Geriatric Care Management Plan for Dementia Patients and The Families Caring For Them

Caring for a loved one with dementia comes with a unique set of challenges that often require professional support to effectively manage long-term care. Because dementia is a deteriorating condition, a physician/caregiver/patient relationship is the recommended approach for meeting the needs of elderly patients with dementia.

Follow these 5 steps to plan ahead and find the Geriatric Care Management support you need:

  1. Making sure physicians who are overseeing medical care for your loved one understand your needs as a family caregiver and the challenges you face are essential aspects of caring for the person with dementia. The physician can help caregivers anticipate changes, plan for role transitions, and arrange for education and support that is needed to provide care.
  2. In the earliest stages of the disease, it is helpful for caregivers to identify a health care proxy for the person with dementia. Encourage the completion of a Durable Power of Attorney for Health Care form (your physician should have copies available in their office.) The copy of completed forms becomes part of the patient’s record. (See What is a Health Directive for Dementia? for a downloadable dementia-specific health care form.)
  3. Caregivers need to maintain their personal health and vitality to provide continuing care for the demented patient. Taking the time for self-care will help reduce the chances of Caregiver Burnout (Also see Dementia and Caregiving Challenges).
  4. Caregivers should become familiar early in the illness with adult day-care services and in-home or in-facility respite services.
  5. It is helpful for caregivers to visit and evaluate several long-term care facilities well ahead of the need for placement. Understand that institutionalization may be a normal progression in the process.

Contact us if you need helping finding Geriatric Care Management support and resources.

Mental Illness and Disorganization

In honor of Mental Health Awareness Month this May, I would like to share some information about the link between mental illness and disorganization/hoarding.

Many individuals with mental illnesses also have issues with disorganization. This is primarily because the area of the brain most often affected by mental illness is the Central Executive. The CE is the primary area for planning future actions, initiating retrieval and decision processes, and integrating information coming into the system, all necessary for successfully organizing.

Disorders that can arise from a faulty CE are depression, attention deficit hyperactivity disorder (ADHD), learning disabilities, compulsive disorganization, and hoarding.

To clarify, disorganization is not the same as clutter. Clutter can also be thought of as messiness whereas disorganization is broader. Disorganization is a lack of basic categorization accompanied by excessive clutter.

The Institute for Challenging Disorganization defines chronic disorganization using three criteria: having a past history of disorganization in which self-help efforts to change have failed, an undermining of your current quality of life due to disorganization, and an expectation of future disorganization.

Sometimes, we all suffer from faulty CE functioning, especially where time management, attention and switching focus is concerned. Ways to help CE include: organizing workspace, minimizing clutter, and creating “to do” checklists.

When dealing with your own or someone else’s clutter and disorganization, it’s important to approach with compassion. Staying organized and relatively clutter free is difficult for everyone at some point in time. Compassion will create a nurturing environment in which to learn good organizing skills.

Hoarding and Mental Health – Finding the Support You Need

Living Life with Dignity on TLC's Hoarders: Buried Alive
Fran Piekarski (left), President of Living Life with Dignity, on TLC’s Hoarders: Buried Alive

For adults with disabilities or special needs, disorganization can be a huge problem — for both the individual and the family.

Individuals with mental health issues often exhibit the attributes of hoarding disorder.

Understanding the delicacy, privacy and pain of a hoarder’s situation is key to gaining their trust and reducing their stress during the process of change. Living Life with Dignity helps people who hoard by providing them with the tools to make decisions about their belongings and their future. We work with mental health professionals, condo associations, municipalities, and families to address the needs of those suffering with chronic disorganization and/or hoarding.

We offer the following services for clients affected by hoarding:

  • Confidential assessment
  • Assembly of customized team
  • Collaborative planning in coordination with your therapist or recommended mental health professional
  • Assistance with execution of our recommendation and collaboration

Transitions – Finding you the place that meets your needs

Often a disability will require a change in an individual’s environment. You or your loved one may be dealing with a temporary or permanent new need and the current environment may no longer suit your needs.

With over sixteen years of experience, we are skilled in working with the hoarding community, including crisis situations and eviction threats.

We can assist you in either re-equipping your current environment or providing new accommodations. Our goal is to locate the least restrictive, most beneficial option available. After all, part of quality living is a quality living environment.

Contact us for more information on help with hoarding.

Image Credit: St. Louis-based artist and photographer Carrie M. Becker created a miniature diorama of a hoarder’s house.

Dementia and Guardianship

Dementia

1 in 3 seniors die with Alzheimer’s or some form of dementia. Of the 5.4 million Americans with Alzheimer’s, an estimated 5.2 million people are age 65 and older, and approximately 200,000 individuals are under age 65 (younger-onset Alzheimer’s). One in nine people age 65 and older has Alzheimer’s disease. By mid-century, someone in the United States will develop the disease every 33 seconds. Guardianship of adults suffering from Dementia can become necessary when the adult becomes incapable of making decisions for themselves and they don’t have a Power of Attorney in place. See What is the Difference between Guardianship and Power of Attorney?

Caring for a loved one with dementia comes with a unique set of challenges, including issues such as harm to self. For example, an individual might set a fire while cooking or become a wander risk or begin to think someone is going to harm them or is breaking into their home. See Practical Advice on Caring for a Parent with Dementia

Typically, as the disease progresses, it becomes more emotionally and physically draining for the caregiver who often reaches a breaking point. When focusing on the negative, it can become exhausting and overwhelming. See Recognizing the Signs of Caregiver Burnout

It’s important to find supportive services such as those offered by Living Life with Dignity before this point is reached. The volatility of the disease can make situations dangerous and upsetting. Depending on the progression or type of dementia, needs can change rapidly. For many, it is a full time commitment. See Dementia and Caregiving Challenges and What is a Health Directive for Dementia?

Case Study

Living Life with Dignity was appointed Guardian of and Advocate for an 83-year-old female suffering from Dementia.

Background

She was a retired nurse living alone, estranged from her adopted son and raising her deceased daughter’s son. The female, having lived in her current home for 60 years, had her neighbors all rally to help. Her phonecalls to the neighbors started to become erratic and she became acutely paranoid that someone was trying to break into her home. She refused having a caregiver and expressed her desire to fire her attorney and Power of Attorney. Upon contacting a new attorney, it became obvious to the attorney that the client needed intervention and guardianship.

Services

Living Life with Dignity was called in and we provided the following services for the client:

Also see: This Job Sucks! Choosing the right Power of Attorney is imperative

10 Safety Tips for the Elderly during the Icy Winter Months

Winter Safety Tips for Seniors

Remember the excitement you felt as a kid when you got a snow day?!  Your imagination went wild as you fantasized about the snow fort you would make next to your perfect snow man.

Unfortunately as we age, snow days become less exciting and more of an inconvenience, and sometimes even dangerous.  Making sure your car starts, getting someone to look after the kids (who are overjoyed at staying home from school), keeping the house warm without breaking the bank, trying to get to work without getting into an accident with that jerk in the SUV who always travels way too fast in bad weather…

If you have an elderly family member that you care for, the weather causes an even bigger issue as they are at greater risk in snowy conditions and freezing temperatures. Slipping on ice, Winter depression, nutritional deficiency and even carbon monoxide poisoning are major concerns for the elderly during the icy winter months.

Here are 10 safety tips to assist your elderly loved one during the winter season:

1. Set up grocery or (better yet) pre-made meals delivery service

This will ensure that your loved one has the food they need on a regular basis and will take some of the strain off you. Make sure that they are eating a varied diet rich in Vitamin D so as to avoid a deficiency from lack of exposure to the sun. Proteins like salmon, tuna, mackerel, beef liver and egg yolks, dairy products like milk and cheese, and certain grains and cereals are all Vitamin D rich foods that can prevent any nutritional deficits.

2. Hire a service or young neighbors to shovel or snow blow your family member’s driveway and sidewalks if there’s a storm

Preventing slips and falls is crucial for the elderly in icy conditions. The older you get the more fragile your muscles and bones become, and one small slip could cause major injuries requiring extensive and painful surgery.

3. Make sure their furnace is in working order and turned on

Have a service come out to check the furnace (before there’s an issue) to make sure it’s in working order. Also check the carbon monoxide detector and replace the batteries if necessary.

4. Connect with your loved one’s neighbors

Exchange information with them so that if you’re not able to get to your elderly loved one due to weather conditions, you can contact them to check in on your loved one.

5. Ask younger neighbors if they would mind checking the mail every few days

This will enable your family member to stay inside and avoid the possibility of falling and breaking a hip on the ice.

6. Put a list of emergency numbers on their refrigerator

Include contact numbers for non-emergency police, fire, immediate relatives and neighbors.

7. Create an emergency plan

If you are unable to get to your loved one during a severe winter storm, create a plan that includes who will check in on your loved one during the storm, where they will go in case of a power outage and who will be in charge of coordinating and implementing the plan. Make sure there are working flashlights with extra batteries and warm blankets around the house in case of a power outage.

8. Encourage fluid intake

Heating a home can cause the house to become dry and cause dehydration.  Pick up some bottled water to keep in their fridge. Remind them that sugary drinks, caffeine, and alcohol act as diuretics so interchanging those fluids with water is important.

9. Encourage your elderly loved one to wear layers and avoid going outside if at all possible

If they must go outside, ensure that they wear rubber soled boots/shoes for traction, and use an adaptive device such as a 3 prong cane for support.

10. Look out for Winter Depression in your elderly loved one

The cold and isolation can lead to depression, so it’s important to make regular contact with your loved one, and ask neighbors, friends and other family members to do the same. Regularly check in on elderly relatives, friends and neighbors in person if possible. If you live far away, contact another relative, neighbor or someone from their local church/synagogue who can stop by and check on them.

Read more on Depression in the elderly here:

Written by Author and Keynote Speaker Sue Salach-Cutler. Sue has a Master’s degree in Gerontology and has worked in the healthcare field for over 25 years.  She is the Author of “Along Comes Grandpa”, a caregiving resource guide, and the novel “If I Walked in Her Shoes”. Her programs and books provide the vital resources needed to help family caregivers as they maneuver through the caregiving journey. Find out more about her books and programs here: CaregiverLife.com. Adapted from: https://theworkingcaregiver.org

Depression: Top Mental Health Threat to Seniors

Depression - Top Mental Health Risk to SeniorsDepression is NOT an inevitable part of aging. Changes that accompany later life – retirement, the death of loved ones, increased isolation, medical problems – can sometimes lead to mental health issues like depression. Depression prevents elderly loved ones from enjoying life. Aside from mood, depression impacts energy, sleep, appetite, and physical health.

Depression in later life frequently coexists with other medical illnesses and disabilities. Because of changes in an elderly person’s circumstances and the fact that elderly people are expected to slow down, doctors and family members may miss the signs of depression. Depression tends to last longer in elderly adults. It doubles their risk of cardiac diseases and increases their risk of death from illness. At the same time, depression reduces an elderly person’s ability to rehabilitate. Also see Late Life Depression, Late-onset Depression and Dementia

In order to pro-actively provide support it helps to be able to recognize the signs of depression in an elderly person, such as expressing feelings of hopelessness or sadness that don’t go away and loss of interest in activities they previously enjoyed.

Causes and risk factors that contribute to depression in the elderly include:

  • Loneliness and isolation – Living alone; a dwindling social circle due to deaths or relocation; decreased mobility due to illness or loss of driving privileges.
  • Diminished sense of purpose – Feelings of purposelessness or loss of identity due to retirement or physical limitations on activities.
  • Health problems – Illness and disability; chronic or severe pain; cognitive decline (dementia/alzheimer’s); damage to body image due to surgery or disease.
  • Medications – Many prescription medications can trigger or exacerbate depression.
  • Fears – Fear of death or dying; anxiety over financial problems or health issues.
  • Recent bereavement – The death of friends, family members, and pets; the loss of a spouse or partner.

Here are some steps recommended by HelpGuide.org that can help your loved one overcome the symptoms, no matter the challenges they face:

  • Encourage them to learn new skills, try new activities, or make fresh lifestyle changes. The human brain never stops changing, so older adults are just as capable as younger people of learning new things and adapting to new ideas.
  • Exercise. Physical activity has powerful mood-boosting effects. In fact, research suggests it may be just as effective as antidepressants in relieving depression. Even if they are ill, frail, or disabled, there are many safe exercises they can do to build strength and boost their mood—even from a chair or wheelchair.
  • Facilitate opportunities to connect with others, face to face whenever possible. Getting the support they need plays a big role in lifting the fog of depression and keeping it away. If you cannot get them out to socialize, invite loved ones to visit them or keep in touch over the phone or email.
  • Maintain a healthy diet. Avoid eating too much sugar and junk food. Encourage healthy foods that provide nourishment and energy, as well as taking a daily multivitamin.
  • Foster participation in activities they enjoy. Pursue whatever hobbies or pastimes that bring or used to bring them joy.
  • Encourage them to Volunteer. Helping others is one of the best ways to feel better and expand their social network.
  • Create opportunities to laugh. Laughter provides a mood boost, so swap humorous stories and jokes with your loved ones, watch a comedy, or read a funny book.

Make sure they get a checkup with their doctor and talk to their pharmacist regarding drug side effects and/or interactions, as symptoms of depression can also occur as part of medical problems such as dementia or as a side effect of prescription drugs.  Watch for suicide warning signs. Seek immediate professional help if you suspect that your loved one is thinking about suicide.

There is help for seniors who are dealing with depression. Be open about asking for professional help. There are experts who deal with these issues and know how to help. For more information visit Helpguide.org

Also see:

For other helpful caregiving resources visit AlongComesGrandpa.com

Written by Author and Keynote Speaker Sue Salach-Cutler. Sue has a Master’s degree in Gerontology and has worked in the healthcare field for over 25 years.  She is the Author of “Along Comes Grandpa”, a caregiving resource guide, and the novel “If I Walked in Her Shoes”. Her programs and books provide the vital resources needed to help family caregivers as they maneuver through the caregiving journey. Find out more about her books and programs here: CaregiverLife.com.  Adapted from: https://theworkingcaregiver.org

10 ways to Maintain Your Brain© from The National Alzheimer’s Association

  1. Head first: Good health starts with your brain. It’s one of the most vital body organs, 10 ways to keep your brain healthyand it needs care and maintenance.
  2. Take brain health to heart: Heart disease, high blood pressure, diabetes and stroke can increase your risk of Alzheimer’s.
  3. Your numbers count: Keep your body weight, blood pressure, and cholesterol and blood sugar levels within recommended ranges.
  4. Feed your brain: Eat a low-fat, low-cholesterol diet that features dark-skinned vegetables and fruits; foods rich in antioxidants; vitamins E, C and B-12; foliate; and omega-3 fatty acids.
  5. Work your body: Physical exercise keeps the blood flowing and encourages new brain cells. It doesn’t have to be a strenuous activity. Do what you can – like walking 30 minutes a day – to keep both body and mind active.
  6. Jog your mind: Keeping your brain active and engaged increases its vitality and builds reserves of brain cells and connections.  Read, write, play games, do crossword puzzles.
  7. Connect with others: Leisure activities that combine physical, mental and social elements may be most likely to prevent dementia.  Be social, converse, volunteer, join.
  8. Heads up! Protect your brain: Take precautions against injuries. Use your car seat belts; un-clutter your house to avoid falls; and wear a helmet when cycling.
  9. Use your head: Avoid unhealthy habits. Don’t smoke, drink excessive alcohol or use street drugs.
  10. Think ahead – start today! You can do something today to protect your tomorrow.

For more information and tips visit: http://www.alz.org

Dementia and Caregiving Challenges

You probably know that caring for a loved one with dementia won’t be easy, but these sometimes embarrassing and unfamiliar behaviors might drive you nuts.

Dementia and Caregiving Challenges

  • Dementia Sleep disorderSleep problems and caregiver exhaustion are two of the most common reasons persons with dementia are placed in nursing homes. Causes of sleeplessness in dementia patients include pain, lack of exercise and activities, anxiety, agitation, or too much fluid or caffeine late in the day.
  • Urinary incontinence is the second leading reason that families institutionalize their loved ones with dementia. Urinary incontinence in persons with dementia should be evaluated for treatable causes, including urinary tract infections, electrolyte and calcium abnormalities, prostatic hypertrophy, and estrogen deficiency. A regular toileting schedule at two to three-hour intervals or verbal prompting may also alleviate this symptom.
  • Agitation and aggressive behavior have been reported in 65 percent of community-dwelling persons with dementia. Reasons for agitation or aggression include overstimulation, physical discomfort, unfamiliar surroundings or persons, complicated tasks, and frustrating interaction, as well as more serious reasons as paranoia, delusions, or hallucinations.
  • Caregivers may be embarrassed or ambivalent about discussing inappropriate sexual behaviors exhibited by persons with dementia.
  • Persons with dementia are often reluctant to stop driving when safety is at issue.
  • Repetitious questions may be due to short-term memory loss and an under-stimulating/over-stimulating environment leading to anxiety, feeling out of control, or fear.

Also see:

Information for this blog cited from the Alzheimer’s Association and the American Medical Association

Written by Author and Keynote Speaker Sue Salach-Cutler. Sue has a Master’s degree in Gerontology and has worked in the healthcare field for over 25 years.  She is the Author of “Along Comes Grandpa”, a caregiving resource guide, and the novel “If I Walked in Her Shoes”. Her programs and books provide the vital resources needed to help family caregivers as they maneuver through the caregiving journey. Find out more about her books and programs here: CaregiverLife.com.  Adapted from: https://theworkingcaregiver.org

What is a Health Directive for Dementia?

People with advancing dementia lose the ability to make decisions for themselves. Their families need to make medical decisions for them. Giving family members guidance about what kind of care you’d want if you were to develop worsening dementia can ease the burden of their decision making and make you feel more secure that you’ll receive the care that you would want.

Following our articles on Late Life Depression, Late-onset Depression and Dementia, and Practical Advice on Caring for an Adult with Dementia, here is a Dementia-specific Advance Directive download that allows you to map out your care and medical intervention plan should you or a loved one become ill with dementia in the future.

Late Life Depression, Late-onset Depression and Dementia

Can you develop depression when you are past some of the most stressful times of life?

LLD is caused by the underlying neurological changes in the brain

So, you’ve raised your children, achieved success in a career and now you’re considering downsizing and finally, retirement. But, you don’t feel quite like yourself. You tell yourself, “I should be happy, but I’m not.” You don’t enjoy things like you used to, you lack energy and engagement with others, and your appetite is poor and you’re not sleeping well. Maybe you’re moving a little slower and not as quick to solve problems or remember things you’re supposed to do. What could be wrong?

You see your physician, who is all too familiar with this condition, and sends you for a neuropsychological evaluation, which reveals that you are suffering from Late Life Depression (LLD). You protest, “I’ve experienced sadness like everyone else, but I’ve never been depressed in my life!” So, what is LLD?

This diagnosis is not to be confused with late-onset depression, which means, more simply, that a typical clinical depression develops later in one’s life. Confused? What differentiates LLD is the underlying neurological changes in the brain. Both are treatable, but LLD has greater implications for more serious, long-term health concerns like dementia.

LLD is defined with an age threshold of 60. Approximately 10 percent of the 60-and-over population is estimated to suffer from LLD in the United States. There is considerable reduction in discrepancy between genders in this population since middle-aged females already suffer from depression at higher rates. If you have chronic illness such as a myocardial infarction or stroke, chances are greater that you will develop LLD.

A key feature of LLD is often the presence of cognitive deficits in meaning, memory, organization, planning, and reasoning, to a degree greater than that expected for your age. Generally, LLD is more difficult to treat than Late-onset Depression, and relapse rates are higher. Furthermore, those with LLD are more likely to age into dementia. See Practical Advice on Caring for an Adult with Dementia.

Differentiating these two types of depression is imperative for accurate diagnosis, prognosis and treatment. If you or a loved one are experiencing these symptoms, a neuropsychological evaluation may be warranted and recommended.

About the Author

Jennifer Wilson-Binotti

Compassionate Neuropsychology, LLC
Neuropsychological Assessment with a Human Touch
Jennifer Wilson-Binotti, Psy.D.
Licensed Clinical Psychologist
Clinical Neuropsychologist
www.compassionateneuropsychology.com

Dr. Wilson-Binotti has worked with older adults since 2012 during her post-doctoral training in Downstate Illinois. She has experience working with those aged 50+ who have increased anxiety or depression, or a decline in functional or cognitive (thinking, memory) abilities. She previously served over 20 nursing/rehab/long-term care facilities and was on staff at six suburban hospitals, remaining on staff at Edward and Linden Oaks Hospitals in Naperville, IL. Currently, she sees patients at nursing facilities and in private residences when seniors are no longer able to physically leave their homes.

Her relaxed and warm demeanor helps patients feel comfortable and perform their best during neuropsychological testing. Many patients have described their experience with Dr. Wilson-Binotti as “fun,” and some even look forward to doing it again!