The Power of Depression

As you search the web for information on depression in older adults, you will find so much information that it is hard to decipher what key points you should take away from it all and how exactly it relates to your specific situation.  Let me start by saying that each and every situation is specific. There is no one article that will relate exactly to your situation at hand and then lead you in a specific direction for treatment.   You need to look at your situation and apply what feels right to you and your loved one.

Depression is a very powerful condition that if left untreated will affect not only your mind but your physical health as well.  It can cause an onset of or worsening of dementia.  It can cause actual physical pain.  It can lead to immobility and falls.  It can lead to a failure to thrive.  It can lead to severe weight loss and loss of appetite.  The continuing downward spiral of health problems that will follow are inevitable.  Early treatment for depression is your best chance of getting it under control.

So how do you start to address this issue and decipher all that information you have read?  First and foremost, you and your loved one must be in contact with your older adult's physician to discuss these concerns.   A plan for treatment must begin there and be agreed upon.  Initially, you want to be absolutely sure that there is not an underlying medical illness afflicting your loved one.  Do not just assume that they are depressed.  If there are physical signs of decline, you want to be sure that you are not overlooking another illness.  The earlier the better is best if you suspect that an older adult is becoming depressed.

If you notice they are withdrawing from activities that they would normally attend or if they are neglecting their own physical appearance when they normally would not, you should take that as a sign that they are depressed.  These are 2 common early signs that they are feeling sad and lonely.   Trust your instincts; if this is someone close to you, you will see these signs easily but may avoid confronting them because confrontation is uncomfortable and can be unpredictable.  In the long run, though, by confronting these suspicions of depression early, it will make it that much sooner that they are feeling better again and can help to avoid further decline in their physical well being.

Treatment plans for depression in older adults will vary from person to person.  Some need the assistance of anti-depressants but the use of these medications must also be accompanied with other aspects of treatment.  For instance, if your loved one is lonely and isolated in their home, consider enrollment in a Senior Center or Adult Day Center that can provide a structured environment and interactions with their peers.   If your loved one has lost someone close to them due to death, consider counseling sessions or spending more time with them.   If your loved one has suffered from a stroke and is left with physical limitations, find ways for them to remain active and make adaptions so they can remain as independent as possible.  These are just examples; your situation is unique.  

Addressing what is causing the depression is the key factor that you should take away with you.  Determining what is causing the depression may be the most difficult part of the task; the help of a counselor can be beneficial with finding the answer to that.

The power of depression should not underestimated.  It cannot be addressed by just the caregiver.  The older adult themselves and other family members should be involved in discussions about their treatment.  The most important key to improvement is that they want to improve.  The more involved they are in making decisions about their care, the more likely they are to cooperate with the plan and be motivated to get better.

Understanding the power of depression in older adults helps maintain Aging with Ease!

The Joy of Music!

One weekend as I was sitting at a music program with my Grandmother, I found myself looking around at all the other older adults in the room.  At first, I began looking around the room because the music they were singing was, let's just say, less than extraordinary.  Not really my cup of tea.  But while looking around at their faces, I saw nothing but happiness.  I began to think to myself, music is one of the common joys that all people love at any age.  It evokes feelings of joy, excitement, sadness, loss, fun and movement.  As well as producing memories of the past, relieving stress and maybe even enticing motivation.

As we age and our bodies begin to slow down, there will still be that song that comes on and it will immediately bring back those feelings.   You want to sing along.  You start tapping your foot.  You start clapping your hands.  It makes you feel young again.  What else can make you feel that way?

As a caregiver, music can be used in numerous ways to improve the quality of life for yourself as well as your loved one.  When my stress level feels high and I just need some time formyself, I find that listening to music that I like to sing to and then turning it up loud lets me sing at the top of my lungs and releases some of that pressure.  Music can be used to bring back wonderful memories that you and your loved one share.  Even when suffering from dementia at any stage of the disease, I have seen first hand those memories come back even if for only fleeting moments.  Those fleeting moments when a loved one with dementia is able to be with you in a moment become very precious.   Music can also bring laughter and fun into a room.  If you are having a difficult day providing care for your loved one, turn on some music and start humming along - just watch to see if the mood in the room doesn't change.

I get asked about music programs a lot when I give tours of the Adult Day Center that I work in.  Do we have music programs?  How often do they occur?  What types of music do we provide? The importance of music all throughout our lives is obvious.  No matter what genre of music makes you get that feelin, make sure you get your daily dose of music in your life.
Music keeps you feet tapping while Aging with Ease!

Alzheimer's Disease Tip: The Importance of Routines

In continuing with hopefully helpful tips when caring for a person with Alzheimer's type dementia, today I am going to write about maintaining routines and the importance of them.

Routines are set in life from the day we are born.  They get us where we need to be.  They keep us focused on chores that need to be completed.  Routines provide us comfort and a feeling of control.  They give us stability and make us feel secure.  Even people that appear to be the most unorganized people you have ever met have daily routines in their life.  It is human nature to develop routines in our daily lives.

If you are providing care for a person with dementia, these routines that we do automatically without even thinking about them become even more important.  If routines are changed too frequently or not maintained well as their memory begins to fail, they will become anxious and resistant.  In fact, many times when changes occur too quickly you will see significant changes in behaviors and an increase in memory loss.  The more stability and security you can provide for them by maintaining certain routines each day, the more you will make them feel secure.

This does not mean that every day you must do the same things day in and day out.  Who could live like that?  You would be scratching the walls trying to escape.  It is not realistic to expect that you must give up every aspect of your life because you are now caring for someone with dementia.  That would only leave you burned out and depressed.  You would not be a very good caregiver in that condition.

What it does mean is that at certain times each day, certain routines should always be done.  For example, establish a morning routine that you can both complete successfully together.  A morning routine could look something like this:

1. Wake in the morning at 8 a.m., go to the bathroom and brush your teeth together.
2. Meet in the kitchen to make and eat breakfast; read the newspaper.
3. Go get showered and dressed.
4. Go for a brisk walk around the neighborhood and discuss what is planned for the day.
5. Return to the house to clean up breakfast dishes.
6. Begin the rest of your day.

This is just an example of what I am talking about; whatever works for your situation is fine as long as it works and can be done with some regularity.  This establishes a set pattern that a person with dementia will be able to participate in for a longer period of time as the disease progresses.  They will be able to begin their day successfully and be able to proceed with the next part of the day more easliy.

Another example of a good time to set a routine is in the evening in preparation for bed.  Develop a routine that encourages relaxation to provide a more restful night for both you and your loved one.  An evening snack, a certain television show you can watch together before bed or an evening shower before bed.
I am betting that as you read this you are thinking: "This is like having a child."  In many ways, it is exactly the same idea; if you are a parent you know the importance of routines when raising children.  They are imperative at maintaining stability within your household!

I do however hesitate to use that comparison though because while the importance of the routine is the same, the way in which we deliver it is very different.  You must remember that you are not caring for a child, you are caring for a grown adult and they will not respond well to being treated like a child.  Dignity and respect must be maintained at all times.  I go back to what I have expressed before in other posts- treat them as you would want to be treated.

Maintaining routines enhances Aging with Ease!

Quality vs. Quantity of Life

As I watched both of my Grandmothers in the final stage of their lives, one being 94 years old and the other being 90, I clearly can see that the most important thing that my family can do for them is keep them comfortable.  Even though their paths to this stage of their lives have been very different, when we visit with either one of them they both frequently express their desire for their life to be over.  You might read that and think they are just depressed and need treatment, but I can assure you that, especially for my older grandmother, this is not the case.  They both also speak frequently about how they enjoyed their life and are proud of the family that they have.  They simply are tired, their bodies are worn out, they are ready to rest.

Inevitably the decisions about their care changes because of this.  It becomes necessary to consider quality of life instead of quantity of life.  What I mean is the goal of further treatment changes from trying to keep them alive to keeping them comfortable and content for the remainder of their lives.   It means as new or continuing health issues arise, we now ask ourselves what is the best treatment to keep them comfortable.  Thankfully my family is wonderful and the decision to change the focus of their care is agreed upon without arguments or hurt feelings.  Having helped too many families to count through this change in treatment, I know that my family is very fortunate to be blessed with this cooperation. Some families are on opposite sides of this fence.  Many times when children do not live nearby it is especially hard to understand this change in focus because they have not watched the aging of their parent first hand.  If you are the sibling that is the primary caregiver, you need to make every effort you can when changes in condition begin to keep in close contact with your brothers and sisters.   Explain the changes you are seeing, ask them for suggestions, tell them what the doctors are saying, and decide on treatment plans together.   You do not want to call them up one day and try to make them understand changes that have been progressing over time in just one phone call.  It will overwhelm them and they will become defensive and feel the need to protect their parent.

Keeping the lines of communication open through the aging process with those closest to you and your loved one will hopefully make these transitions easier on everyone.  Each of you may have different ideas about what quality of life may mean to you.  Allowing each person to express their thoughts enables everyone to hear all sides but try to keep in mind that just because your loved one is old it does not always mean that they are incapable of making these decisions themselves.  It is ultimately about what they want, not what you want...

Quality of care in the last stage of life = Aging with Ease!

Click here: "Romancing The Wind" - Ray Bethell - YouTube

The guy flying the 3 kites is in his 80s, and he's from Canada. He comes to the Washington State International Kite Festival every year. His skin is like leather as he normally flies with his shirt off. He is deaf, so when he flies we hold our hands up and wave them for applause. He flies 2 with his hands and the 3rd one is attached to his waist.

You must watch to the end to see the amazing landing of that last kite!  I would have those so tangled up, you could never get them separated again!  And of course, make sure the volume is turned up because the music is wonderful and totally reflects the soaring of the kites.  Beautiful.

Lewy Body Dementia

Lewy Body Dementia may be one of the most difficult types of dementia to deal with, for the patient and the family.  The person affected with this disease typically goes through extreme changes in mood and personality.  As it progresses, the family simply is not able to recognize the person that they used to know.  These changes tend to come on abruptly, leaving the patient paranoid and unable to trust others while leaving the family very confused about what is happening.

If someone close to you has been diagnosed with this disorder, it is imperative that you research what to expect as the disease progresses.  While every path of dementia is somewhat unique, there are basic stages that, let's say, Alzheimer's patients tend to follow.  With Lewy Body Dementia, the progression has more extreme changes and can arrive very suddenly.  Patients with Lewy Body Dementia will typically have hallucinations and delusions that are, in every way, very real to them.  Trying to explain to them that these things did not occur will only make them upset.  You may not be able to see or understand what they are experiencing, but, in my experience, it is as real to them as anything else that goes on around them.  By not listening and talking through what they are experiencing, you will only cause unnecessary agitation. As a result of trying to dismiss them, they will lose trust in you.  Patients that I have helped through this progression of Lewy Body Dementia are desperately trying to finding someone to believe them.   Someone to discuss what is going on in their mind.  Many times, in the earlier stages, as you talk through what they are experiencing, they can recognize on their own that it did not really happen.

Many times patients with Lewy Body Dementia will require assisted living or a long-term care facility to provide their care and safely manage their behaviors.  These patients have a tendency to become aggressive even if for their whole life they have never even raised a finger of anger toward any living thing.   They can have psychotic episodes that can arrive without notice or cause.  They can have episodes when they are not able to recall any of the recent events that brought them to where they are.  Their communication becomes very broken and hard to follow, which causes them frustration with their caregiver because they do not recognize that they are not speaking clearly - to them it is coming out clear as day.

I do not tell you this to incite fear for caregivers or patients dealing with this disorder.   I tell you this so that you can fully understand the extent of the changes that you should be prepared for.  Early preparation for their needs is vital as you prepare for this challenge.  Your best chances at keeping some of the behaviors from becoming aggressive is by understanding that what they see and feel is real to them.  Listen to them, talk to them, reassure them that you will do whatever you can to help them.

 
Today I had a 20-minute conversation with a client, diagnosed with Lewy Body Dementia, about the 20 men he saw on the roof this past weekend stealing internet signals from our company with a 9mm gun.  Sounds ridiculous right?  Of course it does, he even said as much when he started the conversation by saying, "I know you are going to think I am nuts but...".  He needed someone to talk to about what he saw and express his concerns to make sure that someone would follow up on it to keep things safe.  I was that person for him.  I reassured him that I would report it to our IT department and they would follow up.  He was happy and satisfied by that and was able to go about the rest of his day because he trusts that I will help him.  He felt heard and validated, which is what he needs more than anything.  Every time he comes to me with his concerns, I always listen and provide him a safe place to say whatever he needs to without feeling judged or looked at like he is crazy.  There are some conversations when I can say to him "Do you think that really happened or might it be from your condition?" At times he can recognize that he really has only pieces to a story and that it did not really happen.  Those occurrences are becoming less frequent.

I do not try very hard at all to help him see reality from his delusions because it serves no purpose for his quality of life.  If listening to him for 20 minutes and giving him reassurance allows him to enjoy the rest of his day, that serves to improve his quality of life to a much higher level.

Quality of Life serves Aging with Ease!

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Share Your Stories...

Today I went with my mother to visit my grandmother.  Not the same grandmother that I have mentioned in other posts.  This is my mother's mother and she is 90 years old.  She lived with my parents for more than 10 years and recently, due to health decline, has moved into a long-term care facility.  These last few months have been very difficult to watch as my grandmother began to fail both physically and mentally.

My grandmother has always been a very strong-willed person.  When things needed to get done, you could count on her to do it.  She always kept her word and could be depended on when you needed her.  She also was directly open about telling you what she thought about things.  Most times, she would express her opinions with love, but there were several moments that I can easily think of where she told you what she thought without any regard to what the reaction might be.  Don't get me wrong, my grandmother is a wonderful person.  From her I get my strength to keep moving forward, my stubbornness, my need to always be on time, my work ethic and my confidence.  From her I also inherited the family gene to worry.  She would worry endlessly about everything.  I also inherited from her the talent to keep personal struggles to myself.  Sometimes these two traits can be good things, but sometimes, as you can imagine, they are not.

I think that those last two traits are why, as her mind begins to fail, she spends a lot of her time now paranoid that people are talking about her, worrying that they are going to throw her out of her room and suspicious that they are out to get her.  It is very difficult some days to visit her.  You never know what you are going to be walking into.  One day, she is very pleasant and speaks very highly of the staff who help her.  The next time she spends the whole visit begging us to take her home.  The strain and guilt that this puts on my mother does not go unnoticed.  I know she wonders if things would be better for my grandmother if she did take her home again, but the fact is that my grandmother needs someone with her 24 hours a day.  Watching over her medications, her health and her hygiene.  These are not things that my mother is able to provide for her.

I am never sure what to say to my mother after a visit with my grandmother.  As a nurse in geriatrics, I understand the changes that are going on with my grandmother.  I have seen this progression so many times.  That does not mean that it makes it any easier to cope with it.  It makes you feel awful to see someone that you love, who was once so strong and vibrant, now look so sad and frail.  The only comfort I can give my mother is to reassure her that my grandmother is getting good care.  That she is in a good facility where people do really care about her.  Having worked in long-term care facilities before, I know the signs of quality care and they are all present at her facility.  My mother knows this as well and that does bring her some peace of mind.

My family is very blessed to have had my grandmother in our lives for so long.  Many families are not so lucky.  My hope for her is to find some peace in her own mind as she reaches the last stage of her life.  Perhaps the anxiety she feels is actually a result of exactly that - maybe she is afraid to die?  I don't know what the right answer is to this.  What the best course of action should be.  What we should say to her when she asks us to take her home.  I just answer her honestly about why she needs to be there and hope that some day soon she will accept this stage of her life.

If you are a caregiver who has gone through this transition with your loved one, I would love to hear your stories...

Sharing your stories helps the process of Aging with Ease!

 
I originally posted this in November 2011 on my first Aging with Ease blog, my grandmother passed away in February 2012 at peace with her family at her side.  Her passing would be the first of three close family members leaving me in 2012.  Let's just say this year has been very long, sad and unending.  As the year finally draws close to the final month all I can really say is that my family knows I love them.  Death is final and there is nothing you can do to change it.  All you can do is just love them...

I am working on finding a way to regain some motivation in my life, as my grandmothers and my father taught me to do.  It has been difficult since the three people I have lost were also the three people who motivated and inspired me the most.  I hope any followers that I have are patient with me as I try get back into it.