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!

Click  to visit site and learn more.

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. 

Depression in Older Adults and the Elderly

Article: Depression in Older Adults and the Elderly

Depression is a very common occurrence in seniors for numerous reasons.  They have lost friends and loved ones; they become isolated due to physical losses; some suffer from health issues.  There are many factors that can lead to depression in older adults.  Anti-depressants are not always the best treatment for this problem.  As we age, our body is not able to metabolize medications as well and because of this the side effects of these medications are more commonly noted, which can do more harm than good.  Also medication alone, at any age, will not alleviate depression.  The reasons that are causing the sadness must also be addressed.  Click the image to read a very informative article regarding this issue.

Knowing the signs of depression in older adults improves your chances of Aging with Ease!

Navigating a Hospital Stay, Are You Getting the Help You Need?

Are you getting the help you need?  Navigating our health care system is, let's just say, nearly impossible.   Many people, especially older adults, don't even know if they are getting all the help they need or is available before, during or after a hospitalization.  Why is this such a well kept secret in our health care system?

Seems to me that the more knowledge and assistance you give someone the more likely it will be that they do not end up right back in the emergency room, constantly repeating the near same scenario over and over again.  It does not take a degree in economics to see that the system would be able to keep costs down considerably by giving more priority to this very simple element of health care.  Instead this system leads you to think that it is complete ignorance on our part that keeps costs so high when it appears to me that there is just entirely too many special interests involved in the treatment of sick people.

Every time that I experience, first hand, just how difficult moving through the labyrinth of our health care system is, I am left to wonder how in the world do families that do not have a medical professional as part of their family ever get anywhere.  The education of people should be of top priority, especially during a hospitalization, yet it always feels like the patient and family are left in the dark.   WHY?

As I write, my father lies in a hospital slowly recovering from a bowel obstruction. This is the 4th, yeah that is right, the 4th hospital that he has been over the last month.   Due to preexisting difficulties with advanced chronic obstructive pulmonary disease (COPD), the proper treatment for the bowel obstruction was delayed for far too long.  We started the first week at a local community hospital that either was not permitted to refer us to a larger hospital or just simply did not consider it.  Had it not been because of persistence of the family and a family member with a medical education, my father probably would not be with us at all.  After requesting that he be transferred to a larger teaching hospital with the ability to give him the help he needed we were told by the physician that he feels that would be the best plan and my father was moved within hours and just hours after being admitted to that larger facility with more advanced technology he received the surgery he needed.  He remained at this hospital for three weeks making slow improvements everyday with a few set backs.  He was finally strong enough to be transferred to a rehabilitation hospital at which he stayed for all of 12 hours before they sent him to yet another local community hospital because his oxygen levels were low.

The frustration the I feel about the systems within healthcare are mind blowing.  Many things run through my mind in the care of my father.

1. Why did the rehabilitation hospital not call a family member when his oxygen levels became low? To at least give us the option to say: "Please send him back to the facility he just came from".
2. Why did the current hospital that he is in right now not contact the previous hospital that he just spent 3 weeks at to obtain his records?
3. Did my father miss doses of his medications when he transferred from one facility to the next?  This very fact alone may have been what caused his oxygen levels to drop...
4. Where is he going to go from here?

The common denominator in every question that goes through my head is communication and why is it so poor in our healthcare system?  In this day and age there is no excuse for it!  If I can know with in seconds what my cousin on the other side of the country is eating for dinner right now and even see pictures of it through social media then we should be able to send communications just as quickly about things that truly matter in the care of a persons life.

Not only would some real attention to this aspect of healthcare improve the continuity of a patients' care but it would also help to keep the cost of health care down.  Blood test results, x-ray reports, CT scan reports, MRI reports, medication records, patient allergies, assessments, therapy notes, specialists reports, etc. all at your fingertips thus preventing unnecessary repeat testing.

I spend a portion of each day talking to someone at the hospital, whichever one he may be in, about the care of my father.  Whether it be his social worker, care coordinator, nurse, surgeon or physician I am constantly seeking information about what they are doing to help my father,  what the next steps are going to be and what he needs to be doing to get there.  If I would not be pursuing the information, we would be in the dark.  I hate the dark, don't you!

Learning how to navigate our health care system is essential to Aging with Ease!

Geriatric Care Management

So today I learned about a service that I have not had any experience with.  It is called Geriatric Care Management.  Some of you may already be familiar with this service, but it intrigued me because of my lack of knowledge about it.  So I did some research about it. This service offers support for families caring for older adults.  Many of people who are faced with caring for a spouse or parent who is declining in their health really have no idea where to begin to look for help.  Those difficulties are escalated when you are a child of an older adult and live miles away.   The day-to-day care that is needed can leave you exhausted and feeling depleted to even have the energy to look for help.

Geriatric Care Management offers care managers that specialize in social services. They assist in finding the help you need based on your individual situation.  Their goal is to help older adults find the best quality of life physically, mentally and socially.   If you are looking for help finding the right long-term care or assisted living facility, they can help you with that process.  If you need someone locally to check in regularly on a loved one, they can provide that service.  They will advocate for any needs that will assist in achieving an improved quality of life for the older adult as well as for the caregiver.

Geriatric Care Managers charge clients in a variety of ways, but typically their hourly rates are between $50-$200 an hour.   Medicare, Medicaid and private health insurance very rarely pay for these costs; long term care insurance might, but most often this is an out-of-pocket cost.  I know that sounds expensive, but when you consider the convenience and security they provide, the cost can seem worth it.  Actually, Care Managers usually save families money despite being an out-of-pocket cost because their needs assessments align an individual’s present condition with only those services that are necessary at that point in time.  This prevents unnecessary fees from home care providers and assisted living residences.

This service is worth checking out if you are struggling to decide the best way to provide care for an aging adult.  The first step is to locate one and simply have a phone conversation with them about different ways that they might be able to help your situation.  A simple Google search for Geriatric Care Management will help you easily locate one near you.  If you decide it is worth the investment, they will come to meet you and your loved one to perform a complete assessment; physically, mentally, financially and socially.  Together you create a plan to manage care.

Like I said before, I do not have any first hand experience with this service but it appears to be a very useful resource in assisting caregivers to manage care.  If you have ever used this service or know of someone who did, I would be very interested to hear what the experience was like.  Did they own up to what they offer?

Finding the right kind of help that is available for you is vital to Aging with Ease!

Fulfilling Activities in Adult Day Centers

Creating fulfilling activities for seniors can be challenging at times, especially if they are suffering from memory loss or physical ailments that limit their abilities to participate the way that others can.  I am blessed to work with some of the most creative people I have ever met.   They are constantly meeting this need for the seniors in our Adult Day Center.  They never cease to amaze me and I am constantly learning from them.

There are two main things that I have learned the most from my co-workers:
1. Try anything, no matter how odd it may seem;  you never know what might work.
2. If it failed once, that does not mean that it will fail again.

We offer a variety of different activities every month.  Sometimes certain activities are scheduled on specific days of the week with certain clients in mind.  For instance, for the lawyer who only comes in on Tuesdays and Thursdays, we schedule a game called "You Be The Judge."  This game engages this client extremely well and brings back to his life a chance to share his knowledge.   Then there is the retired English Professor who misses leading lectures in his classroom; he is given an opportunity to present a different topic each month to the other clients and staff.  By providing this activity for him, we are giving him a sense of purpose and a chance to perform.  There also is a client that spent her life raising her nine children - yes that is right 9 children -  she spent much of her time after her children were grown making quilts but because of memory loss she had stopped doing this.  My staff was able to find a way for her to continue this joy in her life.  It took several different approaches to find the best way for her to be successful at it, but she now comes into the center and gets right into it without hesitation.  I could go on and on with examples of these types of great things that happen in our Adult Day Center.

As clients remain at our center over time, their level of functioning will change.   Activities they once were successful at become difficult and frustrating for them.  Again, my staff observes this and quickly adapts to these changes. An example of this would be to remind you of the client that is a lawyer, that I spoke of in the paragraph above.  Since he started at our center, his condition has progressed and he no longer finds fulfillment in that game.  So the activity for this client was changed.  We looked for another opportunity for him to feel useful.  What we found was that he needed to be responsible for something in the center that made him feel useful.  So we gave him the task of helping with setup for activities and clean up when they are over.  He takes this responsibility very seriously and it is a huge help to our staff.  A win, win situation.

These activities are a direct product of my staff - by them constantly looking for ways for our clients to feel important and useful again.   There are also many activities that, in general, can be easily managed no matter what their losses may be.   We do use these activities regularly as well.  But who wants to do the same thing every day?  We all need variety in our lives no matter what age we are.

Adult Day Services can provide useful, fulfilling and satisfying activities for seniors.  They are designed to provide stimulation and socialization, which in the long run will keep older adults more active physically and mentally.  With all that to offer, it seems kind of silly not to check them out.  This kind of structure to a person's day will keep them living independently longer and can provide comfort to families that their loved one is being productive in a safe environment. 

Aging with Ease can be obtained by feeling useful as older adults!

A Visit With My Grandmother

This weekend I was visiting my grandmother who now, at the age of 95, has recently moved into a skilled care setting.  I was sitting there talking with her and bringing her up to date on the happenings in our family as I frequently have to do when I go see her and it occurred to me that my grandmother is the essence of Aging with Ease.  She is the true inspiration for why I began writing and trying to help others.  She is the reason that I care and respect older adults the way that I do.  I have watched her progress from the vibrant person who would always be ready for play to the old woman who now mostly sits in her chair, content with her life and herself the whole way through.  It is her attitude toward life that has aided her the most in gracefully going through the aging process.

I can remember when I was 12 years old and my grandfather became ill with cancer.  I can clearly recall the way in which my grandmother cared for him with respect, love and laughter.  Never changing the way she loved him or how they communicated with each other.  It always stayed with me how she faced the reality of the situation head on, would tell you what she thought about it and then just simply do what needed to be done.  There was never a doubt in her mind, at least not that I saw, of what she should do, care for and love him.  Of course, she would be sad sometimes, but it never held her back; she seemed, to me, to gain strength from the hard times.

Not long after my grandfather passed away is when she decided it was time to sell her house and move to a retirement community, there was no changing her mind.  She knew she could no longer care for the house any longer and the memories that she shared with grandfather in the house that he built for her was just too much.  It was time to move on!  Our family would discuss with her other possible options besides living in a retirement community but her mind was set.  She would say: "This is what I want to do, I don't want to live with my children."  So everything was packed up and the house was sold.

My grandmother transitioned through every level of care within this retirement community over a span of about 18 years.  With every move, she accepted it with ease and trust that she would be taken of even though with every move she was slowly losing her sight, her hearing and eventually her mobility.  She never once doubted her faith or her family.  She would find laughter in the situation and was always so very grateful that we were there for her.   So thankful we were there to make sure that everything would be done the way she would want it and that the things that were most important to her stayed with her.

Now, as she sits in her favorite recliner, unable to see anymore and hardly able to move with out help, all she prays for is a peaceful end to her life.  Not because she is sad or depressed.  If you would meet my grandmother, you would know that she certainly is none of those things.  My grandmother even at the age of 95 could still be the life of a party.  She hopes for the end because she has lived her life to the fullest.  She has no regrets.  She has lead a happy and full life by having fun and helping others.  She is simply just tired, her body aches and she cannot do the things that she once did.

She has gone through the aging process with grace.  I can only hope to follow in her footsteps, even just a little.  In my work I have seen the direct result of negative attitudes on a person's health.  The mind is the most powerful tool you have in overcoming challenges in your life.  She showed me how to always look for something to laugh about, especially if it is about yourself.  She showed me to just let it go.  She showed me that if you can't change what is happening, then find a way to handle it but keep moving forward.

I am truly blessed to have had a person like this in my life.  I think there are probably many people that don't.  All you can do is be responsible for yourself and your own attitude.  You cannot change the way other people think or behave.  The most you can do is maybe make them laugh, which sometimes is all that they may need to improve their attitude, at least for a while...

Finding joy in your life is the essence of Aging with Ease!

• When I originally made this post in November 2011, little did I know at the time that a few short months later my grandmother would get exactly what she was praying for.  She passed away on May 1, 2012.  Thanks to the wonderful nursing staff where she lived she died peacefully with a photo of my grandfather right beside her and her music playing, just the way she wanted it.  I miss her everyday!

It Might Be Time to Step In...

As a child of aging parents, it can be difficult to know when your parents can no longer manage on their own.  Your mother or father will become very adept at keeping it looking good.  You will become very good at looking the other way.  It is not easy to look at your parent as someone who needs help with their activities of daily living.  Parents are the people you turn to for support, advice and strength - not the other way around.  On top of that, your parent will most likely become upset with you if you even suggest that they cannot manage on their own anymore.  No one enjoys confrontation, especially with our parents.

Some of the sure signs that someone may need to step in are easy to spot, if you are looking for them.

• Things in the house are out of order from the normal (laundry piling up, dirty dishes, messy floors, etc.)

• Mail piling up and bills not being paid

• Body odor/ Poor hygiene

• Frequently losing or misplacing things

• Forgetting to go to appointments

• Spoiled foods in the refrigerator

If you notice some of these signs, you need to take a closer look.  There are numerous reason that these things could be occurring.  Pain, fatigue, or memory loss just to name a few.   As uncomfortable as this discussion may be, it needs to be done.  Avoiding it until the situation becomes a crisis will decrease your family's control of the decisions that need to be made.

If you have siblings, you need to involve them in these discussions.  This is a family matter; it should not completely fall on the shoulders of one child.  Typically one child will become the primary care taker for your parents but that does not mean that all the decisions fall to you. 

If you are an only child, seek advice and guidance from other family members.  If you feel like you have no one to help you with this problem, you can look for support online, your parent's physician, your pastor or your local Area Office of Aging. 

Expect confrontation when you approach your parent about these concerns.  Try to keep your cool.  Continue to talk with them calmly and respectfully.  It may need to be brought up more than once until you are able to have on honest conversation with them about the changes that you are seeing.

Knowing when to step in aides older adults' ability to experience Aging with Ease!

Time to Hang Up the Keys?

What do you do when your parent or spouse is unsafe to drive a car any longer?  This is a delicate problem.  Of all the things that you lose as you age, not being able to drive a vehicle any more can be one of the most difficult to face.  It is one of the biggest losses of independence an older adult can encounter.

Some signs that it may be time to stop driving:
1. Slowed motor reflexes
2. Decline in vision
3. Impaired hearing
4. Decline in attention span
5. Physical limitations (neck, arms and/or legs)
6. A few "Close Calls"- almost hitting someone, dents or scratches on your car

If your loved one is experiencing one or more of these difficulties, it may mean that it is time to look at their driving safety.  Being forthcoming about these limitations can help to understand the risk that they may be taking by driving a vehicle.  It would be horrible for them to be responsible for a terrible accident by avoiding these questions.  The last thing anyone wants is to hurt themselves or somebody else.  The risk for fatal motor accidents rises significantly after the age of 70.

Another important point is for them to know their limitations.  If they don't see well at night, then don't drive at night.  If they get nervous driving to certain areas because of traffic congestion, then don't drive to those areas.  If they have pain in their neck when they try to look back over their shoulder, have it checked by a physician.

Tips to staying healthy behind the wheel:
1. Stay active
2. Have regular eye and hearing exams
3. Manage any chronic conditions
4. Know your limitations
5. Plan ahead for trips
6. Drive when weather is good

If you feel that it is time to hang up the keys, you do not have to face this obstacle alone.  Ask your physician for support in this and ask that he recommend this for your loved one. You can request to discuss it with him at an appointment.  There are driving courses available for older adults that you can enroll in to have them evaluated by a professional.

Click Here to visit the AARP link to their Driver Safety Program.

Being safe behind the wheel contributes to Aging with Ease!

Choose Your Battles Wisely

When you are the caregiver for someone, it is essential that you choose your battles wisely.  Caring for someone suffering from dementia, brings times when you will find yourself having the same frustrations with them over and over again.  This is not something they can change.  This is something you must change about yourself and how you handle the situation.

For example, a frequent concern my client's families come to me about is their loved one's refusal to bathe.  Most of us probably shower on a daily basis.  Prior to their diagnosis of dementia, so did your loved one.  It comes as a shock that this very basic activity of daily living is something that they no longer want to or are able to do. 

This can be very frustrating for some caregivers.  I try to help the caregiver realize that this is an issue they have to get over.  If you look at your loved one's current level of activity, it is probably significantly less than it once was so a bath every day is really not necessary.  They probably hardly ever break a sweat.  Unless there are incontinence problems, they have an odor or they have sores, the need for daily bathing is a routine that can be changed.  This is a daily argument or frustration that you could avoid.  Another thing to consider is home health care; in my experience, people are more likely to listen to a stranger that they recognize as a care taker than their own family when it comes to personal hygiene.  If you try to look at it from the patients point of view, it would feel degrading to some degree to need help from your spouse or your children to bathe. 

Another example, which is also a chronic problem that I hear, is difficulty having your loved one with dementia change their clothes.  How many of us wear the same outfit two days in a row?  Not anyone that I know.   So why do so many dementia patients develop this habit?  I don't have the answer to that question but it occurs none the less.

Rather than arguing with them about having worn that outfit yesterday or repeatedly trying to explain that their clothes need to be washed, a simpler solution might be to just remove the clothes they had on that day from their site when they get ready for bed at night and to lay out a new outfit for the next day the night before.  Seems like an obvious solution but you would be surprised at how many caregivers have never thought to do that.  Especially if it is a husband and wife dealing with this situation, they have lifelong habits and routines that have always worked for them and because of the progression of dementia those routines must all change.   Again this is also an area where home health care could offer relief for you in the daily care of your loved one.

I could go on and on with examples of ways that you could try different approaches to the ever-changing challenges of dementia.  The point I want to make the most is that you choose you battles wisely.   Attempting to argue with someone with dementia or trying to make them understand something that they are no longer able to understand or remember is a losing battle that will only make you, the caregiver, feel bad in the end.  The progression of dementia cannot be stopped or controlled not matter how hard you try.  Remember to try to enjoy each moment that you can no matter how brief they may be.  Spending your time trying to get them to understand something when they are no longer able to is a waste of your precious energy.


Choosing you battles wisely promotes Aging  with Ease!

The Value of a Quality Movie!

Ahhh, the movies!  Who doesn't love a good movie?  They can entice your senses.  They can make you dream of another life.  They can give you hope.  They can scare you to death.  They can make you feel warm and fuzzy.  They can open your eyes to the world.   They can make you laugh and cry.  They can educate you.  So many ways that a good movie can satisfy the senses...  The value of a movie is one thing that does not change as we age.  Movies can satisfy your senses at any age!

 However, in this day and age as an older adult, it can be hard to find a good movie to go see.   So many of the current movies don't seem to offer a whole lot of value.  Let's face it, many of them are just plain raunchy!  They seem to just be trying to shock you by just how inappropriate the content can get.  I was thinking about this during the past week as I searched for an appropriate movie to take a group of clients to from the Adult Day Center that I work in.  There were very few choices and really nothing with any value to them. 

I feel that mainstream movie-makers are missing a fairly large group of potential moviegoers by not having more options of movies available for the older population.  As I looked over the listings at our local movie theater, they were showing 12 different movies and only one of them was one that I would even consider taking a group of older adults to.  HELLO, baby boomers are now the largest group of people over 60 years old that has ever occurred!   They should have more options for satisfying their senses when they want to see a movie.

We routinely show movies at the Adult Day Center that I work at.  They are mostly older movies that they have requested to see.  Movies are a great way for them to remember their past.  The movies we show tend to spark memories in our clients, which induce conversations in the center.  I view that as a successful activity.   Any activity that gets people talking to each other and reminiscing about their lives should be viewed as a good thing.  I love hearing these conversations.  It helps me learn more about who these people really were in their life.  It also makes me realize that everybody essentially wants the same things in life.  To be happy, loved and secure. 

The selection of older movies that can be shown  are endless but try to find a list of current movies that fits the criteria, the list does not form so quickly.   I suggest that this is because our society just simply does not value our older adults as they should.   The majority of movies today are driven to attract the young.  Don't get me wrong, I love the movies.  All types of movies.  I am simply suggesting that more quality movies be made more often.  By "quality movies" I mean movies with substance that inspire hope, real life and give a connection to life.  Movies such as: The Help, Moneyball, The Notebook, Blindside and The Greenmile come too far and few between. 

Satisfying your senses keeps a person on the path to Aging with Ease.

Exploring Personal Care

Today I would like to explore Personal Care Living, formally known as Assisted Living.  This level of care is the in-between stage that comes after independently living in your home or apartment but before the need for skilled long-term care.

Personal Care settings offer 24-hour nursing staff, prepared meals, laundry services, housekeeping services, medication administration, health monitoring and activities.  Sounds kind of like long-term care living, but there is a big difference.  Residents at this level of care are still able to mostly perform their own activities of daily living like bathing, dressing, using the bathroom, things like that.  The nursing staff that is on duty are mostly certified nursing assistants and medication technicians who are all overseen by a registered nurse.  The ratios of patients to staff are less than that of a long-term care setting.  These ratios are less because the demand for one-on-one care is significantly less in Personal Care.  That is not to say that additional help will not be provided by staff.

Typically, there are three level-of-care tiers to determine the costs of living in Personal Care.  Residents who are only requiring meals, laundry services, housekeeping services and medication administration will be less expensive than a resident in this setting that needs more assistance with their care.  A resident that is already using all the first-tier options but in addition needs assistance throughout the day to manage problems with incontinence will bump them up to the next tier.  If a resident is using all of the previously mentioned services but in addition to that needs assistance with bathing and dressing each day, that will put them in the highest-tier level.  You need to examine the different tier levels at whatever facility you are looking at to determine which one you would fall into.  The cost of Assisted Living across the country ranges from $1,500 to $5,000/monthly with the average probably somewhere around $2,500-$3,500 per month.

In my opinion, if you are considering looking at admission for Personal Care and you are already at that highest-tier level of care, you should seriously consider a long-term care setting.  Most residents that reach the third-tier level are not able to stay in Personal Care for much longer.  Typically their condition is deteriorating and more extensive care is needed than can be provided in Personal Care.   In addition to this, a move to a new setting can be very difficult and confusing for older adults.  It can cause increased confusion, agitation and depression.  It can take as long as 1-2 months for them to adjust to their new setting.  The last thing you want to do is move them twice in a short period of time.  Some older adults never recover from something like that.  They feel unsettled, unwanted and almost punished in some way for having to be moved again.  As a result of that, the family then feels as though they have not done what is best for their loved one.

This decision should not be taken lightly nor should it be made alone.  This should be a discussion for you along with the people closest to you.  Talk openly about why this could be the best course to take, discuss why the move is needed and explore other possible options that might be available.

If you are a child trying to figure out what is best for Mom or Dad, make sure you are including them in your discussions.  If you have concerns about their living arrangements, express those concerns openly, honestly and respectfully.  Unless you are dealing with an advanced stage of dementia where communication will have no positive outcome, these conversations need to take place no matter how uncomfortable it may be.  Always try to put yourself in the other person's shoes and try to figure out how you would want to be treated.  Trying to find a solution to problems together as a family will increase your chances for success significantly.

Communication is key to Aging with Ease!

Join Me In Supporting Alzheimer's Research

More than 5.4 million Americans are living with Alzheimer's disease today, and that number is expected to grow to as many as 16 million by 2050. And that doesn’t even take into account the nearly 11 million people who care for a loved one with the disease.

Again this year I am participating in "2012 Walk to End Alzheimer's" in Lancaster, PA.  The Alzheimer's Association leads the way in research, development, and caregiver support.  Join me in supporting this worthy cause either by walking with me or donating to the cause.  Donating is easy and even small donations can make a big difference. Just go online to alz.org/walk. Click on “Donate” and search for my name, Christy Carpenter, as a walker.

Supporting efforts to find a treatment for Alzheimer's Disease and supporting their caregivers inspires Aging with Ease!

A Story - End of Life

The care of someone who is reaching the end of their life is a difficult process to undergo no matter what their age is.  It is a time of self doubt, constantly asking yourself if you are making the right decisions, wondering if this is what your loved one would want.

Most of us do not think about reaching the end of our lives on a regular basis and what we would want if that time came upon us.  I know that I would want to die with dignity, without pain or discomfort, and surrounded by the people that I love.  In my experiences with helping patients and their families through this stage of life, they all want those things also.

This truly became apparent to me when I needed to provide care for my father-in-law at the end of his life.  I really did not know specifically what he wanted to be done, what his wish was for this last portion of his journey through life.  I was very close to him and tried to put myself in his shoes to try to figure out what I would want if it was me that this was happening to.  Not an easy place to put yourself! 

My father-in-law passed away rather quickly from cancer that had spread from his lung to his liver and to his brain.  His final diagnosis was established in late October 2008 and he passed away in our home in February 2009.  When we were first told the results of his tests, it seemed to me that he was ready to fight to live, but as I look back now at that time, I realize that he knew before the diagnosis was even confirmed that he was in the last stages of his life.  Even with that being said, he agreed to the treatments and followed all the instructions to the letter.  I think he did those things to give the people he loved time to deal and accept the situation that was at hand.  He would have discussions with me and his son (my husband) about certain aspects of possessions he had and wishes for those closest to him, but we never talked about what he wanted for himself when he was no longer able to communicate with us.

In the end, we brought him to our home to be cared for until his last day.  I was constantly second guessing myself.  Is this the right thing to do?  Is this what is best for my family?  Can I do this?  Nothing can prepare you for providing end-of-life care for someone so close to you.  People think that because I am a nurse and have helped many families through this process that it would somehow be easier for me.  I can assure you that having had the experience I had in my work only made it harder.  Having been through this process so many times before with people that were not my family, I knew all the stages and what to expect.  This was the one time in my life when I wished I was more ignorant.  I knew what it meant when the confusion set in.  I knew what it meant to start giving the morphine to control the pain.  I knew what it meant when he could no longer respond to us.  I knew what it meant when that very distinct smell arrived.  I knew what it meant when his breathing changed.  Knowing all these things only made it harder but also reassured me that there was no other place that he should be than with us. 

My father-in-law died with dignity, without pain and surrounded by the people that loved him.  With the help of Hospice, we were able to give him those things in our home, a place that was his second home, a place that he knew well and felt he belonged.

Was it the right thing for my family?  YES!  Was it the right thing to do?  YES!  Is this what he would have wanted?  YES!  Did we make the right decision?  YES!

I only hope that when I find myself in the last stage of my life that I am surrounded by the people that I love the most, that I die with dignity and that my death is peaceful.

Let your wishes be known to those that love you!  Help your family with making these decisions when you can't.  You are never too young to think about these things.  My father-in-law died at the age of 56.  Having some kind of direction from him about his end of life care would have been priceless to us. 

Five Wishes is a great tool for you to use to write down these wishes for your family and take some of the burden off of them.  I would have valued this information in the care of my father-in-law had I known of it then.

Click image to view

Aging with Ease includes preparing for the end of life, not only for yourself but to help your family know your wishes!

Stay Young, Keep Learning!

“Anyone who stops learning is old, whether at twenty or eighty. Anyone who keeps learning stays young. The greatest thing in life is to keep your mind young.” Henry Ford

This is one of my favorite quotes.  Whenever I feel that there should be more to my life, I find that learning something new makes me feel inspired and young again.  One way you can continue to learn as you get up into those older years is to join groups that offer new learning experiences for you among your peers and at a reasonable cost.

If you live in my area, Southeastern Pennsylvania, then you should check out the Pathways Institute.  They offer many opportunities for older adults to continue to feel young by learning and having new experiences. Click on the below image to view their site and check out their fall schedule!

If you do not live in my area, not to worry.  There are groups like this all over the country, you just need to search for them.  If you are having trouble finding one in your area, send me a message and I will help you try to find one...

Learn something new everyday to maintain Aging with Ease!