Source: Eldercare Network News
Introduction
Healthcare professionals who haven’t personally lived through the nightmare of caring for a difficult elder may have a hard time comprehending the depth of the heartache and despair that families go through. So often, when the professional sees the “challenging” loved one, the patient is pleasant and rational, and certainly not the demon the family describes at home. Since medication will not be prescribed for conditions that are unseen, the family is told that the intermittently odd behaviors are probably just irritability and a normal part of aging. Unfortunately, they are usually sent home to suffer longer than need be.
I have survived this nightmare and can attest to how difficult it is. I was a successful television executive when my life suddenly took a turn into eldercare and I had to go take care of my aging parents. My once-adoring father was occasionally irrational, even turning verbally and physically abusive towards me at times. Yet, it was so amazing that he could act completely normal in front of every professional I took him to.
I grew up experiencing my father’s bad temper (though never at me before), so I assumed that these behaviors were just more of his bad behavior of a lifetime getting intensified with old age and the stress of my mother’s near-fatal illness. Yes, all that was true, but it was also the beginning of Alzheimer’s disease, and not one professional caught it for a whole year.
When my father threw two little dilapidated hand towels at me, screaming and swearing at me for throwing them away, I was stunned and sobbed my heart out. With the knowledge I have now I'd say, "This seems illogical, this seems irrational. Even for him this is over-the-top.” I’d know not to argue or get upset, and I’d know to have him evaluated by a geriatric dementia specialist right away. I'd know not to waste time with his regular doctors who didn't specialize in dementia and who didn’t know how to uncover the earliest stage. Had I known that, I could have been spared the worst year of my life, endless tears, and our families’ entire life savings.
Recognizing Early Dementia Symptoms Is Key
The stereotype of a person with dementia (Alzheimer's is just one of many types) is that of someone who doesn't know what they are doing. That’s way down the line, Stage Three (1-3 years), but there is a long road through Stage One (2-4 years) and Stage Two (2-10 years) first. One out of every ten persons by the age of 65 has some form of dementia, and it rises to nearly one out of every two to three persons by the age of 85. The fastest growing segment of our population is the 85+ group, so there are a lot of elders who need to be evaluated, and a lot of unprepared families needing education about the subtle beginning of the disease.
Dementia starts very intermittently and is generally ignored by families and many professionals statistically for four years, because they incorrectly believe that these occasional strange behaviors are a normal part of the aging process. Because there are usually long periods of normalcy in-between episodes, the tendency is to forget about the irrational incident as soon as the loved one is back to acting normal, instead of seeking diagnosis and treatment immediately.
Early diagnosis is important because with medication (Aricept, Exelon, Reminyl or Memantine) the dementia can be slowed from progressing as fast as it would otherwise, maybe even for several years. Seeking treatment early and keeping a person in Stage One longer can save families a lot of heartache and money, because Stage Two requires full time care. Early diagnosis and treatment will also save our society the burden of caring for so many elders who progress downward sooner than need be.
Alzheimer’s disease costs American businesses $61 billion a year, largely due (79%) to lost productivity from the absenteeism of employees who must take time off work to care for loved ones. If everyone knew the warning sings and reached out to a dementia specialist early, less time would be lost in the workplace and much less frustration would be experienced—saving everyone heartache and money and even reducing elder abuse.
The Ten Warning Signs
- Recent memory loss -- your loved one may ask you the same question over and over, look at a beloved granddaughter and ask her name, or forget that they just told you that story and tell you again.
- Difficulty performing familiar tasks -- such as tying a necktie or shoelaces, or being unable to do the knitting they have enjoyed for many years.
- Problems with language -- using the wrong word or unable to remember the right word to use.
- Disorientation of time and place -- mistaking a time period of hours for days, or giving incorrect directions in the town they have lived in for many years.
- Poor or decreased judgment -- for example, while babysitting they may completely forget about the child they are supposed to be watching.
- Problems with abstract thinking -- inability to balance a checkbook, adding becomes difficult, or they may insist that a one-dollar bill is a 20-dollar bill.
- Inappropriate misplacing of things -- you might find the wristwatch in the sugar bowl, the iron in the microwave, or a hat in the freezer.
- Rapid mood swings -- switching from tears to anger for no apparent reason.
- Changes in personality -- you may notice a tendency toward fear and paranoia.
- Loss of initiative -- your loved one may not want to get out of bed, withdraws socially or says they don’t want to live anymore.
Creative Behavioral Techniques
In addition to slowing down the dementia, the (often-present) depression can be treated with an anti-depressant, and the (sometimes-present) aggression can also be medically improved. Once a patient’s brain chemistry is properly balanced, behavioral techniques can be tried on a challenging elder if they are in the EARLY stage of dementia and their short-term memory is still fairly good.
Amazing as it sounds, the use of rewards helped to turn around the most obstinate man on the planet, my father--even with the onset of dementia. By being 100% consistent, never rewarding his bad behavior and using tons of praise to encourage good behavior, he finally changed his life-long pattern of screaming and yelling to get his way—well, the majority of the time.
By validating his frustrated feelings, giving him a sense of control over as much as we could, he felt more in charge of his own life. We learned not to argue with him and practiced distraction and redirection instead. We developed a calm attitude, used soothing language and gave simple directions. Since he loved the affection (and dessert) he received for good behavior, and hated that we walked away from him when he yelled at us, he gradually started to behave better. He finally learned that he could (as Mom would say), "Catch more flies with honey than vinegar!"
Adult Day Care
Once we got my father better balanced chemically and behaviorally, Adult Day Care was such a help for getting my parents out of bed 23 hours a day just “waiting to die.” They finally had someplace to go, friends to see, and they received the social, physical and intellectual stimulation that we were not able to regularly give them at home. Oh yes, my father hated it at first, saying that everyone was too old, but gradually he got used to the routine and looked forward to going. Keeping him busy gave him less time to focus on his ill health, giving us a much-needed break, and we gained the opportunity to spend quality time with my parents in the evenings and on the weekends.
Assisted Living
Assisted Living is a fantastic solution for seniors because as they need more help and services, they can be added without having to move to a new place. They supply everything that Adult Day Care offers and considerably more: 24-hour safety, numerous activities, socialization, and individual assistance with activities of daily living such as: dressing, bathing and taking medications--with professionals who know how to manage them. Many offer support groups for families on how to cope with a loved one’s decline.
How I wish I could have moved my parents into Assisted Living and been spared the nightmare of trying to find caregivers to come to us. We went through forty that year, as my father would scream and yell and throw them out of the house--so no one would put up with him for very long. Since I didn’t have the right doctors, diagnosis, medications, or appropriate Durable Power of Attorney, I couldn’t force my parents to move.
How Professionals Can Help
Professionals can make a huge difference in the lives of the families they work with by being compassionate, teaching the warning signs and behavioral techniques, and by strongly recommending Adult Day Care, Assisted Living, and support groups. Suggest that the family use a hidden mini tape recorder to capture bad episodes, which will enlighten the doctor and help with obtaining an earlier diagnosis and appropriate treatment. Make sure families understand that “demented” does not mean “stupid” at all (a concept that is not widely appreciated), that manipulative behaviors can still occur, and that socially adjusted elders will rarely show their “Hyde” side to anyone outside the family. Point out that the techniques they used to gain control during their lifetime, will probably be the same methods used now, but that they will be over things that are more illogical and irrational than ever before.
By Jacqueline Marcell, Author
Elder Rage, or Take My Father… Please! How To Survive Caring For Aging Parents
Jacqueline Marcell is a national speaker and the author of, "Elder Rage, or Take My Father... Please! How to Survive Caring for Aging Parents", a Book-of-the-Month Club selection being considered for a feature film. Over fifty endorsements include: Hugh Downs, Regis Philbin, Dr. Dean Edell, and the National Adult Day Services Association--who honored her with their Media Award. Jacqueline also received “Advocate of the Year” from the National Association of Women Business Owners at their Remarkable Women Awards. A recent breast cancer survivor, Jacqueline advocates for caregivers to closely monitor their own health. She also hosts an Internet radio program heard worldwide on www.wsradio.com/copingwithcaregiving. For more information and to purchase book see www.ElderRage.com.
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