I’ve seen many articles this week about preparing pets for the often loud Fourth of July celebrations. It is true that some animals have a severe reaction to the booming blasts of fireworks, so it’s best to keep them indoors and monitor for signs of stress. I feel fortunate that my current crew (one dog, two cats) don’t seem to be bothered much by fireworks.
But the advice made me consider another group who many be overwhelmed by this weekend’s festivities: people with dementia. The noise, the lights, extra people in the house … it can be challenging for someone with dementia.
Here are some dementia caregiving tips on how to navigate the holiday:
Remain flexible: If you are taking your loved one to a public fireworks display or parade, be aware of how your loved one is faring and if you see signs of discomfort or stress, be prepared to leave early.
Keep celebrations small and low-key: An intimate dinner or small barbecue with a select group of people can help keep your loved one with dementia from feeling overwhelmed. Hosting at your home means that if your loved one wishes to retire early, they can do so with ease.
Find fun ways to celebrate: Just because you are stuck at home doesn’t mean you can’t have fun. Indulge in a favorite meal, play festive music, dance, or watch a favorite movie. Take time to connect in simple ways.
Don’t feel guilty if things don’t go as planned: Those with dementia can have good and bad days, and it can be hard to predict what mood they will be in at any given moment. If an event or gathering proves too much for them, don’t be too hard on yourself. Once your loved one is comfortable again in a safe environment, take a moment for yourself. Learning from our mistakes is key in being a successful caregiver.
Here in Atlanta we are looking at a brutal heat wave, with temperatures expected to be in the mid-90s for the next couple of weeks. Summer begins officially on June 21, but in some parts of the country it has arrived early.
It’s important this time of year to check in on elder loved ones and neighbors. No one should be dying of heat exposure in their homes in our modern times, yet each year, heat-attributed deaths occur. Those at greater risk include elders, those with pre-existing health conditions and those in public or institutional housing which may not have adequate air conditioning.
I would note another factor, which may be the most tragic of all. Some elders may have air conditioning, but are afraid to turn it on because of the cost. That’s why it’s important to check in and make sure your elder loved one’s homes are adequately cooled. Fans may not be enough in areas experiencing a prolonged spell of extreme heat. Check with local officials to see if public cooling stations are available.
This is a very good message to pass along to the dementia caregiving community. While I tend to focus on the struggles of being a reluctant caregiver, it’s important to note that some caregivers do find a way to maintain a decent quality of life. As Elaine points out in her blog post, having sufficient funds to cover care costs is part of it, but attitude is also a factor.
Click through the link below to read the thoughtful post from When Dementia Knocks:
I write a lot about the challenges of dementia caregivers…their high rates of clinical depression and anxiety…their loneliness…their daily stressors. This post doesn’t change anything I’ve written in the past, but I do want to acknowledge something. Some caregivers are doing okay. Some caregivers are happy. Some caregivers are enjoying life and thriving. That doesn’t […]
In order to honor our elder’s wishes to age in place, it’s important to make sure they have the proper support. That may include hiring in-home care aides to perform housekeeping and some basic medical tasks. This is especially true for those of us who are long-distance caregivers.
Finding a good fit can be a challenge. Some elders may resent the idea that they need help and sabotage any hopes of securing care services. Those with dementia may become more confused or combative with a stranger in the house. Even those who are willing to accept a care aide in the home may find their routines are disrupted, which may cause short-term distress.
I was fortunate that my mother’s aide, hired through a local home health care agency, was a wonderful woman who clicked with my mother. Not only did she offer my mother a helping hand, she offered her companionship. My mother had a very set way of doing things so I know she probably was a challenge for the aide at times, but I so appreciated the aide’s services. I knew I could trust her and that my mother was receiving the support she needed to stay in her home.
MarketWatch published an article that has helpful tips on what you should look for when choosing an in-home care aide. Beyond the basics like a background check, it’s important to know the aide’s skill set, availability, and career aspirations. Going through a home health agency can offer some peace of mind, but can be more expensive. Word of mouth can be a good way to find a caregiver in your community. When it comes to hiring a care aide, hands-on experience may be more key than formal education.
There are websites and apps that allow one to hire a caregiver remotely, which can be useful for long-distance caregivers but can be a bit more of a gamble without that in-person assessment. Long-distance caregivers should consider a video call before making any hiring decisions. Don’t overlook your gut instinct; if you feel an aide is not the right fit, don’t hesitate to take action. It’s not unusual to cycle through a few care aides before finding a good fit.
This is such an important topic and I’m grateful for Kay Bransford’s excellent blog post. As my father’s dementia progressed, simple tasks like paying for groceries or a fast food meal became a challenge that caused my father to become angry and accuse others of trying to rip him off. My mother eventually had to take over those tasks. After my father’s death, my mother’s loneliness made her susceptible to the barrage of telemarketers who would call on a daily basis. As a long-distance caregiver, it was difficult and frustrating for me to try and manage from afar.
Click on the link below to read the helpful post on Dealing with Dementia:
There were a few odd conversations with my Mom when things didn’t make sense. But the most alarming thing was when I realized my parents had changed their decades-long habit of giving every January. I started to notice that my mother was writing checks to charities that they had never previously supported. I would read…
Anyone who is dealing with chronic pain or caring for someone with a chronic pain condition being treated with opioids will want to pay close attention to the Centers for Disease Control’s updated opioid prescribing guidelines for doctors.
The public comment period has ended and a draft of the guidelines has been completed. The CDC’s final recommendations will follow.
I all too well remember the 2016 guidelines. Doctors were warned about the upcoming changes in 2015, the year my mother died, and those guidelines (along with the doctors’ gross misinterpretation of the guidelines) caused my mother to die an agonizing death. Others sadly experienced a similar fate. Some people who had been on a successful maintenance regimen of opioids found themselves suddenly cut off by skittish doctors. Some people turned to the illicit drug market. Others committed suicide because they could no longer endure the pain.
NPR reviewed the draft document of the revised CDC guidelines. Officials blamed doctors for misapplying the CDC’s 2016 guidelines, saying it was supposed to be a “roadmap” not a “rigid set of rules.” But it’s difficult to put all the blame on doctors across the county who apparently were in fear of losing their medical license if they didn’t follow the CDC’s guidance. Clearly something or someone made them fearful enough to go against their medical training and harm their patients.
America’s overdose crisis prompted the stricter prescribing guidelines in 2016, and states in which opioid overdoses were epidemic passed laws to further restrict opioid distribution. This knee-jerk reaction, after these same states welcomed a flood of opioids from Big Pharma for years, had an unfortunate outcome for those who did use opioids responsibly to treat chronic pain conditions in which no other medications were effective.
My mother had intractable cancer pain in the last several months of her life. The CDC guidelines were not supposed to be implemented for those with cancer. But my mother’s doctor didn’t believer the cancer had returned and that she was dying. She believed my mother had become dependent upon the drugs and started limiting her prescription until she finally let my mother’s opioid prescription run out while the doctor was on vacation. My mother suffered mightily because of the doctor’s misinterpretation and fear of the CDC guidelines.
The 2022 guidelines make some improvements, according to pain specialists interviewed by NPR. There is no specific limits on the dose and duration of an opioid prescription. Clinicians will be encouraged to use their own judgment in deciding what is a safe and effective dose for each patient. And the CDC will stress more clearly that the guidelines are not “intended to be applied as inflexible standards of care” or as “law, regulation or policy that dictates clinical practice.”
While the new guidelines still discourage opioids as a first-line therapy for common acute pain conditions and for chronic pain conditions, it does acknowledge that opioids can play a role in chronic pain treatment, especially if other approaches have been tried.
If you or a loved one is running into issues of doctors not willing to manage your pain properly, keep pushing. Find another care provider. No one should have to die in agony because of bureaucratic guidelines. As NPR points out, the 2016 prescribing guidelines didn’t have the intended effect of reducing opioid overdoses. All of that suffering, all for nothing.
A New York Times article published today discusses a topic near and dear to my heart: the challenges of dying at home.
I have written about this topic extensively, including in my book, The Reluctant Caregiver. I also published an article, “Why dying at home is not all that it’s cracked up to be,” on The Caregiver Space that generated a passionate discussion. Some people thought I was anti-hospice, and that definitely isn’t the case. I think home hospice care, when it’s available in a well-funded and well-staffed form, is a wonderful concept that can support a good death.
But as Paula Span points out in her NYT article, there are challenges and limitations in real-world home hospice care. One issue that I can personally relate to is pain management. My mother suffered because I could not adequately manage her cancer pain at home with the drugs available to me. There was also the battle with her doctor just to get her enrolled in home hospice, which came much too late to be effective.
Caring for the dying at home can be physically strenuous. I struggled to move my mother in bed to change sheets and prevent bedsores. Before she was bedridden, helping her to and from the bathroom was also a challenge. I was a 40-year-old woman in decent shape. But for elder spouses of the dying who may have health issues of their own, it can be overwhelming and untenable.
Palliative care specialists at Harvard Medical School recently published an article in the New England Journal of Medicine suggesting improvements to hospice care, and I agree with their recommendations. For those determined to die at home, it’s essential to have have sufficient home health care services so that families are not overwhelmed. This includes nursing care and personal aide services but also equipment like medical beds. The authors also suggest alternatives that are underutilized, such as inpatient hospice care. This was a suggestion that was made in my father’s case, but there was no bed available at the time of his hospital discharge, so he was sent to a skilled nursing facility instead. We met with the inpatient hospice representative and I appreciated the personal aspect of the care, wanting to get to know him, asking what kind of music he liked, etc. I so wish he could have died in that setting. It’s what I would want for myself.
Hospice units within hospitals is another alternative. This offers access to end-of-life care such as pain management but rooms can be configured to be more home-like by removing unnecessary monitoring machines and having hospice-trained staff provide palliative care. It can be a good alternative in areas without freestanding inpatient hospice facilities.
It’s important to think about these options for yourself and your loved ones now so that you are better prepared to make the best choice for your situation when the time comes.
I came across an interesting discussion recently about whether Ensure and other nutritional beverages marketed towards older people are really the best option.
The discussion that followed the geriatrician’s perspective included interesting pros and cons. It made me think about my parents’ experience with the beverages. My father had never been a fan of milkshakes or similar beverages, but he seemed to enjoy the Ensure drinks, so I would ship cases of them to the memory care center where he spent the last year of his life. My mother existed on Ensure for the last month or so of her life. I have regrets about that, wishing I had taken time to make her something that she would have enjoyed more.
This is why I’m such a strong believer in expanding inpatient hospice and providing more robust home hospice care. As the sole caregiver for my mother at the end of her life, things like whipping up something delicious for her to eat didn’t cross my mind because I was so busy focusing on the “important” things, like her pain medication, treating her bedsores, etc. While I managed to mainly keep her suffering to a minimum, there was no joy in her final weeks.
Those with dementia may struggle with solid food as they enter the final stages of the disease, so liquid forms of nutrition may become a necessity. Homemade smoothies, puddings and milkshakes may interest those who have grown tired of the commercial products. If you can, consult with a nutrition specialist or dietitian about tasty, safe options for your loved one. Bringing loved ones small moments of joy can also lift the spirits of family caregivers.
The pandemic’s impact on health goes beyond those who contracted the coronavirus. Even those who managed to avoid the infection may have suffered consequences to their health, and in an area that many take for granted.
In December, I fell while walking my dog. I slipped going down a moderate slope in the park and landed straight on my rump. The fall knocked the wind out of me for a minute, but I was fortunate not to break or sprain anything. My back was very sore and remained so for about a week. I treated it using over-the-counter pain medication and homeopathic balms. My mobility was limited and I was forced to slow down and take it easy, but fortunately I fully recovered and don’t have any lingering issues.
I’m in my late 40s and in decent health. This was a minor fall, but it reminds me that as I get older, recovery from such incidents takes longer. We often take our mobility for granted, but the pandemic may have a lingering impact on our physical conditioning, making us more prone to falls. Studies suggest that some older adults have experienced a decrease in mobility during the pandemic, The New York Times reported.
What geriatric health experts are concerned about is that decreased activity levels may result in worse physical functioning, which is key to older adults’ ability to live independently. A fall can lead to a lengthy recovery and trigger a fear of falling again, creating a vicious cycle with significant health consequences. The good news is that we can engage in simple activities that will help us reverse the impacts of our sedentary lifestyle and regain our mobility. Walking, yoga, and tai chi are all great ways to get moving and improve physical functioning.
Take inventory of your mobility and your elder loved ones and make an action plan if you desire to increase your mobility. Taking small steps now can make all the difference in keeping ourselves and our elder loved ones living independently.
I’m a big fan of the Netflix show “After Life” created by and starring Ricky Gervais. While the subject matter and profuse profanity make it a show that not everyone will enjoy, I find its take on death and the grieving process refreshing and poignant.
The third and final season debuted this month and I was blown away by one scene in particular, which felt like my mother was speaking to me from beyond the grave.
As I’ve written about extensively on this blog and in my book, The Reluctant Caregiver, my mother was reluctant to discuss any end-of-life issues, but she did give me a poem she had copied by hand and said she would like that read after she died. She didn’t want any service and she chose cremation over burial so it was left to me, her only child, how to honor her wishes.
The poem she chose is the poem that is read during a very moving scene in the final season of “After Life.” When the actress began reciting the poem, I almost jumped out of my seat and my breath caught in my throat. The poem is fairly well-known but still, what are the chances that the poem my mother chose was the one that was recited on a TV show?
I chose to honor my mother’s wishes by not only reciting the poem after her death, but having it imprinted on her urn. You can read the poem below.