Mission: To educate and improve the experience of aging for mature adults and their caregivers.

Mental Health

Care After Losing a Loved One

Care After Losing a Loved OneCaring for Parents Together

One widow shares “When your loved one dies, as a caregiver, there is suddenly a big hole in your life.  It feels almost like a vortex and you become immobilized.  It is hard to make decisions and you lose your groundedness.”
 
“It is invaluable to have a trusted family friend who can walk beside you and help you through the myriad of paperwork attached to the passing of your loved one and their estate or arranging the funeral.  Emotions are heightened and you are more sensitive to the external world because of being in a state of mourning and grieving.  A sense of emptiness and a feeling of loneliness surfaces when you find yourself alone for the first time after the funeral and all the people have gone back home.”
 

You may find yourself going through the 5 phases of grief:
  • Denial and Isolation
  • Anger
  • Bargaining
  • Depression
  • Acceptance
You may spend varying amounts of time in each of these phases and sometimes even double back to previous levels.  The longer you were together, the more apt you are to need extra time in emotional recovery and grieving.

 

Enlist the help of your physician if you are not taking care of yourself; are unable to sleep, or feeling depressed.  Make a relationship with a bereavement coordinator if you have used hospice and, if not, join a support group for spouses who have lost a love one.  Some churches offer bereavement support groups as well.  Utilize clergy if you have a relationship with them.

 

Take the time you need to grieve and process.  Monitor your own health needs.  Reach out and share with a compassionate person – someone who is non-judgmental, empathetic, and a good listener.

 

Men are less likely to reach out after the death of a spouse.  Many times they are depressed.  They are also much more likely to commit suicide after the death of a spouse. Include them in activities and family gatherings. Encourage them to keep eating, exercising and socializing.

 

Here is some recommended reading:
                                                         ImageCaring for Parents TogetherCaring for Parents Together
The Caregiving Wife’s Handbook by Diana Denholm

 

From One Widow to Another by Miriam Neff

 

When Men Grieve by Elizabeth Lavange

 

Caring for Aging Parents: Elder Rage & Alzheimer’s

By Jacqueline Marcell, Author of ‘Elder Rage’ www.ElderRage.com

For eleven years I pleaded with my obstinate elderly father to allow a caregiver to help him with my ailing mother, but after 55 years of loving each other he adamantly insisted on taking care of her himself. Every caregiver I hired to help him called in exasperation, “Jacqueline, I just can’t work with your father–his temper is impossible to handle. I don’t think he’ll accept help until he’s on his knees himself.”

My father had always been 90% great, but boy-oh-boy that temper was a doozy. He’d never turned it on me before, but I’d never gone against his wishes either. When my mother nearly died from his inability to continue to care for her, I flew from southern California to San Francisco determined to save her life–having no idea that it would nearly cost me my own.

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Lifelong Learning Institute

Washington University offers courses for senior adults 55+on many different subjects.  There are no course credits and you may take as many as you want in a quarter.  To find out more, contact 314-935-4237 or visit lli.ucollege.wustl.edu.  Katie Compton is Exec. Dir.  The Lifelong Learning Institute is located at 9 N. Jackson in Clayton, MO.  Classes meet at Washington University’s West Campus.  Permit parking is located in a covered garage with elevator service to the first floor classrooms.

If you have a skill or knowledge that you would like to share, call the number above and discuss it with Katie Compton.

Topic categories being covered:

  • art and architecture
  • contemporary issues/politics
  • creative writing
  • economics
  • film studies
  • history
  • literature
  • math/science/technology
  • music
  • philosophy

Someone I Care About Is Not Not Dealing With His OCD: What Can I Do About It?

Guest Bloggers:  Heidi J. Pollard, RN, MSN and C. Alec Pollard, Ph.D.

     Some people visit their doctor at the first sign of a physical symptom; others may wait till the symptoms interfere with their daily routine. Then there is a group of sufferers who seldom avail themselves of professional help, even when the problem negatively affects their life and the lives of their family. This last group can be characterized as “recovery avoiders,” or RA’s. Recovery avoidance is difficult for most people to understand and there are few resources available to help understand it. The purpose of this article is to provide some information on recovery avoidance and discuss resources available to families and friends of OCD sufferers who avoid recovery. 

What is Recovery Avoidance? 

     Recovery avoidance can be associated with almost any type of problem, from someone who has lung disease and doesn’t stop smoking to someone with manic-depressive illness who refuses to maintain Lithium treatment. In all cases, a person’s behavior is incompatible with the pursuit of health or well-being. RA’s usually downplay the severity of the problem or do not acknowledge having a problem at all. They take few, if any, steps on their own to find help or to learn about their disorder. Family members and friends are usually working much harder than the RA to do something about the problem. If treatment is sought, it is only because others have pressured the RA’s to go. And they do not fully participate once they’re in treatment.


We do not know exactly what portion of OCD sufferers are RA’s. However, it is probably a substantial number. Studies indicate only a minority of OCD sufferers has received appropriate treatment. While there are other reasons why people do not obtain professional help (e.g., lack of information, too few qualified providers, etc.), our clinical experience suggests recovery avoidance is one of the major reasons why so many cases of OCD remain undertreated or untreated altogether.

     It is natural for those who do not have OCD to wonder why an RA would not do everything possible to overcome this disabling disorder. However, it is important to remember RA’s do not fully recognize the self-defeating nature of their behavior. They are usually responding out of habit and do not know what else to do. It is easier to empathize with an RA if we recognize most of us have avoided dealing with some problem or another in our lives. Putting off addressing a problem is very common. The consequences of not dealing with OCD, however, can be devastating for those who sufferer from this disorder and for their loved ones as well. The effect on family and friends can lead them to conclude the RA is lazy, spoiled, unmotivated, or selfish, or that s/he must like being ill. Judgments like these may feel justified to someone who does not understand recovery avoidance, but demeaning labels tell us nothing about why RA’s behave the way they do. Such harsh judgments, expressed or unexpressed, do not spur the OCD sufferer to change, nor do they help the family heal. A useful explanation of recovery avoidance should make sense of the individual’s behavior and provide clues for how to improve the situation.

Why Don’t Some OCD Sufferers Deal with Their Disorder? 

     There may be other factors involved, but we believe there are two main reasons why some people avoid recovery. The first reason is fear. Those who do not have OCD often fail to appreciate the level of fear an OCD sufferer experiences. The fear may not be based on realistic concerns, but that does not matter. What a person perceives determines the level of fear. The very thought of giving up the avoidance and compulsions can be overwhelming to an OCD sufferer. These counterproductive ways of coping create an illusion of safety and control that is not always easily surrendered. Nobody wants to be disabled, but some OCD sufferers are terrified of getting better. The second reason some people avoid recovery is what we term incentive deficits. Incentives are things that push a person to act. Money, for example, motivates people to go to work. Money is an incentive. Human behavior is influenced largely by incentives, and recovery behavior is no exception. You go to the doctor because you want to get rid of something negative (e.g., unpleasant symptoms) or because you want something positive the disorder is keeping you from obtaining (e.g., a job, food, relationships, pleasurable activities, etc.). In order to be willing to endure the discomfort of treatment and generate the effort necessary to pursue recovery, a person must have sufficient incentive. Incentive is different from motivation, which is characterized as desire. For example, one may desire (be motivated) to lose weight, but without sufficient incentive to maintain behaviors that need to be performed to accomplish the weight loss, the goal will not be accomplished. Desire alone is not sufficient for behavior change, wanting something to occur is not the same as doing what needs to be done. Incentives increase motivation and fuel action. Some OCD sufferers do not fully recognize the negative consequences of their disorder. Others do not sufficiently recognize the positive things in life they are missing because of their OCD. Still others no longer believe life’s pleasures are possible for them. All of these individuals may desire to get better. A few may have even tried therapy. But they are unable to do what needs to be done to maintain the behaviors that will accomplish their goal. These individuals have incentive deficits.

     We can summarize the relationship between fear, incentive, and recovery behavior with a general proposition: All things being equal, a person will not seek recovery unless the incentive to get better is stronger than the fear of getting better. Therefore, an RA’s behavior is unlikely to change unless the fear goes down, the incentive goes up, or both. The significance of this understanding of recovery avoidance is that both fear and incentive can be modified to assist the RA. Remember, a useful explanation for problem behavior should provide clues for how to change the behavior. In the next sections, we discuss how families and friends positively and negatively influence both the fear and incentive of OCD sufferers.

How Do Family & Friends Unintentionally Contribute to Recovery Avoidance? 

     Before discussing this topic, it is important to address the sometimes overwhelming guilt and shame experienced by many family members, especially parents. Some parents worry the OCD is a sign of their inadequacy as a parent (“Was there something I could have done to prevent this?”).  Please be clear. There is no convincing evidence the behavior of parents or any other family member causes OCD. Too many parents are tortured by misguided guilt and shame, blaming themselves for something over which they had no control. This level of self-criticism and overassumption of responsibility is harmful for everyone involved. Guilt and shame only complicate the already challenging task of dealing with OCD.


Does this mean families have no responsibility? Certainly not. Although families don’t cause OCD, family behavior can influence how a person deals with the OCD. And how people deal with OCD can determine whether or not they get better. It is pointless to ask, “Did I cause the OCD?” It is useful, however, to ask, “How can I support recovery?”

     In order to understand how to support recovery, it is helpful to know what not to do and why. There are two ways in which family members and friends unintentionally contribute to recovery avoidance. The first we call “minimizing” because the person’s behavior minimizes the severity of the problem. The assumption underlying minimizing behavior is that the OCD sufferer should be able to change simply because of something the family member or friend says or does. Examples of this behavior include nagging, prodding, lecturing, yelling, threatening, pressuring, criticizing, name calling, shaming, etc. These tactics rarely achieve the desired effect. In fact, they are usually met with increased resistance and anger. The implicit message of minimizing is “you can and should change now,” a pressure which may only produce more fear and defensiveness.

     Remember, fear is one of the factors behind recovery avoidance. The minimizing behavior of loved ones risks generating more fear, which can make an RA even less likely to seek treatment. The second way to contribute to recovery avoidance is called “accommodating,” also known by the more popular term “enabling.” Accommodating is engaging in abnormal behavior (i.e., behaving differently than you would around someone who does not have OCD) in order to help OCD sufferers avoid exposure to obsessive triggers or assist them to perform compulsions. Parents, for example, who have trouble witnessing their children experience frustration or failure, may do their children’s homework for them. Other examples include family and friends doing chores the person with OCD should be doing, repeatedly providing reassurance, complying with irrational demands, and unconditionally supporting an adult OCD sufferer financially.  Accommodation sends the opposite message of that implied by minimizing. It says to the OCD sufferer, “you are incapable of doing these behaviors and we must do them for you.” Accommodation promotes recovery avoidance because it protects OCD sufferers from the natural consequences of their OCD and, thus, reduces the incentive necessary to actively pursue recovery.

How Can Family and Friends Support Recovery? 

     The goal is to support recovery from OCD. That means promoting the recovery of everyone affected by the disorder, not just that of the OCD sufferer. In order to accomplish this goal, family and friends must at times perform a balancing act. They must try to be understanding and empathic of the OCD sufferer’s plight, while gently but firmly refusing to participate in the OCD sufferer’s avoidance. They must stop trying to control the OCD sufferer’s behavior and start focusing on the things they can control – their own behavior. Here are a few things families and friends of an RA can do:

1. Learn as much as you can about OCD and its treatment.

2. Share what you learn with the OCD sufferer and with other family members and friends who are interested.

3. Express your concerns to the OCD sufferer about the OCD and the impact you feel it has had on his life and your own. And communicate your hope that s/he will seek help. Also, inform the OCD sufferer of any changes you will be making in how you deal with the OCD. Include other family members in the discussion if they are willing to participate. This should not be confused with nagging or lecturing. The type of discussion we are suggesting is respectfully prearranged with the OCD sufferer. It is not initiated spontaneously out of anger and repeated over and over. And it does not involve arguing. Make your point, but do not argue. You are there to express your concerns and perhaps to set some limits, but not to change anybody’s mind. Your well-being and that of the OCD sufferer do not depend on convincing him/her of anything right now.

4. Normalize your life as much as possible. By this we mean take steps to reduce the impact of the OCD on your life and any other participating family members and friends. This does not require the cooperation of the OCD sufferer. It does require that you stop accommodating the OCD. A family impaired by the stress of accommodating OCD is not in a state to truly help the OCD sufferer. They must first take care of their own health.

 
We do not suggest these steps are easy to implement. On the contrary, disengaging from minimizing and accommodating can be extremely difficult and stressful. You will be trying to change behaviors that may have become strong habits. These changes are likely to make you feel guilty or fearful (“Am I doing the right thing?”). It will not be easy to witness your loved one experience the distress of being less protected from the consequences of OCD. And you will need to be prepared to deal with the OCD sufferer’s negative reactions to the changes in your behavior.

     Some people have tried implementing steps like these but were unable to follow through. It can be extremely difficult to do without help. When the OCD sufferer is participating in treatment, family and friends often receive guidance from the patient’s mental health professional. In this instance, changes in the family’s accommodation of the OCD are typically made gradually in collaboration with the therapist. Accommodation is withdrawn in a way that is sensitive to the patient’s level of progress. However, an RA often does not agree that changes are necessary and s/he is usually not in therapy. Without a therapist involved, family and friends have to decide for themselves at what pace they are going to withdraw accommodation. Fortunately, there are some resources available to help them.

What Help Is Available for the Family and Friends of a Recovery Avoider? 

       There are numerous resources to help family and friends learn about OCD and its treatment. It is well worth the investment in time to browse the many sections on quality web sites.  Another resource is people who have been in a similar situation. On the internet, there are several chat rooms and bulletin boards related to OCD. Although mostly for OCD sufferers, many family members and friends seek information and assistance there as well. Also, check to see if there is an OCD support group that meets in your area. Many of them allow people other than OCD sufferers to attend and some even have special groups for families and friends. In addition, the International OCD Foundation’s annual meeting has many programs specifically for families. 

     Despite the value of resources we have already mentioned, many people need ongoing professional consultation to deal successfully with a friend or family member who is an RA. A therapist can help you anticipate and deal with real life complications that arise as you implement the steps we have outlined. Admittedly, you may have to search to find the expertise you need.


There is still a limited number of clinicians experienced with OCD and not all of them work with families. We suggest you begin by contacting OCD therapists in your area and ask them if they have ever provided this type of service. If you cannot find an appropriate therapist in your area, technology offers another option. Some of the major treatment centers provide ongoing phone or email consultation to families and friends of RA’s. For over 15 years, our clinic has been helping families from various parts of the country through long distance consultation. 

      The good news is there is hope for families and friends confronted with the difficult challenge of dealing with an RA. They have options other than minimizing or accommodating the OCD or waiting helplessly for the recovery avoidance to go away. They can begin by doing something for themselves and focusing their efforts on the things they can actually control. No matter what you do, there is no guarantee the OCD sufferer will ever decide to seek help. However, recovery avoidance is less likely to persist when those around the RA are actively seeking to improve their own quality of life.

Ms. Pollard is a staff therapist at the Anxiety Disorders Center and Clinical Instructor at St. Louis University School of Nursing.  Dr. Pollard, PhD, is a Professor of Family and Community Medicine and the Director of the Anxiety Disorders Center at the St. Louis Behavioral Medicine Institute. 


Families of OCD Sufferers Seldom Get The Help They Need: Why They Don’t and Why They Should

Guest Bloggers: Heidi J. Pollard, RN, MSN and C. Alec Pollard, Ph.D.

12-year-old Jill is late for a family gathering and getting more frustrated by the minute. She and her parents have been waiting in the car for half an hour while her brother checks every corner of his room to be certain nothing has been lost. She wonders, “Why does the whole family have to suffer because of him?”

Sam lost his temper this afternoon after his wife asked him the same question for the 25th time. He’s the only one who can reassure his wife she is harmless despite her obsessive doubts about being a serial killer. He feels guilty about losing his temper, but is overwhelmed by his wife’s constant reassurance-seeking.

Jack and Susan have compassion for their 29-year-old son, but their resentment and anger are growing. “If he’s too disabled to help out around the house or to get a job, then why won’t he seek help for his OCD?” They try to be understanding, but they know he must feel their discontent.

OCD is a family affair. The toxic tentacles of this disorder extend far beyond its identified victim. Jill, Sam, Jack, and Susan all suffer from OCD. Though none of them has the disorder, their lives and those of many other family members are greatly affected by OCD. In addition to dealing with the disruption OCD creates, family members must contend with their own emotional reactions, which can include guilt, shame, anxiety, frustration, and depression.

Research has documented the plight of those who interact with or care about an OCD sufferer. A majority of family members report some degree of distress adjusting to OCD (Calvacoressi et al., 1999) and for a smaller portion the stress is significant. In one study of individuals who were the primary caregiver for an OCD sufferer, a quarter of those surveyed indicated they were “severely burdened” by the situation and “extremely distressed” at the prospect of continued burden (Laidlaw et al., 1999). If there are benefits that come from the effort involved in accommodating the OCD sufferer’s avoidance and compulsions, they may not justify the costs. Although accommodation can temporarily relieve the distress of the OCD sufferer, in the long run it may contribute to unsatisfactory treatment outcomes (Amir et al., 2000).

Given the far-reaching impact of OCD, one might expect to see family members lining up at therapists’ offices or busily seeking other resources to help them cope effectively. But such is not the case. The usual focus of family concern is squarely on the OCD sufferer. They may work diligently to find help for the OCD sufferer, but it is the exception when family and friends exert similar effort on their own behalf.

This state of affairs is not too surprising when we examine the number of people with OCD who do not pursue professional help. If many OCD sufferers do not seek help, why would we expect other members of the family to do so? In fact, some of the obstacles that discourage help-seeking in OCD sufferers are the same as those that dissuade other family members from getting help.

There are a number of practical obstacles that make it difficult for families to get help. Some people are unable to locate a qualified provider or support network in their area, while others have difficulty paying for healthcare even if it is available. If a family member is fortunate enough to have met with a clinician familiar with OCD, the discussion is typically focused on the OCD sufferer. Many otherwise knowledgeable clinicians pay insufficient attention to the rest of the family. Too often, they underestimate the amount of support and direction needed by families who have to deal with OCD and its impact.

Families also have to contend with psychological obstacles. In another article entitled, “Someone I Care About is Not Dealing with His OCD: What Can I Do About it?”, we discussed how fears about the recovery process and competing incentives lead some OCD sufferers to avoid dealing with their disorder constructively. We called this failure to pursue help “recovery avoidance.” Other family members may grapple with recovery avoidance as well. A husband may avoid therapy because he mistakenly believes the therapist will blame him for his wife’s problems or parents may not want to deal with the anger their son might exhibit if they seek help. An individual’s assessment of the costs (e.g., danger) and benefits (e.g., incentives) of seeking help are influenced by his or her beliefs about therapy, personal control, responsibility, and other issues. Unfortunately, there are several common, but misguided notions that can discourage family members from effectively attending to their own well-being.

For the purposes of this article, we will call these notions “myths.” These myths are fictitious ideas that discourage the families of OCD sufferers from seeking help. There might be dozens of such myths, but in this article we focus on the 6 we have observed most often. Table 1 outlines the 6 myths and the fallacies behind them. If you are stressed by the presence of OCD in your family and have not considered getting help for your self, take a moment to review Table 1. See if any of the myths described have influenced your behavior.

Table 1. Six Family Help-Seeking Myths and the Fallacies Behind Them

The Myth

The Fallacy

1. The only way for my life to improve is if the person with OCD gets better. This myth recognizes only one way your life can improve and rests your happiness completely on the behavior of another person. It will almost certainly be better for you if he gets better, but his progress is not in your control. What if he chooses not to seek help? What if he seeks help and doesn’t participate adequately in treatment? What if his OCD is not treatable? These possibilities are difficult to accept. But, once you do, you can refocus your efforts on to things you can do to improve the quality of your life, which is still important if he gets better and even more important if he does not.
2. It’s selfish to try to help myself.This myth portrays healthy concern about your self as something shameful. The word “selfish” is a put down, not an accurate or useful description of taking care of your self. It implies that concern about your own well-being is inconsiderate, that it is somehow harmful to someone else. On the contrary, taking care of your self usually helps others (see myth #3 for more on this).
3. Getting help for me will jeopardize my efforts to help her. This myth incorrectly suggests that helping yourself will make you less able to help her. In fact, quite the opposite is true. When you are less burdened by frustration, guilt, and other negative emotions, you will actually be more effective in dealing with other people, including her. Can you honestly say that how you interact with her in your current state of mind is always level-headed and constructive?
4. He’ll be upset if I seek help. The inaccuracy of this myth is not the prediction that he will get upset. There is a very good chance he will. In fact, you should be fully prepared for this outcome and plan how you will handle his expressions of anger. The problem with this myth is its two underlying assumptions: 1) that you can control whether he gets upset; and 2) that he won’t get upset if you don’t seek help. You really don’t have a choice over whether he gets upset. He has OCD. He will get upset. The choice you have is whether what you do is helpful or unhelpful.
5. I shouldn’t have to be the one to change. This myth is based on the laws of a world that doesn’t exist, a world in which things are always fair. People usually use the word “should” when they don’t want to deal with the real world. “Should” refers to how you feel things ought to be. But it has little to do with the world in which you live, the world about which you must make real decisions.
6. I should be able to cope without help. There is that “should” word again. This myth refers to the make believe world in which you are all-knowing and never need assistance from others. In the real world, reasonable people seek assistance from others who have expertise or access to resources they don’t have. Knowing when to seek help is not a weakness. It is a strength that improves your ability to function. Don’t be the person who never reaches her destination because she won’t ask for directions.

Left unchallenged, these myths can be quite persuasive. They are not just intellectual concepts. They are deeply held convictions tied to strong emotions. Unfortunately, that is what makes them so powerful. If myths of this nature are as common and influential as we believe they are, then it is easy to understand why so many family members neglect their own needs.
If there is someone in your life who has OCD, we hope this article has helped you sort some things out. Perhaps you have determined that the OCD in your family does not directly affect you. However, if you are one of the many family members whose lives are adversely impacted by this disorder, please consider taking action steps to improve your emotional well-being. If the OCD sufferer is in therapy, ask his or her therapist for consultation or a referral. If not, check with clinicians in your area to see if there is someone who can work with you. See if there is a support group for family members within driving distance. Explore resources on the internet. Attend the annual meeting of the OC Foundation. Do everything you can to free yourself from the negative effects OCD has had on your life. Or, you could wait until the OCD sufferer gets better. It’s your choice.


Ms. Pollard is a staff therapist at the Anxiety Disorders Center and Clinical Instructor at St. Louis University School of Nursing. Dr. Pollard, PhD, is a Professor of Family and Community Medicine and the Director of the Anxiety Disorders Center at the St. Louis Behavioral Medicine Institute.

Secrets to Why Your Brain May Not Be Working Properly

There may be times when you feel mental confusion or fuzziness.  Many factors affect the brain’s function.  Since the brain utilizes up to 25% of the oxygen in the body, it must be pumped from the heart.  If you don’t exercise regularly and spend a lot of time sitting in a chair, you will experience mental dullness.  Get up and walk around or jog in place to get your circulation moving.  If you have sleep apnea or snore a lot, you are depriving your brain of oxygen.  You may want to be tested to make sure this is not your problem.

Other reasons why you may experience lack of mental clarity may include lack of sleep or oversleeping.  Poor diet can contribute by not nourishing your brain cells with the energy they need to function.  Medications and/or over the counter drugs can contribute to mental fuzziness as can allergies.  Depression causes lack of mental clarity. Stress can deplete the B vitamins in your system and take a toll on your brain.

Urinary tract infections can make it appear as if you have dementia but once it is cleared, you will be back to being your old self.  Research is finding that a B vitamin deficiency will affect mental functions.  Those who had normal levels of vitamins C, E and B scored higher on tests.  As the body ages, B vitamins do not replenish themselves so they must be supplemented to ensure your body is being adequately nourished.

Another reason your brain may not function properly is sugar level sensitivity.  If you have hypoglycemia, sugar levels may drop suddenly and your ability to remember or calculate will be affected.  Drinking alcohol can have the same effect temporarily.

What can you do?  Practice relaxing through meditation or breathing exercises.  This will activate the parasympathetic nervous system which tells your body to relax.  Breathe in to the count of 6; then breathe out to the count of 6.  Think of something that brings a smile to your face.  Practice breathing this way for 25 times.  You will find that you feel relaxed and sleep very deeply.  It also helps to release negative emotions because you reach a place of calm where you can think more clearly.  Therefore, your thoughts are more organized and dependable so you can make better decisions.

Lastly, lack of mental stimulation and social interactions will contribute to a dull mind.  Do something to have fun and invite others to join you.  Sponsor a game night and use games that are social and stimulate your brain.  Re-learn how to relax. And, most of all, laugh.  This releases endorphins which puts you in a good mood and more healing mode.

7 Tips for Combating Stress in Caregivers

Caregiving is Stressful

Caregiving has difficult and challenging moments.  Many times you are isolated with the person for which you are caring.  Frustrating
episodes can escalate.  Here are some tips to help you cope and stay calm.

1.  Breathe deeply to a count of six (6) and then exhale to a count of six (6).  Do this for five minutes.  You will feel refreshed after you do
this.  It helps to engage your parasympathic nervous system which relaxes tense muscles. Continue reading

Alcohol Use in the Elderly

Alcohol causes more problems as people age

Alcohol use in the persons 65 and over is notable for several reasons.  First, the older person has a diminished capacity to handle alcohol and what he/she was able to handle  when they were younger no longer applies. Secondly, because older people often have multiple medical conditions for which they are being treated, it can be dangerous to mix alcohol and medications. For instance, aspirin use with alcohol can cause excessive bleeding; acetaminophen and alcohol can cause risk of liver damage.  Allergy medication and alcohol can cause sleepiness, making it risky for older people to drive. Thirdly, as people age, they are subject to losses, changes in life arrangements, medical conditions and surgeries which create stress.  Alcohol and depression are relational, meaning that alcohol can contribute to a person’s inability to handle the situation and deepen the depression. Continue reading

My Firsthand Experience with Alzheimer’s

When a Loved One Has Alzheimer’s

My mother had Alzheimer’s. It began with little strokes called TIAs where she would have numbness and tingling down one side of her body. She didn’t realize what they were. She was in the generation where women were not assertive so she did not tell the doctor’s assistant why she was trying to get in to see him. By then it was too late and she continued to have these TIAs.

Often dementia follows after a vascular event. If Alzheimer’s symptoms were present when the vascular event occurs, it weakens the body enough to trigger the dementia.

When her neighbor across the street from her died and her best friend across the block had passed, she no longer had people close to check on her. She was furious when we insisted that she move into an assisted living center. For one month, my brother and I were persona non gratis. Then she went back to the home she had lived in for over 42 years and realized she was glad that she no longer had the responsibility.

After her strokes, she continued to drive. She lived out in the country. She had a blind spot on her right and so she would only go on trips where she could turn left. We were terrified that she would hit a jogger or child riding a bike but she didn’t. During the last year, she did have three accidents. She was beginning to get lost on previously familiar routes. When she moved into the assisted living center, they provided transportation and so there was no need for her to drive. The car sat in the parking lot for a year before my brother bought it.

Difficult Behaviors

Mom became overtly sexual in a way that she never had before. She talked about it openly and it was out of character for her. She also began to drink wine. She would have ‘only a little bit’ but 15 minutes later, she didn’t remember that she had already had a little bit and she would have more. It masked some of her pain, I believe. This happened at a time when she was on oxygen all the time. We found wine bottles hidden throughout her apartment. She would just go to the grocery store and buy more. Her psychologist recommended giving her a little drink every night before bed. That way she could still have some.

Many times she would be frustrated and angry and say “Parts of my life are missing!” In the beginning she knew that she was losing her memory. She was depressed and felt like her control over her life was slipping away from her.

Later, she became more complacent. She couldn’t remember anything to make her agitated so she focused on what she appreciated about her family.

We found that anything hidden behind the door in the refrigerator or in the cupboards or drawers were as good as gone. She did not remember them. Eventually, we had to remove the coffeepot and have the oven unplugged because she couldn’t remember to turn it off and we were afraid she would start a fire. In the end she could not even change channels on the TV so she watched the same channel all day.

She couldn’t remember that we had come to visit her even if we had been there the night before. Finally, we placed a calendar by her bed with instructions that anyone who visited had to write their name in on the day so she would know that they had been there.

I had come for a 3 day visit in-between jobs and stayed with her. During that time I noticed that she was always scratching her face. It was dry so I purchased some moisturizer. Her nose was bleeding from the constant oxygen. The nurse suggested vasoline placed on her nose membranes to act as a barrier. Her toe had a fungus that had not been noticed by the nurses. I tried to soak her feet in vinegar which is good for removing fungus.

Saying ‘Goodbye’

During my visit I noticed that she was getting more and more tired. At lunch she was practically falling asleep in her plate. I walked her down to her room and she laid peacefully on the sofa. The intake nurse came in to take her vitals as she was being placed in a higher care facility. The nurse said, “Your mother’s blood pressure is only 80/40.”

“What does that mean?” I asked. She replied that protocol was that you sent them to the emergency room so I called 911. An ambulance wisked her off to the hospital. She had pneumonia but had shown no outward symptoms. I remember saying to her, “Mom, I just need to know that you are going to get better.” The truth was, it was only going to get worse.

Once she was treated, she moved to the long term care facility. Within a week, she had a massive stroke and was in a coma for 2 weeks. All of my brothers and sisters were there day after day and she even began to rally a little. The one day that we took a breather and didn’t show up to the hospital was the day she died.

Knowing what I do now, if the intake nurse had given me alternatives, I might have called my brothers and sisters and said, “Mom is getting ready to pass. Come say your goodbyes” However, nurses are trained in the medical model which is to cure. When one reaches a certain age though, there is not going to be a cure and it is important to let go and give them permission to go.

Measuring Brain Reserve

Recently I became certified to administer the Reality Comprehension Clock Test offered through RCCT Press, Toledo, OH.  It is capable of determining how much a person is understanding, their ability to process and follow instructions and their functional level.  It also reveals whether they are a fall risk, their Stage of Deterioration and potential deficits.  There may be instances when an infection is present that has not yet been diagnosed.

Studies done indicated a strong relational link between the Mini-Mental State Examination and the Reality Comprehension Clock Test  in determining the status of an individual’s brain.  This test can help families who are uncertain about how much care is required for their loved one to get a realistic picture of what they are capable of handling and how they can plan activities at which they will feel successful.  For more information, go to http://www.clocktestrcct.com.

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Diane is currently available for speaking engagements. For fees and scheduling, call 314-484-8623. To send an email, please click here.

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