Category Archives: Caregiving – Dementia

Drugs to avoid or be cautious of in the elderly (2-page Canadian cheat-sheet)

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Group member Dorothy emailed me this link recently:

www.rxfiles.ca/rxfiles/uploads/documents/psyc-elderly.pdf

Psychotropic Drugs in the Elderly
Treatment Considerations
Sept 2011
The RxFiles Academic Detailing Program
Saskatoon City Hospital

It’s sort of like a two-page “cheat sheet” for medical professionals on:

  • what medications the elderly should avoid or be cautious of
  • suggested medications for depression, insomnia, pain, psychosis, agitation, anxiety, etc.
  • how to assess and treat what are known as BPSD (behavioral and psychological symptoms of dementia)

Throughout the cheat sheet, the acronym SE is used.  This refers to “side effects.”

One thing that is obviously missing — but it’s not part of this chart
— is what medications to avoid if dealing with a person with
Parkinson’s Disease or parkinsonism.  For example, some medications have anti-dopamine effects, and they shouldn’t be given to people to parkinsonism.  A less-sophisticated but more user-friendly list of medications to avoid with PD can be found here:

www.apdaparkinson.org/userfiles/files/Medications%20to%20be%20Avoided%207-11.pdf

If you find other things missing or items you would take issue with on the “cheat sheet,” please let me know!  This is the sort of document where more than one reviewer is needed as it’s densely-packed with details.

Robin

 

40 Requests of Family, Friends, and Care Team (Jill Bolte Taylor, PhD)

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Here’s another list of requests that those with neurological
conditions may have of their family, friends, and care team.

This list of 40 items was written by Jill Bolte Taylor, PhD, and is
part of her book titled “My Stroke of Insight.”  I highly recommend the book, if you haven’t read it before.  Or there is a good online video of Dr. Taylor giving a TED Talk.

I don’t think all 40 items will apply to those with PSP, DLB, MSA, or CBD.  For example, Dr. Taylor’s #17 is “Ask me multiple-choice
questions. Avoid Yes/No questions.”  Initially the maximum number of choices my father (PSP confirmed upon brain donation) could handle was two.  Later, he could only tolerate yes/no questions.  Later, when he could no longer respond, we’d tell him what choice we were making on his behalf,and said we thought it was the choice he would make.

Below, I’ve listed a few of Dr. Bolte Taylor’s 40 requests.

Robin

Excerpts from

“My Stroke of Insight”
by Jill Bolte Taylor, PhD

1. I am not stupid, I am wounded. Please respect me.

2. Come close, speak slowly, and enunciate clearly.

3. Repeat yourself—assume I know nothing and start from the beginning, over and over.

4. Be as patient with me the 20th time you teach me something, as you were the first.

5. Approach me with an open heart and slow your energy down. Take your time.

6. Be aware of what your body language and facial expressions are
communicating to me.

7. Make eye contact with me. I am in here—come find me. Encourage me.

8. Please don’t raise your voice—I’m not deaf, I’m wounded.

9. Touch me appropriately and connect with me.

10. Honor the healing power of sleep.

11. Protect my energy. No talk radio, TV, or nervous visitors! Keep
visitation brief (five minutes).

12. Stimulate my brain when I have any energy to learn something new, but know that a small amount may wear me out quickly.

“I’m Still Here” Approach to Those With Dementia

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John Zeisel, PhD, has developed a philosophy called “I’m Still Here” about how we treat someone with dementia.  He says that people with dementia can have a life worth living.

There will be a PBS special in March titled “Hopeful Aging” that will review Dr. Zeisel’s philosophy.  There’s a 4-minute trailer to the PBS special here:

www.youtube.com/watch?v=-2IY7MhkUVk

In the trailer, he notes that there are seven myths about people with dementia:

1.  They can’t remember.
2.  They lose their identity.
3.  They have no attention span.
4.  They can’t make decisions.
5.  There’s always an aggressive phase.
6.  They can’t enjoy anything because they forget.
7.  They can’t learn.

He says it’s natural to believe that our loved ones with dementia are not there, but it’s not always the case.

Here’s a blurb about “Hopeful Aging” published in Alzheimer’s Daily News:

“Journey through the aging brain with Dr. John Zeisel, explore the possibilities of learning and connection at any stage of life and discover proven strategies that help anyone get the best out of later life. Hopeful Aging is a program that focuses on the journey of brain aging. It brings together proven strategies to help everyone get the most out of their later life by harnessing the lessons of neuroscience with a revolutionary learning technique called C-MAP. Utilizing the principles in Hopeful Aging, viewers will see how a different approach to dementia and Alzheimers can help create a life worth living.”

Robin

How to get loved one to accept help?

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Stacey Gordon is a geriatric care manager.  She recently posted about how to get a loved one to accept caregiving assistance. Here are excerpts from that post:

The word “caregiving” is intensely evocative, and identifying a loved one’s need for care can be emotionally stirring. … We may have watched someone fall and pick themselves up, stubbornly refusing to either ask for or accept our help, and feel an increasing sense of defeat at our inability to give our loved ones the help they need.

In my role as geriatric care manager, I am often contacted after loved ones watch an older adult struggle and reject their offer of help. Concerned clients ask “how do I get my loved one to accept the kind of care I think is good for her, or any care whatsoever?” This very question in most cases, is misconstrued. Regardless of how compromised you feel your loved one might be, and no matter how much of a challenge their stubbornness might pose, you must be patient. Your job is to initiate and then revisit a conversation about care. The conversation should begin with the type of care they think is best for them, while offering your opinion in a way they can hear. You can then, through discussion, and with patience, strive for a resolution all will embrace.

One caveat: If you have cause for concern about a loved one in a life threatening situation, posing an imminent danger to themselves or others, clearly a medical professional should be notified immediately, to recommend emergency care.

By no means should your loved one be in the position of having care foisted upon them, as long as they are able to make an independent decision. Indeed, long after we may question a loved one’s judgement, it may well be possible for that person to make a viable decision for care, on their own terms. It behooves us to respect an older adult’s lifetime of experience, self determination, dignity and expectations for the next phase of their life. It’s our job to think about making decisions for care with them, and if needed, support them to enact their plan.

Here’s a link to the full post if you’d like to read all of it:

www.huffingtonpost.com/stacey-gordon/mushroombarley-soup-and-o_b_2348296.html

Considering Caregiving
Huffington Post
by Stacey Gordon, Consultant, Care Manager, Advocate, Mediator
12/21/2012

Robin

“3 Questions to Ask About Assisted Living Memory Care Communities”

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This post will be of interest to those who may be looking at memory care facilities for their loved ones with dementia.  (This is the name given to care facilities that specialize in caring for those with dementia.  Since the most common dementia is Alzheimer’s Disease, and AD has prominent memory issues, these facilities use the word “memory care” rather than “dementia care.”)

Steven Russell, BSN’s treasurer, recently came across a column in the Huffington Post in December 2011 on three broad questions to ask memory care facilities:

1- how good is the quality of care?
2- how rich and individualized is the activity program?
3- how well-designed and maintained is the place?

For each broad question, there are many sub-questions provided.  The article was written by Marguerite Manteau-Rao, the Palo Alto-based social worker who is a long-time BSN friend.

Here’s a link to the article:

www.huffingtonpost.com/marguerite-manteaurao/memory-care-communities_b_1155043.html

3 Questions to Ask About Assisted Living Memory Care Communities
by Marguerite Manteau-Rao, LCSW
Huffington Post
Posted 12/21/11

Robin