Tag Archives: caregivers

The Depression-Dementia Link and What Caregivers Need to Know

Far too often I talk to family caregivers who are concerned about their loved one’s cognitive decline.  It is not uncommon to hear such explanations go something like this:

Mom just has not been on top of things lately.  She seems scattered.  Her house is messier than normal, and she can’t seem to get things in order.  What concerns me most is that it doesn’t seem to bother her, and that is so unlike her.”

Dad was always such a strong decision maker, and now he can’t decide something simple, like where to go for dinner.  It seems like he’s stuck in limbo with just about everything when it comes to making choices – not just about the big stuff but everyday things”.

My wife has no interest in meeting with friends, going to church, or even going out for a stroll.  This is so unlike her.  I know she is blue, but it seems to be affecting her memory.  The other day she asked me the same questions many times.”

All of these scenarios certainly look like potential dementia-like symptoms.  Being disorganized, not able to make decisions and social isolation are certainly cause for concern, especially with older adults.  What often goes unnoticed is the possibility of depression.

What is Pseudodementia?

There is a link between depression and dementia.  It actually has a name – it’s called pseudodementia. Pseudodementia is a term—not an official diagnosis— that is sometimes used to describe symptoms that resemble dementia but are actually due to other conditions, most commonly depression. Unlike true dementia, depression that is caused by depression is often reversible.

Why is the Depression-Dementia Link often Overlooked?

My non-clinical opinion (but based on years of working with family caregivers and my own caregiving story) is that far too often families and even primary caregivers are not tuned into their loved one’s risks for depression.  Older adults who have at least one chronic health condition and 50% have two or more.  Depression is more common in people who have illnesses that limit their normal daily activities.

Loss and grief are common denominators in the elderly, especially those who are living alone, lost loved ones, especially spouses, and because of illness have lost their independence.  If, for instance, a parent has recently lost a spouse, moved from a life-long home, been diagnosed with a significant illness, can no longer drive or has to have help with everyday tasks – ALL of these are precursors to the possibility of that person’s loss and grief lead to depression.

The domino effects that occur when illness strikes, depression sets in and cognitive decline is recognized are often confusing and shocking for families.

It’s very important that loved ones look at life circumstances, and begin to make notes of lifestyle changes (such as not wanting to go out), lack of ability to make decisions, unkempt dress or cluttered living conditions.  The importance of noting these things will make all the difference when visiting the doctor.  Since we have limited time to spend with busy health care professionals, it is more important than ever that older adults have a health care advocate (preferably a family member) accompany their loved ones’ to doctor visits.

More often than not depression is not going to be diagnosed during a doctor visit unless their advocate is there to share what has been observed.  If it is too uncomfortable to do this with a loved one present, then ask for a consultation visit or at the least leave a note that clearly outlines your concerns so the doctor can read this before visiting with your loved one.

Dementia caused by depression is often reversible by treating the depression.  Before loved ones jump to conclusions that their loved one has Alzheimer’s disease or another form of dementia, they should step back and make comprehensive observations, share this with their healthcare professional and see if treating depression first will reverse what looks like symptoms of dementia.

As the holidays’ approach and families come together, this is an important reminder to observe your loved one’s emotional health just as much, if not more than what is going on physically.  Be willing to talk to others and what they have observed, and even with your loved one should be on your to-do list.

And lastly, keep in mind that the oldest generation did not grow up in the era of “happy pills” so, talking about depression and the possibility of taking a medication to treat depression can often be considered an “off the table” topic.  I’ve found that approaching with empathy and kindness and being prepared to explain that depression is treatable –  just like high blood pressure is helpful.  Above, as the saying goes, use your finest kid gloves.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  A longtime family caregiver herself, Pam has guided thousands of care partners and their loved ones with complex  challenges.

 

 

 

Communication Skills Training Improves Dementia Care

Caring for people with dementia requires specialized communication skills training.  Unfortunately, healthcare professionals and family caregivers often receive little training to enable them to meet the communicative needs of people with dementia.

Research has shown that communication skills training in dementia care significantly improves the quality of life and well being of people with dementia and increases positive interactions in various care settings. Communication skills training shows significant impact on professional and family caregivers’ communication skills, competencies, and knowledge.

As we look at the look at the vast growth taking place across the spectrum of those serving older adults,  in addition to the health and long-term care fields.  Communication skills training is being implemented by EMS professionals, Social Work, Case Management, Chaplains and Volunteer workers and to the broader community of those serving older adults in a wide variety of capacities.  Financial advisors, insurance personnel, retail, and banking are all seeing a rising need for communication skills training to better serve their older adult customer base that often is living with dementia or other cognitive impairments.

Key qualities for those directly serving the elderly and aging populations are

1. communication skills

2. compassion

3. physical stamina.

With the growing demand for in-home care services, home health aides and certified nursing assistants (CNAs),  communications skills training is more important than ever so they are well prepared to care for the high percentage of people living with dementia.  These are high demand professions and one of the fastest growing occupations projected.  Already, in many areas of the US and around the world, shortages and the consequences of these staffing challenges are affecting the quality of care.

Quality communication skills training, starting with awareness and empathy training will better prepare our health care teams, retailers,  legal and financial advisors, faith communities and first responders to face the already ballooning numbers of aging adults who deserve better care and certainly more respect here and around the globe.

Pam Brandon is President/Founder of AGE-u-cate® Training Institute and a passionate advocate for older adults and those who serve them.  Pam is the creator of the internationally recognized Dementia Live® awareness and simulation training program.  

http://www.AGEucate.com

 

Responding to Agitation and Aggression in persons living with Dementia

Agitation and Aggression- Individuals with dementia frequently become restless, anxious, or upset you may see a resident pacing, moving furniture or objects, talking to themselves, yelling or swearing. These behaviors can escalate to aggressive behaviors like, threatening or causing harm to another by pushing or hitting, cornering another resident or staff, or even throwing objects or food. And unfortunately, aggression among people with dementia can happen suddenly and seemingly without warning.

I am here to let you know if you pay attention you may be able to diffuse the situation or even prevent it.

Things to try to decrease agitation and aggression:  First thing to do is remind yourself to stay calm, it can be very very difficult but by reassuring your resident you are offering them security and creating a safe environment.

Our job is to figure out What they are trying to tell us?? remember all behaviors stem from something. So, we are going to listen to our resident as they verbally and maybe physically express their frustrations. They may not make much sense to you but sometimes a good detective can figure it out and ease the person agitation.

Possible triggers:

So, what are possible triggers:  Pain, discomfort, like being too hot, too cold, hungry, needing to use the bathroom, etc.). Perhaps they may be frustrated or overstimulated.

Environmental triggers: turn down the tv/radio, decrease noises that are loud and startling, move the resident to a smaller dimmer area, play soft music, hold their hand if they will let you and continue to reassure them you want to help.

Do Not: scold them or tell them things like “you know better”  “stop that” “ don’t touch that” that’s not yours” “ this is not acceptable. Because it is not going to help, in fact, it may make things worse.  Get yourself into their reality they are only trying to meet their needs.

Your Behaviors: It is also very important to reflect on your behavior in response to the person. If you are not already doing so, reassure the person that you are there to provide assistance and comfort. If it seems like the person needs something to do, try redirection to an enjoyable activity. Refer to a social history if there isn’t one accessible talk to your manager.

Behavior charting:  when charting on a behavioral incident or when filling out a behavior flow sheet, it is helpful to use specific, concrete words that clearly describe what a resident is doing so you can truly track whether the interventions/changes the environment work to decrease the behavior

Remember: no person is the same so not every intervention will be successful and what works for one may not work for the other. When you do find something that works, share it with your coworkers and manager.

Emmy Kaczmarksi, RN is a Master Trainer for AGE-u-cate® Training Institute, Dementia Educator, Behavioral Specialist and lives in Hudson, WI. 

http://www.AGEucate.com

The Important Role that Money plays in Caregiving Decisions

It’s no secret that families tend to shy away from the topics of money and death more often than not.  The fact, however, is that caregiving decisions often revolve around money, as care options will vary greatly depending on one’s assets.  So money plays a very important role in the choices that are made and discussions that take place between family members.

Understanding generational differences with respect to money can help today’s caregivers.  Like my own parents who were raised during the Depression,  money for our oldest generation was to be saved.  Before the era of mass production of goods, this generation did not waste, valued “things” in terms of their quality and how long they would last.   Older generations did not accumulate debt but rather watched their nest egg grow through hard work and perseverance.  One of their goals is the ability to leave an inheritance for their children.   In turn, adult children have expected this nest egg, rightfully or not.  And this is when conflict arises when families are faced with decisions on parent’s long-term care.

Too often, parents are reluctant to talk with their children about their financial situation.  My advice was always to give their children the gift of talking about it BEFORE  needs arose for decisions to be made that may conflict with theirs.  So plan A is always for families to approach this difficult topic earlier than later.

Try to start the conversation with a what-if scenario.  “Mom, we want to make sure that decisions regarding care are ones that you had envisioned.   We never know what to expect, but what if you fell and broke your hip and this required you to have ongoing care.  Can we talk about what this might entail and what you would want as next steps?”

Or another conversation starter might look like this:  “Dad, you have always been such a wonderful provider and keep such great care of your finances;  I know everything is fine now, but what if something happened to you?  Can we talk about how you would like help with paying bills?”

Children and other family members need to be respectful of the money issue, understanding that when one gives up oversight of their finances, even if it’s perceived as such, it’s a huge step in losing independence.  Tread these waters gently, approach with a sincere heart and understand that an initial response from others may be to pull back.  If that’s the case, then give it time, and reapproach maybe at a different time and with another family member present.

Put yourselves in the place of that person before approaching, and ask how you would like to hear the words of the person talking about the difficult money topic.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  

http://www.AGEucate.com