Joined: 12/15/2011 Posts: 18519
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I hear you, Alz+. You chose the screen name Alz+ for a reason. To look for the positive, or to make things better. You have already done that in regards to daily life, in encouraging us to manage our environment and to SMILE.
Now you are thinking about the end. I believe you can come up with a paradigm for yourself. You have already convinced me that the end does not have to be as bad as people say it could be.
Many family members are scrambling around in the dark, figuratively. They are uneducated about living with a person with dementia. The advantage of early diagnosis is we can educate ourselves, and hopefully educate the people who we want to be close to us. If they are unwilling, we can find new people. That's my plan.
I believe we have to be pro-active and figure out now, what we want for ourselves for the future. Only we can do it. We can't rely on others, because they don't know what we want or need, for the most part.
There are a small number of people who are forward thinking and are learning how to treat us. They are out there, scattered about. We have to find them.
Have you read this article? It's about making life easier and more pleasant for the patient with dementia, and thus, also for the care partner.
Giving Alzheimer’s Patients Their Way, Even Chocolate
By PAM BELLUCK
Published: December 31, 2010
PHOENIX — Margaret Nance was, to put it mildly, a difficult case. Agitated, combative, often reluctant to eat, she would hit staff members and fellow residents at nursing homes, several of which kicked her out. But when Beatitudes nursing home agreed to an urgent plea to accept her, all that changed.
Disregarding typical nursing-home rules, Beatitudes allowed Ms. Nance, 96 and afflicted with Alzheimer’s, to sleep, be bathed and dine whenever she wanted, even at 2 a.m. She could eat anything, too, no matter how unhealthy, including unlimited chocolate.
And she was given a baby doll, a move that seemed so jarring that a supervisor initially objected until she saw how calm Ms. Nance became when she rocked, caressed and fed her “baby,” often agreeing to eat herself after the doll “ate” several spoonfuls.
Dementia patients at Beatitudes are allowed practically anything that brings comfort, even an alcoholic “nip at night,” said Tena Alonzo, director of research. “Whatever your vice is, we’re your folks,” she said.
Once, Ms. Alonzo said: “The state tried to cite us for having chocolate on the nursing chart. They were like, ‘It’s not a medication.’ Yes, it is. It’s better than Xanax.”
It is an unusual posture for a nursing home, but Beatitudes is actually following some of the latest science. Research suggests that creating positive emotional experiences for Alzheimer’s patients diminishes distress and behavior problems.
In fact, science is weighing in on many aspects of taking care of dementia patients, applying evidence-based research to what used to be considered subjective and ad hoc.
With virtually no effective medical treatment for Alzheimer’s yet, most dementia therapy is the caregiving performed by families and nursing homes. Some 11 million people care for Alzheimer’s-afflicted relatives at home. In nursing homes, two-thirds of residents have some dementia.
Caregiving is considered so crucial that several federal and state agencies, including the Department of Veterans Affairs, are adopting research-tested programs to support and train caregivers. This month, the Senate Special Committee on Aging held a forum about Alzheimer’s caregiving.
“There’s actually better evidence and more significant results in caregiver interventions than there is in anything to treat this disease so far,” said Lisa P. Gwyther, education director for the Bryan Alzheimer’s Disease Research Center at Duke University.
The National Institute on Aging and the Administration on Aging are now financing caregiving studies on “things that just kind of make the life of an Alzheimer’s patient and his or her caregiver less burdensome,” said Sidney M. Stahl, chief of the Individual Behavioral Processes branch of the Institute on Aging. “At least initially, these seem to be good nonpharmacological techniques.”
Techniques include using food, scheduling, art, music and exercise to generate positive emotions; engaging patients in activities that salvage fragments of their skills; and helping caregivers be more accepting and competent.
Changing the Mood
Some efforts involve stopping anti-anxiety or antipsychotic drugs, used to quell hallucinations or aggression, but potentially harmful to dementia patients, who can be especially sensitive to side effects. Instead, some experts recommend primarily giving drugs for pain or depression, addressing what might be making patients unhappy.
Others recommend making cosmetic changes to rooms and buildings to affect behavior or mood.
A study in The Journal of the American Medical Association found that brightening lights in dementia facilities decreased depression, cognitive deterioration and loss of functional abilities. Increased light bolsters circadian rhythms and helps patients see better so they can be more active, said Elizabeth C. Brawley, a dementia care design expert not involved in the study, adding, “If I could change one thing in these places it would be the lighting.”
Several German nursing homes have fake bus stops outside to keep patients from wandering; they wait for nonexistent buses until they forget where they wanted to go, or agree to come inside.
And Beatitudes installed a rectangle of black carpet in front of the dementia unit’s fourth-floor elevators because residents appear to interpret it as a cliff or hole, no longer darting into elevators and wandering away.
“They’ll walk right along the edge but don’t want to step in the black,” said Ms. Alonzo, who finds it less unsettling than methods some facilities use, bracelets that trigger alarms when residents exit. “People with dementia have visual-spatial problems. We’ve actually had some people so wary of it that when we have to get them on the elevator to take them somewhere, we put down a white towel or something to cover it up.”
When elevator doors open, Beatitudes staff members stand casually in front, distracting residents with “over-the-top” hellos, she said: “We look like Cheshire cats,” but “who’s going to want to get on the elevator when here’s this lovely smiling person greeting you? It gets through to the emotional brain.”
New research suggests emotion persists after cognition deteriorates. In a University of Iowa study, people with brain damage producing Alzheimer’s-like amnesia viewed film clips evoking tears and sadness (“Sophie’s Choice,” “Steel Magnolias”), or laughter and happiness (Bill Cosby, “America’s Funniest Home Videos”).
Six minutes later, participants had trouble recalling the clips. But 30 minutes later, emotion evaluations showed they still felt sad or happy, often more than participants with normal memories. The more memory-impaired patients retained stronger emotions.
Justin Feinstein, the lead author, an advanced neuropsychology doctoral student, said the results, being studied with Alzheimer’s patients at Iowa and Harvard, suggest behavioral problems could stem from sadness or anxiety that patients cannot explain.
“Because you don’t have a memory, there’s this general free-floating state of distress and you can’t really figure out why,” Mr. Feinstein said. Similarly, happy emotions, even from socializing with patients, “could linger well beyond the memories that actually caused them.”
One program for dementia patients cared for by relatives at home creates specific activities related to something they once enjoyed: arranging flowers, filling photo albums, snapping beans.
“A gentleman who loved fishing could still set up a tackle box, so we gave him a plastic tackle box” to set up every day, said the program’s developer, Laura N. Gitlin, a sociologist at Thomas Jefferson University in Philadelphia and newly appointed director of a new center on aging at Johns Hopkins University.
After four months, patients seemed happier and more active, and showed fewer behavior problems, especially repetitive questioning and shadowing, following caregivers around. And that gave caregivers breaks, important because studies suggest that “what’s good for the caregiver is good for the patient,” Professor Gwyther said.
Aiding the Caregiver
In fact, reducing caregiver stress is considered significant enough in dementia care that federal and state health agencies are adopting programs giving caregivers education and emotional support.
One, led by Mary S. Mittelman, a New York University dementia expert, found that when people who cared for demented spouses were given six counseling sessions as well as counselors whom they could call in a crisis, it helped them handle caregiving better and delayed by 18 months placing patients in nursing homes.
“The patient did not have fewer symptoms,” Dr. Mittelman said. “It was the caregiver’s reaction that changed.”
The Veterans Affairs Department is adopting another program, Resources for Enhancing Alzheimer’s Caregiver Health, providing 12 counseling sessions and 5 telephone support group sessions. Studies showed that these measures reduced hospital visits and helped family caregivers manage dementia behaviors.
“Investing in caregiver services and support is very worthwhile,” saving money and letting patients remain home, said Deborah Amdur, chief consultant for care management and social work at the Veterans Affairs Department.
Beatitudes, which takes about 30 moderate to severe dementia sufferers, introduced its program 12 years ago, focusing on individualized care.
“In the old days,” Ms. Alonzo said, “we would find out more about somebody from their obituary than we did when they were alive.”
The dementia floor was named Vermillion Cliffs, after colorfully layered rock formations formed by centuries of erosion, implying that, “although weathered, although tested by dementia, people are beautiful” and “have certain strengths,” said Peggy Mullan, the president of Beatitudes.
The facility itself is institutional-looking, dowdy and “extremely outdated,” Ms. Mullan said.
“It’s ugly,” said Jan Dougherty, director of family and community services at Banner Alzheimer’s Institute in Phoenix. But “they’re probably doing some of the best work” and “virtually have no sundowning,” she said, referring to agitated, delusional behavior common with Alzheimer’s, especially during afternoon and evening.
Beatitudes eliminated anything potentially considered restraining, from deep-seated wheelchairs that hinder standing up to bedrails (some beds are lowered and protected by mats). It drastically reduced antipsychotics and medications considered primarily for “staff convenience,” focusing on relieving pain, Ms. Alonzo said.
It encouraged keeping residents out of diapers if possible, taking them to the toilet to preserve feelings of independence. Some staff members resisted, Ms. Alonzo said, but now “like it because it saves time” and difficult diaper changes.
Family members like Nancy Mendelsohn, whose mother, Rose Taran, was kicked out of facilities for screaming and calling 911, appreciate it. “The last place just put her in diapers, and she was not incontinent at all,” Ms. Mendelsohn said.
Ms. Alonzo declined to pay workers more to adopt the additional skills or night work, saying, “We want people to work here because it’s your bag.”
Finding Favorite Things
For behavior management, Beatitudes plumbs residents’ biographies, soothing one woman, Ruth Ann Clapper, by dabbing on White Shoulders perfume, which her biographical survey indicated she had worn before becoming ill. Food became available constantly, a canny move, Ms. Dougherty said, because people with dementia might be “too distracted” to eat during group mealtimes, and later “be acting out when what they actually need is food.”
Realizing that nutritious, low-salt, low-fat, doctor-recommended foods might actually discourage people from eating, Ms. Alonzo began carrying chocolate in her pocket. “For God’s sake,” Ms. Mullan said, “if you like bacon, you can have bacon here.”
Comforting food improves behavior and mood because it “sends messages they can still understand: ‘it feels good, therefore I must be in a place where I’m loved,’ ” Ms. Dougherty said.
Now, when Maribeth Gallagher, dementia program director for Hospice of the Valley, which collaborates in running Beatitudes's program, learns someone’s favorite foods, “I’m going to pop that on your tongue, and you’re going to go ‘yum,’ ” she said. “Isn’t that better than an injection?”
Beatitudes also changed activity programming. Instead of group events like bingo, in which few residents could actually participate, staff members, including housekeepers, conduct one-on-one activities: block-building, coloring, simply conversing. State regulators initially objected, saying, “Where’s your big group, and what you’re doing isn’t right and doesn’t follow regulations,” Ms. Alonzo said.
Ms. Mullan said, “I don’t think we ever got cited, but it was a huge fight to make sure we didn’t.”
These days, hundreds of Arizona physicians, medical students, and staff members at other nursing homes have received Beatitudes’ training, and several Illinois nursing homes are adopting it. The program, which received an award from an industry association, the American Association of Homes and Services for the Aging, also appears to save money.
Arlene Washington’s family moved her to Beatitudes recently, pulling her from another nursing home because of what they considered inattentive and “improper care,” said her husband, William. Mrs. Washington, 86, was heavily medicated, tube fed and unable to communicate, “like she had no life in her,” said Sharon Hibbert, a friend.
At Beatitudes, Dr. Gillian Hamilton, administrative medical director, said she found Mrs. Washington “very sedated,” took her off antipsychotics, then gradually stopped using the feeding tube. Now Mrs. Washington eats so well she no longer needs the insulin she was receiving. During a recent visit, she was alert, even singing a hymn.
That afternoon, Ms. Nance, in her wheelchair, happily held her baby doll, which she named Benjamin, and commented about raising her sons decades ago.
Ms. Alonzo had at first considered the doll an “undignified” and demeaning security blanket. But Ms. Gallagher explained that “for a lot of people who are parents, what gives them joy is caring for children.”
“I was able,” Ms. Gallagher said, “to find Margaret’s strength.”
Ms. Gallagher said she learned when approaching Ms. Nance to “look at her baby doll, and once I connect with the doll, I can look at her.”
She squatted down, complimented Benjamin’s shoes, and said, “You’re the best mom I know.”
Ms. Nance nodded earnestly.
“It’s good to know,” Ms. Nance said, “that somebody knows that you care.”
This article has been revised to reflect the following correction:
Correction: January 5, 2011
Because of an editing error, an article on Saturday about a comfort-centered approach to Alzheimer’s caregiving misstated the professional affiliation of Laura N. Gitlin, a sociologist at Thomas Jefferson University. Dr. Gitlin has been appointed director of a new center on aging at Johns Hopkins University; she is not the newly appointed director of the Center on Aging and Health at Johns Hopkins, a separate entity.
A version of this article appeared in print on January 1, 2011, on page A1 of the New York edition with the headline: Giving Alzheimer’s Patients Their Way, Even Doses of Chocolate.
http://www.nytimes.com/2011/01/01/health/01care.html?pagewanted=all&_r=1&
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Joined: 7/24/2015 Posts: 3020
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Well, *digs toe into dirt*...I find good things about Alz all the time.
However, how you view (and the experience that follows) Alz...is 100% a matter of perspective. And so the same adage applies, if the view sucks, step over to a different window...simple as that.
First of all...reality is reality...independent of whether you like it or not. In fact, reality could care less what you think about it. The sky is blue. I am sure some people could be really offended by that...but it is blue just the same. Simple logic...if I get all upset at the sky being blue - I will be miserable? Do I want to be miserable? No. Indeed, life is infinitely WAY too short (esp if you have this disease) to spend even one more second than you have to being miserable. So, if I don't want to be miserable, I have to change my point of view.
Some good things about the disease. I have a support group now. Indeed, I have a few. And I have made some amazing wonderful new friends whom I love to no end.
I have an Association...and I got to go on the walk. Now, that might not seem like much to most people...but when you consider that I suffered for 7 years with a "mystery illness" and nearly lost my ability to walk...it is a big deal to me.
I have a diagnosis...and an explanation for why things are so hard. Again, from the perspective of years of shrugs and I don't knows...and no reason for why I was getting worse - it is really nice to know.
I have a medicine that helps me function better. OMG, that is thrilling in an of itself. To have something, anything that helps...you have no idea. That goes for the physical issues too...went from barely walking to now can run up the stairs, and cam walk around the block. I don't think my heart will ever stop singing inside from that.
I have a host of wonderful workers who help me do all kinds of things...and yup, I love the too.
Did you know, doctors take you far more seriously when you have a diagnosis? That is pretty cool too.
I was dying anyways...only now I know what is to blame. Again, it is all a matter of perspective...if you spent years, literally years, getting worse...knowing you are dying...and having nothing to pin it to...that definitely sucks worse than knowing what it is.
After a lifetime of service to others...I have to say, that their is such a beauty and grace and love in witnessing others do for me, as I used to for others...that I never would have known, if not been o the receiving end. I *LOVE* seeing others hearts that way...*LOVE*...might even be the single most beautiful thing this world has in my opinion.
And, I have to say, I find that there are a lot of spiritual lessons involved in dementia, like that one...too.
There is so much work to be done, true...but that also means that there is so much opportunity to STILL be of use. And the whole fact that the "normals" leave it entirely up to us...couldn't be more perfect. Because that means, even in stage 6, I have a chance to be of use...without having one of them rush in to take over. Not that I wouldn't appreciate their help and support...but I dig the opportunity all the same. And, it has the side effect of evoking neuroplasticity.
If all things in my situation were not exactly as they are, I wouldn't be getting what I am getting.
Not that life is all peaches and cream, mind you...just that there is a lot of good to be had on the way out of this life...and I, for one, am grabbing all I can of it. Again, knowing that it is all a matter of choice of windows to view things...to me, life is just way, way, way too short to waste even one second of it being miserable.
If nothing else, this diagnosis should be a huge (loud) wake up call, and kick in the seat...to make the most of what you have left.
As to spouses...people say the long goodbye like it is a bad thing. But imagine if you two fought one day and one of you died suddenly in a car crash. You'd never have the chance to say sorry. You'd never have the chance to say how you really felt...or to make right. Dementia and Alzheimer's gives you that time and opportunity.
Alzheimer's gives you time...that in itself is a huge blessing and gift. Time to make what you will of. Time that YOU get to decide how you will use...or squander...or piddle. I *LOVE* that it gives me time.
And it is the same exact lesson we each had our whole lives...to make what you will with what you have.
But is true...we each have our hard season, where we have to come to terms with it...and make peace with it...because it isn't going away. Do what you can to set yourself in the best possible position. And live as fully as you can, doing what you are most passionate about.
I also don't see it as having to be "so-bad" for caregivers...and I know that is a bit anti-the established agreement. But I have been caring for my mom for the last 10 years, and I love it. Indeed, it is the highest act of love I have experienced...and I feel blessed to be a part of it.
Peace. <3
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