Elderly folks are different from us. (Big shock, huh?)
If you live in an area where there are geriatricians, I would recommend making a "get to know you appointment! If you live in an area where a visit to a geriatrician would involve a long drive or other inconvenience, please keep in mind that if you are struggling, or if your loved one is struggling, that inconvenience would pale compared to the benefit that you would probably get from a geriatrician.
Geriatricians have special training to help them be more aware of the needs of elderly people. They are very familiar with conditions and illnesses that tend to be associated with "old age", like incontinence, nutrition, falls/fall prevention and memory problems.
A geriatrician can help with behavior problems and "acting out". If your loved one has any type of problem that is causing your family or the facility stress beyond what is "normal", a geriatrician might be in order.
A geriatrician is also more aware of some of the medication interactions and side effects that elderly people may be more prone to. Since the metabolism of an elderly person is different from that of a younger person, drugs that we wouldn't think twice about can cause significant problems in an elderly person. Many non-geriatrician doctors are very good at what they do, but aren't fully aware of some of the problems that medications can cause.
On the flip side, though, a geriatrician has likely "seen this before", if you are dealing with a specific problem. They are aware of resources and medications that can help. Sometimes just talking to a geriatric team can make you feel less alone, because virtually nothing you tell them about your loved one will be shocking to them, and they can reassure you that you are doing just fine!
If you do not live in an area where a geriatrician is available at least on an as-needed basis, I would suggest that you ask the staff at your loved one's facility (or even at your loved one's clinic, if he or she is not in a facility yet) which doctors seem to be more skilled in treating elderly people, and which doctors are kind and gentle with elderly people--doctors are just regular people like you and me, and many of them are "younger". They may not have had a lot of experience with dementia or other problems of the elderly, so it's good to find someone who has.
Wednesday, October 31, 2012
Tuesday, October 30, 2012
But....it's not always a UTI
Even though my previous post alerted you to the fact that confusion or unusual behavior may be a UTI, it isn't always.
Especially as my mom's dementia progressed, she was less able to communicate discomfort to us. Usually discomfort manifested as confusion and agitation.
Some of the things that caused confusion for my mom:
1) UTI
2) heart attack --really, she had no chest pain, she just was really confused and "didn't feel good" and couldn't get out of bed.
3) medication interaction or side effect
4) excessive ear wax causing discomfort and difficulty hearing
5) a bad cold
I'm sure there are others, too. But the main point of this post is that unusual confusion can signal a problem and should be checked.
Don't be afraid to overrule the staff of the facility if you believe that your loved one needs medical care and they think it's just "natural progression". Believe me, you'll feel better if you have some tests done and find out it's "nothing" than you will if your loved one's condition worsens because you didn't take action.
Sometimes the staff of assisted living facilities and nursing homes see so much dementia and so much confusion, that what you recognize as "abnormal" might look "normal" to them. YOU ARE THE BEST JUDGE OF WHAT IS NORMAL FOR YOUR LOVED ONE!
Especially as my mom's dementia progressed, she was less able to communicate discomfort to us. Usually discomfort manifested as confusion and agitation.
Some of the things that caused confusion for my mom:
1) UTI
2) heart attack --really, she had no chest pain, she just was really confused and "didn't feel good" and couldn't get out of bed.
3) medication interaction or side effect
4) excessive ear wax causing discomfort and difficulty hearing
5) a bad cold
I'm sure there are others, too. But the main point of this post is that unusual confusion can signal a problem and should be checked.
Don't be afraid to overrule the staff of the facility if you believe that your loved one needs medical care and they think it's just "natural progression". Believe me, you'll feel better if you have some tests done and find out it's "nothing" than you will if your loved one's condition worsens because you didn't take action.
Sometimes the staff of assisted living facilities and nursing homes see so much dementia and so much confusion, that what you recognize as "abnormal" might look "normal" to them. YOU ARE THE BEST JUDGE OF WHAT IS NORMAL FOR YOUR LOVED ONE!
Monday, October 29, 2012
UTIs--they usually "come back"!
Well, after that first portentous UTI, silly me, I thought we were out of the woods. But even once we got Mom settled into the assisted living center, the UTIs came back. And usually, because I was so unaware, and the staff of the assisted living was relatively unaware, we didn't always recognize them at first.
The first sign was always confusion and behaviors that weren't normal for my mom. But since we all recognized by this time that she had dementia, it was difficult to determine if the change was just "natural progression" of the Alzheimer's, or "something else". For a while there, every time something concerned me, I was requesting a test for a UTI.
One more nice thing about the assisted living place, though, was that they were able to do the test right there in the facility so that we didn't have to stress my mom out with a doctor visit.
So.....when in doubt, check for a UTI.
The first sign was always confusion and behaviors that weren't normal for my mom. But since we all recognized by this time that she had dementia, it was difficult to determine if the change was just "natural progression" of the Alzheimer's, or "something else". For a while there, every time something concerned me, I was requesting a test for a UTI.
One more nice thing about the assisted living place, though, was that they were able to do the test right there in the facility so that we didn't have to stress my mom out with a doctor visit.
So.....when in doubt, check for a UTI.
Saturday, October 27, 2012
Considering Assisted Living
My mom's UTI was a doozie, of course. She was hospitalized for 6 days while they administered antibiotics. At some point, while she was hospitalized, they did some type of cognitive testing, and strongly informed my brother and me that "She should not be living alone any more, a person with dementia at that level cannot be safe at home alone." That, in itself, was a shock, because we had no idea that there was dementia involved. After all, she was fine a few days ago!
When my mom had recovered sufficiently to discuss what they had said about her not living at home any longer, she was, of course, resistant to any change. She absolutely refused to live with my brother or with me, stating that she did not want to be a "burden". The hospital gave us a book of assisted living facilities in the city where she lived.
Something people don't know when they are considering assisted living for a loved one or themselves is that while nursing homes are very similar to each other in many ways, assisted living facilities can vary greatly. For example, one of the less-expensive assisted living communities that we looked at was almost (in my eyes anyhow) identical to a nursing home. The resident had a bedroom with an attached bath, and all meals were taken in the "dining room" with all of the other residents. It was also possible to have a roommate, which would lower the price even more.
Most of the assisted living facilities that we looked at, however, were more along the lines of a small apartment with services provided. However, even the way the services are provided can differ by facility. Some facilities only charge for the services that a resident needs. For example, if a resident needs help getting dressed and taking pills, but doesn't need help with laundry, the client would not be charged any fee for laundry services. Other facilities went more of an all-inclusive route, where a set "rent" amount covered all services to a certain point, and then once the resident needed more of those services, then the "rent" would increase.
"Rent." The most intimidating aspect of assisted living for a family member. We looked at several of the available assisted living situations in my mom's city and oh, they were SO expensive, almost as much as a nursing home! By that time, we were pretty frustrated, and my husband happened to notice that there was an assisted living facility in our small town. By calling them, here was what we found:
1) the rent was HALF of what a comparable unit in the city would be
2) in a small town, the staff turnover is much less because there are fewer jobs available.
So.....we did opt for the small-town assisted living. It provided a 2 bedroom apartment with a regular kitchen and bath. She could have her cat there. She had free cable TV and all utilities were paid except the phone. We told her that if she tried it for a month and hated it, she could move back to her house and we would find a different solution. So she agreed to give it a go.
My mom was very scared of moving, and who could blame her? She had lived in her house for nearly 40 years. Her new apartment, although built in the '80's, would be much more updated than her house was. And not matter how we tried to explain the "assisted living" concept, and no matter that she had visited the apartment with us, she believed it would be a nursing home. I think we all were pleasantly surprised, my mom most of all!
Basically, what it started out to be was her own apartment. With her cat. Where people checked on her 3 times a day, but she was absolutely free to come and go as she pleased. She (or I) could cook a meal in her apartment, go out to eat, or eat in the dining room. So she didn't have too cook. She had a "beeper" that she wore on a chain around her neck, where, if she felt like she needed help of any kind, all she would have to do is push the button and someone would come. The aides did her vacuuming and other cleaning. It was all on one floor, so there was no worry about stairs. If she wanted to go into town to shop or go to a doctors appointment, the facility provided transportation. It ended up being so good for my mom!!! She had people to chat with again, she could go to the in-house beauty salon, she could attend activities and exercise classes, it was genuinely freeing for her and ultimately, she loved it. I wished she had moved there sooner, because it was exactly what she wanted and needed. I teased her often about "living like a rich person" because she had people to cook for her, people to clean her house, and someone to drive her around town, too!
My mom lived in the assisted living apartment for four years. During that time, as her needs increased, the staff just adapted. Yes, her rent went up as her needs increased, but we always got much much more than we paid for.
In summary, if you are considering assisted living for a loved one, some things to consider are:
1) a small town or rural facility will likely be cheaper for the same or better services
2) a small town or rural facility will have more consistency of staff
3) you might not realize how isolated your loved one has become--the social interactions at an assisted living facility may be hugely beneficial!
4) an assisted living facility can be like the best of both worlds--an apartment with "helpers".
5) just because a facility is titled "Assisted Living" does not mean it will be similar to others.
6) pets, if the resident can adequately care for them, are usually allowed.
7) be sure to ask about meal plans, some facilities only provide one meal a day.
There were a few things I wish we could have changed with the assisted living, I'll address them in the next post. But in general, watching my mom's experience in the assisted living gave me a great deal of comfort and hope. I would recommend assisted living to everyone!
When my mom had recovered sufficiently to discuss what they had said about her not living at home any longer, she was, of course, resistant to any change. She absolutely refused to live with my brother or with me, stating that she did not want to be a "burden". The hospital gave us a book of assisted living facilities in the city where she lived.
Something people don't know when they are considering assisted living for a loved one or themselves is that while nursing homes are very similar to each other in many ways, assisted living facilities can vary greatly. For example, one of the less-expensive assisted living communities that we looked at was almost (in my eyes anyhow) identical to a nursing home. The resident had a bedroom with an attached bath, and all meals were taken in the "dining room" with all of the other residents. It was also possible to have a roommate, which would lower the price even more.
Most of the assisted living facilities that we looked at, however, were more along the lines of a small apartment with services provided. However, even the way the services are provided can differ by facility. Some facilities only charge for the services that a resident needs. For example, if a resident needs help getting dressed and taking pills, but doesn't need help with laundry, the client would not be charged any fee for laundry services. Other facilities went more of an all-inclusive route, where a set "rent" amount covered all services to a certain point, and then once the resident needed more of those services, then the "rent" would increase.
"Rent." The most intimidating aspect of assisted living for a family member. We looked at several of the available assisted living situations in my mom's city and oh, they were SO expensive, almost as much as a nursing home! By that time, we were pretty frustrated, and my husband happened to notice that there was an assisted living facility in our small town. By calling them, here was what we found:
1) the rent was HALF of what a comparable unit in the city would be
2) in a small town, the staff turnover is much less because there are fewer jobs available.
So.....we did opt for the small-town assisted living. It provided a 2 bedroom apartment with a regular kitchen and bath. She could have her cat there. She had free cable TV and all utilities were paid except the phone. We told her that if she tried it for a month and hated it, she could move back to her house and we would find a different solution. So she agreed to give it a go.
My mom was very scared of moving, and who could blame her? She had lived in her house for nearly 40 years. Her new apartment, although built in the '80's, would be much more updated than her house was. And not matter how we tried to explain the "assisted living" concept, and no matter that she had visited the apartment with us, she believed it would be a nursing home. I think we all were pleasantly surprised, my mom most of all!
Basically, what it started out to be was her own apartment. With her cat. Where people checked on her 3 times a day, but she was absolutely free to come and go as she pleased. She (or I) could cook a meal in her apartment, go out to eat, or eat in the dining room. So she didn't have too cook. She had a "beeper" that she wore on a chain around her neck, where, if she felt like she needed help of any kind, all she would have to do is push the button and someone would come. The aides did her vacuuming and other cleaning. It was all on one floor, so there was no worry about stairs. If she wanted to go into town to shop or go to a doctors appointment, the facility provided transportation. It ended up being so good for my mom!!! She had people to chat with again, she could go to the in-house beauty salon, she could attend activities and exercise classes, it was genuinely freeing for her and ultimately, she loved it. I wished she had moved there sooner, because it was exactly what she wanted and needed. I teased her often about "living like a rich person" because she had people to cook for her, people to clean her house, and someone to drive her around town, too!
My mom lived in the assisted living apartment for four years. During that time, as her needs increased, the staff just adapted. Yes, her rent went up as her needs increased, but we always got much much more than we paid for.
In summary, if you are considering assisted living for a loved one, some things to consider are:
1) a small town or rural facility will likely be cheaper for the same or better services
2) a small town or rural facility will have more consistency of staff
3) you might not realize how isolated your loved one has become--the social interactions at an assisted living facility may be hugely beneficial!
4) an assisted living facility can be like the best of both worlds--an apartment with "helpers".
5) just because a facility is titled "Assisted Living" does not mean it will be similar to others.
6) pets, if the resident can adequately care for them, are usually allowed.
7) be sure to ask about meal plans, some facilities only provide one meal a day.
There were a few things I wish we could have changed with the assisted living, I'll address them in the next post. But in general, watching my mom's experience in the assisted living gave me a great deal of comfort and hope. I would recommend assisted living to everyone!
Thursday, October 25, 2012
Urinary Tract Infection
What did I think of if someone mentioned a Urinary Tract Infection? I thought of burning urination and lots of cranberry juice. And a trip to the doctor for an antibiotic if the cranberry juice didn't work. More of an inconvenience than anything.
I arrived at my mom's house one night after work to just say "hi". When I got there, though, she was upset because she couldn't get her lights to work, and her washing machine was broken, too. I told her to turn the lights on so that I could see what was going on, and she couldn't remember how. I flipped the light switch and was surprised that the lights seemed to work fine. Becoming alarmed now, because this was the house she had lived in for over 30 years, I checked the washing machine. Nothing wrong.
We headed for the hospital. All I could think of was that she was having a stroke or something, because her thinking was so confused. I was shocked to learn that a "simple little" UTI could, in fact, cause this kind of confusion in an elderly person. Yet, I was relieved, because I still thought that a UTI was not a big deal.
They did hospitalize my mom for the UTI. The antibiotics worked, though, and my mom slowly returned to "normal".
UTI's will be revisited throughout this blog. One thing people should remember is that UTI's in the elderly are rarely a one-time thing. And they can be extremely serious.
I arrived at my mom's house one night after work to just say "hi". When I got there, though, she was upset because she couldn't get her lights to work, and her washing machine was broken, too. I told her to turn the lights on so that I could see what was going on, and she couldn't remember how. I flipped the light switch and was surprised that the lights seemed to work fine. Becoming alarmed now, because this was the house she had lived in for over 30 years, I checked the washing machine. Nothing wrong.
We headed for the hospital. All I could think of was that she was having a stroke or something, because her thinking was so confused. I was shocked to learn that a "simple little" UTI could, in fact, cause this kind of confusion in an elderly person. Yet, I was relieved, because I still thought that a UTI was not a big deal.
They did hospitalize my mom for the UTI. The antibiotics worked, though, and my mom slowly returned to "normal".
UTI's will be revisited throughout this blog. One thing people should remember is that UTI's in the elderly are rarely a one-time thing. And they can be extremely serious.
Monday, October 22, 2012
Eccentricity
My dad passed away in 1987 of lung cancer. It was right at the time when I was in college, and my brother was newly graduated from high school. My mom didn't know what to do. She didn't have anyone to take care of.
It took me a few years to recognize that she was pretty isolated. She didn't drive, ddn't work, didn't go to church too often.....After that, I tried to get her involved in any activity that I was involved in, so that she could feel like she was helping me, and so that she could get out of the house. One of the activities she did enjoy without me, though, was shopping. She especially enjoyed the dollar store. And this is where the hindsight kicks in.
Every time I would come to visit, she would have a "care package" for me. It would be several grocery bags of food that she had bought at the dollar store. A family of eight would have a tough time eating all of that, but when I gently tried to explain to her that I didn't eat that much, she got a hurt look in her eyes that just about killed me, so I continued getting the food for several years. I can see now that this may have been the beginnings of the Alzheimer's, but at the time I thought she was just wanting to feel needed.
Another thing I noticed, but didn't recognize, was that she had had a trainer come to her house a couple of years before, to train her dog in basic obedience. It was amazing how much that dog learned in just a couple of lessons! My mom learned how to do a hand signal to get her dog to sit and used the hand signal often, because it was so impressive to have the dog obey when she didn't even say a word. It was a couple of years after the training sessions, that my mom kind of "forgot" how the hand signal went. Instead of a definite signal with her hand, she would just fling her arm around and say "sit!" or she might say "go over there and sit down!" (and of course the dog didn't understand that.
And her cat. She would feed her cat five or six times a day. And then she would worry when the cat wouldn't eat (it was full).
If I had to put it into words, I would say at this time, she seemed to have less of an understanding of the relationship between what she wanted to accomplish and the right way to do things in order to accomplish her goal.
But of course, that's 20/20 hindsight. I didn't see any of that at the time. I just thought she was getting eccentric, probably from living alone for so long. My mom wasn't old, and Alzheimer's was something that happened to "old" people, so why would I even be concerned???
It took me a few years to recognize that she was pretty isolated. She didn't drive, ddn't work, didn't go to church too often.....After that, I tried to get her involved in any activity that I was involved in, so that she could feel like she was helping me, and so that she could get out of the house. One of the activities she did enjoy without me, though, was shopping. She especially enjoyed the dollar store. And this is where the hindsight kicks in.
Every time I would come to visit, she would have a "care package" for me. It would be several grocery bags of food that she had bought at the dollar store. A family of eight would have a tough time eating all of that, but when I gently tried to explain to her that I didn't eat that much, she got a hurt look in her eyes that just about killed me, so I continued getting the food for several years. I can see now that this may have been the beginnings of the Alzheimer's, but at the time I thought she was just wanting to feel needed.
Another thing I noticed, but didn't recognize, was that she had had a trainer come to her house a couple of years before, to train her dog in basic obedience. It was amazing how much that dog learned in just a couple of lessons! My mom learned how to do a hand signal to get her dog to sit and used the hand signal often, because it was so impressive to have the dog obey when she didn't even say a word. It was a couple of years after the training sessions, that my mom kind of "forgot" how the hand signal went. Instead of a definite signal with her hand, she would just fling her arm around and say "sit!" or she might say "go over there and sit down!" (and of course the dog didn't understand that.
And her cat. She would feed her cat five or six times a day. And then she would worry when the cat wouldn't eat (it was full).
If I had to put it into words, I would say at this time, she seemed to have less of an understanding of the relationship between what she wanted to accomplish and the right way to do things in order to accomplish her goal.
But of course, that's 20/20 hindsight. I didn't see any of that at the time. I just thought she was getting eccentric, probably from living alone for so long. My mom wasn't old, and Alzheimer's was something that happened to "old" people, so why would I even be concerned???
Friday, October 19, 2012
Who is/was my mom?
While I don't intend this blog to be a memoir in a traditional sense, it seems like I should start by explaining who my mom was before this all started. Since this blog is peripherally about her, it seems like you should all know that she was not always like she is now. She was (and still is) a very precious soul.
My mom, Esther, is 83 now. She was born on a farm, the youngest of five children. Her mother died when she was 14, and she was expected to be the "woman of the house" at that point, cooking and cleaning for the men. When she was 18, she moved to the city.
She was 38 years old when I was born, my dad was her second husband. Her first husband had passed away several years earlier, they had never had any children. I was the first.
At the time I was born, my mom worked as a clerk for the State of Minnesota. It was normal "way back then" (in the '60's), for a woman to quit her job once the children started coming, and to stay home with the kids. And that's what she did. My brother was born a year and a half after I was.
She was an amazing mom. She volunteered at the school. She took part in the PTA. She made our lunches, took us to the playground, taught us how to play checkers and Yahtzee. When I was sick, she had certain rituals that were designed to make me feel emotionally better, even if they didn't cure my cold--hot jello, chicken noodle soup, a special cup, a special blanket.....
As I got older, I failed to appreciate the treasure I had--my mom would have walked on hot coals for me, but I, a teenager, was "too cool" to acknowledge it. I would ask my dad for money, and he would say "no". But as soon as he left, my mom would sneak me a five.
My mom was always shy and quiet. I inherited that from her. She was also quite intuitive, which she also passed on to me. She could somehow sense good and bad in people, long before others could.
She liked to listen to the radio, and she liked to sing. Mostly, though, she wanted to make my brother and I (and my dad, who passed away in 1987), as happy as could be. That was what she lived for.
And that, is the foundation of love that this journey has been built upon.
My mom, Esther, is 83 now. She was born on a farm, the youngest of five children. Her mother died when she was 14, and she was expected to be the "woman of the house" at that point, cooking and cleaning for the men. When she was 18, she moved to the city.
She was 38 years old when I was born, my dad was her second husband. Her first husband had passed away several years earlier, they had never had any children. I was the first.
At the time I was born, my mom worked as a clerk for the State of Minnesota. It was normal "way back then" (in the '60's), for a woman to quit her job once the children started coming, and to stay home with the kids. And that's what she did. My brother was born a year and a half after I was.
She was an amazing mom. She volunteered at the school. She took part in the PTA. She made our lunches, took us to the playground, taught us how to play checkers and Yahtzee. When I was sick, she had certain rituals that were designed to make me feel emotionally better, even if they didn't cure my cold--hot jello, chicken noodle soup, a special cup, a special blanket.....
As I got older, I failed to appreciate the treasure I had--my mom would have walked on hot coals for me, but I, a teenager, was "too cool" to acknowledge it. I would ask my dad for money, and he would say "no". But as soon as he left, my mom would sneak me a five.
My mom was always shy and quiet. I inherited that from her. She was also quite intuitive, which she also passed on to me. She could somehow sense good and bad in people, long before others could.
She liked to listen to the radio, and she liked to sing. Mostly, though, she wanted to make my brother and I (and my dad, who passed away in 1987), as happy as could be. That was what she lived for.
And that, is the foundation of love that this journey has been built upon.
Welcome
Welcome to my bittersweet blog. My mom, Esther, is 83 years old now, and has had Alzheimer's for at least 8 years, and probably longer than that. We have traveled through many phases, problems and new experiences. Throughout this journey, I've constantly found myself thinking "I wish someone had told me that before!"
I've found that a lot of the things that a patient and family are expected to know and understand, are not clearly explained as we go. And probably, I could have done a much better job of advocating and caring for my mom if I had been aware of how these things work. I figure that I'm probably not the only one.
Thanks for visiting!
I've found that a lot of the things that a patient and family are expected to know and understand, are not clearly explained as we go. And probably, I could have done a much better job of advocating and caring for my mom if I had been aware of how these things work. I figure that I'm probably not the only one.
Thanks for visiting!
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