In today’s post on Depression Later in Life, I will focus on the fact that depression is treatable.

Most depressed elderly people can improve dramatically from treatment. In fact, there are highly effective treatments for depression in late life.  Some treatment prescribed by physicians include:

• Psychotherapy
• Antidepressant medications
• Electroconvulsive therapy (ECT)

Antidepressants work by increasing the level of neurotransmitters in the brain.  Neurotransmitters are the brain’s “messengers.” Many feelings, including pain and pleasure, are a result of the neurotransmitters’ function.  When the supply of neurotransmitters is imbalanced, depression may resul.

A frequent reason some people do not respond to antidepressant treatment is because they do not take the medication properly.  Missing doses or taking more that the prescribed amount of the medication compromises the effect of the antidepressant.  Similarly, stopping the medication too soon often results in a relapse of depression.  In fact, most patients who stop taking their medication before four to six months after recovery will experience a relapse of depression.

Usually, antidepressant medication is taken for a least six months to a year.  Typically, it takes four to twelve weeks to begin seeing results from antidepressant medication.  If after this period of time the depression does not subside, the patient should consult his or her physician.  Antidepressant drugs are not habit-forming or addictive. And because depression is often a recurrent illness, it usually is necessary to stay on the medication for six months after recovery to prevent new episodes of depression.

Electroconvulsive therapy (ECT) is a treatment that unnecessarily evokes fear in many people.  In reality, ECT is one of the most safe, fast-acting and effective treatments for severe depression.  It can be life saving.  ECT often is the best choice for the person who has a life-threatening depression that is not responding to antidepressant medication or for the person who cannot tolerate the medication.

After a thorough evaluation, a physician will determine the treatment best suited for a person’s depression.  The treatment of depression demands patience and perseverance fore patient and the physician.  Sometimes several different treatments must be tried before full recovery.  Each person has individual biological and psychological characteristics that require individualized care.

In tomorrow’s final post on Depression Later in Life, I will discuss caring for the depressed person.

Dressing

• Simplify choices. Keep the closets free of excess clothing. A person may panic if clothing choices become overwhelming. If appropriate, give the person an opportunity to select favorite outfits or colors, but try offering just two choices.
• Organize the process. Lay out clothing in the order that each item should be put on. Hand the person one item at a time while giving short, simple instructions such as “Put on your shirt,” rather than “Get dressed.”
• Pick comfortable and simple clothing. Cardigans, shirts and blouses that button in front are easier to work than pullover tops. Substitute Velcro® for buttons, snaps or zippers, which may be too difficult to handle. Make sure that clothing is loose fitting, especially at the waist and hips – and choose fabrics that are soft and stretchable.
• Choose comfortable shoes. Make sure the person has comfortable, non-slip shoes.
• Be flexible. If the individual wants to wear the same outfit repeatedly, buy duplicates or have similar options available. It’s all right if the person wants to wear several layers of clothing, just make sure he or she doesn’t get overheated. When outdoors, make sure the person is dressed for the weather. Offer praise, not criticism, if clothing is mismatched.
• Be patient. Rushing the person can cause anxiety and frustration.

Grooming

A person with dementia may forget how to comb hair, clip fingernails or shave. He or she may forget what the purpose is for items like nail clippers or a comb.

• Maintain grooming routines. If the person has always gone to the beauty shop or a barber, continue this activity. If the experience becomes distressing, it may be possible to have the barber or hairstylist come to the person’s home.
• Use favorite toiletries. Allow the person to continue using his or her favorite toothpaste, shaving cream, cologne or makeup.
• Perform tasks alongside the person. Comb your hair, and encourage the person to copy your motions.
• Use safer, simpler grooming tools. Cardboard nail files and electric shavers can be less threatening than clippers and razors.

If you missed our last webinar- watch it here on our youtube channel along with other past webinars and favorite videos.

As we age, the thinking/cognitive part of the brain begins to change:  there is
1) gradual decline in short-term memory;
2) slower processing of thoughts (it takes longer to retrieve what you know); and
3) it takes longer to learn new skills.

Beyond these normal changes, additional cognitive impairment can be caused by a number of sometimes correctable or treatable conditions — anxiety and depression, vitamin deficiencies, medications (too many or the wrong kinds), excess alcohol and other medical illnesses.

For some people, however, cognitive decline may progress to more serious difficulty with thinking and memory, such as mild cognitive impairment (MCI) or dementia.  MCI means a person has problems with memory, attention, language, orientation (whether to date or place), reasoning skills, insight, and/or judgment that are severe enough to be noticed by others and are reflected on cognitive tests, but are not severe enough to interfere with daily life.

Ten to 15 percent of people with MCI progress to dementia each year.  Dementia (the most common type being Alzheimer’s) means progressive deterioration of those aforementioned cognitive abilities that is severe enough to interfere with daily life, such as managing finances, taking medication safely, cooking and driving.  Factors that may increase risk of MCI and dementia include smoking, poorly controlled chronic illnesses (diabetes and depression, for example), genetics, and people with little social support.

Reducing your risk
The good news is that there are a number of factors that may reduce your risk of dementia.
• Dietary factors — increased fruits and vegetables, coffee (before 3 p.m. so it doesn’t interfere with sleep), mild alcohol intake, omega 3 fatty acids, and limiting saturated fats (butter, lard).
• Cognitive reserve —education level as well as accumulated life knowledge can provide a “cushion” against future cognitive decline.  Learning new things at any age can build cognitive reserve.
• Exercise enhances cardiac health and also protects against cognitive decline.
• Laughter — the use of healthy humor (not sarcasm) strengthens the immune response, lowers blood pressure and provides pain relief; some research shows that one minute of laughter has the health benefits of 10 minutes of aerobics.
• Social support — relationships with family, friends and involvement in community service can protect against the isolation and loneliness that increase the risk of cognitive decline.  Smiling at strangers, a small kindness or compliment to a neighbor or store clerk — it all counts as connecting with others and reaching beyond our own lives — as does working beside others at the brain gym.
• Cognitive/mental skill training — we have long underestimated the ability of the human brain.

There is a growing body of knowledge that suggests that exercising our brain can reduce our risk of cognitive decline just as physical activity can reduce our risk of heart disease.  In particular, learning new things (not just practicing things we already know) is protective, just as learning techniques to help memory, learning how to develop reasoning skills and decrease reaction time — there so many available tools now, here are some of the most common, and most fun!

Puzzles
Comedy Videos
iPads
Wii
X-Box
Book Clubs
Chess
Crossword Puzzles
Sudoku
Mahjong, Bridge & Other Card Games
Bingo
Dominos
Learning a new language

Do you have any more ideas or things that YOU DO to help maintain your brain? We’d love to hear them!  Send us an email at Info@ElderCareatHome.org

I found this story on PBS today and wanted to share it.  Susan Dentzer reports on early onset Alzheimer’s, a degenerative brain disease, and how a forum organized by those suffering from the diagnosis has proven an effective means of coping.
JIM LEHRER: Finally tonight, dealing with Alzheimer’s disease at an earlier age. Susan Dentzer reports for our Health Unit, a partnership with the Robert Wood Johnson Foundation.

RICHARD BOZANICH: This is just really rough.

SUSAN DENTZER, NewsHour Health Correspondent: Richard Bozanich and Jay Smith spent months planning and preparing. On the big day here in Los Angeles, Bill Bridgwater flew in from Colorado. James Smith and his wife, Juanita, came from Minnesota. And Carol Kirsch and her hud, Howard, drove in from ther aging baby boomers present, you might have thought this gathering was about prepring for retirement, launching a second career,acation home. But iasn’t.

FORUM SPEAKER: This is the largest gathering of people with dementia in one room in our country.

SUSAN DENTZER: In fact, what was billed as the Early Memory Loss Forum was one of the nation’s first-ever gatherings of baby boomers with early-onset Alzheimer’s disease, organized and led by these Alzheimer’s sufferers themselves.

Bozanich, who’s 49, welcomed the crowd on behalf of himself and co-organizer, Jay Smith.

RICHARD BOZANICH: Our motto has always been that this day was by and for persons with early memory loss. So for those of you who are traveling the same road as the two of us, this day is for you.

SUSAN DENTZER: It isn’t known how many Americans have the early-onset form of Alzheimer’s, but estimates range anywhere from 250,000 to 500,000. The cause isn’t fully understood, either, although several genetic mutations are implicated in some cases.

Meanwhile, it’s estimated that 5.1 million Americans now suffer from all forms of the disease, including the type that typically hits people 65 and older. With the population aging, the number of sufferers with all forms of Alzheimer’s could more than triple over the next 40 years.

We wanted to know more about what it’s like to be struck by Alzheimer’s in the prime of life, so we sat down for a conversation with this group, all suffering from early-onset Alzheimer’s. All have worked with the National Alzheimer’s Association and are among the nation’s most vocal spokespersons for the urgency of fighting the disease.

This diagnosis came along when you all were at the peak of your careers and the peak of your capabilities.

BILL BRIDGWATER: Prior to the onset of my Alzheimer’s at age 48, I was an information technology executive, and I had held senior-level positions at numerous multibillion-dollar companies.

RICHARD BOZANICH: I was managing editor of Daily Variety, which is an entertainment trade publication.

JAMES SMITH: I was an information technology director for a Fortune 100 company, a global company. I referred to it as our charmed little life, because everything just seemed to be firing on all cylinders.

Developing strange symptoms

SUSAN DENTZER: Each described how these seemingly charmed lives were suddenly interrupted by a bizarre range of symptoms, as Alzheimer’s, a degenerative brain disease, progressively killed neurons in different parts of the brain.As they lunched at the conference, they recalled how they’d sometimes exhibit the classic signs of memory loss, but often the symptoms were altogether different. Work colleagues were among the first to notice.

JAMES SMITH: People would ask me, they would say, “Well, why weren’t you at the meeting?” And I said, “Well, there was no meeting that I’m aware of.” And they said, “Well, you called the meeting. You should be aware of it.”

BILL BRIDGWATER: One of the things that was just driving me to distraction was insomnia. I could not sleep at night. I would get up and do 50 push-ups, 50 sit-ups, 50 leg kicks with each leg, and do everything I could to just drain myself. I laugh and tell people that I didn’t get much sleep, but I was in the best shape of my life.

CHUCK JACKSON: My arm would be sitting here and suddenly it would just shoot up and hit me in the head almost. And my legs would kick.

RICHARD BOZANICH: I was just bumping into walls and bumping into partitions. And, you know, you see a wall in front of you, and the obvious thing is to either go left or right, and I would just walk straight into the wall as if it weren’t there.

Conflicting diagnoses

SUSAN DENTZER: The group told us about dozens of visits to doctors who handed out conflicting diagnoses. Jay Smith, a successful architect who is not related to James Smith, had helped design courts and other facilities for California’s justice system.JAY SMITH, Alzheimer’s Sufferer: I thought I had a brain tumor, so I went to the neurologist, and I didn’t have a brain tumor. He said he thought I had a benign condition called migraine that doesn’t always cause headaches.

JAMES SMITH: For me, the initial diagnosis was depression. Then they shifted over and thought, well, maybe it’s a movement disorder, like MS or something like that. And for a while, they were thinking it might be Huntington’s disease.

SUSAN DENTZER: Most of the group told us the correct diagnosis was only arrived at when they finally got a battery of neuropsychological tests and a PET scan of the brain.

But for Chuck Jackson, who most recently worked as a counselor to laid-off workers, the diagnosis was far easier.

CHUCK JACKSON: We’re one of those groups of families that have the highest rate or incidence of Alzheimer’s in their family. I watched my mother go through it when I was — I was 13 at the time. And when she died at the age of 50, I knew what was coming.

SUSAN DENTZER: In fact, out of his mother’s family of 14 children, 12 died of the disease, thanks to inherited mutation in a gene called PSEN2. Now Jackson and his older brother both have Alzheimer’s.

The group members told us that getting the diagnosis prompted a range of reactions.

JAY SMITH: It came as a shock, because I hadn’t thought about Alzheimer’s or memory loss up to that point, and relief to have an answer, “I can now focus on my life knowing what’s wrong.”

CAROL KIRSCH, Alzheimer’s Sufferer: I just refused to believe it. I just said, “No, this can’t be.” I knew enough about it that I was scared. I was scared.

SUSAN DENTZER: James Smith and his wife, Juanita, spoke at the conference about how they reacted after getting the diagnosis.

JAMES SMITH: We would just lay in bed together, and hold each other, and cry, and really not know — it felt like you were in a maze and all the doors just suddenly slammed shut. And there’s just no path that takes you anywhere. I remember it as being one of the — probably one of the darkest periods of our entire life.

Every day we work with caregivers that are responsible for not only helping to keep the Alzheimer’s/dementia patient at home, but to provide appropriate, cognitively stimulating activities.  An article in the American Journal of Alzheimer’s Disease found that playing BINGO specifically provides mental stimulation that is highly therapeutic. Patients participating in the study performed significantly better on measures of cognition. Staff members reported increases in alertness and in awareness in the test subjects for hours after testing.

BINGO has other advantages as a game for dementia patients. It comes not only in the familiar “B-6, N-23″ version, but in a number of alternatives that are stimulating on different levels and for different abilities. Players can identify anything from animals to items of food, to body parts. This allows for the game to be played, in one version or another, by patients at different stages of the disease, and to stimulate memories, thought process, or other cognitive abilities.

Games for Alzheimer’s should be played for stimulation, not for competition, and can be enjoyed by a group, by just two or three participants or with just the caregiver. Whenever possible, have children play with the older adults.  You can find a wide variety of BINGO games at Toys R Us and in most drug stores.

The demands on a person who is taking care of elderly parents result in a great deal of stress. If caregivers aren’t careful, they jeopardize their own health and well-being. Call us today for 1/2 off your 1st coaching session at CoachingforCaregivers.com or 1-800-29-4342.

A study of family caregivers found that those who experience caregiving-related stress have a 63% higher mortality rate than non-caregivers of the same age. There are several reasons why stress occurs, such as working too much, not sleeping enough, having to deal with family and work at the same time, and not having as many hours in the day as you need to take care of yourself.

Remember you can’t care for your loved one if you are ill yourself. The first step in dealing with caregiver stress is to recognize the signs. Then, you can find ways to deal with it and enlist support or medical help when needed.

10 signs of caregiver stress

• Depression. Symptoms include constant sadness, feelings of hopelessness and increased crying.
• Withdrawal. This can occur if you are depressed. You may not wish to see family and friends. You may stop taking part in things you used to enjoy.
• Anxiety. You may feel anxious to get things done or you may feel that you don’t have enough time, or about facing another day and what the future holds.
• Anger. You may start yelling at your loved one more, or have difficulty controlling your temper with other people. Caregivers often become angry at their loved one because they are sacrificing their own lives to care for them. Feeling angry at family members for not helping is also common.
• Loss of concentration. You are constantly thinking about your loved one and everything that you need to do. As a result, you have difficulty concentrating at home or at work.
• Changes in eating habits. This results in weight gain or loss, as well as increased illness.
• Insomnia. You may feel tired, but cannot sleep. Or, you may not feel tired even if your body is tired. You also may wake up in the middle of the night or have nightmares and stressful dreams.
• Exhaustion. If you frequently wake up feeling you can’t get out of bed despite a good night’s sleep, you’re in distress.
• Drinking or smoking. You may find that you are drinking or smoking more. Or, you start drinking or smoking when you haven’t in the past.
• Health problems. You may catch colds or the flu more often than usual. This is particularly common in caregivers who do not take care of themselves, by not eating properly and exercising.

Here are some tips for reducing stress related to caregiving:

• Use respite and healthcare resources available to you. Taking a break, and ensuring your loved one is well cared for is one of the best ways to reduce stress.
• If you need financial help, don’t be afraid to ask family members to contribute their fair share.
• Say “no” to requests that are draining and stressful, such as hosting holiday meals.
• Forgive yourself for your imperfections. There is no such thing as a “perfect” caregiver.
• Identify what you can and cannot change. You may not be able to change someone else’s behavior, but you can change the way that you react to it.
• Set realistic goals. Break large tasks into smaller steps that you can do one at a time.
• Prioritize, make lists, and establish a daily routine.
• Keep in touch with family and friends and make time for yourself.
• Join a support group for caregivers. If your loved one has a particular affliction, such as Alzheimer’s or dementia, look for a support group targeted at that disease.
• Make time to be physically active on most days, even if it’s a short walk. Eat a healthy well-balanced diet and get enough sleep.
• See your doctor regularly for checkups.
• Keep your sense of humor and practice positive thinking.
• Find out about caregiving resources in your community. Your Area Agency on Aging (find it in the phone book) is a great, free resource.
• If you work outside the home, consider taking a break from your job. Employees covered under the federal Family and Medical Leave Act may be able to take up to 12 weeks of unpaid leave per year to care for relatives.

Don’t wait until a crisis occurs!  For over 12 years ElderCare at Home has helped hundreds of families not only create a strong ElderCare Plan, but also stop a crisis from occurring in the first place!

You have a crisis? Do you have a plan in place?  Who will care for your loved one that suffers from Alzheimer’s disease or dementia?   If something happens to you tomorrow, what will happen to your loved one?

ElderCare at Home will help you create a plan that will identify the needs and issues involved in caring for your loved one, and will provide you with the information, resources, and direction needed to enhance their quality of life and yours!

JOIN us for a FREE webinar this Wednesday July 27th from 3-4pm , Alzheimer’s Disease & Crisis Prevention, presented by Elayne Forgie, CMC, will teach you different ways you can prevent a crisis from occurring in the first place.

This webinar is a must if you are a family caregiver, paid caregiver or a friend. To register for the webinar click here! 

Patients that are so far advanced in their disease process that they require total care, rarely show signs of improvement. For the past few months we have been providing companion care to Mr. S at a local nursing home.

On Friday I spoke to his companion who told me that for the first time in a very, very long time, Mr. S reached for a cup of water as she put it to his mouth.  Although his hands shook, she placed the cup in his hands, he opened his eyes, was able to raise it to his mouth and he drank!  It doesn’t matter in the least that a little bit of water spilled. What matters is that this small accomplishment is what I call a “millimeter milestone”.  

This simple act required very little movement, however it was a huge milestone for Mr. S.  Although he can not verbalize his joy at completing what to most of us is a simple task, I am confident that deep down inside he not only felt a great sense of accomplishment, but a restoration of his dignity.  Even small, millimeter improvements in a patients quality of life are always  welcome milestones.

Congratulations to Mr S and to his companion for recognizing and encouraging him to try!