How is Alzheimer's/ Dementia (AD) Diagnosed?

Q: How is AD Diagnosed?

A: Today, the only definite way to diagnose AD is to find out whether there are plaques and tangles in brain tissue. To look at brain tissue, doctors must wait until they do an autopsy, which is an examination of the body done after a person dies. Therefore, doctors must make a diagnosis of "possible" or "probable" AD.

At specialized centers, doctors can diagnose AD correctly up to 90 percent of the time. Doctors use several tools to diagnose "probable" AD:

* A complete medical history includes information about the person's general health, past medical problems, and any difficulties the person has carrying out daily activities.

* Medical tests - such as tests of blood, urine, or spinal fluid - help the doctor find other possible diseases causing the symptoms.

* Neuro-psychological tests measure memory, problem solving, attention, counting, and language.

* Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal.

Information from the medical history and test results helps the doctor rule out other possible causes of the person's symptoms. For example, thyroid problems, drug reactions, depression, brain tumors, and blood vessel disease in the brain can cause AD-like symptoms. Some of these other conditions can be treated successfully.

This helpful information was found on http://www.alzheimers.org/diagnosis.htm

Activities for Alzheimer's

~ There are many different stages that a person with Alzheimer’s and dementia will go through, therefore activities for individuals in the early or middle stage of the disease will differ from the end stages of Alzheimer’s.

~When planning activities for the person with Alzheimer’s disease, creating routine and structure is extremely important.

~ In order to improve quality of life at each stage of the disease it is important to focus on the patients’ strengths and abilities. It is important to look at what the patient can do, instead of what they cannot do. Planning activities is a process of trial and error involving continual exploration, experimentation and adjustment.

~ Activities can be passive or active. Some patients may participate in an activity, while others may only observe or watch.

~ It is important to understand that activities are not just planned activities. Activities can include life skills, such as encouraging patients to hold their toothbrush, wash cloth or to choose an item of clothing. Mealtime activities may include folding napkins, setting the table, clearing the table and washing dishes.

~ Regular exercise is an important activity for overall health. It may help improve sleep and prevent restlessness.

~ Walking: Take short walks if distance is a problem, and then slowly progress to longer walks. Make sure the patient is in comfortable clothing and shoelaces are tied. If the weather does not permit, utilize the hallway of a building or an indoor shopping mall. A stroll in the wheelchair is also good exercise if the person is able to propel him or herself.

~ For chair exercise use props such as streamers, maracas, batons, pom poms, canes, stretch bands, tambourines, clappers, top hats, scarves, or small hand held balls. Hand held props help develop hand strength and provide stimulating visuals for the patient.

~Music is another important activity for patients with Alzheimer’s. It may help in calming the individual, bringing back memories and adding to the quality of life.

~ Activities using music can include sing-a-longs and name-that-tune. Tunes should be short, catchy and easy to follow. They should also be easy to recognize and remember. Relaxing music is suggested for mealtimes and toward the end of the day.
Information obtained from www.alzinfo.org

There's more....
1. Try folding washcloths, over and over again.
2. People with Alzheimer’s still love to look through their photo albums
3. In the early stages, you can have them check to see if all of your pens are still working.
4. Color in a coloring book
5. Play with a deck of cards
6. Do water colors
7. Fold socks
8. Fold napkins
9. Sing "head, shoulders knees and toes" and other simple activity songs
10. Read children's picture books (most love them!)

Do you have any more ideas? Feel free to send them to me ~Dutchy

MedicaidMedicare

Q:What is the difference between Medicare and Medicaid?

A: Often times when people mention Medicaid and Medicare they are grouped together, MedicaidMedicare...the words are blended together quickly with a "whatever, you know what I am talking about!" Type of disclaimer.

Just like people often group Alzheimer’s and Dementia together. The lines tend to blur a bit. The lines intertwine or blur because; most people don’t know the difference between the two. But they know they hear the words together so they must have a similar meaning, yet they sense they are different, or they just can't keep the two straight.

I have been in the health care profession for many years and I have to admit, that up until the last year or so, I never really took the time to figure out the difference between Medicaid and Medicare. I am not alone in this though, last week I spoke with a health care provider who needed this explained to her.

So here is a simple explanation for you, and a tip for keeping it straight.

Medicaid is a federal program for low-income, financially needy people, set up by the federal government and administered differently in each state. Tip to remember this: the aid in Medicaid suggests someone needs aid or support.

Medicare is also a federal program. It is an entitlement program; you are entitled to it because you or your spouse paid for it through employment or self-employment taxes. Most seniors qualify for Medicare when they turn 65.

I hope that clears up a bit of the confusionmisunderstanding. ~Dutchy

Reasons why the elderly won't eat

Here are some practical reasons why elderly people do not eat. These reasons should help you clue in to your senior. If their eating problems are persistant or chronic you should consult your primary care provider.

Several factors can cause malnutrition in older adults, including the following:

* Loss of appetite. Older adults lose their appetites for many reasons, including physical disease, mental illness, or emotional distress.

* Decreased sense of taste and/or smell. Many of the diseases that affect older adults and the medications they take can reduce their sense of smell and taste, making it difficult and even unpleasant to eat.

* Difficulty chewing and/or swallowing. Poor dentition affects many older adults and can contribute to a vicious cycle of malnutrition; as older people become malnourished and lose weight, their dentures may not fit correctly, making it even more difficult to eat. Swallowing problems also affect many older adults, making eating difficult.

* Loss of physical strength or mobility. Elders who are frail or immobile are often unable to shop and cook. Even something as simple as opening a can of soup or a frozen dinner and putting it into the microwave can be difficult for someone who is physically debilitated.

* Chronic diseases and medications. Older adults often have at least one chronic medical condition and often take a slew of different medications. Certain disease states, as well as side effects from medications, can interfere with appetite, digestion, and even absorption of certain nutrients.

* Mental and emotional factors. Mental illness, such as depression and age-related dementia, and social isolation affect many elders and can dampen their desire and ability to eat.

* Financial insecurity. Financial problems can make it difficult for many older adults to get the nutrition they need.

Resources:
Administration on Aging

American Dietetic Association

Eat up!

When working with the elderly getting them to eat enough was often a problem. We learned a few tricks to get more nutrition and more calories down them and still keep the food, tasty!

Make meals and snacks nutrient-dense. This means making nutrient-rich foods the focus of the meal. For example, instead of plain chicken broth, try a hearty chicken and vegetable soup. Casseroles, stews, and roasts are also good meal ideas.

Add extra calories without extra volume. For people who have a small appetite, there are ways to boost nutrition without adding lots of extra food. For example:

* Add extra sauces, gravies, and grated cheese to entrees and side dishes
* Stir powdered skim milk into milk, milkshakes, and cold and hot cereals
* Add honey, molasses, or maple syrup to hot cereal
* Sprinkle wheat germ into hot and cold cereals, and add it to baked goods, such as breads and muffins

Use herbs and spices liberally when preparing foods. Because many elders have diminished sense of taste and smell, making food as flavorful as possible is important. Try cooking with garlic and onion powder, salt-free seasoning blends, and fresh and dried herbs, such as basil, oregano, thyme, rosemary, and cilantro.

Make meals colorful and appealing. Instead of regular mashed potatoes, try mashed sweet potatoes for a colorful and nutritious boost. Instead of plain buttered noodles, try pasta with a vibrant red tomato sauce.

Serve several small meals and snacks, instead of three big ones. Older people with diminished appetites are often overwhelmed by large meals, so serving smaller, more frequent meals and snacks can help them feel less overwhelmed and more able to eat what they need.

Don't fill up on non-nutritious items. For people with a small appetite, it's important not to fill up on things like coffee, tea, and soft drinks, which can take the place of more nutritious items. Donuts, cookies, candy and cake can raise the blood sugar levels making them feel full. They are empty calories.

Make mealtime enjoyable and social. When possible, invite friends or family over for meal times or visit community-based senior meal sites for social interaction during meals.

Use nutrition supplements when necessary. While a well-balanced diet is the best bet, some people may sometimes find it easier to sip a nutrition supplement drink (available at supermarkets and drug stores) than to eat a meal.

RESOURCES:

Administration on Aging
American Dietetic Association

Hiring, with Peace of Mind

A great question was asked at our seminar last week. I think the information should be shared.

How do you know if the person you are hiring to provide care for your loved one is a good person?

Here are some measures you should take to insure that a vulnerable adult is being cared for by a good person.

1. In most states you can obtain a criminal background report. In Washington state you can submit a criminal background form by linking to www.watch.wsp.wa.gov the request will cost you $10.00

2. Health care proffessionals should also be listed with the Department of public health. They should have a card to prove they have registered. There is a toll free number on the back of that card. Call that number, give them the candidates full name and they will be able to tell you if there has ever been a complaint against the caregiver.

3. Check several job references.

4. Check personal references

You should use all precautions and never hire someone with the intent of checking their references later. ~Dutchy

WWJD

Six years ago, we moved into an adult family home. I knew it would be a demanding job, since I had worked there as staff for the previous five years. My whole focus on taking care of the five ladies I had was to do my best and do just what Jesus would do. No matter how tired I got.

Of course our first month was quite interesting. I realized that after the first few weeks of living in this house, I had all the classic signs of burn out. I figured realizing I was burned out was half the battle, and forged ahead until, I truly burnt out about 5 years later.

One of the hardest nights I spent was with a woman who came to our house from the hospital, she didn't want to go into the rehab facility, and cried for her family to get her out of there. She had been in a coma, and wasn't supposed to pull through. Her family left the hospital one night, saying their goodbye's, acknowleging that she probably wouldn't make it through the night. They arrived the next morning, only to hear her chastising them, "Where have you been??"

Needless to say the next day she was with me. That first night was insane, I was up all night long with her, every 5 minutes she was ringing her bell, for this or that. Finally after a Lorazapam, some tylenol, a trip to the commode, rearranging pillows, gettting fresh water, etc, I fell asleep around 5 am. Sometime around 5:10 am I was awoken by a sickening thud. Unfortunately my poor lady had fallen out of bed and had cut herself in a few places. Still in good spirits though she started chastising me, "Get me up! Don't just stand there." I was a bit afraid to move her as quickly as she wished. I called for my husband to help save the day. As he picked her up, he descovered, he really had no place to land with her, but to set this little lady on his lap. Which went over extremely well in the chivalry department. (and started a lasting bond between the two)

At any rate we called home health visiting nurse services to patch her up and we were on the mend. Except for the fact that she was ringing her bell, every five minutes, 24 hours a day. I kept in mind that I came here to do a job, and I was going to do it just as Jesus would do. Some times I wouldn't even turn around to walk out the door and she would be ringing me again. On day 3 "Jesus told me to take that bell away!" :wink: Somehow, over the next few weeks, we were able to build a trust and the bell wasn't needed anymore. I absolutely fell in love with this lady! Her wit and humor made every day worth while. Her family visited her almost everyday. They were the most supportive fun loving family I have ever worked with.

Break through moments

Q:My dad was sitting at our table last night and actually asked me when dinner was going to be ready. He talked off and on through dinner. Due to Alzheimer's he hasn't been saying complete sentences for months now. Is this for real? Is this normal?

A: Yes this is for real. And it is normal. However these moments are very rare. Most people call them break through moments.

When I was caring for elderly women with Alzheimer's they would surprise me every once in a while, with a very lucid moment. I say moments, but sometimes they lasted for several hours, or they would go in and out of this pattern for a few days. Unfortunatly since I was the caregiver and was the one around most of the time, their family members often missed out on this small miracle.

Break through moments...when everything inexplicably aligns ...when they find their space in time, again...when we get a small glimpse of the real person still inside...a place where there really isn't an explaination...so, just sit back and cherish the moment. ~Dutchy

Keep Your Brain Active

Some specific ways to exercise your brain are:

-Learn a foreign language
-Keep a daily journal or start a blog
-Learn to play a musical instrument
-Read challenging books on various topics of interest
-Play strategy games
-Play board games
-Visit museums
-Join a club or active group
-Take classes offered by your local community college
-Take a walk in the park
-Dance to your favorite music
-Do puzzles of all sorts
-Start a new hobby
-Play memory games to improve your memory
-Research and debate political issues, if it won’t stress you out!

If you would like to add to this list send me an e-mail at director@mycarelink.net.
I'd love to hear from you.

Honey, where are the car keys?

Q:My mother is always losing, hiding and hoarding things, I am losing my mind! What can I do to get her to stop?

A: This is a great question and I have a lot of material to work with.

My grand mother had made me the most beautiful doilies. One resident in my adult family home insisted that they were the ones she had made and took them when I wasn’t looking. I would put her in bed at night only to find my doilies hidden in her diaper.

After dinner one evening we discovered a client’s $3000.00 dollar pair of hearing aids wrapped up in a nice little napkin and stuffed in her drinking cup.

Some residents would go through others belongings, when I would suggest that they stop because the purse belonged to someone else, they would reply, “I know that” and would continue digging.

The weirdest experience I had was a resident who liked to clothes shop so much that she would go shopping in other peoples closets.

Invariably, just when you need something, it has disappeared, whether it’s your doilies, car keys, glasses, or hearing aids. Hiding, hoarding and losing things are very common things you have to deal with when you are caring for a person with Alzheimer’s.

To cut down on the prospect of losing very important things, here is a list of things to do to help you.

1.Simplify your surroundings. You would be amazed at how much easier it is to care for a person with Alzheimer’s if you aren’t surrounded by clutter. If you lose something, you will have less to sort through to find it.

2.Keep really important things in a locked and secure place.

3.Childproof your cabinets and doors that you don’t want your loved one rummaging through.

4.Don’t leave things lying around.

5.Keep your loved ones glasses, hearing aids, and teeth in a plastic container or tub when you put them to bed at night. That way you will always know where they are in the morning.

Here are a few other things to keep in mind.

1.People with Alzheimer’s like to put their teeth and hearing aids in their napkins at meal time. Always check napkins before throwing them into the trash.

2.Check their wastebaskets before you throw out the trash.

3.Check their pockets before doing the laundry-if they haven’t put something of value in them, I can almost guarantee that there is a Kleenex in them, a load of laundry washed with a Kleenex is the not very fun.

4.If a person with Alzheimer’s is a wanderer you will want to check the sides of their chairs frequently also.

While you may not be able to stop this behavior all together you might be able to control it a bit better with these tips.

I need nose plugs

Q:I can't seem to get my mom in the shower without a lot of hassle. I need help, or I need nose plugs.

A:Bath time can be very distressing to a person with dementia who feels attacked and responds defensively with verbal and/or physical resistance. The caregiver also feels attacked and frustrated due to the bathing/showering experience.
Here are a few tips to help you through the process.

1. Consider the time of day. Do you always try to give her a bath at night? Perhaps she is too tired and can't deal with the extra stimulation. Try doing it at a different time of day.

2. If her doctor has prescribed Lorazpam to help your mom with anxiety, you can give her one, wait a few minutes, and then try the bath. Don't try this if Lorazapam makes her too groggy.

3. Warm up the towels and the bathroom. It might not be the shower she is fighting, but the coldness in the room.

4. Talk to her in a very soothing manner. Even though the situation is frustrating, if she feels your anxiety, this will add to her distress.

5. Explain what you are doing while you are doing it.

6. Or you can talk about something she enjoys and keep her focused on you and not the shower.

7. You will need to strike a balance between getting it done quickly for her to stay warm, and slowing it down so she doesn't feel rushed.

I feel like it is worth the effort to keep trying. A lot of people would suggest that you use no rinse soap or shampoo. Use this only as a last resort. These items may help your mom smell nice, for a very limited amount of time. But they really won't get her clean. ~Dutchy~

Take Care of Yourself!

Because you, as the caregiver, spend most of your time taking care of a loved one you tend to forget about yourself.

Debbie, a friend of mine, gave me this next idea.

Sometimes you can't get out of the house, if the day has been a bit more than you can handle-you should take a few minutes and have a "me break!"

What you need to do is fill a basket with small things that you would enjoy. My basket would be filled with chocolate.
Perhaps your basket would include a small book of poetry, a cd of your favorite music, a notepad and paper, a candle, a bit of chocolate, a coloring book, and a journal, a book of psalms, a facial mask or a copy of your favorite magazine. Keep your basket in a place where others won't be tempted to share!


Providing Care for someone else is the hardest job there is. Taking care of yourself when you are providing care for someone else, is the second hardest job! Try doing a little something for yourself today. Hang in there!

Thanks for the idea Debbie!

Can't sleep through the night

Q:I have been caring for my dad with Alzheimer’s for the past 6 months. I am starting to feel like I am losing it. I think we would do better if he would sleep at night. I relax and just get to sleep and I hear him rummaging around his room and then he starts wandering.

A: I do have a few suggestions for you.

Your father may be restless at night for several reasons, so here are some suggestions to start with.

1. Your father may be sleeping too much during the day. Try to keep him on a schedule that keeps him busy during the day. Stepping out and taking a brisk walk once or twice a day would help both of you.
2. Sometimes medication can make your father sleepy. You need to talk to your father’s doctors and explain the problems you are having. Perhaps he can make some medication adjustments.
3. You need to avoid sugar in the evening, which can agitate a person with Alzheimer’s.
4. You should also avoid drinks with caffeine in them.

These are just a few of the basics to get you started. Keeping a person with Alzheimer’s or Dementia on a routine or schedule is a very important thing to do. Here is a schedule I found; perhaps it will help you.

Sample Daily Schedule
7:00 Wake and assist with toileting and dressing
8:00 Have your loved one assist in preparing, serving, and eating breakfast
9:00 Assist with toileting
9:30 Read the paper together and have coffee
10:00 Quiet time (give them a magazine, watch TV, etc.)
10:30 Activity (Go for a walk, go grocery shopping, do a craft, etc.)
11:30 Assist with toileting
12:00 Have your loved one assist in preparing, serving, and eating lunch
1:00 Assist with toileting
1:30 Nap time
2:30 Wake from nap and Assist with toileting
3:00 Activity (give them a "project", do a craft, etc.)
3:30 Quiet time
4:00 Assist with toileting
4:30 Activity (go for another walk, read another section of the paper)
5:30 Have your loved one Assist in preparing, serving and eating supper
6:30 Quiet time
7:00 Assist with toileting, bathing and preparing for bed
8:00 soothing activity (listen to music, read together, etc.)
9:00 Assist in going to bed. (or coarse toileting)

This schedule may seem a little unrealistic for you; perhaps you can develop a routine of your own.

Please let me know if these suggestions help ~ Dutchy

Mom has Alzheimer's...difficulties with sister

Q: I have a sister who is being so selfish about how she will take care of our mother, that it is real frustrating to me. She thinks that mom doesn’t have Alzheimer’s disease and really we do not know for sure. But I have been working in a care home for 12 years now and let me tell you I would almost guess she does! But how do I tell me sister this isn’t about her! It's mom who needs the care! CT

A: You are correct in saying that it is your mother who needs the care. I am assuming you don’t have the Power of Attorney (POA) or this wouldn’t be an issue.

The first thing I would recommend to you in a situation like this is checking out a book by Dr. Henry Cloud and Dr. John Townsend: Boundaries: When to Say Yes and When to Say No To Take Control of Your Life (Zondervan, 1992)

Whenever I am asked a question from a family member who is irritated with another family member, my first response is, “Yes there is a problem that needs some attention, but the first thing that needs to be addresses is a boundary issue.”
What do I mean by “boundaries”? In the book, the authors define boundaries as the setting of “mental, physical, emotional, and spiritual boundaries for our lives to help us distinguish what is our responsibility and what isn’t.” (page 25)

Once the boundary issue is cleared up, then the real problem solving can begin.
Here is an excerpt from the book, and hopefully you will see what I am getting at:

“When you react to something that someone says or does then you have a problem with boundaries. If someone is able to cause you havoc by doing or saying something, she is in control of you at that point, and your boundaries are lost…When you are reacting they are in control. When you respond you are.”

You can’t make your sister do anything she does not want to in this situation. You will only make yourself miserable trying. Honestly, read this book, step back and look at the situation and see if there is anything you can do without “making” your sister do anything. You may find it surprisingly affective when you apply these principles with your sister, at how much respect you gain for yourself, and how much respect she will have for you. And with the knowledge you gain from reading this book, if she is still causing problems you will always have the upper hand, because you will know how to set boundaries.

Unless your mother is in immediate danger, taking a step back and giving everyone a little more time might be to your advantage. I think you are a lot like me, in that you want to deal with it now, especially since you have had so much experience in this field. Others might not be as anxious to deal with it head on (We are going through the same situation with my father in law, with my mother-in-law resisting).

Also, I sincerely doubt your sister wants to deal with this on her own forever. Often you will see that when you learn how to set these boundaries, others will come around.
Sincerely hope this helps you ~ Dutchy