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Jill Troman

Recent Posts

Coping with Elderly Parent's Denial of Dementia

Posted by Jill Troman on Oct 4, 2015 4:20:00 PM

It's becoming very clear to my sister and I that Mom is exhibiting signs of dementia.  Until recently, she was mentally sharp and in control of her life.  After surgery and extended hospitalization 9 months ago, Mom has seemed like a different person with significant memory deficiencies and diminished cognitive skills.  Mom does not seem to be aware that she is "slipping".   In fact, she becomes immediately defensive and angry when the topic is broached.   We are  accused of "picking on her" when we bring up concerns.  After several months of trying to convince her to see a neurologist, my sister and I have all but given up. According to Mom, she's "fine" and we are just overly critical.  How do we get these concerns out in the open so they can be addressed?  

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Apparently, this lack of awareness is a very common component of Dementia and Alzheimer's Disease and it has a name, Anosognosia.  Up to 81% of Alzheimer's patients are affected.  Stroke patients often experience this condition, temporarily and it occurs frequently in those suffering from mental illness or traumatic brain injury.   Although the cause is not known for certain, studies suggest that deterioration in the brain's frontal lobes may be the culprit.  The frontal lobes are the region that play a key role in "problem solving, planning and understanding the context and meaning of experiences and social interactions" according to the New York Times' New Old Age blog.   So, when this area breaks down,  the left side of the brain works to keep the individual's mental model and belief system intact by using strategies such as denial and rationalization.   These strategies are not employed consciously by the person with Anosognosia.   He or she does not even recognize the problem.  

This condition can be incredibly difficult for family members and caregivers who are trying to help someone who is ill and can not recognize it.  A loved one can be having trouble with tasks that were once routine but will refuse to admit that she needs help and may refuse a medical evaluation that would diagnose the problem and potentially lead to treatment.  Before you jump the gun and assume that your really difficult elderly parent has this condition; consider the following key signs.

What are the sign of Dementia with Anosognosia?

  • Not keeping up with regular daily tasks or personal hygiene.   My sister started noticing that our mother was not keeping up with laundry and was wearing dirty clothing.  This was out of character for her and very concerning.
  • Difficulty managing money and bills.  This has recently become a problem with mom frequently becoming confused and irritated when reviewing her billing statements.   Even normal, reoccurring charges were suddenly confusing.  Rather than asking for assistance, she would allow statements to pile up on her kitchen table.  
  • Being less inhibited in conversation and behavior in public.  Yep, mom is off the charts with this symptom.  My sister reports that EVERY single time she takes mom out for lunch, she sends her meal back to the kitchen.  To make matters worse, it's never done discretely.  The scene is so embarrassing that my sister has stopped taking our mother out for meals. Unfortunately, shopping and lunch was something that they used to enjoy together.
  • Becoming angry when confronted with forgetfulness, lack of self care or poor decision making. This is probably the most challenging symptom for caregivers to deal with.  Well meaning and concerned family members often walk into a mine field when trying to confront these issues with their loved one.  The anger and verbal abuse can be frustrating and at times, frightening.  
  • Confabulation; making up answers they believe are true though the details may be "sketchy" and may pertain to something from the past or something they read or heard elsewhere.  This was not a term that I was familiar with but there are definitely times when I feel like mom substitutes manufactured stories for the truth when her memory is hazy.  I have been thinking that this was intentional, maybe not.

If your loved one exhibits some of the symptoms above, it's time to discuss the matter with her primary care physician for further guidance.  If a diagnosis of dementia with Anosognosia is made, what's next? For starters, it's probably best to stop trying to convince your senior parent or family member of their limitations.  That is likely to be an exercise in futility.  Instead, look at ways to change how you relate and communicate with him to mitigate the effects of the disease.          In-Home Care for Alzheimer's

 

Strategies for helping a loved one with Anosognosia : 

  • Keep interactions calm and low key.  Try not to put a spot light on areas where your loved one is struggling. Focus on the positive. 
  • Where possible, provide a structured schedule for tasks.  Be subtle; don't force the issue. My sister found that leaving a calendar behind for mom with key appointments recorded as well as suggested schedule for taking care of routine tasks like laundry, linen change, and bill payments was helpful as a subtle reminder.  
  • Try to downsize your loved one's responsibilities while being careful not to suggest he or she is incapable.  Perhaps someone else can take over or assist with paying bills, cleaning the house or coordinating home maintenance?  
  • Use positive approaches to communication.    Try to be gentle, encouraging and empathetic when speaking with your loved one.  Remember that he or she is not aware of negative behaviors and can not control them.   If you are feeling impatient or frustrated, take a break. Both parties will benefit.
  • Avoid putting your loved one in situations that trigger upsetting or embarrassing behavior. If you know that your parent tends to lose appropriate filters and manners in restaurants, simply avoid them and save your sanity.

For my sister and I,  it helps a little knowing that Mom is not simply being "difficult" and stubborn; she is just not aware of her limitations.  We try and remind each other of this fact when the going gets really tough.  

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Elderly Care: Taking the "Ick" Factor Out of Pureed Diets

Posted by Jill Troman on Sep 27, 2015 11:16:00 AM

When your elderly parent or loved one suffers from swallowing disorders like dysphagia, preparing meals can become a real chore.  Seniors may develop dysphagia for a multitude of reasons including: Gastrointestinal Reflux Disease, digestive problems, esophageal cancer, stroke and  neurological diseases like Parkinson's and Alzheimer's.  Regardless of its cause, dysphagia can have serious consequences including  impaired nutrition and hydration and often, diminished quality of life.header_image-1

If you notice that your parent or other senior loved one is exhibiting signs of swallowing problems, consult with your physician for proper diagnosis before beginning any dietary changes.  Treatment and diet will vary significantly depending on the degree of dysphagia present. For severe cases of dysphagia, a pureed diet will likely be prescribed to minimize the choking risk.

A visit with the dietitian may leave you with the impression that your loved one's diet will be forever reduced to mushy, unappealing, and bland options.  Not necessarily so!  With a small amount of effort and creativity, your elderly parent can look beyond baby foods and applesauce to more flavorful options.  Tasty, appealing meals are critical in nutritional care and in keeping an elderly person interested in eating.  

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Tips for Nutritious, Appetizing Pureed Meals:

  • After pureeing meats like ham, beef or chicken, try wrapping the meat in parchment paper and freezing. When frozen, cut meat into cubes and use in main courses, like stews.  The cubes maintain their shape and look very realistic.  Keep a bag of frozen cubed meats on hand as a time saver.
  • When making meals, puree each food item separately.  Most people prefer to eat the veggies separate from the main dish.  Blending the items together might save preparation time but will likely result in some strange and unappealing flavor combinations.
  • Invest in some molds designed for use with pureed foods.  These molds can make pureed food look like the real thing.  . Some of the results are incredible, capturing the shape and texture of various vegetables and meats.  Pureefoodmolds.com is good source for reasonably priced molds but there many other options available on the internet.  Making pureed foods resemble their original form goes a long way in restoring dignity at meal time for dysphagia patients.  
  • Experiment with other ways to create realistic shapes for pureed food.  For example, chefs at assisted living facilities often use pastry bags to shape foods like pasta noodles and green beans.  Tomato slices for sandwiches can be created by mixing unflavored gelatin and tomato juice, pouring into cups and freezing.  Frozen juice can then be sliced to simulate a tomato slice.  It will take practice to perfect but can be fun to try.
  • Spend some time perusing the large collection of puree recipes on foodnetwork.com.  There is something for everyone in their huge on-line cookbook.  Variety is especially important to someone on a pureed diet.
  • Try perking up staple items with some easy, flavorful additions.  Enhance, nutrient dense, plain Greek yogurt with fresh pureed fruit mixtures.   Add brown sugar, molasses or pureed fruit to thinned Cream of Wheat or oatmeal.  Don't forget spices when pureeing foods.   Basics like salt (use sparingly), pepper, salad dressings, and smooth prepared sauces can be added to pureed mixtures to enhance flavor.
  • If not using molds to prepare foods, consider using garnishes to enhance presentation.  Using colorful food combinations is also important in meal planning.  Vibrant  spice garnishes can  improve the appearance of pureed foods. Even simple additions like paprika and parsley flakes can add visual interest.  Sprinkling cinnamon on top of pureed apple can be a welcomed change.  Offer varying sauces, relishes and condiments to spice things up.  Use a fork to "fluff up" the pureed food and add texture before serving.
  • Consider putting strong smelling foods like fish or broccoli into a casseroles with other ingredients. The process of pureeing these foods can magnify the sometimes unpleasant odor. 
  • A well made smoothie can be a great meal substitute for someone with a poor appetite.  With so many recipe options, it's difficult to run out of ideas for great tasting, nutritious smoothies.  The most important ingredient in a smoothie is the thickening agent.  Use yogurt, pureed banana or frozen fruit as natural thickeners. 

Preparing meals for a loved one on a pureed diet can be a bit challenging at first.  Spending a little time experimenting with recipes created especially for those on a pureed diet is worth the investment.  Putting a little thought into the presentation can also go a long way in maintaining appetite.  Serving some "smooth textured" foods to the entire family such as hummus for an appetizer or mousse for desert can help to take some of the stigma and embarrassment out of consuming a pureed diet for your elderly parent.  

Please let us know how these suggestions work for your family.  Feel free to share your ideas with our readers, as well.   Thank you!

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Organizing an Elderly Parent's Move

Posted by Jill Troman on Sep 13, 2015 8:39:00 PM

Moving is stressful...period. Let's face it; no one looks forward to the process of moving. There's only one thing more challenging than moving yourself, moving your elderly parent. Helping a senior get prepared for a move can be an endeavor fraught with intense emotions, anxiety, and frustration for adult kids and parent. The physical, cognitive and emotional changes associated with aging will likely impact a senior's ability to participate in the process.   While there are sure to be some very positive reasons for moving, most seniors relocate for one or more of the following emotionally charged reasons:

  • Health conditions 
  • Changes in mobility
  • Loss of a spouse & associated bereavement
  • Reduced income and need to cut expenses
  • Loneliness
  • Negative changes in surrounding community
  • Inability to care for home independently
  • Access to support and care

Organizational Tips for Moving Elderly Parents

 

You will need to quickly dismiss the notion that the move will involve simply packing up boxes and calling in a moving company.   Do not underestimate the emotional impact that sorting through and purging a lifetime's possessions will have on your elderly parent.  Expect this process to include  a roller coaster ride of emotions--rediscovering forgotten possessions, reliving memories and making the  numerous decisions that will have lasting impact.   So, if you are about to embark on the process of helping your parent to relocate,  take a deep breath and get prepared for the challenge!     

Downsizing and Moving Tips for the Elderly

  • Allow significantly more time for the physical work needed in preparing for the move.  If possible, break the sorting and clearing portion of the process into several smaller portions of time. This will likely be the most emotionally exhausting part of the process.  Do NOT attempt to force the process into a short time window such as a weekend.  
  • Allow for frequent breaks and snacks.  Keep your parent comfortable, nourished and hydrated during the process to reduce stress.  Consider allowing your parent to sit in a comfortable chair while you bring items to them when decisions are required.  If emotions take over,  take a break to get refreshed. 
  • Draw up a floor plan of the new accommodations.  Make it as detailed as possible, including window, doors, closets, etc.   This will help in deciding which items will fit into the new space and imaging how they will look.  This should provide guidance in the sorting and selection process. 
  • Set up multiple staging areas.  Organize the sorting and purging process by setting up distinct staging areas for items to be trashed, donated, saved for family and packed.  If you anticipate needing to dispose of large items or quantity, consider contacting your local waste disposal company for options.  Perhaps delivery of a dumpster will facilitate the disposal process. 
  • Go for quality rather than quantity.  Keep a favorite vase, for example, and give the rest away.  Inject a dose of reality when needed. Be realistic about new needs.  Perhaps, that large formal dining set would be better off as a gift to a growing family in the neighborhood?
  • Emphasize donation.  Encourage your parents to donate or recycle as much as possible.  It's much easier to let go of things if they are going to benefit someone else.  

  • Avoid moving items to storage facilities.  Your parents may want to move items off-site to a storage unit rather than making decisions in the moment.  Discourage this move; it's just postponing the hard work of making selections.  Remind them that it's just an unnecessary expense. 
  • Enlist help, especially if organization is not your strong suit.  Consider employing a professional organizer to assist.  Look for one experienced in working with elderly transitions. A caring, objective professional may be what's needed to keep the project on track. 
  • Keep the end goal in sight.  Take time to celebrate progress.  Try hard to keep the process positive by keeping the goal of improved circumstances in sharp focus. 

Do not forget to acknowledge the impact this process will have on you, as their adult child.  This move will likely bring you face to face with the new realities:  changing roles, increased care needs, and perhaps the loss of your childhood home, as well.  This is emotionally and physically draining work so prepare well and take care of yourself along the way.  

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Preparing for your Parent's New Caregiver

Posted by Jill Troman on Sep 9, 2015 11:57:00 AM

Congratulations!  You have taken an important step in assisting your elderly parent to remain safe and comfortable at home.  You've done your homework, asked every question you could think of and have selected your family's Home Care Agency.  The agency has introduced you to a fantastic caregiver.  She is credentialed, experienced, and confident.   She made a great first impression and your Mom is looking forward to her companionship.  Why are you still nervous?  

First of all, it's completely normal  to feel a little anxious about a new care situation for a family member. The concerns are heightened if the elderly parent has complex care requirements. You worry something will fall through the cracks.  The best way to alleviate the worry and look forward to a successful care relationship is to prepare well for that first day.  Develop a checklist or daily task log to help guide your parent's new caregiver.   If you prefer, the instructions can be written in narrative form instead and can be set up as a CARE BINDER.  Sit down with the caregiver and review the care instructions together. Be sure to solicit input and express appreciation for her training and experience.   With all of the care essentials documented, you can relax and feel confident, knowing that you have done your part in getting the caregiver off to a great start . 

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Consider including these items when preparing your parent's care instructions:

  • Medication Instructions.  Provide a comprehensive listing of all medications that your parent is taking along with dosage and purpose.  All medications should be pre-dispensed by family members and organized in daily pill dispensing containers.   Indicate the time of day the medications should be given and any special considerations like whether meds should be given with/without food.  If convincing your parent to take medications on time has been a problem, alert the caregiver to any strategies that have been successful in the past.
  • Meal Time Preferences.   In all likelihood, your parent looks forward to sitting down for a tasty meal. If your caregiver is not especially skilled in the kitchen, make it easy for her to prepare something that your parent will enjoy.  Include a list of simple to prepare favorites with instructions, if necessary.    Specifically identify foods or ingredients that your parent doesn't like.  Of course, highlight any food allergies or dietary restrictions in your care document.  For example, if liquids are restricted in the evening to avoid night time incontinence; alert the caregiver.  
  • Assistance with Basic Tasks.    Identify the specific type and level of assistance your parent needs with routine tasks like ambulating, eating, showering, dressing, toileting, oral hygiene, and household duties. Identify critical safety concerns like choking potential, such as cutting food into small pieces,  Share insights and tips that will benefit both the caregiver and your parent. For example, if you know that your mom is extremely modest, alert the caregiver so she can take that into consideration when providing shower assistance.  
  • "Quirks".  Let's face it.  We all have them!  Prep your parent's caregiver by alerting him or her to those things that drive your parent nuts.  Perhaps your dad isn't a morning person and too much conversation in the morning sets him off.  Let your caregiver know so she can avoid this pitfall.  
  • Daily Routines.  Is there a particular way of ordering the day that seems to make things flow better for your parent?   Provide a brief outline as a guide to help structure the day, leaving room for the caregiver to make adjustments. If your parent is more independent and prefers to "call the shots", let the caregiver know that as well. 
  • Preferred Activities.  List some things that your parent might enjoy doing with the caregiver or things that he or she can be encouraged to do by himself.  Identify favorite TV shows & movies or reading material. Perhaps there are places your parent would like to go that you simply don't have time for like the movie theater, shopping, library or parks. 
  • Contact Listing.  Include an organized list of key phone numbers for your caregiver such as family members, neighbor, primary care physician, pharmacy and service providers like hair salon or physical therapist..  Identify the home address so that the caregiver can reference it in the event of an emergency.  It may also be helpful to provide driving directions to places like grocery store, pharmacy, senior center, physician office and favorite destinations. 

This is certainly not an exhaustive list but can be a great starting point for getting prepared to welcome a new caregiver. Remember to  keep an open mind and allow for alternate ways to accomplish the same task.  If the care tasks are very involved, consider arranging for a paid orientation session with the caregiver prior to the first day of service.    A little planning and prep work can help foster a great care arrangement for your parent and some freedom for you!

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Elder Care: How to help from a distance

Posted by Jill Troman on Aug 30, 2015 3:14:00 PM

It's Sunday evening and I am getting ready for a another hectic week as a single, working mother.  I've just finished folding laundry and have collapsed on the sofa, anxious to relax and enjoy a favorite TV show. The phone rings.  It's my sister.  I know she has been with Mom all evening and is likely calling to "vent".  Do I pick up and listen sympathetically to another harrowing tale of dealing with Mom or do I settle in for some needed rest?  Feelings of guilt win over and I take the call.  Just as I thought, my sister is beyond frustrated with caring for my mother and in desperate need of emotional support and validation.   Amy is single, has no kids and by default, has ended up shouldering  most of the caregiving duties.   Our mother is 80 and while mobile and generally in "ok" physical health, suffers from untreated depression, mild dementia, chronic fatigue and fibromyalgia.  She's volatile, emotionally needy and believes that her daughters should meet all of  her companionship, transportation and care needs.  In short, she is simply exhausting to be around. 

No wonder my sister  feels trapped and fearful about what the future holds.  She's young, energetic and wants a life of her own.  Living 13 hours away, I can do little to assist with the care.  I know that Amy resents having to do all of it on her own.  How can I provide support from a distance?  I began brainstorming and searching for ways I might help support my sister in her role as primary caregiver for our mother.   

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5 Ideas for Supporting a Sibling Caring for a Parent from a Distance:  

1.  Handle paperwork and make phone calls.   I have assumed responsibility for handling "little things" that can quickly add up to a great deal of time and energy.  For example, mom's home was recently damaged by a storm.  On lunch breaks during the week, I made phone calls and lined up contractors to go out and quote the job.  I then reviewed the estimates over the phone with mom so she could make the decision.   With mom's authorization, I negotiated settlement with the insurance company.    

I also call mom's doctor after appointments and stay up to date on her medical conditions.  When my sister tells me about new or worsening symptoms, I connect with the physician for guidance so that Amy doesn't have to. 

I  serve as the designated "research person".   Whenever we are confronted with a new issue or need a resource, I sit down and do the internet research for options.  This can be a major time saver for the primary caregiver. 

2.  Help diffuse tension.  When our mother is stressed about having to make a difficult decision, I step in and assist via phone.   With mom's diminished cognitive skills, decision making can be very difficult for her and frustrating for my sister.  Based on past experience, I know this is a trigger point for tension between the two.  I spend the time on the phone, guiding mom through the decision making process and listening  to her concerns.  Because of my distance, I am able to remain calm and dispassionate  which both parties appreciate. 

 3.  Recognize efforts and show appreciation.   Caregiving is a difficult job and often the rewards are few and far between.  I have learned that expressions of sincere appreciation go a long way in sustaining a sibling who is handling most of the  care responsibilities.   For my sister, a gift certificate for a relaxing spa treatment like a massage or pedicure is very much appreciated.   It gives her something nice to look forward to and lets her know I value that huge sacrifices she is making to care for our mom.   Often, a simple note of thanks goes a long way in sustaining a weary caregiver.  

4.   Make arrangements for respite care.   Out of town siblings simply must make  the time to takeover for the primary caregiver on occasion.    Besides, providing much needed respite,  it's important to stay current on a parent's changing needs.  The holidays are a great time to visit and relieve an overtaxed sibling. My sister isn't aware yet but I plan to surprise her by making arrangements to come up at Thanksgiving time and step in for her so that she can get away without worry.  If personal circumstances prevent travel, consider making arrangements with a Professional Caregiver Agency to provide respite care.   A small investment in giving a tired family the rest needed to sustain them as a caregiver is truly worthwhile. 

5.  Take the call.   Whenever possible, be there to listen and offer emotional support to your sibling when she needs it.  You may be the only person in the world who truly "gets it".  I have found that just listening and validating emotions goes a long way.  Often, my sister just needs me to hear what she is going through and to agree that she has the most world's most difficult job.  After all, I am pretty sure that she does!

Do you know someone struggling to care for an aging loved one?

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