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How Does Dementia Impact Incontinence?

 

Your mother hasn’t been going out as much lately. She even declined a few outings with you recently, which is unlike her. Then you noticed a pair of soiled underwear shoved behind the toilet…and another soiled pair under the bathroom sink.

 

 

What she may be hiding is trouble with urinary continence.  She may be feeling embarrassed and is trying to hide it, or if she has dementia, she may be confused about how to cope with this new change.

 

There are many possible reasons and treatments for urinary incontinence.  Ensure your mother sees her doctor and speaks openly about what she is experiencing.  Many causes of incontinence can be addressed medically, and those should be addressed immediately.

 

You may be able to suggest some lifestyle adjustments that will help to support your mother’s bladder, rather than irritate it. Read our other blog that addresses natural ways to support the bladder. If your mother has dementia though, the source of her challenge may be related more to her functional abilities than to her bladder directly.

 

As your mother’s dementia advances, she may not be as responsive to the signals her body is sending.  By the time she realizes that her bladder needs relief, it may be too late to respond and she may not be making it to the washroom in time.

 

 

Another challenge can be complicated clothing. Buttons, snaps, zippers or belts may be proving a challenge in the washroom. The more barriers there are to quick washroom use, the more likely your mother is to be slowed down and not make it in time. Be especially aware of skirts or dresses with back closures since it may not be self-evident how to undo the zipper. Modified and accessible clothing may make it easier for your mother to be quick and self-sufficient in the washroom. Drawstring or elastic-waistbands are often the easiest to manage.

 

If your mother’s dementia is advanced, it is possible she is confused about where to find the washroom.  Washrooms are not always easy to find, especially for someone with dementia.  Often, washroom doors remain closed, even when unoccupied.  Someone with dementia may not think to open closed doors to see what is behind the door. They may not have an intuitive sense of where a bathroom is likely to be located within a home or apartment. Although she may have lived in the same home for years, or decades even, dementia can cloud her memory and obscure what was once familiar. If she cannot easily find the washroom, she will not make it in time when nature calls.

 

 

Once she is able to locate the washroom, she may be confused about what to do once she’s in there.  For some people with advanced dementia, the washroom can feel very confusing and overwhelming.  If the toilet seat lid is down, the toilet may not look familiar. A white toilet and white sink may look very similar and can be confusing.  A wastepaper basket may seem more familiar and is often mistaken for the toilet itself.

 

Sometimes people attempt to sit down facing the toilet, rather than with their back to the toilet tank, as it is typically used. Because it feels so unusual when facing backwards, there is no long-term memory to cue what to do next.  It can also be dangerous since balance is impacted and there is a risk of falling.

 

If someone needs cueing through each step of toileting, their apparent challenges with incontinence may be more related to functional abilities and less so to their bladder or bowel function. They may be able to hold their bladder or bowel and may even be aware of when they need a washroom, but the confusion sets in with how to use the washroom.  If someone is experiencing functional decline, various support measures can be implemented to promote independent washroom use.

 

 

Cue cards can be helpful for those who can read and interpret directions. If your mother is inclined to read instructions and follow the directions, a cue card in the washroom to cue each step may be helpful.  In some cases, colour coding the toilet seat vs. the sink can be helpful. Contrasting colours can make it easier to see which item is which. If cue cards and colour coding are insufficient, your mother may need a caregiver to cue her through each step of the toileting process. 

 

When functional ability is preventing someone from toileting successfully, look for which step is causing the confusion, or which component of mobility is posing the challenge

 

By solving that specific component, you can help support someone to toilet as independently as possible.  Engaging the support of a professional caregiver may also help in identifying precisely where the needs exist. For more ideas on supporting independent toileting and continence, contact us at Warm Embrace Elder Care.

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It's Okay to Ask for Help

 

When self-isolating at home, have you found yourself scrolling through random online updates more often than you want to admit?  If so, you’ve probably seen articles and posts about parents who are going crazy being cooped up with their children for weeks on end. Both the parents and the children are feeling the strain.

 

It isn’t just the parents of young children who are feeling the parent-child relationship strain. It can be felt at all ages but is showing up particularly strongly for those who have been thrust into a caregiving role that is more extensive than they anticipated.

 

 

Adult children of ageing parents who have dementia or other high-care needs may suddenly find many of their regular support systems removed. The Adult Day Program that your mother attended a few days weekly is now closed; her regular social groups at the church have shut down; even the PSW who usually comes to bathe her has not been coming. Your mother’s schedule is in upheaval and you have become the primary—and only—caregiver.

 

It can be pretty overwhelming to suddenly find yourself in the full-time position of caring for someone with dementia. While you’re happy to help sometimes on some days, being the only support person day after day is wearing you out and you’re starting to feel the strain.

 

 

It is okay to admit that, just like your mother, you’ve experienced a massive upheaval in your schedule and routine, with newly added responsibilities.  And though you may be tempted to think “I’m not working at the moment so I should be fully available to care for mom,” providing 24/7 dementia support is more than one full-time job.

 

Providing care to a loved one with dementia is more than just physically taxing. It can be emotionally exhausting as well. There are certainly very meaningful moments with laughter and joy, but when it is your parent or your spouse whom you’ve known for decades, it will undoubtedly be emotionally exhausting as well.

 

 

Just because you are home at the moment and may not be working does not mean that you are equipped to provide 24/7 dementia care. It is okay to acknowledge that sometimes, a professional is required and someone who is not related to your mother may be better able to provide the assistance she needs right now.

 

Fortunately, caregivers to the elderly are essential and permitted to continue caring for seniors. Here at Warm Embrace, we continue to serve our longstanding clients and we are also equipped to help families who are now finding themselves in need of more care.

 

As an essential service provider, we’re here to help your family through this difficult time. Contact us for more information.

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Being Factually Correct is Not the Point

 

When you break down the format of everyday conversation, you might be surprised how much it tends to be an exchange of facts.  We’re often using the old-fashioned newspaper reporter method of the W’s: who, what, where and when. Sometimes we also include the “why” and “how”, but often it’s just the first four W’s.

 

 

Conversation tends to report on who did what with whom, where they went and when.  We depend on each other to convey those “facts” in an accurate way, and we equate that with telling the “truth”.  Since we tend to consider “truth” as a value, we place a lot of importance on conveying facts accurately.

 

The reality is that any of us is only ever conveying our perspective, our experience of the world, our interpretation of events.  You know the old saying….” if there are 10 eyewitnesses, there are 10 different accounts”. I might even argue that you’d get 11 or 12 different accounts with 10 eyewitnesses!  We each have our own understanding of events or recollection of past events.

 

Oftentimes, a conversation that includes sharing past memories becomes an exercise of correcting each other’s recollections of the “facts” or telling the “truth”.  When different narratives emerge, a lot of effort is spent trying to reconcile those different narratives, assuming only one can be correct; or that details of each need to be merged and one variation decided upon.

 

The focus on “facts” and telling the “truth” makes conversation very difficult for those with dementia. 

 

Recalling the first 4 W’s is tough: who, what, where and when.  When someone’s brain has been impacted by dementia, their ability to recall precise details is impaired.  Short term memory no longer encodes details into long term memory.  When someone attempts to retrieve the details a few hours or days later, the information is no longer there since it was not encoded into long term memory.

 

 

Long term memory that was established decades ago may remain as the strongest memory.  Eventually, even long term memories are impacted by the progression of dementia. When those memories are affected, it will be the details and the “facts” of the memory that are first at risk.  Someone will continue to remember the feeling associated with a memory, but they can’t necessarily recall who was present, or when it occurred, or where exactly it was. They’re more likely to remember the “why” or the “how” of the event because those elements are typically more connected with the feelings of an event.

 

When trying to recall a memory, and someone with dementia or Alzheimer’s has an impression of the “why” or “how” of an event, their brain may fill in the gaps on some of the missing “facts” of the story to help it make sense. Their brain may provide a missing “who” or supply the “when” of the story—and those details do not line up with your recollection of the event. 

 

In fact, those supplied details may not line up with the version of the story that the person told yesterday. Each time they retell the story, their brain may have to supply a different missing detail.

 

Instead of focusing on the “facts” of the story, focus on the feelings.

  • Don’t worry about correcting the details that may have different from the last telling of the story. 
  • Don’t contradict the details or get worried about the “accuracy” of the story. 
  • Do listen to the “why” and the “how” of the story that starts to emerge.

Let your loved one explore their memory and remember that they are trying to put words to an emotional experience. The emotion of the memory may remain strong, but finding the words to express it can be difficult. If the details they supply keep being corrected by someone else, they may stop trying to articulate what they’re feeling.

 

 

Stop and consider: what is the purpose of this conversation? 

 

If it is a nice conversation between you and a parent, then enjoy it for all it is worth! Savour the clear moments, find the emotion underneath the words, and use it as an opportunity to connect.  Correcting “facts” will only inhibit the purpose of this conversation—which is to create a connection and convey love and caring.

 

If it is a conversation with your loved one’s family doctor, then the purpose of the conversation is different. Suddenly, the facts of a particular symptom are critical. In this case, having correct “facts” truly is the purpose of the conversation and being focused on precision is important.

 

When you consider the purpose of a conversation, you can remain focused on what matters most.  If exchanging factually correct information isn’t the point of the conversation, then don’t worry about correcting facts! 

 

If the purpose is to create enjoyment for your loved one, you can achieve that by supporting their feelings and their recollections.  Focus on the feelings, not the facts and you’ll find conversations far more enjoyable!

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What is Doll Therapy?

 

When someone has advanced dementia, their ability to complete tasks may become impaired, but their desire to have an important role and care for others often remains strong. While they may require quite a bit of assistance themselves, they are keen to offer assistance in return.

 

 

Caring for others is a deeply rooted desire for many people that persists throughout the journey with dementia. Simply trying to tell someone “you’re retired and you don’t have to worry about anything!” often produces more agitation. Instead, figure out how to tap into that desire to help for even better results.

 

One option is to provide doll therapy. 

 

Doll therapy allows someone with dementia to care for a doll as though it were a baby.  For some people, this can be highly effective and meaningful since it connects with identify—someone’s identity as a parent or a caregiver.

 

In some cases, a regular doll is sufficient. In other cases, a true therapy doll is more effective. A therapy doll is designed to be as life-like as possible. The doll is weighted so it feels similar to holding an actual baby.  Most are designed to look like a peacefully sleeping infant.

 

The ways that people interact with their own personal therapy doll can vary significantly.  We served two different clients, Mildred and Betty who each resided in long term care and had a therapy doll, but their forms of interaction with their dolls differed.  In each case, we let the client initiate the interaction with the doll and we matched their interaction.

 

 

Mildred treated her therapy doll as though it were a real child. She held the baby properly and laid it down to nap peacefully.  In this case, we mimicked Mildred’s interactions and also treated the doll as though it were real.  Often, Mildred wanted to put the baby’s needs above her own—she would decline to go to the dining room for dinner since the baby was sleeping and she didn’t want to disturb a sleeping baby. In this case, we offered to hold the baby during dinner so Mildred could eat.  We went together with Mildred to the dining room and sat by her table, holding the doll where she could keep an eye on her baby during mealtime.

 

Betty had quite a different interaction with her doll. Betty always wanted to have her doll nearby, but she didn’t always hold it the way one would hold a child. Sometimes she’d pick the doll up by its head, or carry the doll around in a plastic grocery bag.  She was comforted by having the doll nearby, but she didn’t interact with it as though it were real.  Out of respect for Betty, we handled the doll carefully, but rocking the doll throughout dinner wasn’t necessary for Betty’s peace of mind.

 

When interacting with someone who is soothed by doll therapy, always ensure that you act as though the doll is a real baby.  Offer to hold the baby, and hold it correctly as you would a real child.  If someone is upset their therapy doll is not within sight, provide an explanation that would make sense if it were a real baby.

 

 

Saying “it doesn’t matter where the baby is—it’s just a doll!” can be quite upsetting. Instead, saying “oh, your baby is having a nap and the nurses are keeping an eye on her. Best to let the sleeping baby sleep.”  Your reassurance with an explanation that fits the scenario will provide more peace of mind.

 

Therapy dolls can meet someone’s need to nurture and care for others. It isn’t only women who have a need to nurture. Many elderly men with dementia do very well with a therapy doll as well.  One gentleman we met, Dyck, was rather despondent. He wasn’t interested in joining any of the activities in the long term care home he had just moved into. He was even trying to avoid some mealtimes. 

 

The introduction of a therapy doll completely changed his demeanour. He was proud of his new role and was keen to show off his baby to others. When staff and visitors would say: “Good morning Dyck, how is your baby today?” he would proudly respond “she slept through the night again!”  The tactile comfort of carrying the baby, joined with the sense of purpose and newfound caregiving role helped Dyck with his transition into long term care.

 

 

Doll therapy does not have universal appeal. Many people are not at all interested in carrying a doll; others are very well aware it is a doll and not a real baby; others still become so preoccupied with the doll that it can become problematic. Some people become concerned that the baby is sleeping all the time and they’re concerned when they cannot wake the doll. The inverse can happen too if the doll is designed to look like it’s awake—a concern that the doll never sleeps.  If someone is distressed in any way by the details, then doll therapy may not be ideal for them.

 

The next time you’re in a long term care home and you see someone carrying a baby doll, remember that it could be a therapy doll and you should treat it as though it’s a real child.  Ask the person holding the doll about their baby—you will likely see them perk right up and be very proud to tell you more.  While doll therapy certainly isn’t for everyone, it can be a great comfort and benefit to those seeing a nurturing role.

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Our Mission During COVID-19

 

What a turbulent week it has been!  Undoubtedly, you’ve been following the news more than usual as things have been changing by the day, sometimes by the hour. It is easy to get swept up in the wave of uncertainty. Here at Warm Embrace, we are remaining grounded by our mission of:

 

Empowering the elderly

To experience fulfillment daily

Through dignified care

 

Our clients need us just as much today as they did last week, last month, and last year. In some ways, they probably need us even more than before!  We remain committed to doing more than just meeting basic needs. We aim to go above and beyond each day to help our clients have the best day possible.

 

Right now, meeting basic needs includes practical measures such as doing the grocery shopping so that elderly clients and their loved ones are not out in stores. It also means sanitizing the home more thoroughly and frequently than usual. It means cooking homemade meals to ensure quality nutrition.  It means serving clients whose family members may be in self-isolation and are unable to visit.

 

 

Going above and beyond to ensure our clients experience fulfillment each day means meeting clients’ social and emotional needs.  For those with dementia who may not understand all that is happening, we are maintaining a routine.  People with advanced dementia may have a difficult time following the facts of a news story, but they are very aware of the emotions conveyed by the coverage. They can feel the anxiety and stress of those around them without understanding the source of anxiety. For our clients, we are a reassuring presence, the calm in the storm.  Instead of focusing on what’s happening out in the world, we remain present, in the moment, with the person at hand to help them feel at ease.

 

We’re here for those who continue to need support caring for loved ones. Family members who live at a distance are now unable to travel; we will provide the help needed for local elderly relatives. For those who typically attend adult day programs, we can provide one-on-one support instead of the usual group setting.

 

 

As always, we prioritize the health and wellness of our clients and our caregivers. We continue to monitor and follow the recommended guidelines of the CDC and public health. We have equipped caregivers with specific COVID-19 training and essential supplies such as personal-sized hand sanitizers that they can carry at all times.

 

Of course, the situation continues to remain fluid and is ever-changing and we will adapt to keep up with the changing times. Through it all, we’re here for you and we’re here to serve the elderly who need us most. If we can be of assistance in any way, please reach out to us; we look forward to hearing from you.

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Springing Forward!

 

It’s almost that time of year again—time to change the clocks!

 

The springtime change has a hopeful element to it; the days get longer and you have more daylight to enjoy in the evening hours.  It almost feels like you can measure the increased daylight every day!  It signals that spring is truly on its way.

 

There is one big challenge first though.  That’s the loss of one hour!  For most of us, that means the loss of an hour of sleep.

 

 

It would seem as though losing one hour of sleep shouldn’t be that detrimental. Surely we can handle one less hour of sleep.  And yet, statistics indicate that losing one hour of sleep does impact us, and not for the better.   It’s a well-known fact that there is a higher incident rate of automobile collisions on the Monday following the spring time change. Some studies have indicated an increased risk of heart attack too!  

 

If losing one hour of sleep can cause us to drive poorly and increase our risk of heart attack, what does it do for someone with dementia who may not understand what is happening with the time change?

 

Adjusting to the time change is essentially like dealing with jet lag. While it is only a one hour difference, it is enough to throw us out of whack for a few days as we slowly adjust. Our bodies are finely tuned mechanisms that follow a very careful circadian rhythm.  When that rhythm is interrupted, it takes us a while to get back on track.  If that much adjustment is needed for those of us who can cognitively understand the time change, how much more difficult is it for someone with dementia who cannot tell time?

 

 

Someone with advanced dementia may not be able to tell time anymore. Some days, it may seem as if they don’t have much routine if they are waking at odd hours and sleeping during the day. But even if their routine has shifted from what it was years ago, they still have an internal sense of the passing of time. Suddenly missing an hour throws off that internal sense, and it can feel disorienting and confusing.

 

Sleep is critical for brain functioning in all people, and especially so for those with dementia.  The brain needs a chance to recover and it is during sleep that memory is encoded. When someone’s brain is impacted by a disease that impairs memory, they may require extra sleep to encode even minimal memory.  Sleep is essential, and losing an hour of sleep can have an enormous impact on how someone functions. 

 

As much as possible, try to adjust bedtime and waking time in advance of the time change to make it a more gradual adjustment rather than a one-hour change overnight.  On the eve of the time change and the subsequent nights, ensure that your loved one still receives their usual allotment of sleep, even if it means going to bed a bit earlier or getting up a bit later.

 

 

When caring for someone with moderate or advanced dementia, just knowing what to expect can make a difference.  Recognize that the time change is just like dealing with jet-lag and it will be an adjustment for your loved one. Expect that they may exhibit some unusual behaviour or feel agitated and anxious the week following the time change.

 

Prepare as much as possible by making the adjustment gradual. And remember, these adjustments will be helpful not only for your loved one but also for you!

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A Love Story: Violet and Lawrence

 

Violet and Lawrence have been married for 68 years. After a lifetime of hard work, travelling through early retirement and most recently relaxing in retirement living together, they are now separated.  Lawrence’s dementia progressed and he began wandering at night. He could no longer be safely cared for in retirement, and he moved to long term care.

 

Violet had been very physically healthy and she had been caring for Lawrence for years within the retirement home where, together with staff, she could handle his needs. But once he began exit seeking and leaving in the night, even Violet had to admit she couldn’t manage his needs safely. 

 

It ripped her heart out to have him move to another location across town.

 

Now, Violet attempts to visit most days.  She wasn’t a confident driver, to begin with, but she is attempting to drive across town every day and stay with Lawrence throughout the afternoon and dinner.

 

She fears that he won’t eat unless she is at his side, so she remains for both lunch and dinner. She worries about how she will visit every day when the winter weather begins. She never drove in the winter and at 89, she isn’t keen to start winter driving.

 

You can see the toll it is taking on Violet. She appears to be withering before your eyes. She has lost weight and she looks exhausted. She suddenly strikes you as rather frail. She is probably stretching herself too thin, but she wants someone to be with Lawrence through lunch and dinner.

 

Violet needs Warm Embrace to provide a caregiver for Lawrence.  A Warm Embrace caregiver could visit Lawrence through lunch and dinner and keep him engaged in activities throughout the afternoon.  Of course, we can’t replace Violet’s visits, but we can supplement her visits.

 

We can provide a regular schedule so that Violet does not feel obliged to visit every day. She can take some much-needed time to relax and rejuvenate herself.

 

Warm Embrace caregivers can visit Lawrence on set days of the week, and on those days, Violet can remain at the retirement residence, eating her meals in the dining room with her friends.

 

She can rejoin the social activities and events that she participated in for all those years and not become disconnected from her peer group. But she can do so with the reassurance that Lawrence is not alone. He is with a dedicated caregiver who will ensure that he has the best afternoon possible.

 

By recommending additional support for Lawrence, you may actually be saving Violet’s health. She needs the support—possibly more than Lawrence does—and your recommendation to alleviate her stress could make the difference for Violet.

 

We’d be happy to improve the quality of life for each of them by providing a dedicated caregiver when they need it most. Reach out to us today!

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Living in the Moment

 

Learning to be zen and mindful is something that takes incredible focus, dedication and practice. There are entire fields of study dedicated to mindfulness and how beneficial it can be to our overall health. People spend excessive amounts of money to attend yoga and mindfulness retreats where they aim to be entirely present in the moment without regretting the past or worrying about the future. While these retreats may have their place, there’s another way to learn how to be present directly from a zen master.

 

 

Spend the afternoon with someone who has dementia.​ That’s right. That’s all there is to it.  People with advanced dementia or Alzheimer’s disease can teach us a lot about how to be in this moment, completely and fully. 

 

When you spend time with someone who has dementia, they are present in that moment and they’re acutely aware of their environment around them. They are noticing sights and sounds and temperature variations in that particular moment in time. They may not be able to articulate it entirely, but they are very much present in the moment.

 

The challenge is usually more for us than it is for them. We are the ones who have a hard time slowing down. How many details from our immediate environment do we miss completely because we’re totally absorbed thinking about the past or worrying about the future?  When you spend the afternoon with someone who has dementia, they are truly with you for that afternoon. They are not creating a grocery list in their head. They aren’t worrying about what to cook for dinner later. They aren’t wondering if they’ll have enough time to squeeze in an extra errand after the visit. They are present, with you, in the moment. 

 

 

Sometimes, someone with dementia will jump from one topic to the next and you might think that they weren’t engaged in the conversation if their brain was heading in such a different direction than yours.  Remember that the connections between areas of the brain and the way information is stored, retrieved and processed is very much impacted by dementia.  Two different topics that to you seem unrelated, might be connected in an abstract way for someone who has dementia.  In their mind, those two topics may be connected and to them, it feels that the conversation is flowing.  They aren’t feeling that the conversation is disjointed; they are following the conversation exactly as their brain is permitting in that moment. They are entirely present and engaged; their brain is just taking a different route than your brain.

 

Sometimes when someone has advanced dementia they may be using the knowledge that they gained early in their life to make sense of their world.  They may ask for their parents; they may call you by their sibling’s name. They may reference attending school, or planning for their wedding, or having their first child. Sometimes, people interpret this to mean that someone with dementia is “living in the past.”  This isn’t true. 

 

 

Someone with dementia is living entirely in the moment today—they are as much in the moment as you are. Their brain is just relying on information from decades ago to explain what they are experiencing in this present moment.  They recognize that you are a person who is close to them and very much connected to them, and their brain uses that archived knowledge when it assigns the name of their sibling to you. They are not living in the past; they are engaging with you in this very moment. They are just relying on data from their long-term memory that is no longer reliable. But be aware that they are very much present in the moment and acutely aware of information they’re absorbing through their five senses.

 

We can learn a lot from our friends who have dementia. If we can join them, at their pace, to experience the world around them, we can have a very zen moment. We can learn to notice and appreciate small details.

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Dementia Care: 5 Conversation Starters

 

When a loved one has dementia or Alzheimer’s disease, it can be difficult to know what to talk about. Sometimes, family members will even say “I didn’t know what to talk about and it felt awkward, so I just stopped visiting.”

 

Rest assured, your visits mean the world to your loved one!  It’s almost guaranteed that any awkwardness was felt by you, more than it was felt by them.  Sometimes, just being present is enough. Just being together in the same room conveys love and caring and appreciation.

 

When you do try to strike up a conversation, here are a few tips that may ease the conversation.

 

1. Talk about right now

 

 

Comment on your surroundings—are the flowers just poking through the ground outside? Is it warm or cold out? Is it a bright sunny day or dreary and overcast?  When you comment on the environment around you, you are welcoming the person with dementia to experience the environment equally. They too can comment on the weather or the temperature. They too can appreciate the view out the window of the garden or the trees or the sky.  Commenting on this very moment does not require memory or complex executive functioning.  Simply noticing and commenting on your five senses is a great way to stay focused on the moment at hand and invite your loved one to join you on equal footing.

 

2. I thought of you the other day when…

 

This is a great way to draw your loved one in and help them to feel connected to you and your everyday life.  This simple line conveys ongoing love and caring.  It gives you the opportunity to share more about what is happening in your life.  You can cue your loved one with some information and it may spark a memory that otherwise may not have surfaced.  When you say “I thought of you when I was driving Liam to school the other day…” you might be surprised that your loved one suddenly asks about their grandson Liam and a whole new conversation starts.

 

3. I was remembering the time you…

 

 

Get the storytelling rolling without asking a question.  If you ask “do you remember the story you used to tell about….” It puts pressure on your loved one to remember something specific. Instead, you start the story by saying “I was remembering the story you told about…”  If you see the spark of recognition, then step back and let your loved one fill in all the blanks. If they can’t recall that story in the moment, you can tell it however you best remember it and share that family moment together. Either way, you’re sharing your family history together without it feeling like a “test” that someone has to remember.

 

4. What is your favourite…? Do you prefer…?

 

If you’re going to ask a question, be sure it’s an opinion-based question.  Opinions can’t be wrong! If you ask an opinion-based question of someone who has Alzheimer’s disease, you may be amazed at the robust answer you receive.  Asking “did you attend bingo yesterday afternoon?” is a fact-based question. The answer is either correct or incorrect and the person with dementia can sense it. If they’re unsure of the answer, the question suddenly feels like a test.  Instead say, “I see both bingo and euchre are on the schedule this week. Which do you prefer?The opinion-based question invites your loved one to provide a personal opinion as a response. If they actually did attend bingo yesterday, you may cue their memory of attending bingo by providing information before you ask the opinion question.

 

5. What do you think about…?

 

 

Again, this question is an opinion based question.  Ask “what do you think about…?” of things that are in the moment and do not depend upon memory or complex reasoning.  Asking “what do you think about the upcoming election?” is probably not a fair question unless your loved one is a long-standing political junkie who has been following the news.  Asking “what do you think about this guest on Ellen DeGeneres?” while you’re watching the show together is probably a better question. It is current and based on information from that moment only. Because it is an opinion question, it allows for a response of “I don’t know” or “nothing” and that’s perfectly fine. You may just be surprised at what does pop out though!

 

Don’t be afraid of having a conversation with loved ones who have dementia or Alzheimer’s disease.

 

There may be times when you need to carry more of the conversation or times when you are simply sharing comfortable silence together, but there will also be times when your loved one will surprise you by sharing more opinions or memories than you expected!  If you follow the 5 tips above and stay completely in the moment, provide some information to cue your loved one, and only ask opinion-based questions, you just may have more engaging conversations.

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Holiday Tips when a loved one has Dementia

 

Do you ever find the holidays overwhelming? There are lights and music, decorations and crowds, shopping and cooking, parties and dinners, rich food and alcohol, late nights and busy days— sometimes it feels like you need a holiday to recover from the Christmas season!

 

 

If we feel overwhelmed during this season—and we are cognitively well, our brain is fully working—then imagine how overwhelming the holidays may be for someone who has dementia. Someone with dementia may not remember what “Christmas” or “the holidays” mean because they become abstract terms. 

 

Here are some holiday tips to help a loved one with dementia through the holidays!

 

Beware of Decorations

 

You see an impressively life-like St. Nicholas welcoming people to your front hallway, but what does your loved one with dementia see? Is she concerned about “the man in the hallway who isn’t having dinner?” Life-like or oversized decorations can be confusing or even scary to someone with dementia. Consider from their perspective how the decorations could be misinterpreted.

 

Flashing lights draw a mixed response. Some people with dementia are mesmerized by flashing lights; others become alarmed or agitated. Keep consistent bright lighting in all rooms. Dark rooms with candlelight or just the tree lights may be fearful for someone with dementia.

 

 

Remove all ornaments that are not edible but look like real food. Fake gingerbread men or houses, fake candy canes or apple ornaments should all be avoided. Someone with dementia may not realize that it is just an ornament and may attempt to eat the decoration.

 

Have a Quiet Room

 

You want to include your loved one who has dementia, but you also need to provide a space where they can retreat and have some peace and quiet. People with dementia typically interact best in small groups or one-on-one. If a loved one with dementia is attending a large family gathering, set up a separate room—well lit with comfortable furniture—and recommend that family take turns visiting that person, one at a time. This allows for quality interaction in a way that best matches your loved one’s needs.

 

Maintain Routine

 

Routine is often the first casualty of the holiday season. We stay up late at night, we don’t eat meals at the usual time and we often stray from our usual, healthy diet. Remember how you felt last January after eating heavily and having your routine interrupted? Now imagine someone with dementia. The person with dementia cannot rationalize why they feel different, all they know is that something doesn’t feel right.

 

As much as possible, keep routine familiar and consistent. Try to maintain regular meal times (even if that means eating separately from the party), and try to limit intake of rich, sugary foods or excessive alcohol. Respect nap times and bedtimes—sleep is as important as ever! By maintaining routine as much as possible, your loved one may be able to better handle the surprises that come with the season

 

Forewarn Family

 

If family members live at a distance, they may be visiting for the first time since the last holiday season. Your loved one may have changed significantly since last holiday season. Advise family and friends in advance so that they know what to expect. Request their assistance in making the holidays easier for your loved one, and outline exactly what you need them to do. Here are some suggestions:

 

 

  • Please do not ask “do you know who I am?” this causes undue stress. While she may not be able to name you, grandma knows you are an important person whom she loves.
  • Please be aware of the fact that mom now needs to take some time away from the crowd. She finds noise and groups over-whelming. We will have a Quiet Room set up and we invite you to visit mom one at a time in the quiet room.
  • Please do not encourage alcohol consumption by saying “it’s only one drink!". Dad is now on a medication that does not react well to alcohol and he will not enjoy the event as much when he is trying to process the alcohol.

Set Realistic Expectations

 

Set realistic expectations for your loved one by limiting the number of events they attend. No more than one event or activity in a given day; only a few in a week with recovery time between events. Step back and try to asses what is realistic for your loved one. Maybe a dinner with 50 people will not be a successful event, but attending a hymn sing would better match your loved one’s preferences and current abilities.

 

Your loved one will not be able to suddenly do more or handle more because it is the holiday season. If anything, their coping abilities may be taxed and they may become agitated or stressed more easily than usual. Be realistic when scheduling the season.

 

Select the Top Priority

 

What is more important—that your loved one attend every event and every tradition is followed in detail, or that your loved one has a merry Christmas feeling loved and happy?

 

If the top priority is your loved one having a wonderful Christmas season, then focus on the elements that create that sense of joy, peace, and love for them. If you really analyze it, you’ll realize it has nothing to do with decorations or traditions. It has everything to do with family and interaction.

 

 

If you are stressed because of holiday prep, your loved one will feel that stress and not enjoy the season. A person with dementia would rather have you slow down, match their pace, and be patient than present a tray with 15 varieties of home-baked cookies that stressed you out! 

 

Your loved one with dementia might enjoy singing a few familiar Christmas carols (because the words of those favourite tunes tend to stick), rather than feel the pressure of keeping up with an animated conversation at a cocktail event.

 

What will make your loved one smile? When will they seem most at peace? What will have them feeling safe, secure, and loved? Aim to focus on those elements and your loved one will have a truly blessed Christmas.

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