Church Day

Called Mom a little earlier than usual this morning to check and see if she was up for church.  She said, "I don't know."  (She is starting to say that a LOT lately)  I asked her to let me talk to one of the staff.  I heard her say, "Would you talk to my son?" as she handed the phone to someone.  It was Tiffany.  I asked her if Mom was ready for church this morning and she said that Mom was all dressed in her church clothes and ready to go.  I thanked her and she hung up.  I called Mom right back and told her that everything was fine and that I would be there within thirty minutes to pick her up for church. 

Mom was in her usual spot on the couch in the front room when I arrived.  She seemed to give me a double take before it looked like she recognized me.  She didn't have her cane.  They are now getting her used to using her walker instead.  I got her signed out around 9:20am and we slowly made our way out of the East wing - down the hall - through the front waiting room - to the front door.  I had my pickup parked at the curb by the front entrance.  I got Mom secured and bucked up in the passenger seat and placed her walker in the bed of the pickup.  Rather than trying to initiate the conversation I decided to see if Mom would talk on her own.  It was a very quiet ride to church.  When we arrived, I got the walker out of the truck bed and Mom made her way up the ramp into the sanctuary.  Ladybug was already there playing the piano.  I said , "Isn't that a beautiful piano player?"  Mom just looked at me and smiled.  Ladybug told me later that she wasn't sure if Mom recognized her.  During Sunday School, Mom sat with her hands on her legs, fingers straight, pointed to her knees and often had her eyes closed. In between Sunday School and the morning worship service I helped Mom find the rest room.  After the congregational singing, Ladybug went and sit  next to Mom to help find the scriptures for her in the Bible during the preaching.  Mom said she didn't want to read them but would just listen.  

After the morning service, we had a noon meal served in the fellowship area and I got Mom all set up with a bowl of chili and a small plate of food.  She really didn't eat very much.  After dinner, I helped Mom back out into the sanctuary and after sitting there for a few minutes she seemed slightly agitated so I asked her if she needed anything.  She wanted to know why it was taking them so long to clean up in the kitchen.  I said, "Well, Mom some people just now finished eating and there aren't very many that are helping with the cleanup.  Are your getting tired?  Do you want me to take you home?"  She said, "I don't care."  It seemed to me that she was starting to get a little cranky, so, I made arrangements for some of the other brethren to take care of the duties I usually perform and loaded Mom back up in the pickup and we returned to OAR.  I signed her back in at 2pm.  

We had received word that Mom's brother Glen (who also was an Alzheimer's patient) Passed away last night.  I didn't say anything about it to Mom.  When I talked to Snickers this afternoon, she and Popcorn were headed over for a visit with Mom and planned to tell her about Uncle Glen.  Mom was the oldest of eight siblings and now she and her youngest brother are the only two survivors in the family.  

Watch the medication.

Had a good visit with Mom on the phone this morning.  She seemed to be back to her old self again.  Snickers had requested that they cut back on some of her medication after the problems earlier in the week.  In doing some follow up reading about the side effects of some of the medication they have Mom on, Snickers noticed that the negative side effects coincide with many of Moms recent symptoms.  One medication actually said "Not recommended for dementia patients."  She is going to OAR today with this info and "is ticked".  (pray for them)   I'll try and get better data on this medication thing and post it here later.  One of the side effects also explains Mom's sudden weight gain. 

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The following write up  explains so much.

 

"Ever walk into a room with some purpose in mind, only  to completely forget what that purpose was?  Turns out, doors themselves are  to blame for these strange memory lapses.

 

Psychologists at the University of Notre Dame have discovered that passing through a doorway triggers what's known as an event boundary in the mind, separating one set of thoughts and memories from the next. Your brain files away the thoughts you had in the previous room and prepares a blank slate for the new locale."

 

It's not aging, it's the door!

 

 

Whew! Thank goodness !!!

 

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Anxiety

Mom was having another bad morning today. She was very fearful. She said she didn't know who she was or what she was supposed to do. Snickers called her and she simply handed the phone to the staff. Staff told Snickers that Mom was having a very stressful morning and extremely anxious. Snickers said she was coming in for a visit this morning. They got Mom to take her medication and Snickers texted me for an update. When I called Mom around the usual time, she still seemed very un-nerved. She recognized my voice and settled down a little. She said she didn't even remember how to pray anymore. I told her that is why God gave us the promise in Romans the 8th chapter that the Holy Spirit would pray for us when we didn't know how to pray and asked her if we could pray together on the phone and she said yes. We had a good little prayer time and she said a hearty amen at the end. She was doing better. Unbelievers would probably say that her anxiety medication was probably kicking in but I think it was the prayer.  

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Elderly Anxiety Disorders 
By Jeannette Franks, PhD

We all experience anxiety-worrying about the future is part of being human and helps us plan ahead and make better decisions. Some anxiety is normal and even productive. However, when anxiety becomes disruptive and disabling to a person's life, it is considered an unhealthy psychiatric disorder. As many as one quarter of all people experience anxiety to an unhealthy extent, and older people can be at particular risk. Seniors may experience more troublesome anxiety than other age groups for several reasons: they experience more losses, suffer from more pain and chronic conditions, are often on multiple medications that might exacerbate anxiety, and have confounding ailments such as Alzheimer's disease or depression. Some experts suggest that in general anxiety is equally prevalent in all adult age groups but perhaps is less often reported by seniors, and not as accurately diagnosed and treated as in younger people. A large study published in the American Journal of Psychiatry(1998, A. Beekman) found that 10 percent of adults 55 to 85 years of age had elderly anxiety disorders-the same prevalence as for other age groups.  

Major types of elderly anxiety disorders in older people
• Acute stress disorder: Anxiety and behavioral disturbances that develop within the first month after exposure to an extreme trauma.
• Post-traumatic stress disorder (PTSD): Symptoms of acute stress disorder that persist for more than one month.
• Panic attacks: A sudden, unpredictable, intense, illogical fear and dread.
• Social anxiety: A preoccupation with how a person is viewed by others.
• Generalized anxiety disorder (GAD): A pattern of excessive worrying over simple, everyday occurrences and events.
• Phobias: Irrational fear of situations such as heights, or fear of objects, such as snakes.
• Obsessive-compulsive disorder (OCD): A pattern of intrusive thoughts that assault the mind and produce extreme anxiety that can only be mitigated by an action, such as hand washing in a ritualistic way.

The latter two are perhaps less common in older people, because they can and often are successfully treated in youth or middle age. Few long-term studies track elderly anxiety disorders, so there is little information on how these problems vary with age. It is important to recognize that anxiety disorders are not because of some moral weakness or lack of character, but a genuine biochemical disturbance. There also appears to be a genetic predisposition. A recent study of identical twins found that if one twin had a generalized anxiety disorder, there was a 50 percent chance that the other twin would as well.  

Acute and post-traumatic stress disorder (PTSD) Rebecca's mother screamed frantically when the aides in the nursing home tried to give her a shower. Regardless of how kind, gentle, or persuasive the caregiver was, she began yelling and sobbing hysterically when brought to the bright, white, shower room, where the aide attempted to remove her clothes. The social worker spent an hour talking to the woman and determined that she had been raped in the high school gym shower room as a teenager. The staff changed the bathing routine to a quiet, homey room with a bath tub and soft lights and music. Bathing was no longer a battle. Acute stress disorder develops within the first month after exposure to an extreme trauma. Symptoms include: repeatedly experiencing the trauma in images, thoughts, dreams, or flashbacks; extreme distress when exposed to cues that remind the person of the trauma; avoidance of reminders of the trauma; a numbing of emotions; and symptoms of agitation, arousal, insomnia, anger, irritability, and inability to concentrate.  

When these symptoms persist for longer than a month, the anxiety is diagnosed as PTSD. Often the elderly did not receive therapy for traumatic events such as rape, abuse, torture, or war. Until a trigger such as the shower situation or dementia-which can disinhibit protective behaviors-these older people have never expressed their emotional pain and horror. The woman in the dementia care unit screaming may be a Holocaust survivor. The man who panics at the sight of the Asian face of his well-meaning caregiver may have been a prisoner of war. They may be re-experiencing horrifying events in their mind's eye over and over again. Reasoning with people who have these issues is not effective. Nor is simply demanding that someone toughen up and "get over it."

Panic attacks Margaret, a 74-year old widow, volunteered twice a week at a senior center a half-hour drive from her house, which she found very satisfying. It kept her in touch with friends, gave her a chance to contribute and feel productive, and she enjoyed the hot lunch in a social atmosphere. One day, while crossing the bridge over a large river between her home and the senior center, she experienced a horrendous feeling of dread. Her heart pounded and her hands began to shake. She thought perhaps she was having a heart attack. As soon as she got over the bridge she pulled over, sweating and weak. After a few moments, the feeling passed. She drove herself to an urgent care clinic and the doctor there could find nothing wrong. She met with her primary care physician a few days later-he assured her that she was fine. The next week, driving over the high bridge, she didn't experience another attack, but felt nervous and worried that it would happen again. She tracked down the social worker at the senior center and described the experience. The social worker asked, "Do you think that it might have been a panic attack?" After discussing what comprised a panic attack, they agreed that one had occurred. Margaret drove home, comforted by the diagnosis and the knowledge that not only might it never occur again, but if it did it would quickly pass. She never had another panic attack.

 It is normal to feel panic at a terrifying event such as an earthquake or car crash. But people with a panic disorder may experience horrific terror with no discernable trigger or cause. For some minutes they experience intense and overpowering feelings of fear that leave the sufferers helpless. Physical symptoms may include fainting, dizziness, heart palpitations, sweating, and or difficulty breathing. A panic attack can come once in a person's lifetime or frequently. Attacks can begin at any age and are twice as common in women. There is a genetic pre-disposition. If one identical twin has this disorder, there is a more than 80 percent chance that the other will. How to help someone who is having a panic attack • If you know the person's relaxation methods, do them together • Be calm and gentle • Go together to a safe, quiet place where he or she can sit or lie down • Help the person slow down breathing by slowly inhaling and exhaling together • Use imagery such as, "We are lying in the warm shade of a beautiful, tropical beach listening to the gentle murmur of the waves," • For some people the gentle contact of hand holding or an embrace can be reassuring.  

Generalized anxiety disorder (GAD) GAD is common-as many as 5 percent of the population experiences this disorder during their lifetime. There appears to be a genetic component. If one identical twin is diagnosed with GAD, the chances are 50 percent that the other twin will too. However, in non-identical twins, the chance is only 15 percent. People with GAD tend to be pessimists who expect the worse, and often interpret everyday mishaps as major disasters. Rather than seeing the glass as half full; it must be half empty. Simple setbacks such as a dented fender are exaggerated out of proportion and cause the person far more pain than such minor events would normally merit. GAD is often a chronic condition, with negative events exacerbating the disease. Perhaps half the people with GAD are clinically depressed and there is a tendency to attempt to self-medicate with overuse of alcohol, over-the-counter and illegal drugs, and prescription medications. Most people with GAD know they shouldn't worry so much, but are powerless to change their thinking. Symptoms include tight muscles, back pain, or headaches for which a physician can find no biological cause. People with GAD often feel restless, on edge, and are easily startled. Chronic anxiety can cause the body to feel tired, exhausted, or fatigued, all of which are made worse by the insomnia associated with GAD.  

Social anxiety disorder Many of us feel uneasy meeting strangers or speaking in public. But people with social anxiety disorder are so terrified of social situations that they withdraw and refuse many social occasions. This problem may be exacerbated in older people because of hearing impairment, issues with incontinence, or embarrassment over using a walker or wheelchair. Social anxiety occurs in perhaps 10 to 20 percent of the population and is the third most common psychiatric disorder, after substance abuse and depression. It can cause an increased spiral of isolation and inability to interact socially. Treatment All of these elderly anxiety disorders usually respond well to a combination of talk therapy and medication. While prescription drugs should be used with caution in the elderly, and often at lower doses, there are now some particularly effective medications that a physician can prescribe such as Paxil®, Prozac®, and Zoloft®. Numerous studies have indicated that for a medication to be most effective, the patient should also be meeting on a regular basis with a skilled counselor, therapist, or social worker. Other treatments effective for some people include meditation, biofeedback, massage, and acupuncture.

Jeannette Franks, PhD, is a passionate gerontologist who teaches at University of Washington and Bastyr University; she is the author of a book on assisted living and numerous articles.

Good answer for speeding

I hope my friends and family will be praying for Mom. As time wears on, she is failing. Pray also for Lady Bug and her family in the loss of her Mother, Ushi (91). Lady Bug and I visited Mom yesterday on the way home from a visit with Snickers and Popcorn. We found Mom sitting in "her" spot out in the family room of the East Neighborhood of OAR fast asleep around 1:15PM. I tapped her on the knee and said, Hello gorgeous." She smiled and laughed and said, "Hello son." We had a nice visit for a few minutes before we had to go and pick up a grandson from school. I found out later in the afternoon that when Snickers called her, she didn't remember us being there. Here is a funny story I received by email today... When asked by a young patrol officer, "Do You know you were speeding?" this 83-year-old woman gave the young officer an ear-to-ear smile and stated: "Yes , but I had to get there before I forgot where I was going." The officer put his ticket book away and bid her good day. Makes perfectly good sense to me.
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Alzheimer’s Around the World
By Jeffery Anderson

September is World Alzheimer’s Month, which reminds us that it’s not only Americans who are dealing with the ravages of Alzheimer’s and other age-related dementias. Dementia knows no borders. People around the globe suffer from dementia, as have people throughout time. History of Dementia Since ancient times, people have experienced age-related dementia memory impairment. According to a June 1998 article in the Journal of Neurological Science by F. Boller and MM. Forbes, “The history of dementia is probably as old as mankind itself.” A January 2006 article from the same journal, titled Dementia in the Greco-Roman World and written by Axel Karenberg and Hans Forstl, credits the Ancient Greeks as first recognizing and describing dementia.Illustration of Ancient Conception of the Mind About 2,400 years ago Plato described an illness that “gives rise to all manners of forgetfulness as well as stupidity.”

Dementia in the Greco-Roman World also quotes the Roman poet, Juvenal, who almost 2,000 years ago characterized a phenomenon that’s easily recognized as dementia: “Diseases of all kind dance around the old man in a troop. But worse than any loss in the body is the failing mind which forgets the names of slaves, and cannot recognize the face of the old friend who dined with him last night, nor those of the children whom he has begotten and brought up.” Evidence of dementia in Ancient Egypt exists as well. A paper by Dr. Deborah Sweeney of Tel Aviv University, quotes a 25th century BCE Egyptian, Ptahhotep, describing in hieroglyphs an aging person who “every night becomes more and more childish.” This, in fact, may be the earliest extant piece of writing describing dementia.

During the Dark Ages, advancement in understanding of dementia halted abruptly. There’s no doubt that dementia continued to afflict people in the times between Antiquity and the Enlightenment, but it was hardly written about. According to a 1998 article in the Neurobiology of Aging by Berchtold and Cotman, the next notable leap in understanding of dementia after ancient times was in the early 1600s by English philosopher Francis Bacon, who authored a work called Methods of Preventing the Appearance of Senility. Bacon may have been the first to recognize dementia as a brain disease, noting, “In the posterior part of the brain occurs oblivion, concerning the saying that old age is ‘the home of forgetfulness.’”

Shakespeare’s plays Hamlet and King Lear also used dementia as dramatic device. It’s also widely recognized by historians, including Berchtold and Cotman, that many of the victims of the 17th century witch trials in Europe and the United States who were burned at the stake may have been simply suffering from dementia. Public understanding of dementia didn’t enter the modern age until the German psychiatrist, Alois Alzheimers, described the first case of what we now know as Alzheimer’s Disease in 1910, classifying it as a subtype of “senile dementia.”

A Global Problem People are living longer than ever. According to the World Health Organization the global average lifespan was just 31 years in 1900. Today the global average is 70 years. This trend means that age-related dementia has become a major worldwide problem. In a groundbreaking report, the World Alzheimer’s Association estimated that as of 2010 there were 35.6 million people worldwide with dementia and that the global costs of dementia are over $300 billion dollars. According to the report, dementia is most prevalent in the Caribbean, with 8.12% of those over 60 having dementia. The region of the world with the lowest rate of dementia is Western Sub-Saharan Africa (Nigeria and nearby countries), with only 2.07% of those over 60 reported as having the disease. But the worldwide differences in estimated dementia prevalence may actually have to do with the way we diagnose (or fail to diagnose) the illness.

A study by the National Institute of Health seemingly low rates of dementia in Africa may be due to “the hiding of cases by relatives because of stigma, reluctance to seek medical assistance, poor access to medical care, and defective-case finding techniques.” These same barriers to diagnosis could apply equally to any other area of the developing world. Memory Care Around the World Whatever the actual rates of dementia across different parts of the globe, it’s clear that all nations—especially those with a large aging population—face a difficult burden of caring for people with dementia.

A recent New York Times article describes how American-style memory care communities are beginning to sprout up in China. The article quotes an official in Shanghai who says, “We’re planning to build at least one nursing home that can care for dementia patients in every district. Every year, we’ll need at least 5,000 additional beds.” But unlike America, where memory care homes have names like “Whispering Creek Manor” or “Sunny Brooke Estate,” the new memory care home described in the New York Times article is known simply as (in classic communist fashion), “Shanghai No. 3 Elderly Home.” While Shanghai No. 3 Elderly Home may not have the most creative name, its care is cutting-edge: “He says the new facility has a multimedia room that can display images of Shanghai streets, and even images that appear to show the neighborhoods of the patients. This is supposed to make them feel at home. Many patients also wear GPS armbands that help the staff monitor their locations.”

In Europe, entire villages are now being built for people with dementia. Residents are led to believe they’re in a regular European village, but in fact they are being carefully supervised and cared for. The first of these villages nicknamed Dementiaville was built in the Netherlands 20 years ago. As of writing, a second “Dementiaville” is being constructed in Switzerland at a price of more than $30 million.

Can We End Dementia? Dementia is so ubiquitous that we could include a story from each of the world’s countries; but it’s already clear that dementia affects people everywhere, and has been basic, element of humanity since its dawn. Our blog recently reported that the Department of Health and Human Services has set a goal to cure Alzheimer’s by 2025, with extra funds devoted to research and caregiver support. The goal may strike many as overoptimistic, but a goal-setting approach is probably better than complacently accepting dementia as a part of life.

September already

Here it is September already. Mom is having more trouble with confusion and anxiety in the mornings lately and seems to be going downhill a little more rapidly. Earlier this week on my morning call, she kept asking what she is supposed to be doing now. Recent evaluations have upgraded her to a higher level of care giving. She is eating well and has actually put on about 20 pounds. Some of her clothes are too small for her now. Her roommate has moved to another facility and she has the room all to herself, at least for now. OAR is going to repaint her room and possibly install a new carpet. We could not reach her on her phone for a couple of days last week as the battery had died but they got it recharged for her and it is working OK now. At one point, she held out the phone to one of the attendants and asked, “What is this?” This morning she did not answer my morning call in but a little latter she actually called ME and said that she was sorry she missed my call. I was impressed. Yesterday I picked her up for church and she had another real good day but she was very tired when I got her back “home” again. She is not walking for exercise like she used to do. Last week was a rough week for her but she seemed to be doing better today and yesterday. It was a joy to see her singing the old hymns of faith with uplifted face and her eyes closed. It was special.

Hot August Weather

Nice hot weather here in Washington this August. OAR is able to keep the facility relatively cool. Mom had another good trip to worship services at church last Lord's Day. All went well. Monday at my morning check in phone call, she remarked on how much she enjoyed being in church. We also talked about how Snickers and Popcorn are having a good time on their trip to Germany and look forward to hearing all about it when they get home. Tuesday was her "Beauty Parlor" day. She always feels so much better after her session in the Beauty Parlor and is usually the first in line for it. She is an early riser. We also helped her with her voting ballot for the Washington Primary and she was proud to send in her absentee ballot. Everything else seems to be going alright. Attached is an article on six things to think about in financial planning for seniors. Click Here.

Surprise visit yesterday

Mom had a good time at church on the 8th of July. All went well. Yesterday Ladybug and I stopped in for a surprise visit with her. She was in her usual spot out in the great front room of the East Neighborhood as they call it there at OAR. We went back down the hall toward her room and sat on the couch at the end of the hall and visited. I told her I was going to mail her the outlines of the sermons last Lord's Day. She said she really enjoys getting them in the mail. Today when I called her for our morning check in, she had already been to the beauty parlor and was out in the chapel area where she said they had some kind of entertainment coming in. I told her I'd call her back later. Love ya bunches. TWO BUNCHES!