Characteristics of Alzheimer’s Disease: When to Get an Evaluation

Posted by on Oct 29, 2013 in Diagnosis and Treatment

Characteristics of Alzheimer's DiseaseI am often asked what some of the main characteristics are of someone who might need to be evaluated due to symptoms of Alzheimer’s disease.  Here are some of the characteristics that might be worth a check-up:

  • Memory problems, inability to remember names, people, or events in recent history
  • Combativeness in conversations
  • Loss of coordination, especially eye-had coordination; slowing reflexes; bumps and falls
  • Confusion over days and time
  • Unwarranted fears and suspicions
  • Overreactions, emotional outbursts, uncharacteristic profanity, and loss of “filters”
  • Hoarding, stealing, and possessiveness
  • Urinary incontinence
  • Unusual moodiness, boredom, or inability to follow a story
  • Loss of appetite

Scientists also  believe that one of the first areas of the brain affected by Alzheimer’s disease is the sense of smell.  If your loved one has difficulty recognizing the aromas from roses, peppermint, leather, pineapple, natural gas, smoke or lemons, it may indicate a disruption in the brain’s hippocampus, the area where such memories are stored.

Some of the most helpful tips that I can pass long to anyone caring for someone with a cognitive impairment include:

  • Don’t argue, but change the subject
  • Don’t try to shame or lecture your loved one into doing what is best for them; distract and divert their attention
  • Avoid using the word “remember”. Instead reminisce with your loved one, remind and reassure
  • Physical touch is important
  • Monitor medication
  • Get rid of clutterl
  • Simplify as much as possible
  • Take care of yourself
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The Challenge of Making an Alzheimer’s Diagnosis

Posted by on Jun 25, 2013 in Diagnosis and Treatment

ElderCare at HomeThere is a wide range in the estimated number of people with Alzheimer’s disease – between 2 million and 5 million people.  That’s becausee scientists are discovering that some of the symptoms of the disease may occur earlier than previously thought.

In other words, the exact point at which Alzheimer’s may be said to be present in the body is becoming more and more difficult to determine.

Definitions of mild Alzheimer’s vary, and different doctors may use different criteria.  Furthermore, diagnosis of Alzheimer’s disease is generally obtained by excluding all other conditions that might be causing signs and symptoms.

As a result of all these reasons, it often becomes a challenge to determine precisely who has Alzheimer’s and who doesn’t.  Many scientists and professionals worldwide are working to come up with improved criteria for diagnosis.

You can learn more about Alzheimer’s disease here.

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Hospitalization and the Dementia Patient

Posted by on Jun 11, 2013 in Alzheimer's Care West Palm Beach, Dementia, Diagnosis and Treatment, Patient Care

Hospitalization and the Dementia PatientDementia patients are confused. Being hospitalized in a strange environment surrounded by strange people and being powerless to “escape” is very confusing and scary for them.

Whatever the reason is for the hospitalization everyone who interacts with your loved one will need to be aware of the dementia diagnosis and will need to, in some way, deal with the symptoms. A dementia patient requires extra care, extra supervision, and extra understanding.

The dementia caregiver will need to be an advocate, an educator, and a friend. Hospitalization is a challenging time. Here are some things that we learned during the many times our Mom was hospitalized.

Hospital Admission

A dementia patient is not usually hospitalized for the dementia symptoms. Most of them are elderly and when they are hospitalized it is often for something like cardiovascular disease or diabetes. The added symptoms and pain that these kinds of diseases bring can make hospitalization even harder for the dementia patient.

If your loved one is being hospitalized for scheduled tests or surgery you will have the opportunity to pack a bag with their toiletries and clothes and also to gather needed medical and insurance information.

Talk to your loved one about the upcoming hospitalization. Explain what it is for, what they can expect, and how long they should be hospitalized. Assure them that you will see that they get the best possible care.

Avoid making promises that you may not be able to keep, like it won’t hurt, or that you will always be with them. If you do, they may become even more confused and agitated if they feel pain or if you are separated. Do all that you can, but realize that you can’t do everything.

Emergency Room Wait Times

Most of our Mom’s hospitalizations in her later stages of Alzheimer’s disease resulted from visits to the emergency room. She was brought there by ambulance twice and once she was told to go there by her primary care physician.

Whether we were waiting in the crowded waiting room or in the treatment room to be seen by a doctor waiting was a long, trying, difficult, tiring ordeal. Mom was in pain. She was confused. And often she was not able to get up and move around. She would get angry at us for keeping her there.

Because the hospital was so crowded, and because she required extra care due to dementia, it was not unusual for her to be admitted from the emergency room, but have to wait 2, 3 or even 4 days in a small emergency room treatment “room” with just a curtain for a wall before she would be moved to a regular room.

Mom was confused, sad, and angry, in pain and there was nothing we could do to help her. Waiting with her was one of the hardest things we have done.

Always keep an “Emergency Bag” packed at home to grab as you run out the door. Having the necessities with you while you wait can make the time a little more bearable.

Find ways to distract your loved one. Listening to music or singing, talking on the phone, cuddling with a stuffed animal, telling stories, looking at picture books or magazines are all helpful activities. Set aside your own discomfort during this time and make your loved one as comfortable as possible.

Be sure the staff (all of them) knows of your loved one’s dementia symptoms so that they can adjust their care techniques to best serve her. Don’t assume that all of them have read the medical chart or even had any contact with the attending physician.

Strangers—Doctors, Nurses, Everyone!

Added to the pain, anger, and general confusion, the dementia patient will be surrounded by strangers while they are in the hospital. Doctors, nurses, specialists, therapists, food service workers, housekeeping staff, volunteers, and many, many others—sometimes more than one at a time.

Your loved one will most likely not even see their Primary Care Physician while they are hospitalized. There was one time that I (Paula) never even met my Mom’s treating physician. I kept missing him and the nursing staff could never give me an accurate time frame when he would make his rounds.

Besides trying to comfort and reassure your loved one you will also need to communicate effectively with all of those involved in her care. This can be extremely difficult when you are communicating only through notes left at the nurse’s station.

If possible, try to get the hospital to assign a specialist who is familiar with your loved one’s case. Mom had been hospitalized several times with problems related to blood clots and saw the same vascular surgeon several times. It was easier for us to talk with him because we didn’t constantly have to explain our Mom’s medical history.

Whether your loved one has a physician who is familiar with their case or not, be sure to write down his name, office contact information, specialty, and the hours he usually does his rounds. He may be reluctant to give you his office contact info saying that you can leave a message at the nurses’ station if you need to speak with him, but I would push him for it anyway. Leaving an important message with a staff member who works specifically for that doctor can be much more efficient than leaving a message with an over-worked nursing staff at the hospital.

The Dementia Patient Needs an Advocate

If you are the only caregiver you may be in for a long stay. Many sources recommend that a patient never be left alone when they are hospitalized. This is especially important for a dementia patient. A dementia patient lacks the ability to ask proper questions and to understand instructions. She needs someone to be her advocate.

It is possible that some of the people who provide care and services to your loved may not be familiar with dementia and the symptoms it produces. You, as the caregiver may need to explain why your loved one is acting the way they are acting.

It was so refreshing when we got a nurse or therapist who was well-acquainted with dementia symptoms. They were able to help us deal correctly with our Mom. When she would get out of bed, again, even though her legs were not strong enough to support her weight, the staff who understood her desire to escape would gently help her back to bed. Not everyone was as helpful as they could have been.

It may be useful to make up a sign to put in your loved one’s room (Hang it on the outside of the door, if possible, so most people who enter the room will see it.) The sign could say something like,
br>

“Hi! My name is ____________. I have dementia.

If I

  • Cry
  • Don’t answer your questions
  • Speak in gibberish
  • Repeat words or phrases
  • Am scared of you
  • Get out of bed and wander down the hall
  • Cannot control my bowels
  • Get very restless at night time
  • (and any other symptoms your loved one may experience)

Please understand that it is part of the disease. I am normally a very pleasant, friendly, person, but I have not been myself lately. Thank you for your understanding and support.”

Along with educating the hospital staff the dementia caregiver will also have the responsibility of reassuring the dementia patient. The confusion of the disease may make this an ongoing job, but just having your familiar face there as much as possible will help to calm the dementia patient and to reassure them that they are safe.

It is difficult enough for most patients to comprehend the diagnosis of their illness, but for a dementia patient it may be impossible. The dementia caregiver will have to be the one to ask questions and make decisions. If you have a medical power of attorney and an advance directive in place these decisions will be easier to handle.

It is also necessary for the dementia caregiver to insure the safety of their loved one. Check medications and dosages, know why a treatment is being given and what are the expected results. If something doesn’t seem right, ask questions. Get the answers you need even if you have to demand them. Don’t allow the hospital staff to be vague with you.

If possible, enlist the help of friends and family members to stay 24/7 in the hospital room. Be sure that they are familiar with your loved one’s normal symptoms and what thet can be expected to act like in the hospital.

Leave a notepad and several pens in the room for the caregiver to write down everything that happens to the patient. Designate a section in the notebook for questions and answers. If one caregiver has a question for the doctor they can write it down and even if they aren’t there when he shows up the caregiver who is on duty can ask the questions and write down the answers.

Dealing with a dementia patient in the hospital is challenging. It is tiring and it can be quite frustrating. Remember that the hospital staff, doctors and nurses included, work for you. You don’t have to be bossy, impatient, or unkind when dealing with them, but you are trusting them with someone very precious to you. Be sure your loved one receives the very best care possible.

While You Are Spending So Much Time At the Hospital . . .

Listening to audio books can be a great source of information and a relaxing distraction.

See if the Hospital Will Provide a Watcher or a Sitter

Our Mom had severe blood clots. This coupled with the dementia symptoms made her at risk for falling. Plus, she didn’t understand that the I.V., the catheter, and any other tubes or equipment could not just be pulled off. She needed someone to stay with her all the time.

With Lanette living out of town, Paula having a family with young children at home, and our step-dad having health problems that prevented him from staying 24/7 with our Mom at the hospital, we needed help.

Friends weren’t always available. For these times the hospital provided a watcher or a sitter to stay with our Mom. This person was usually a medical student or nurse of some kind and his/her job was to stay in the room and make sure that out Mom stayed in bed and had the things that she needed.

These helpers didn’t provide any support in the way of communicating with the doctors or nurses. They weren’t able to give us any medical advice. They didn’t administer medication. But what they did do was invaluable to us. With their help we knew that Mom was safe.

Fall Prevention

Many dementia patients are considered to be a fall risk. They may not be unsteady on their feet, but because they tend to like to wander they may be treated as a fall risk. This designation means that the hospital staff will do everything they can to keep them in their bed or at least in their room.

When our Mom was in the hospital they always put a brightly colored autumn leaf on her door to alert people that she was a fall risk. If a watcher/sitter wasn’t available and Mom was alone in her room they would often put restraints on her in the form of a vest that wrapped from her front to her back and was tied to the bed frame.

This may seem cruel and, honestly, it made comforting Mom even more difficult, but after she tore an I.V. out of her arm and bled so badly she required a complete change of clothes and bedding we saw the necessity of these restraints.

Know your loved one’s limitations and risks and work with the hospital staff to make them as comfortable as possible while also making them as safe as possible.

Sundowners Syndrome

Dementia patients may experience what is called Sundowners Syndrome. This is what happens when the dementia patient gets very restless and agitated in the evening and at night time. This condition seems to worsen while they are hospitalized.

Patients with this syndrome may lie down and then sit back up repeatedly, pick at the bed covers, pull the covers on and off over and over again, doze off, but keep their eyes half open then suddenly wake up again and start these behaviors again.

No one yet knows exactly what causes this phenomenon or how to prevent it. While our Mom was like this the only thing we found that helped was to distract ourselves. We kept an eye on her to be sure she was safe, but we would read, listen to music, watch movies, etc.

Sundowners Syndrome is exhausting to watch. Our Mom would experience it very badly in the hospital and for a couple of weeks after being released. Anticipate needing to deal with this, and prepare yourself.

Dementia Patient Emotions during Hospitalization

No one wants to stay confined to bed, especially if they are kept there with restraints. Being hospitalized brings fear, anger, confusion, sadness, and pain. These emotions are magnified in the dementia patient.

Our Mom would get angry at us for keeping her there and demand that we release her so she could go home. If we had to leave her while she was awake she would cry and become so sad.

She thought that the doctors and nurses were holding her hostage and tried many times to escape. It was so difficult to see our Mom act this way.

Whatever symptoms your loved one experiences under normal circumstances, expect them to worsen while in the hospital. Do what you can to reassure and comfort them, but realize that the treatment they are receiving is necessary and that it is for their good.

Understanding Discharge Instructions

Ultimately the goal of a hospital stay is for the dementia patient to be released well on the road to recovery. As the dementia caregiver it is your responsibility to understand the discharge instructions and to provide the care your loved one will require at home.

If it will not be possible for them to return to their old living arrangements then you will need to research care homes, assisted living homes, or nursing homes, or the possibility of moving the dementia patient into your home or the home of another caregiver.

Work with the doctors and nurses well ahead of discharge time to be aware of what your options may be. Know what level of care will be necessary after discharge and make appropriate plans. If possible have everything in place before your loved one is discharged as trying to hire help, interview care homes, etc. will be extremely difficult if you must bring your loved one along with you.

If you need to apply wound dressings, administer injections, monitor any symptoms or any other special care, be sure that you thoroughly understand these instructions before the patient is discharged.

Depending on the reason for the hospitalization it is possible that your loved one’s dementia symptoms will have worsened by the time they are released. Our Mom got steadily worse following each hospital stay. There is nothing that can prepare you for having a parent or spouse forget your name, but you can prepare yourself for the possibility that your job as caregiver may be more difficult following a loved one’s stay in the hospital.

For more information or to learn more about hospitalization for a loved one who has Alzheimer’s Disease or Dementia, contact ElderCare today at 800-209-4342.
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A Proactive Approach to Chronic Illness

Posted by on May 30, 2013 in Alzheimer's Help, Diagnosis and Treatment, Geriatric Care Management Services, Long Distance Caregiving, Patient Care

Managing Chronic Conditions

In a perfect world, doctors would instruct patients with chronic illnesses and their families to make regular and systematic observations about their conditions and report any early signs of change.  In this world, few doctors do.
The current fee-for service system does not make it rewarding for physicians to monitor a patient’s status outside of an office visit.  But that’s no excuse for not taking a proactive approach to dealing with chronic illness.  You can take on the task of monitoring your parent’s condition.  For many common problems, it is not hard to imagine what you should be recording.  Keeping careful records is the best way to manage chronic illnesses.  This way, you will detect early signs of deterioration and be able to rapidly notify clinicians.

An early intervention can prevent severe complications.  This approach requires teamwork between you and a clinician.  Observing and recording your parent’s status doesn’t help unless you have a clinician who is prepared to react promptly.  The best you might hope for is to undertake monitoring and make an arrangement with a physician that he or she will respond quickly to a call for help.  A good monitoring arrangement will include tracking essential variables and agreeing on what counts as an early warning of potential problems.

Many kinds of observations must be made to track the progress of disease.  The observations should be recorded on paper daily and brought in with each visit and shown to the doctor.  These observations provide the doctor with a pattern of problems that reflect the progression of the disease.  You should bring all of your lists – diagnoses, medications, and ongoing observations – to every doctor appointment and emergency room visit.  Here is a list of conditions and observations your loved one’s doctors will need to be aware of during appointments:

PROBLEM

OBSERVATION

Diabetes Blood Sugar
Congestive Heart Failure Weight, edema, shortness of breath
Angina Episode of chest pain
Hypertension Blood pressure
Chronic Obstructive Pulmonary Disease Need for extra inhalations, exercise tolerance
Falls History of new falls and consequences
Dementia Independence, memory, wandering, combativeness, anxiety, delusions

If you have any additional questions or concerns about how to take a proactive approach in managing a chronic illness, call ElderCare at Home at 561-588-0400.

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Symptoms That Might Indicate Dementia – Memory Screenings West Palm Beach

Posted by on May 14, 2013 in Alzheimer's Care Resource Center, Alzheimer's Care West Palm Beach, Dementia, Diagnosis and Treatment, Early Onset Alzheimer's Disease

Memory Screening West Palm BeachIf you’re concerned that someone you love might have dementia, positive answers to the following questions can help to identify dementia as a possible cause of their symptoms.

Although this is not an inclusive list, does the person have increased difficulty with any of the activities listed below? If the answer is yes, he or she should receive a comprehensive dementia assessment and memory screening

  • Learning and retaining new information. Is he/she more repetitive? Does he have trouble remembering recent conversations, events, appointments?  Does he frequently misplaces objects?
  • Handling complex tasks. Does he/she have trouble following a complex train of thought or performing tasks that require many steps, such as balancing a checkbook or cooking a meal?
  • Reasoning ability.  Is he/she unable to respond with a reasonable plan to problems at work or home, such as knowing what to do if the bathroom is flooded? Does he show uncharacteristic disregard for rules of social conduct?
  • Sense of direction.  Does he/she have trouble driving, organizing objects around the house,  or finding his or her way around familiar places?
  • Language.  Does he/she show increased difficulty with finding the right words to express what he wants to say and have difficulty  following conversations?
  • Behavior.  Does he/she appears more passive and less responsive? Is he more irritable or suspicious than usual?  Does he misinterpret visual or auditory stimuli?

If you are concerned that your loved one might have signs of dementia, call the Alzheimer’s Care Resource Center at 561-588-4545 to schedule a memory screening.  Memory screenings in West Palm Beach, Wellington, Royal Palm Beach and throughout Palm Beach County, can be performed in their office or in the comfort of your own home.

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Let’sTalk About Strokes

Posted by on Jan 9, 2013 in Alzheimer's Care West Palm Beach, Caregiver Health, Diagnosis and Treatment, Long Term Care, Patient Care

strokeA stroke can cause lasting physical and mental problems and even death in older people. Knowing the symptoms of a stroke and acting quickly could mean the difference between life and death. Knowing the symptoms of a stroke and acting quickly could mean the difference between life and death. You can also take steps to lower your chance of even having a stroke.

What is a Stroke?

A stroke happens when something changes how blood flows through the brain. Blood brings oxygen and nutrients to brain cells. If blood can’t flow to a part of the brain, cells there could soon start to die. If brain cells are only damaged, they sometimes get better. But brain cells that have died can’t be brought back to life. So, someone who has had a stroke may have trouble speaking, thinking or walking.

There are two major types of strokes. The most common kind (ischemic) is caused by a blood clot or the narrowing of a blood vessel (artery) leading to the brain. This keeps blood from flowing into other parts of the brain and keeps needed oxygen and nutrients from reaching brain cells there. In the second major kind of stroke (hemorrhagic), a broken blood vessel causes bleeding in the brain. This break in the vessel also stops oxygen and nutrients from reaching brain cells.

Stroke is an Emergency. Call 911.

Never ignore the symptoms of stroke. Call 911 if you have any stroke symptoms, even if they don’t last long.

Call 911 RIGHT AWAY if you see or have any of these symptoms:
  • Sudden numbness or weakness in the face, arm or leg – especially on one side of the body
  • Sudden confusion or trouble speaking or understanding
  • Sudden problems seeing in one eye or both eyes
  • Sudden dizziness, loss of balance or coordination, or trouble walking.
  • Sudden severe headache with no known cause

Sometimes the symptoms of a stroke last only a few minutes and then go away. That could be a TIA (transient ischemic attack), also called a mini-stroke. A TIA is a medical emergency. You should get medical help right away. If a TIA is not treated quickly, it could be followed within hours or days by a major disabling stroke.

What Will the Doctor Do?

The doctor will diagnose a stroke based on symptoms, medical history and medical tests, like a CT scan. A CT scan is a kind of test that lets doctors look closely at pictures of the brain.

All strokes benefit from immediate medical treatment. But, only people with ischemic stroke, the kind caused by a clot, can be helped by a drug called t-PA (tissue-plasminogen activator). This drug breaks up the blood clots and can greatly lessen the damage caused by an ischemic stroke. Starting treatment with the drug t-PA within three (3) hours after an ischemic is key to recovery. Getting to a hospital right away allows time for a CT scan of the brain. This scan will show whether this clot-busting medicine is the right treatment choice.

What Happens After a Stroke?

A stroke can cause a variety of health problems. Someone who has a stroke might be paralyzed or have weakness, usually on one side of the body. He or she might have trouble speaking or using words. There could be swallowing or memory problems. Someone who has a stroke might feel depressed or find it hard to control emotions. There might be pain or numbness.

There are many different ways to help people get better after a stroke. Many treatments start in the hospital and continue at home. Drugs and physical therapy can help improve balance, coordination and some problems such as trouble speaking and using words.

Occupational therapy can make it easier to do things like taking a bath or cooking.

A family doctor can provide follow-up care. Some people make a full recovery soon after a stroke. Others take months or even years. But, sometimes the damage is so serious that therapy cannot really help.

Lower Your Risk of Stroke

Talk to your doctor about what you can do to lower your risk of stroke. Even if you’re in perfect health, follow these suggestions:

  • Control your blood pressure. Have your blood pressure checked often. If it is high, follow your doctor’s advice and lower it. Treating high blood pressure lowers the risk of both stroke and heart disease.
  • Stop smoking. Smoking increases your risk for stroke. It’s never too late to quit.
  • Control your cholesterol. If you have high cholesterol, work with your doctor to lower it. Cholesterol, a type of fat in the blood, can build up on the walls of your arteries. In time, this can block blood flow and lead to a stroke.
  • Control your diabetes. Untreated diabetes can damage blood vessels and also leads to narrowed arteries and stroke. Follow your doctor’s suggestions for keeping your diabetes under control.
  • Eat healthy foods. Eat foods that are low in cholesterol and saturated fats. Include a variety of fruits and vegetables every day.
  • Exercise regularly. Try to make physical activity a part of your everyday life. Doing things like taking a brisk walk, riding a bike, swimming and working around the yard lower your chance of stroke. You might check with your doctor before you begin if you are over 50 and aren’t used to energetic activity.

For more information on the various resources on stroke such as support groups, home care and how to find a good neurologist, reach out to us today at

(800) 209-4342

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