How to protect your loved ones from elder abuse during the coronavirus lockdown

senior man covering his face with his hands. Depression and anxiety Copy space.World Elder Abuse Awareness Day is June 15. According to the World Health Organization elder abuse is a violation of human rights and a significant cause of illness, injury, loss of productivity, isolation, and despair. It touches people across all socioeconomic groups, cultures, and races. But only about one in five cases is ever reported. People with dementia are particularly vulnerable because they are unable to recognize that they are being abused or to report it.

This year during the coronavirus lockdown, there have been massive increases in reports of elder abuse  ranging from financial scams to incidents of family violence.

The most vulnerable

Aging adults are highly susceptible to the deadly effects of COVID-19. Just knowing this, amps up anxiety levels and depressive symptoms in aging adults who might be isolated, lonely, and alienated from their families. Isolation and loneliness make the elderly even more vulnerable to scams, and to abuse by caregivers, neighbors, family and financial advisors.

Adults with mental disabilities and/or dementia who live in care facilities are exclusively cared for by staff who may not be in communication with family members. Family members have been restricted from entering the facilities in order to manage the spread of the virus. Consequently, family members are unable to see first-hand whether their loved one is being well cared for.

A news story recently reported that a son was shocked to learn that his father was severely dehydrated, hadn’t eaten for days, and was left in a dirty diaper for more than a couple days. The response he got from the facility was that they were short of staff because so many people were out sick.

Also, people who have diminished eye sight or hearing, or are confined to a wheel chair are vulnerable. My friend’s father who has macular degeneration and is hearing impaired was scammed out of thousands of dollars by a caller who claimed that she was his niece. She said that she was being held in jail and needed bond money. This type of family emergency scam has been going on for years via telephone calls.

We’ve all heard of telephone scams in which a caller claims he is a jailed grandson who pleads with his grandparents to send bail money, or the IRS scam where the caller threatens severe consequences if the senior doesn’t pay tardy taxes.

These types of occurrences are all too common, especially in under staffed, underfunded nursing homes.

Verify an emergency

If someone calls or sends a message claiming to be a family member or a friend desperate for money:

  • Resist the urge to act immediately, no matter how dramatic the story is.
  • Verify the person’s identity by asking questions that a stranger couldn’t possibly answer.
  • Call a phone number for your family member or friend that you know to be genuine.
  • Check the story out with someone else in your family or circle of friends, even if you’ve been told to keep it a secret.
  • Don’t wire money — or send a check or money order by overnight delivery or courier.
  • Report possible fraud at ftc.gov/complaint or by calling 1-877-FTC-HELP.
  •  Report COVID-19 related scams to the National Center for Disaster Fraud (1-866-720-5721)

 

Types of abuse

  • Physical–causing pain or injury
  • Neglect–failure to provide food, shelter, clothing, medical and other necessities required to provide a safe, nurturing environment
  • Emotional and Psychological—Verbal assaults, harassment, threats, intimidation
  • Confinement –restraining or isolating the person
  • Financial—Scams, misuse or withholding of the person’s financial resources to the disadvantage of the elderly person, and to the advantage of another person.
  • Deprivation—Denying the person medication, medical care, food, shelter or physical assistance
  • Sexual abuse –Any sexual activity, including fondling, when the person is unable to understand, unwilling to consent, or threatened or physically forced

Signs of abuse

  • Bruises, pressure marks, broken bones, abrasions and burns
  • Bruises around the breasts and genital area could indicate sexual abuse
  • Poor hygiene, bed sores, unattended medical needs, unusual weight loss
  • Sudden withdrawal from normal activities, unexpected depression, and a sudden change in alertness can be an indicator of emotional abuse. However, these symptoms can be the result of a progression of dementia or other disease.
  • Sudden changes in financial situation can be a result of exploitation.
  • Aggressive behavior from a caregiver or from the person being cared for can result in verbal or emotional abuse on either end.

Report abuse

Abuse can occur anywhere: at home, in nursing homes, and memory care homes. If you suspect abuse don’t hesitate to report it. You do not have to prove anything. It is up to the professional staff to investigate your suspicions, and put the proper safety measures in place.

If you suspect abuse, call the police or 911 immediately if you someone you know is in immediate or threatening danger.

Caregivers also are the recipients of abuse from the person they care for. If a caregiver feels physically threatened it’s important to get help in providing safe care for the person being cared for, possibly in a facility.

What can you do to protect yourself and your loved ones?

Report suspected mistreatment to your community’s Human Services Adult Protection agency and/or law enforcement office. Even if a situation has already been investigated, if you believe circumstances are getting worse, continue to speak out.

If you or others experience abuse or neglect in a community setting:

Report suspected abuse or exploitation to the local Adult Protective Services or Long-Term Care Ombudsman Program .

Human Services provides help with:

  • In-home assessment for abuse, neglect, and/or exploitation
  • Crisis intervention
  • Monthly visits by a case worker, if risk continues
  • Assistance with housing and/or placement to alternative housing
  • Assistance with obtaining benefits
  • Money management
  1. To report suspected abuse in a nursing home or long-term care facility, contact your local Long-Term Care Ombudsman. Each licensed long-term care facility is required to display a poster with the facility’s assigned ombudsman’s name and contact information. If you are a resident or family member of a resident in a facility, call the ombudsman listed on the poster. To learn more about the ombudsman program visit: Long-term care ombudsmen are advocates for residents of nursing homes, board and care homes and assisted living facilities. http://www.ltcombudsman.org
  2. Caregivers (both family and professionals) are most often the abusers of the elderly. Stress and feelings of being overwhelmed may provoke unintentional belligerent feelings. If you feel overwhelmed or frustrated as a caregiver, talk to someone for support.
  3. To speak with an Alzheimer’s Association Care Consultant call: 1-800-272-3900
  4. To find a support group in your area visit http://www.alz.org/apps/findus.asp
  5. To receive support from other caregivers visit https://www.alzconnected.org/
  6. To report an incident or concern of abuse or neglect, call the Alzheimer’s Association (1.800.272.3900) or Eldercare Locator (1.800.677.1116). You’ll be connected to your state or local adult protective services division or to a long-term care ombudsman. You do not need to prove that abuse is occurring — it is up to the professionals to investigate suspicions.
  7. Read more: http://www.alz.org/care/alzheimers-dementia-elder-abuse.asp#ixzz2W9DhCbSL
  8. Keep in contact. Talk with your older friends, neighbors, and relatives. Maintaining communication will help decrease isolation, a risk factor for mistreatment. It will also provide a chance to talk about any problems they may be experiencing.
  9. Join Ageless Alliancea national, non-profit grassroots organization working to promote aging with dignity and eliminate elder abuse, neglect and exploitation through Awareness, Advocacy and Action. Based at the Center of Excellence on Elder Abuse and Neglect at the University of California, Irvine, Ageless Alliance is a grassroots campaign to give a voice to those who have been affected by elder abuse and abuse of adults with disabilities.
  10. Plan ahead to protect against financial exploitation. Download a handout on ways to protect yourself or a loved one.http://www.ncea.aoa.gov/Resources/Publication/docs/NCEA_ProtectYourself_web508.pdf
  11. Be aware of the possibility of abuse. Look around and take note of what may be happening with your older neighbors and acquaintances. Do they seem lately to be withdrawn, nervous, fearful, sad, or anxious, especially around certain people, when they have not seemed so in the past?
  12. Contact your local Area Agency on Aging (AAA) office to identify local programs and sources of support, such as Meals on Wheels. These programs help elders to maintain health, well-being, and independence—a good defense against abuse. See the Eldercare Locator, www.eldercare.gov Welcome to the Eldercare Locator, a public service of the U.S. Administration on Aging connecting you to services for older adults and their families. You can also reach us at 1-800-677-1116.

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Why hydration is crucial, especially during the pandemic

Glass of waterAdipsia is the fancy name for the loss of the sense of thirst. As we get older, our sense of thirst diminishes, just as our sense of smell and taste diminish. Chronic dehydration  is one of the most common problems among seniors and the elderly who reside in care facilities.

If you have a loved one at home with dementia or in a care facility it’s important that you learn the signs of dehydration (below) and offer water or another beverage to your patient every hour and throughout the day.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

Better monitoring of fluid intake is needed at care facilities

Studies have shown that nearly all nursing home residents suffer from inadequate hydration. Additionally, in one study, 25 out of 40 participants suffered from diseases that may have been caused or exacerbated by their being dehydrated.

If your loved one is in a care facility now—during the COVID-19 pandemic–it is more important than ever to try to encourage them to drink. Ask the staff to put signs up in their room as a reminder. It’s especially important if your loved one has dementia and forgets to drink or is not thirsty.

What happens when you are dehydrated?

Your blood begins to thicken, which interferes with normal blood flow and viscosity. This is one of the reasons why, especially during the  pandemic, it’s crucial to stay hydrated. There have been many reports of blood clots and other cardiovascular episodes in patients with COVID-19. The kidneys, liver, pancreas and other organs can be severely affected from dehydration, and severe dehydration can lead to acute pancreatitis in some individuals.

Dehydration can interfere with brain function

This is a good example of what happens when our brains are dehydrated. My mom wasn’t able to walk the last two years of her life, and was dependent upon two private caregivers. She also drank thickened water, which is a disgusting thickened pudding-like liquid that substitutes for water. The reason?  She aspirated water and food into her lungs, which caused her to cough. Sometimes, the result was pneumonia. She may have felt thirsty and not wanted to bother with the thickened water, or maybe she wasn’t thirsty. But she ended up being severely dehydrated on more than one occasion.

When Mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear:

  • dry lips and sticky or dry mouth
  • no tears when crying
  • dry, papery skin that tents when it is pressed
  • decreased urine output
  • sunken eyes
  • headache
  • lethargy
  • dark urine
  • extreme thirst
  • unable to sweat
  • fast breath rate
  • low blood pressure
  • the mental symptoms are not as obvious, but can result in mental confusion, irritability, delirium
  • extreme cases of dehydration can lead to loss of consciousness, coma, kidney failure, and seizures.

Ways to stay hydrated

If you are a caregiver (and that includes caring for yourself!) here are some helpful guidelines:

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by herbal teas, milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.
  • Smoothies and shakes are nourishing and filling.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity. It is especially important now as we head into summer and during the COVID-19 pandemic. But it’s just as important all year round.


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Does dementia increase a person’s risk of getting Coronavirus?

Elderly woman looking sad out the window.Although dementia in itself doesn’t increase one’s risk, there are other factors that might contribute to a person’s increased risk.

Does the patient have any underlying conditions such as high blood pressure, diabetes, auto-immune disease, lung diseases including asthma and COPD, cancer? All of these increase risk of serious symptoms associated with the COVID-19 virus.

If a person with dementia is living at home, s/he may be at increased risk if they forget to wash their hands or socially distance. And, of course, as we are all well aware of, patients in care  facilities are at higher risk simply for the fact they are communally living together. Caregivers come in and out of the facility, go to their homes, and may be interact with others. See Should you move a family member back home from a care facility?

What can you do?

  • If your loved one is living at home and can still read, place sticky notes around the house  (refrigerator, bathroom, kitchen sink) in appropriate places to remind him/her to wash their hands.
  • Call often to check in. Use Zoom or Skype, Facetime, if the person can manage technology. Amazon’s new Portal, which is like a large iPad that is kept plugged in, is an easy device. Check it out: It’s a smart, hands-free video calling device with Alexa built-in.
  • Make sure your loved one has adequate food. If s/he can still prepare meals, drop off their groceries. If they have trouble in the kitchen, bring home-cooked meals or make arrangements with an organization such as Meals on Wheels that can deliver foods.
  • If you have to go inside the person’s home, make sure you have on a mask and gloves, and maintain physical distance as much as possible.
  • A person with dementia is probably not keeping a clean, tidy home, which is important to health and wellness. Try to clean around the person. Have him or her sit in front of the TV or at the kitchen table, while you vacuum and clean the bathroom. Then move him/her to another room in order to clean the kitchen.
  • The main thing is to stay in daily contact. Have the grandkids write notes and draw pictures to send in the mail. If you live in the same town, visit from the lawn and have your loved one sit on the front or back porch.
  • Set up a daily schedule for your loved one. Keep it posted on the fridge. For example: 8:00–wake up, toilet, brush teeth, shower. 8:30 Take meds, eat breakfast. 9:30 Do fitness routine, etc. Do 10 sit-to-stands while watching TV. Walk through the house for 10 minutes a couple times a day.
  • It’s important to protect our loved ones physically but to engage them socially to prevent loneliness and to keep them mentally stimulated. Here’s a great way for seniors whose dementia is minimal.

Well Connected (formerly called Senior Center Without Walls), is a telephone-based national program that offers free weekly activities, education, friendly conversation, classes, support groups, and presentations to individuals 60 years or older anywhere in the United States for English and Spanish speakers. There are activities occurring throughout the day, every day 10:00 am-8:00 pm, Mountain Time, depending on the day. Sessions run between 30 minutes to one hour.

Play a game, write a poem, go on a virtual tour, meditate, share a gratitude, get support, and most importantly, connect and engage with others every day. Well Connected is a community consisting of participants, staff, facilitators, presenters, and other volunteers who care about each other and who value being connected. All groups are accessible by phone and many are accessible online.

Well Connected offers 75 different programs. People can join a particular group, call in the same time each week, hear the same voices on a regular basis and make friends. This has a positive impact on their emotional and physical life. “The gratitude activity, which is offered twice a day, is especially popular and well attended,” says Wade, Social Call director (see below). “Participants share something they are grateful for. This allows for an increase in social connectedness. We also have fun and intellectual programs that help individuals feel valued, stimulated and engaged, and sometimes we invite presenters from the outside in.”

Wade pointed out that Well Connected, is not just for people with mobility concerns. We get folks who are active, people who are married and individuals in a co-housing situation. Anyone can feel lonely, she says. “We take a survey every year and the results indicate that 85% of our participants feel more intellectually stimulated and  socially connected. And on a daily basis, we get calls of gratitude from participants who say, ‘this program saved my live,’” says Wade.

Well Connected also offers a program called Social Call, in which volunteers call participants for a weekly phone visit. For more information, email coviaconnections@covia.org or call 877-797-7299.

Well Connected is an award-winning program of Covia, formerly called Episcopal Senior Communities. For more information: To register call 1-877-797-7299,  https://covia.org/services/well-connected/


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Should you move a family member back home from a care facility?

I'll have to learn to walk againAccording to the New York Times (April 17, 2020), about a fifth of U.S. virus deaths are linked to nursing homes and other long-term care facilities. That’s about 7,000 people.

It’s an extremely difficult time for families who have a loved one in a care facility. You’re not able to visit, and you and your loved one might be missing the physical touch that we as humans crave.  You might be too overwhelmed with caring for others at home to make the drive to the care facility, only to be allowed to peer through a window and touch hands separated by glass.

Two of my friends recently lost a parent who was in a nursing facility. Their parents didn’t die from Covid-19. One died from Alzheimer’s (yes, Alzheimer’s is a fatal disease) and the other had dementia and was recovering from a broken pelvis. Neither friend was able to get to the facility in time to say good-bye, partly because of the imposed lock-down on these facilities.

You might be worried that your loved one will contract Covid-19. What should you do?

Should you move your loved one home?

  • Consider why you moved your loved one to a care facility in the first place. Are you able to safely care for him/her at home?
  • How is your health? Have you been sick? Do you have a chronic condition that prevents you from taking on added stress?
  • Are you overwhelmed caring for children who are doing online schooling?
  • Are you working from home?
  • Is your loved one mobile? Continent? Can you bathe and dress him/her? Do they need a two-person transfer?
  • Can you hire in-home care? This option comes with the risk of having an outsider who has possibly been exposed to Covid-19 come into your home.
  • A person with dementia might have compounded anxiety during the pandemic. Anxiety increases when a person with dementia has their routine disrupted. The individual may not be able to understand what is going on, but pick up on the stress of those around him/her. Would you have the patience and time to devote to caring for such an individual?
  • Be honest with yourself, and consider your own health, psychology and emotional well-being.

If moving your loved one is out of the questions, consider these tips from The Alzheimer’s Association.

If your loved one is in a care facility:

By now, almost all care facilities are not allowing visitors through the door. 

  • Check with the facility regarding their procedures for managing COVID-19 risk. Ensure they have your emergency contact information and the information of another family member or friend as a backup.
  • Do not visit your family member if you have any signs or symptoms of illness.
  • Depending on the situation in your local area, facilities may limit or not allow visitors. This is to protect the residents but it can be difficult if you are unable to see your family member.
  • If visitation is not allowed, ask the facility how you can have contact with your family member. Options include telephone calls, video chats or even emails to check in.
  • If your family member is unable to engage in calls or video chats, ask the facility how you can keep in touch with facility staff in order to get updates.

What if the care facility has or had Covid-19 incidences?

  • Ask the facility about their quarantine procedures. What is your level of confidence that CDC guidelines are being followed?
  • How many people in the facility have been impacted by COVID-19? Are those affected staff, residents or both?
  • Is your family member able to follow social distancing procedures (with or without help)?
    • In some cases, the person may not be able to walk or move about on their own. This could help maintain social distancing.
  • Does the facility have and use personal protective equipment?
  • How many staff members interact with your family member on a regular basis? Is the facility able to limit the number of staff who work with your family member?
  • Is the facility adequately staffed to provide the level of care your family member requires?

The Centers for Disease Control has issued these guidelines for nursing home visitation in the wake of the COVID-19 outbreak:

Limiting Visitation: For facilities that are in counties, or counties adjacent to other counties where a COVID-19 case has occurred, we recommend limiting visitation (except in certain situations as indicated above). For example, a daughter who visits her mother every Monday, would cease these visits, and limit her visits to only those situations when her mom has a significant issue. Also, during the visit, the daughter would limit her contact with her mother and only meet with her in her room or a place the facility has specifically dedicated for visits.

Facilities should actively screen and restrict visitation by those who meet the following criteria: 1. Signs or symptoms of a respiratory infection, such as fever, cough, shortness of breath, or sore throat. 2. In the last 14 days, has had contact with someone with a confirmed diagnosis of COVID19, or under investigation for COVID-19, or are ill with respiratory illness. 3. International travel within the last 14 days to countries with sustained community transmission. 4. Residing in a community where community-based spread of COVID-19 is occurring.

Be kind to yourself, and try not to feel guilty about not being able to visit your loved one. Caregiver guilt is complicated, but you are probably doing the best that you can.

This pandemic lock-down is unprecedented. Hopefully, the restrictions will lift soon and you’ll be able to be with your loved one again. Until then, take extra good care of yourself.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Easy art projects to do with your care partner when you’re both going nuts

Brush point in watercolor paint closeup

If you’re a caregiver taking care of someone at home, you probably feel like pulling your hair out. It’s tough, especially if you or your care partner, or both of you are experiencing anxiety or stress.

Here are a few things you can do by yourself and with your care partner.

“Art Exercises for Caregivers” by Meg Carlson, chapter 11 in my book Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia.

  1. Making an Inside/Outside Box

Materials:

  • Boxes-shoe box, tea box, metal tin, etc.
  • Mixed media-crayons, paint, markers, glue, feathers, felt, rocks,

Decorating a box allows the artist to reflect his/her persona or face that is shown to the outside world on the outside of the box. Decorating the inside of the box is an opportunity to express the internal feelings and conflicts that are private or feel too big to find words to express. Use whatever materials that are available to decorate the outside of the box, and then the inside of the box to express these feelings.

Outside Box: How do you experience being around others with your loved one? What do you share with the outside world about your process/how do you share?

Inside Box: What is really going on inside of you each day? What isn’t shared with others that have an impact on you?

What has this process, or your imagery expressed to you? What kinds of responses are you having?

  1. Daily or Weekly Mandalas

A mandala is a circular image. It begins with a circle drawn on a page. It can be any size and any media can be used.

Materials:

  • Paper: Bristol, Watercolor, or mixed media (6×6 is a great size)
  • It is small enough to be done in a brief sitting, and large enough to have room for several images or areas of focus.

Pencils, markers, watercolor, colored pencil, pastels, or crayons are all great.

A version of mandala exists in many spiritual traditions (rose windows in Cathedrals, Navajo and Tibetan sand paintings, Buddhist imagery, etc.) Mandalas can be used to support focusing attention, as a self check-in tool, to express emotions in a contained space (circle), for establishing a sacred space, and to aid in mindfulness and mediation. Carl Jung, through his own art process, came to realize that mandala paintings enabled him to identify dysfunctional emotional patterns and work towards integration and wholeness. 

  1. Color-Texture-Pattern Feelings Portrait

         This process is about awareness of how much is going on in each of us at any given moment. It is an opportunity to just GET IT OUT through color, movement, and expression. The imagery is usually abstract. It is the process of expressing that is beneficial here, not the finished product. Feelings are difficult to have, and when they are expressed visually they can be difficult to look at. But that is okay. If you use this process, when you are finished, take a moment to witness it like a loving friend. Then just set it aside. If your image invites a redo or edit, you can come back to it and work with it, even tear it up and re-create it. If not, let it go. The materials will support you to express emotions and that is their purpose sometimes …. to help you create something that is not necessarily pretty, but honest. That is their gift to you.

Materials:

  • Small to medium paper, mixed media paper is sturdy. Taped to surface is best. When you prep ask yourself, What size is my expression today? That will tell you what paper size to use.
  • Pencils, markers, watercolor, colored pencil, pastels, or crayons are all great.
  • This can be done between 5 and 25 minutes. It is simply the process of choosing colors and making textures and patterns that express the layers of feeling present. Let the speed and movement be an extension of your expression. It will be unique every time.
  1. Two Inch Window Drawing

The goal is to work with detail and discernment to create a bird’s eye view. Another way to use this tool is one of magnification, to zoom in to one aspect of something larger; examples could be to feel a single sensation, filling a small (contained) space with just what is magnified. Used as a daily or coping practice it may serve to redirect concentration or focus energy and attention, provide containment while titrating an intense sensation. They take between 1-10 minutes to complete. Think Macro and Micro… what would be most helpful, to step back or lean in?

Materials:

    • Paper: Bristol, watercolor, or mixed media (2×2 or 4×4)
    • Card stock scraps come in several colors, and can usually be found at craft stores.
    • This drawing is small enough to be done in a brief sitting, and can even be a single set of colors.
  1. Process: Journey Drawing

Materials:

  • Paper: Bristol, watercolor, or mixed media (6×6 or larger)
  • Collage materials, or a material you enjoy (fabric, craft papers, natural materials, etc.)
  • Chalk/oil pastels, pencil, watercolor

Where are you in this journey? Emotionally … physically . . .personally . . . socially? Is there stuckness . . . is there movement? What colors, shapes, textures represent where you are right now? What colors feel supportive of your journey or give you strength? What emotions are present for you about your current life, about being a caregiver? Can you think of any supportive guides/helpers that you have met along the way? How has your identity or personality been challenged or changed in this process? Who in your life is accepting these changes, who in your life are having difficulty accepting the changes?

What has this process, or your imagery expressed to you? If you had a chance to respond to it, what kinds of responses are you having? Are you in a different place in your journey than you assumed/thought/hoped? What are the qualities of where you feel you are in your journey as a caregiver? As you have moved through different stages, what has each stage offered you?

Lastly, choose a color that feels strengthening, a color that will help you move into the next stage of your journey. Now create a final piece of you drawing that will offer you strength and power when you look at it.  Be one of the helpers for yourself in this moment of your journey.

6. Process: Breath Drawing

Materials:

  • Oil pastels or chalk pastels
  • Large paper
  • Your breath
    With one color in each hand, draw your breath. Notice the qualities of your in breath (short, stunted, deep, long, interrupted, fast, shallow) and allow your hands and the colors to express it. Same with the exhale. What are the qualities present in your out breath? Move each hand/arm in a circular motion with the expression, notice how the lines change over time. Notice similarities and any shifts. Follow your own breath with soft awareness.

What has this process, or your imagery expressed to you? What kinds of responses are you having?


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

20 Ways to give your body the nutrition it deserves

Health food fitness. Food sources of omega 3 on dark background top view. Foods high in fatty acids including vegetables, seafood, nut and seeds

Health food fitness. Food sources of omega 3 on dark background top view. Foods high in fatty acids including vegetables, seafood, nut and seeds

It’s National Nutrition Month and a perfect time to think about ways to increase your nutritional intake. By now most folks have forgotten about their New Year’s resolutions to lose weight, eat healthier, become a vegetarian, reduce sugar intake, etc. It doesn’t matter. New Year’s resolutions are made to be broken.

This is a good time to develop a new plan that makes sense. Whether you want to support your brain health, relieve stress and anxiety about caregiving responsibilities, or just want to rev up your energy, stamina and immunity, here are some ways to protect your health and support your mood.

  1. Did you know that 70% of your immune system lies in your gut? Probiotics are live bacterial microorganisms that populate the human gastrointestinal tract. They combat the daily bombardment of toxins and pathogens (bacteria, fungus, parasites, and viruses) that enter our digestive system every day through contaminated food and other toxins. Recent studies show that the bacteria in your gut can also affect your mental health, mood and stress levels. Fermented foods such as kombucha, Greek yogurt, kefir, sauerkraut, miso, cottage cheese are probiotics. Probiotic bacteria colonize the digestive tract with good bacteria. Prebiotics are the food and nutrients that feed probiotics. Prebiotic fiber is found in fruits and vegetables such as artichokes, jicama, wild yams, onions and garlic, asparagus, beans, oats, chicory root and Jerusalem artichokes. Prebiotics support mineral absorption, vitamin utilization, and healthy blood sugar levels. Your gut needs both pro- and prebiotics in order to stay healthy and keep you healthy.
  2. The brain is very sensitive to the food we eat. A new study published in The New England Journal of Medicine (Aug. 8, 2016) evaluated 242 participants, measuring fasting blood sugar and neuro-cognitive functioning. Those with elevated blood sugar, including people who did not have diabetes, had a dramatic increase of developing dementia. Just remember that what is good for your heart is good for your brain. So try eating a Mediterranean based diet of olive oil, fish, and lots of fruits and vegetables, whole grains, beans, and nuts and seeds, with less meat, cheese and sweets.
  3. Drink plenty of water to keep your body hydrated and to flush out toxins. Your brain is 70% water when fully hydrated, and it gets dehydrated just like your body. When it is dehydrated neurotransmission—which is heavily dependent on water—is impaired, resulting in poor memory, concentration and impaired abstract thinking. The next time your mind is muddled, drink a tall glass of water and notice the difference.
  4. Take a complete B-vitamin supplement to make sure you are getting a balanced amount of B vitamins. Vitamin B complex optimizes cognitive activity and brain function, has a positive effect on memory, learning capacity and attention span, and supports a healthy nervous system and a stable mood. Vitamins B6 and B12, in particular, play a role in the synthesis of serotonin, the neurotransmitter linked to improving memory, lifting mood and regulating sleep.
  5. Berries are berry good for your health. Blueberries, strawberries, raspberries, cherries, cranberries, as well as some others you may never have heard of, contain unique phytochemicals that may help prevent cancer, heart disease, age-related brain declines, and much more. Blueberries score highest on the Oxygen Radical Absorbance Capacity (ORAC) test—a measurement that rates the total antioxidant score of foods, and many berries, such as raspberries, blackberries, cranberries, and strawberries contain ellagic acid, which preliminary research suggests may help to prevent certain types of cancer. Summer is almost here, so enjoy your berries. They are good for you!
  6. Eat more healthy fats and skip the hydrogenated and trans fats found in doughnuts, potato chips and other pastries and desserts.  Omega-3 fatty acids are rich in DHA, the major unsaturated fat in the brain. This long-chain fatty acid provides the necessary fluid quality to the membranes of the nerve cells so that electrical nerve impulses can flow easily along the circuits of the brain. One study found that Alzheimer’s patients given an omega-3-rich supplement experienced a significant improvement in their quality of life. Eating fish such as wild-caught salmon, sardines and other cold-water fish can protect you against Alzheimer’s disease and other forms of dementia. Numerous studies have shown that elderly people who did not have dementia had high blood levels of docosahexaenoic acid (DHA), an essential fatty acid found in cold-water fish, in comparison to those with dementia, who had on average 30% to 40% lower blood levels of DHA. Ways to increase your DHA intake: eat cold-water fish such as wild-caught salmon, sardines and mackerel, at least twice a week. Add flax meal to cereal and baked goods, sprinkle flax oil on your salad, eat a small handful of walnuts at least several times a week.
  7. Eat breakfast! It is the meal that you break your fast with. During the night our blood sugar levels drop, so it’s especially important to eat within one hour of arising and by 10am. Eating breakfast restores healthy blood sugar levels, but make sure your breakfast isn’t coffee and a doughnut. Have some protein and a healthy fat such as an omelet and avocado and a piece of whole grain or gluten-free toast. It’ll provide you with the energy you need to get through the morning while maintaining a sense of equilibrium. My favorite cool weather breakfast is eggs (any way you like them), a side of beans such as black or pinto, and a pile of sautéed greens. When the weather is hot, I prefer home-made granola made with oats, a bit of coconut oil and maple syrup, coconut flakes, and lots of nuts including almonds, walnuts, cashews, and pumpkin seeds. Add chia seeds, flax meal, yogurt and fresh berries and you’ve got a breakfast for champions.
  8. Avoid commercially processed meats and favor grass-fed meats, free-range chickens and eggs fed an organic, non-GMO diet. And limit your meat consumption to no more than twice a week.
  9. Eat like a rabbit to reduce your risk of stroke, dementia, macular degeneration, and other chronic illness. Veggies are low in calories and high in fiber. Fruits are also high in fiber and like veggies, contain numerous vitamins and minerals. Just like people, fruits and vegetables come in a variety of shapes, sizes and colors. And it’s the colors that identify many of the bioactive substances called phytonutrients that give us antioxidant protection and other special health benefits. The scientific community has produced a large body of research showing the potential of these super nutrients. Compared with people who eat few fruits and vegetables, populations that consume a large variety and generous amounts of plant foods enjoy longevity and reduced risk of disease. For example, the people of Okinawa have a long life expectancy, numerous centenarians, and a low-risk of age-associated diseases. Their diet is low in calories, fat, sugar, salt, and meat and dairy products. Instead, Okinawans eat fish, tofu, whole grains, and lots of fruit, dark green leafy vegetables, onions, green peppers, sea vegetables and sweet potatoes—which are all dense in phytonutrients and antioxidants. These islanders are known for a low-stress, carefree and relaxed attitude. Their rates of stroke, dementia, cancer and heart disease are also the lowest in the world. For every 100,000 people in Okinawa, 30 have passed their 100th birthday, one of the highest rates in the world.
  10. A cup of Joe will do you good . . . just don’t overdo it and don’t add lots of cream and sugar. Researchers from the University of Scranton found that coffee is the number one source of antioxidants in the U.S. diet. Coffee has been shown to improve mental acuity. In fact, a study published in the Journal of Alzheimer’s Disease (2012) found that people older than 65 who had higher blood levels of caffeine developed Alzheimer’s disease two to four years later than people with lower caffeine levels. The study included 124 people who had mild cognitive impairment (MCI). Typically, 15% of people with MCI will go on to develop full-blown Alzheimer’s disease each year. The study participants who had less than 1,200 ng/ml of caffeine levels in their blood developed Alzheimer’s disease. This is equivalent to drinking several cups of coffee a few hours before their blood was taken. The people whose memory loss did not progress to full-blown Alzheimer’s disease had higher levels of caffeine in their blood. Coffee appeared to be the only source of caffeine for the participants in the study. Some big caveats: if you have high blood pressure limit your coffee intake to 2 cups a day, and avoid drinking it before exercise or physical labor which both naturally raise blood pressure. Coffee acts as a diuretic, depleting the body of necessary fluids, so make sure you drink a glass of water for every cup of coffee you drink. Coffee can raise homocysteine levels, an indicator and risk factor for cardiovascular disease. It can also cause headaches, fatigue, depression, anxiety and drowsiness if a coffee drinker forgoes his or her usual daily dose of caffeine. So be smart and listen to your body.
  11. Drink green tea if you don’t like coffee or are unable to drink it. Scientists have found evidence that green tea extract can help fight everything from glaucoma to prostate cancer and leukemia. Now a research team composed of chemists, biochemists and biophysicists at the University of Michigan has found a new potential benefit of green tea extract: preventing the clumping of proteins associated amyloids in the brain, which is associated with Alzheimer’s disease and other neurodegenerative conditions. The study found that the specific molecule in green tea, ( — )-epigallocatechin-3-gallate, also known as EGCG, prevented aggregate formation and broke down existing aggregate structures in the proteins that contained the metals copper, iron and zinc. At Tohoku University Graduate School of Medicine, researchers tracked the green tea consumption of nearly 14,000 people over age 65 for three years. The participants’ quality of life (measured in day-to-day activities such as getting dressed, walking the dog, and performing household chores) was examined in relation to how much green tea they drank. The authors found that the more green tea participants consumed, the longer they were able to ward off the difficulties associated with old age. The people who drank at least five cups a day were one-third less likely to develop disabilities than those who had less than a cup per day. Those people who averaged three or four cups a day had a 25 percent lower risk. Just remember that while green tea and its extracts are considered safe in small amounts, they do contain caffeine and small amounts of vitamin K, which means it could interfere with drugs that prevent blood clotting. So the next time you feel the need for a cup of coffee or black tea, consider drinking a cup of green tea instead. It just might help you maintain clarity of mind, healthy bones, and cardiovascular health well into your senior years.
  12. Herbs or adaptogens can be helpful for increasing energy without stimulation. An adaptogen is a natural substance—usually an herb—that helps the body adapt to stress by producing a calming effect on the whole physiology, and stress is often blamed with being the root cause of many illnesses and diseases. Phytosterols, the plant compounds in the herbs ashwaghanda, gotu kola, passion flower, schizandra, skullcap, rhodiola, and cordyceps have been scientifically shown to support the adrenal glands and healthy blood chemistry, and enhance the body’s ability to resist the ravages of stress. Valerian, Siberian ginseng, kava kava, oat straw, and hops also help reduce stress. These herbs can be taken as a tea or in the form of a nutritional supplement. Culinary herbs also have numerous health benefits. Turmeric, the spice used in Indian cooking, has dozens of studies backing up its ability to reduce inflammation, another major cause of chronic disease, and risk of Alzheimer’s disease. Cinnamon helps to stabilize blood sugar levels, which is vital to healthy aging. Oregano contains antioxidants that offer antibacterial protection. Garlic has been called the natural antibiotic, and ginger root has been used for thousands of years for its anti-inflammatory and anti-microbial effects. The list goes on and on.
  13. Magnesium is the fourth most abundant mineral in your body—which means it is absolutely essential to your healthy blood pressure, cardiovascular health, bone and overall health. In fact, you cannot live without it! Magnesium is involved in more than 300 biochemical reactions, particularly as a catalyst for food metabolism and the release of energy. Yet, only about 25% of Americans meet the Recommended Dietary Allowance (RDA) of 400 mg per day for magnesium. Good sources of magnesium include: dark green, leafy vegetables such as spinach, Swiss chard and kale dark green, legumes, peas and beans (especially soybeans), seeds and nuts (especially almonds, cashews and pumpkin seeds) whole, unrefined grains, including oatmeal and bran, and halibut
  14. Go nuts on Brazil nuts. They are rich in selenium, a potent antioxidant which is concentrated in the thyroid gland. They also contain copper, which helps to support a healthy thyroid. Regardless of whether you have thyroid issues, selenium is a good all-round antioxidant. According to the Institute of Medicine, the tolerable upper intake level (UL) (i.e., the highest level of intake that is known to avoid toxicity) for selenium is 400μcg per day. On average, Brazil nuts have 544 mcg selenium per ounce, but studies indicate that the selenium content may vary widely depending on country of origin, cultivation methods, etc. With that in mind, a good starting point for most folks would be to consume 2 – 3 Brazil nuts per day.
  15. Eat more tomatoes. Recent epidemiological studies have suggested that eating tomatoes and tomato-based food products can reduce the risk of prostate cancer and macular degeneration.  This protective effect has been attributed to carotenoids, which are one of the major classes of phytochemicals in this fruit. The most abundant carotenoid in tomato is lycopene. Cooking tomatoes in olive oil helps you digest and assimilate the lycopene so if you like tomato sauce on your pasta, go for it. Just make sure you are eating a healthy pasta product–think whole grain, quinoa, etc.
  16. Include flax oil, flax meal or flax oil in your diet. They are the best source of lignans. Lignans are compounds that form the building blocks of plant cell walls. They contain phytoestrogens that help regulate the body’s estrogen production. When we eat plant foods the lignan compounds are converted in our intestines by good bacteria to produce a form that the body can assimilate. Enterolactone—the primary lignan metabolite (a substance produced by metabolism) that circulates in our blood—produces weak estrogenic activity. Dozens of reports have revealed that high levels of enterolactone in our blood help to reduce risk of breast, prostate and colon cancers, and cardiovascular disease. Studies have also shown that high levels of lignans can support healthy weight and glucose metabolism, reducing the risk of insulin sensitivity, metabolic syndrome and diabetes. Most plant foods contain small amounts of lignans, but flax seeds are by far the best source. Other good sources include high fiber foods such as whole grains (wheat, barley), sesame seeds, sunflower seeds, cashews, kale, broccoli, carrots, legumes, garlic, asparagus and berries.
  17. Lutein and zeaxanthin reduce eye health risks. What are they? They are antioxidants in the carotenoid family—a group of naturally occurring, fat-soluble pigments found in plants—that play a key role in our the health of our eyes.  Carotenoids are the red, orange and yellow plant pigments that give fruits and vegetables their vivid colors.  All fruits and vegetables contain varying concentrations of carotenoids.  But their colors are often covered up by green chlorophyll contained in the plant. Lutein is found in spinach, kale, collard greens, romaine lettuce, leeks, peas, egg yolks, tomatoes, carrots, marigold flowers, and fruits. Zeaxanthin is found in corn, kale, mustard greens, spinach, egg yolk, orange peppers, collard greens, lycii berry fruit, green algae spirulina and other types of commercially produced algae. Lutein and zeaxanthin accumulate in the macula, the prominent, bright yellow spot in the center of the retina that allows you to clearly distinguish fine detail. And studies are showing that people with macular degeneration—the slow deterioration of the cells in the macula, which affects your central vision, the vision you use for reading, writing, driving and identifying faces—have low concentrations of these two pigments in the macula. So make sure you are eating plenty of the above mentioned fruits and veggies.
  18. Chromium is a first class blood sugar and insulin regulator. Yet, nine out of 10 American diets fall short of this trace mineral, which is essential for the transfer of sugar from the bloodstream to muscle cells, giving them the fuel they need to work.  Chromium is also involved in maintaining cholesterol and triglyceride levels, and supporting healthy muscles.  Chromium levels decrease with age and are often low due to poor diet. Eat more foods that are naturally high in chromium: broccoli, barley, oats, green beans, tomatoes, Romaine lettuce, black pepper, Brewer’s yeast.
  19. Coenzyme Q10, or CoQ10is a vitamin-like compound and an important antioxidant. It exists in every cell of your body and you could not survive without it. CoQ10 is essential in the body’s production of adenosine triphosphate (ATP), which produces energy within the cells and is the basis for normal functioning of all body systems and organs. If you think of the body’s cells as little engines that use oxygen to burn the organic fuels that come from food, you may think of CoQ10 as the part of the engine that provides the spark for this process. No other substance will substitute for CoQ10. Without it there is no spark and therefore no production of energy for the cell. And without energy there is no life! As we age, it becomes more and more difficult for the body to produce enough CoQ10. An 80-year-old person has about half the CoQ10 levels of a 20-year-old.  Body levels of CoQ10 are also influenced by stress, cold, illness, high blood pressure, hormone concentrations, physical activity and prescription drugs, which can deplete CoQ10 levels. Scientists estimate that once levels drop below the 25% deficient level, a variety of health problems can take hold. But your cells’ energy and efficiency can be restored with supplementation and/or by eating eggs, dairy products, meat, and poultry, fatty fish, nuts and seeds, broccoli, cauliflower, and some fruits and vegetables.
  20. Are you getting enough vitamin D? Most people, especially the elderly, are vitamin D deficient.  Researchers have found a correlation between vitamin D deficiency and low mood, depression and worse cognitive performance in older adults. In a recent study, 1618 patients who averaged 73.8 years old were tested for vitamin D deficiency. Those with severe vitamin D deficiency were twice as likely to suffer from depression. Vitamin D is most commonly known for helping the digestive system absorb calcium and phosphorus. In that way it helps the body build and maintain healthy bones. But it does much more. Adequate vitamin D is believed to play a role in the reduction of falls, as well as supporting cardiovascular health, a strong immune system and cognitive function. Also, scientists theorize that one of the reasons that influenza occurs in the wintertime is that we do not manufacture enough vitamin D, and the resulting vitamin D deficiency might promote our susceptibility to the flu virus. Which foods contain vitamin D? Fatty fish such as salmon, trout, tuna and sardines, milk, and fortified cereals provide more than 100 IU per serving. And mushroom is the only food in the produce section that has vitamin D. But you’d have to eat an awful lot of these foods to get the recommended daily dose of vitamin D, which is 2400 IU, according to a study published in the Journal of Nutrition. For instance, you would have to eat at least five servings of salmon a day or drink 20 cups of fortified milk. Play it safe and take a vitamin D dietary supplement. According to a study published in the Journal of Nutrition (March 9, 2009) adults need at least four times the current recommended dose of 600 IU of vitamin D. In 2008 The American Academy of Pediatrics (AAP) doubled its recommended minimum intake for infants, children and teens from 200 IU to 400 IU per day.

Be well, be heathy, and please subscribe to my blog for more articles filled with information on how you can support your health and the health of your loved ones.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

Does Alzheimer’s Cause Vision Problems?

Depressed old woman in eyeglasses on ophthalmologist appointment, vision problemMy husband wore glasses. And he had Alzheimer’s. And he had a retinal tear that required a laser procedure, which was no fun.

My kids and I thought Morris’s vision was deteriorating because he couldn’t see objects, such as a drinking glass right in front of him. This went on for years. Sometimes he was afraid to walk, thinking he’d fall or run into something. But it wasn’t his vision. The problem was in his brain.

It can be difficult to tell the difference between sight loss and visual problems due to dementia. Often times, one condition can mask the other.

Here’s what I learned.

People with Alzheimer’s and other dementias have visual difficulties caused by what is happening in the brain. They can still have healthy eyes, or have vision that hasn’t changed significantly. Their perception problems are not due to how clearly they see, but to changes in the brain.

Some of these difficulties may indicate dementia. My husband had to deal with almost every one of these issues.

  • reading
  • recognizing people
  • coping with low light, bright light or both
  • finding objects
  • avoiding obstacles
  • recognizing food on the plate
  • seeing well even with glasses on

In Alzheimer’s dementia, there are five main areas of visual deficit that can affect perception.

(See the last section, below, for some ways to help with these issues.)

  • reduced ability to detect motion
  • reduced peripheral vision
  • loss of depth perception
  • difficulty recognizing colors, especially in the blue-violet range
  • reduced contrast sensitivity to gradients of color–trouble picking out objects that are surrounded by similar colors, i.e. finding the toilet in a bathroom where the floor, walls and toilet are all white

Alzheimer’s disease can be detected through an eye test

According to researchers, changes in your sight and smell may be the key to early detection of Alzheimer’s disease. A decreased sense of smell is an early clue. In the case of vision, people with Alzheimer’s have fewer blood vessels and less blood flow in the retina (back of the eye). The retinal nerve that comes out of the brain gets narrower and this can be detected by an eye test that uses a non-invasive scanning technique called OCTA (optical coherence tomography angiography).

Having a thinner retina can also cause blurry vision at first that may interfere with normal activity, making things to appear hazy or out of focus.

Results from two studies show that OCTA can see signs of Alzheimer’s disease in a matter of seconds. Researchers at Duke University in North Carolina compared the retinas of 39 people with Alzheimer’s, 37 people with Mild Cognitive Impairment (MCI), and 133 healthy people. The average age was 71.

The researchers excluded various people from the study, including people with non-Alzheimer’s dementia, diabetes, high blood pressure, neurological conditions like multiple sclerosis, glaucoma, age-related macular degeneration or poor vision.

They took scans looking at the tiny blood vessels in different parts of the retina, and then compared blood vessel density between the groups. They found that people with Alzheimer’s had fewer blood vessels and less blood flow in the retina than healthy controls and those with MCI, and that a specific layer of the retina was thinner. They also found that the small blood vessels in the retina are altered even in patients who have a family history of Alzheimer’s but have no symptoms.

Because the retina is connected to the brain by way of the optic nerve, researchers believe that the deterioration in the retina and its blood vessels may mirror the changes going on in the blood vessels and structures in the brain, thereby offering a window into the disease process.

Because genes play a significant role in how Alzheimer’s disease begins and progresses, another team of researchers from Sheba Medical Center in Israel examined 400 people who had a family history of the disease but showed no symptoms themselves. They compared their retina and brain scans with those who have no family history of Alzheimer’s.

They found that the inner layer of the retina is thinner in people with a family history. The brain scan showed that their hippocampus, an area of the brain that’s first affected by the disease, had already begun to shrink. Both factors, a thinner inner retina layer and smaller hippocampus, were associated with scoring worse on a cognitive function test.

The goal of this latest research is to find a quick, inexpensive way to detect Alzheimer’s at the earliest signs. Diagnosing Alzheimer’s is a currently a challenge. Some techniques can detect signs of the disease but are impractical for screening of millions people: Brain scans are expensive and spinal taps can be harmful. Instead, the disease is often diagnosed through memory tests or observing behavior changes. By the time these changes are noticed, the disease is advanced. Even though there is no cure, early diagnosis is critical as future treatments are likely to be most effective when given early. Early diagnosis would also give patients and their families time to plan for the future.

Regular eye exams are important

I wondered how the doctor could ascertain what Morris’s eye glass prescription was since Morris was unable to read the eye chart. The ophthalmologist assured me that they have their way of checking someone’s eyes without verbal feedback. The doctor adapts the test for the patient, and allows for more time. It is important, however, that someone who knows the patient well accompanies him/her.

People with dementia can have the typical causes of sight loss that many aging people have, including cataracts, macular degeneration, normal aging of the eye, and stroke.

Ways to help your patient with sight loss and dementia

  • Make sure their eyeglass prescription is current.
  • Clean the glasses often, and try to prevent loss or misplacement by attaching them to a strap, lanyard or chain.
  • Improve the lighting where the patient lives, and install automatic lights that come on at dusk.
  • Use contrasting colors to help the patient discern places and things, i.e. Serve colorful veggies (which are higher in antioxidants and vitamins) on a white plate. Put DO NOT ENTER signs on outside doors, if there is a risk your patient might wander, etc.
  • Play books on tape, or read to your patient if he/she is unable to read.
  • Focus on what your patient can do and is familiar with, and help him/her to have positive experiences.


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”—Winner of the 2018 Book Excellence Award in Self-Help—in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

When your loved one has difficulty eating

senior woman eatingMeals can be challenging for someone with Alzheimer’s or another form of dementia, not to mention their caregivers. As the disease progresses, it can become difficult for the person to consume enough calories to maintain a healthy weight. But there are ways to encourage healthy eating. Eventually, toward the end of life, it’s natural for humans, and all animals, to lose the desire for food.

As his Alzheimer’s progressed, my husband, had trouble recognizing food items. Morris forgot how to hold a sandwich, and I’d have to place it in his hand. He forgot how to cut his food, so I served it to him already cut into small pieces.

Once when I handed him a sandwich to eat, he asked what it was. I replied, “Chicken salad.” He threw the sandwich across the table and exclaimed, “This chicken is dead!” It was hilarious, and shocking.

But there are ways to encourage your loved one to enjoy food and get good nutrition throughout most of the course of the illness.

Here are some suggestions:

  • Seniors and elders with health issues tend to be hungriest in the morning and eat less as the day progresses. Make a healthy breakfast packed with protein, healthy fat, antioxidants, vitamins and minerals. Eggs, anywhere you like them, served with avocado, toast, beans, and  greens provides everything needed to establish the beginning of a good day. The same goes for caregivers! You need the strength and energy to get through the day, so start it off with a nutrient- rich breakfast.
  • Setting the table–Put as little on the table as possible in order to not confuse the patient or detract for their ability to clearly see what is in front of them. Use a colorful plate mat, and a white plate so the food stands out. And serve colorful foods, which are higher in antioxidants and vitamins and minerals. Think sweet potatoes, winter squash, corn, beets, greens, etc. Root veggies can be pureed and served in a mash, which is easier to chew and swallow.
  • Make sure the environment is clean and pleasing. Put on some favorite music. It can be stimulating or soothing, depending on the mood.
  • Has the patient kept up with their dental appointments? My mother was always fastidious about dental care, visiting her dentist several times a year for cleanings. But at the end of her life, she began to lose teeth, most likely from poor nutrition. Observe your loved one and make sure there are no signs of pain, grimacing, trouble chewing, etc.
  • Sometimes, a person will not remember that they have eaten just a little while before saying, “When is lunch (or dinner)?” Or, “I’m hungry. When are we going to eat?” Leave their plate on the table longer as a visual reminder. You might have to hide food, if they have the tendency to overeat. And if you want to make sure they, as well as you, are eating the best diet possible, refrain from buying cookies, sweets, chips, and crackers, that are filled with empty calories and hydrogenated fats.
  • Provide a meal companion for your loved one. If you can’t eat with him/her, ask a friend to share a meal. Or, if he/she is still able to eat in a restaurant, have a friend make a weekly lunch date and bring them to a quiet restaurant that serves their favorite food.
  • The taste for sweet things is the last one to go. If your loved one doesn’t have any appetite, it’s almost guaranteed that they will enjoy ice cream. There are lots of options on the market to choose from ranging from traditional ice cream to frozen desserts made with cashew cream, coconut cream and soy milk.
  • Make sure the temperature of the food isn’t too hot or too cold, and that the patient is seated comfortably in a room that is neither too hot or cold.

Dysphagia

Dysphagia is any problem with swallowing. This was a major issue for my dear mother, who, at the end, couldn’t eat without the food going into her lungs instead of her stomach. In determining the extent of dysphasia, the patient does a swallow test drinking liquid of various consistency and thickness.

Food and drink categories

  1. Nectar thick, he consistency of nectar, quickly runs off a spoon
  2. Honey thick, the consistency of honey, slowly drips off a spoon
  3. Pudding thick, the consistency of pudding, plops off a spoon

My mom had to drink water that was thickened, which tasted disgusting. As a result, she often refused to drink and once became dehydrated to the point where she was hospitalized.

If your patient is put on a dysphagia diet, experiment and find ways to keep him or her hydrated. Puree their favorite foods, make shakes that are delicious and nutritious. You can puree just about anything and make it taste good with herbs, tomato sauce, etc. Please don’t add salt. Yogurt and puddings are another good option. Read the labels and try to avoid added sugars. Especially watch out for high sugar content in flavored yogurt.

Poor appetite

If your loved one doesn’t want to eat, accept it as the course of the illness. But if they are still walking and reasonably active, rule out contra-indications of newly administered drugs and illness, such as urinary tract infections.

Additionally, your patient might have a poor sense of smell, which will translate into a poor appetite. Try adding more seasoning to the food, but try to avoid salt and use herbs and spices that include antioxidants such as thyme, basil, oregano, cumin, cinnamon, and cardamom.

Laraine Pounds, R.N., an internationally recognized aromatherapist lists aromatherapy essential oils that stimulate appetite in chapter 18 of my book “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia.”

Eating issues are common amongst individuals with dementia. Experiment with these suggestions and see what makes a difference. Sometimes, just sitting next to someone and offering gentle conversation helps.


 

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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

High blood pressure is a risk for (MCI) mild cognitive impairment

Close up of digital monitor device with cuff showing high diastolic and systolic blood pressureDid you know that high blood pressure puts you at risk for developing Mild Cognitive Impairment (MCI)? The problem is, MCI can eventually develop into dementia and Alzheimer’s disease.

A recent study involving 9,400 adults that was published in JAMA (January 28, 19) indicates that you can reduce your risk of MCI by lowering your blood pressure.  Adults in their 50s or older with high blood pressure participated in a clinical trial led by scientists at the Wake Forest School of Medicine in Winston-Salem, NC. The purpose of the trial was to evaluate the effect of blood pressure control on risk of dementia. The participants received either intensive blood pressure control or standard treatment.

Intensive control was used to bring systolic blood pressure below 120 millimeters of mercury (mm Hg), while the purpose of standard treatment was to lower it to under 140 mm Hg. Systolic blood pressure is the pressure in the arteries when the heart contracts. It is the top number in a blood pressure measurement, as in 120 mm Hg over 70 mm Hg.

The results revealed that significantly fewer of those who received intensive blood pressure control went on to develop Mild Cognitive Impairment, compared with those on the standard treatment. The lead investigator Dr. Jeff D. Williamson said that “three years of lowering blood pressure not only dramatically helped the heart, but also helped the brain.”

However, the study did not show that intensive blood pressure control reduced the incidence of dementia. The authors suggested that low numbers and the study finishing earlier than planned could be reasons for this.

What is Mild Cognitive Impairment? 

MCI is a condition in which the individual has some loss of mental acuity, such as forgetting appointments, losing the flow of a conversation, and difficulties making decisions and keeping track of finances, as well as trouble with reasoning. The individual is still able to care for him or herself and live a fairly normal life.

Approximately 15 to 20 percent of people 65 and older have MCI. People living with MCI are more likely to develop Alzheimer’s disease or other dementias. But MCI doesn’t always lead to dementia. In some cases, MCI remains stable or resolves on its own. Some medications may result in symptoms of MCI, including forgetfulness or other memory issues.

There are no pharmaceutical drugs approved in the U.S. for the treatment of MCI. However, the study discussed above, is a good indication that high blood pressure that is controlled through changes in lifestyle can help prevent MCI.

Why is high blood pressure dangerous?

It’s called the “silent killer” because it is insidious. It often has no warning signs or symptoms.

If your blood pressure is high it causes strain on the vessels carrying blood throughout your body. This can injure the vessels and lead to plaque buildup as a response to injury. Eventually, this can lead to narrow blood vessels and then clotting of passageways, which can cause damage to the heart and/or brain. High blood pressure ultimately increases your risk for getting heart disease, kidney disease, dementia, and for having a stroke.

Taking Your Blood Pressure

When your doctor takes your blood pressure, he/she is measuring the pressure in your arteries as your heart pumps. The heart contracts and relaxes during each heartbeat. When it contracts, the blood is being pumped out of the two ventricles (chambers) and your blood pressure goes up. Systolic pressure (the top number in the blood pressure reading) is the peak reading of the pressure produced by this contraction.

When the heart relaxes, blood fills the ventricles and your blood pressure goes down. The diastolic pressure (the bottom number in the blood pressure reading) measures the pressure between the beats as the heart relaxes.

What’s normal blood pressure?

High blood pressure used to be considered 140/90 or higher.

According to the National Heart, Lung and Blood Institute (a division of the Institutes of Health), normal blood pressure is now considered to be lower than 120/80 according to the guidelines released in November 2017.

The guidelines state that for BP above 115/75, every rise of 20/10 mm Hg doubles the risk of cardiovascular disease. Since 2017, the American Heart Association has advised that people with high BP should receive treatment at 130/80 rather than 140/90.

In the new guidelines, the AHA also recommends that doctors only prescribe medication in cases of a previous heart attack or stroke, or in the presence of risk factors such as: age, diabetes, or chronic kidney disease. Rather, at the earlier stages of hypertension, another word for high blood pressure, patients should make lifestyle changes. Here are a number of ways to do that:

10 Ways to support healthy blood pressure and prevent MCI

  1. Eat a nutritious, high-fiber, low-fat heart healthy diet. Learn about the MIND diet.
  2. Beware of your intake of sodium.
  3. Include foods high in phytonutrients—fruits and veggies.
  4. Take nutritional supplements proven to support a healthy heart: magnesium, potassium, B vitamin complex, vitamin D3, CoQ10, Grape seed extract, Resveratrol, Quercetin.
  5. Avoid decongestants if possible. These drugs can raise blood pressure.
  6. Practice a stress reduction technique such as yoga or meditation.
  7. At the minimum, take a walk 3-4 times a week.
  8. Stop smoking and reduce consumption of alcohol.
  9. Drink 6 to 8 glasses of water every day.
  10. If you snore, have sleeping problems, or are sleepy during the day, discuss sleep apnea with your physician.

Give yourself the gift of peace and get plenty of rest and sleep.

Happy Holidays!


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

10 Great Gifts for Caregivers

New Year's box with gifts and bows, fir cones, snowflakes and Christmas toy on old boardsIf you’re a caregiver, you have little time for yourself and you’re probably stressed out. You don’t need another pair of pajamas, and you don’t need another coffee mug.

What you desperately need is some time for yourself to relax and rejuvenate, and ways to make your life easier.

When friends and family ask you,” How can I help?” Or, “What do you need?” send them this list. They will appreciate it, and you will definitely appreciate the rewards.

  1. You know how wonderful it feels to have a sparkling clean house. And you probably haven’t had time to do a deep cleaning in a while. Ask your friends and neighbors for recommendations for a good house cleaner or cleaning service. Merry Maids is a national company available in most parts of the U.S. They also have gift cards online to make it convenient for your gift givers.
  2. Wouldn’t it be heavenly to get away for a few hours? It’s important to maintain friends throughout our lives, and even more important when we need to vent or just need a friendly chat or someone to tell you that you’re doing the best that you can. Gift cards to a neighborhood coffee shop or restaurant can help provide an excuse to connect to a friend you haven’t seen in a while. Make a date.
  3. But in order to make a date, you might need a companion to stay with your loved one. Providing TIME to you may be the greatest gift of all. Ask for a time donation, possibly in blocks of time. Two hours a week for a month? Four hours a month? Spread your wishes around. You’re bound to get several “yeses.”
  4. Do you like to sing? Whether you sing in the shower or in a chorus, it’s been well documented that singing reduces stress levels and depression. Group singing boosts oxytocin levels, and creates a feeling of “togetherness.” (Oxytocin is called the “love  hormone” because it is released when mothers breastfeed and when people snuggle up or bond socially. Request a favorite music CD that you like to sing to. Try to include the person you are caring for. Invite neighbors over for a singalong, and make it intergenerational. It’s amazing that people who even have advanced dementia can often remember the words to songs they sang decades ago.
  5. What about dance? You might have two left-feet, but you can dance away your blues without anyone watching in your living room. I always say that dance is what kept me off anti-depressant medication during the 10 years I cared for my husband. I did folk dance, salsa, and contra on a weekly basis. It was well worth the expense of hiring someone to keep my husband company on those evenings. Dance supports the release of endorphins from the brain into the bloodstream. I experienced firsthand a rush of happiness for hours, and sometimes days, after dancing for just a couple hours. Not only does dancing uplift your spirit, it can help you think more clearly. A 21-year-long Einstein Aging Study that was published in the New England Journal of Medicine in 2003 found that dancing is the best form of exercise to help prevent dementia when compared to 11 other activities including swimming, bicycling, and team sports. The study also found that dancing can help slow down cognitive decline. Dancing to music that carries special significance can be a wonderful way to connect with your care partner. Why not ask for a CD of your favorite music and dance in your living room, alone or with your care partner? Or, learn a new dance. Request a DVD to teach you the steps. Or, try a Zumba class. Fitness is a Latin-inspired cardio-dance workout that uses music and choreographed steps to form a fitness party atmosphere. While many of the types of dance and music featured in the program are Latin American inspired, classes can also contain everything from jazz to African beats to country to hip-hop and pop. Attend a Zumba class at your local recreation center or YMCA. They are also available on YouTube videos. And ask for a gift of companion-sitting for your loved one.
  6. House maintenance is often neglected when you have a million caregiving tasks. When is the last time you raked your lawn, pulled weeds, fixed a leaky sink, or had your carpets cleaned? The offer of someone volunteering their time to provide these services or the gift of a handyman service is always appreciated.
  7. Would you like to try a yoga class, either online or at a studio? Ask for a yoga mat, yoga blocks and a yoga strap. That’s all you need to help you release stress, build up endurance, relax muscles, and reduce risk of osteoporosis. Yoga videos are sold on Gaim, and are offered on their website for $11.99 per month after doing a free 2-week trial at https://www.gaia.com/yoga?utm_source=google+paid&utm_medium=cpc&utm_term=gaiam%20yoga&utm_campaign=1-USA-ENGLISH-BRAND-EXCT&utm_content=gaia&ch=br&gclid=Cj0KCQiA5dPuBRCrARIsAJL7oejWgk-kRRzIVjk_nt7xXY3-I5F_cYeHbltpDj4H7vba2QBjnQPwwiMaAqLVEALw_wcB
  8. Everyone loves a home-cooked meal. A personal chef who prepares meals in your home or theirs is an extravagant service. But put the idea out there. You never know . . . . A more affordable option is home-delivered meal kits. Home Chef, Blue Apron, and Green Chef are a few of the meal kit companies that allow you to choose meals that arrive with fresh, pre-measured and prepped ingredients, and instructions on how to create a fast meal.
  9. Massage is a wonderful way to relax and tune out the world. I highly recommend asking for a gift certificate to a spa that offers massage with hot stone and aromatherapy. You will emerge like a new person.
  10. One of the best gifts you could receive is respite care.  Do you have a relative or friend who could stay with your loved one a night or two so you can get away and totally tune out the world? If not, maybe one of they would generously provide you with a professional care service. Just imagine getting away from it all without any responsibilities for 24 or 48 hours.

You deserve gifts that will help you, the caregiver. So don’t be shy. When people ask how they might help or what you need or want, send them this list.

Have a happy, restful and peaceful Thanksgiving!


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Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at Barnes & NobleBoulder Book Store, Tattered Cover Book Store,  Indie Bound.org, and online at Target and Walmart, and many other fine independent bookstores, as well as public libraries.