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.

What do you most remember/or miss about your loved one this Alzheimer’s Awareness Month?

christmas angel on blur bokeh city lights at night on background. Little white guardian angel in snow.As we honor our loved ones this Alzheimer’s Awareness Month of November, I invite you to submit:

  • a memory, poem, or tribute on how being a caregiver has changed your life
  • how having a loved one with Alzheimer’s disease has changed your life
  • a bit of advice that you’d like to share
  • just a memory

You can add it as a comment on this site, or send it to my email account and I will add it for you. Feel free to send a photo. calmerwaters410@gmail.com

I’d like to share something that my husband said to me three years before he passed away from younger-onset Alzheimer’s disease. This is in response to being asked what it’s like to have Alzheimers.

In Morris’s wordsMarch 2007

One time I feel one way and another time I feel a different way. I cope by finding things to do. I read, talk to people, go out to lunch with my friends. I feel just like anybody else, but I’m limited in things that I want to do, or where I want to go. I have to have someone take care of me. I would rather be my own person and do what I can do as much as possible. It’s not great having this [Alzheimer’s] and there’s not much I can do about it. But I do have lots of great friends and family, and I’m lucky to be able to think and act and live a partial life.

I’m not very happy at times. It’s not easy for me, and my wife tries to help as much as possible. I feel frustrated. I can’t have my car, which was taken away. I don’t have as many options. We have our TM lunch*; one of the things I look forward to. That’s a happy thing to do. Having people around is obviously good. I like watching movies and TV.

Sometimes I don’t know what to do, or I forget things and have to depend on my wife. I’ve had things taken away from me. When I first got the diagnosis, I thought it was a bunch of crap. I didn’t think the doctor had the right diagnosis and that I was pretty much okay. Now I understand that I have Alzheimer’s disease and things are more difficult. That’s the way it is. Having a support group is very important to me. Sometimes I get frustrated and sometimes I feel that I’m still a human being and that I can do things.

I know I’m taken care of.  I’m able to just be a good person that other people want to be around. I’m already enlightened in my own way. I feel like I’m my own being, my own person, and am living a life to the best of my ability. I like music and culture. I’m very lucky to have a support group of friends and family. In this life, I’m doing the best I can and I’ll continue to with friends and family.

I want to be treated like any other human being. My message to others is try to find your own happiness and do the best you can. I still like to meditate and I like to take a nap every day. I am getting more tired. I can’t do a lot or do as well as I used to do.

* About a dozen friends who practice Transcendental Meditation have been meeting regularly for lunch every Tuesday for the past 18 years.


This morning, I listened to an interview with the flutist Eugenia Zuckerman on NPR. Sadly, she was diagnosed with Alzheimer’s three years ago. This past September, Zukerman was playing Claude Debussy’s “Syrinx” — a piece she said that she’s played more than 20,000 times since the age of 10.  In the middle of playing it, she drew a sudden blank.

Eugenia said that she wants people to know that having cognitive decline is “not the end of the world.” At this early stage of the disease, she is able to write, play the flute, and enjoy her everyday life. Her recently published book “like falling through a cloud” is a lyrical memoir of poetry that addresses coping with forgetfulness, confusion, and a dreaded disease.

Eugenia spoke of living each day to the fullest—a definite mantra of mine and most people.  I am happy that she is enjoying her life by loving, sharing and playing her flute. But she doesn’t have a clue about what’s in her future. There will tragically come a time when her memory lapses manifest as blank stares. She may eventually not be able to recognize her face in the mirror and ask the existential question who am I? 

I wish you, and Eugenia’s family and friends peace and strength on the hard journey ahead. Make each day count and, as Morris said, live it as well as you can. There will be days that are hard to get through, and days where you just want to stay in bed. Even if you have to drag yourself out of bed, do at least one thing that will bring you an inkling of joy. Make a cup of chai, take an Epsom salts bath, light a candle. Take a whiff of your favorite essential oil. Remember the good times.

 


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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.

What if your dementia patient becomes abusive, aggressive or violent?

Angry, enraged senior woman yelling at a landline office phone, unhappy with customer service provided by the agent on the other side, giving off steam and smokeMy husband Morris was a gentle man. But occasionally, if things didn’t go his way, he would get nasty. Once Alzheimer’s took his brain hostage, he exhibited a darker side. But only when he was frustrated or confused.

Morris spent the last two years of his life in a memory care home. He was popular among the staff because he liked to goof around. When he walked the halls listening to music on his Walkman, he’d have a smile on his face and swagger to the rhythm. But if another resident got in his way, watch out. If it was crowded in the dining room and someone accidentally bumped him, he’d swing his arm out to shoo that person away. When one of his neighbors walked into Morris’s room mistaking it for his own, the two got into a rumble on the bed and fought like school boys. After this happened a couple more times, the neighbor was moved to the opposite side of the facility.

When Morris hit a resident in the dining room, the on-call physician prescribed a depressant to “calm him down.” Morris reacted to the drug by transforming into a zombie who slumped in his chair and slept too many hours during the day. I insisted that he get off the drug and Morris returned to his mostly cheerful self.

I once had a next door neighbor whose wife had Alzheimer’s. She threatened to kill her husband with a knife and then went on to slash a painting hanging in their living room. Was she or Morris responsible for their actions? No. A person with dementia is not responsible for acts of violence because as the disease progresses, neurons in the cortex that are responsible for language, reasoning and social behavior are destroyed. This leads to some Alzheimer’s patients engaging in aggressive or violent behavior such as biting, kicking, spitting, slapping, punching, and/or using foul language.

Research from the National Institutes of Health indicates that up to 96 percent of patients with dementia who were studied over a 10-year-period exhibited aggressive behavior at one time or other. In 2011, CNN Health reported that 5 to 10 percent of Alzheimer’s patients exhibit violent behavior at some point during the course of the disease.

There is usually a reason for aggressive behavior.

What to watch out for

  • Urinary tract infection
  • Pain or stress
  • Loneliness, depression
  • Too much noise or stimulation
  • Boredom
  • Constipation
  • Soiled diaper or underwear
  • Uncomfortable room temperature
  • Physical discomfort (stomach ache, etc)
  • Confusion
  • Anger about loss of freedom (to drive, living independently)
  • Drug reaction or contra-indication
  • Resistance against being told what to do such as bathing
  • Sudden change in routine, environment or caregiver
  • Communication problems
  • Hunger or not liking the food
  • Dehydration

What to do

  1. If your life or the life of the person you care for is in danger, get help immediately!
  2. The Alzheimer’s Association has a 24-hour helpline at 800-272-3900.
  3. Rule out UTIs, pain, discomfort, etc.
  4. Use an essential oil to help calm the person down. When my husband got agitated I’d put a few drops of oil on a cotton pad inside a diffuser and plug it into the wall. He usually calmed down immediately.  The following oils can be used in a diffuser, or put in a bath or fragrance free moisturizer. They can also be sprayed on a pillow or handkerchief. Citrus oils are generally refreshing and uplifting for the mind and emotions, relieve stress and anxiety, and are useful for odor management and appetite support. Consider: bergamot, grapefruit, lemon, and orange. Floral oils are often used as a personal fragrance and are useful to relieve anxiety, depression, and irritability. These oils are useful as an inhaler, in a body lotion, and for the bath. Consider: clary sage, geranium, lavender, rose, and ylang ylang. Tree oils are revitalizing with immune boosting properties, ease respiratory congestion, and are supportive to breathing ease. They are useful for pain relief, skin infections, and odor management, and can relieve nervous exhaustion and depression. Consider: eucalyptus (Eucalytpus citriodora or globulus), pine needle, sandalwood, or Tea Tree.
  5. Reassure your patient by speaking gently and calmly.
  6. Play calming music, i.e. Mozart
  7. Try to distract the person with a TV show, favorite snack (ice cream almost always works), or a walk outside.
  8. Maintain a regular routine.
  9. Make sure the lighting is suitable in the home or facility.
  10. Help the person to maintain as much dignity and independence as possible.
  11. Make sure the person is eating a nutritious low-sugar, low-salt diet, with no or very limited amounts of alcohol and caffeine.

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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.

5 Things that Help Dementia that your Doctor Probably Hasn’t Mentioned

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Photo by Anastasia Dulgier

As a researcher and writer for manufacturers of nutrition supplements, I was in a unique position to care for my husband who was diagnosed with younger-onset Alzheimer’s disease right after his 60th birthday. Morris had opened and operated one of the first natural foods stores in Colorado in the late 1960s. After we married in 1974, I helped him run it. Working in a natural foods store was a natural fit for me because I had been a vegetarian for several years and was eager to learn more about natural health.

Later, I obtained a master’s degree in professional writing and my first job out of school was working as chief copy writer for a manufacturer of nutritional supplements. I learned a lot about supplements and ended up forming my own copy writing service. I learned how to interpret scientific studies, which especially came in handy when Morris was diagnosed with Alzheimer’s disease.

After the initial shock, I immediately went to work researching the drug protocol for Alzheimer’s. I discovered Namenda before it was FDA approved in the U.S. and ordered it from a European company. I gave Morris nutritional supplements, in addition to the prescribed pharmaceuticals, and butted heads with the neurologist who didn’t think that vitamins or minerals could possibly help someone with Alzheimer’s disease.

There have been some negative studies indicating that supplements don’t relieve symptoms of Alzheimer’s disease. But from what I can tell, they have been poorly designed and seem to be the fodder for sensational headlines. But there have also been many studies that show some dietary supplements can slow down dementia symptoms, and in some instances even reverse symptoms.

My purpose is not to convince you one way or the other. Rather, I encourage you as a caregiver to learn about dietary supplements and other modalities that have science backing them up.

  1. Souvenaid is a once-daily drink containing a mixture of long-chain omega-3 fatty acids, uridine, choline, B vitamins, vitamin C, vitamin E, and selenium) with some clinical evidence to suggest that it can benefit dearly Alzheimer’s patients. Doctors can prescribe it as a medical food in Australia and Europe, but it is not yet available in the United States. It is, however, available online. Read about the clinical evidence here: https://alzres.biomedcentral.com/articles/10.1186/s13195-019-0528-6

2. What about the use of cannabis for dementia? I live in Colorado where cannabis has been legal since 2014. Medical marijuana has been legal here since 2000. My husband smoked marijuana before it was in legal in Colorado to relieve his anxiety. He also ate “edibles.” It definitely calmed him down and made him happy, which may be the best outcome associated with cannabis. I did not notice any cognitive improvement.

This is the latest study on cannabis for dementia, published July 17, 2019.

 Limited evidence from one systematic review and one uncontrolled before-and-after study suggested that medical cannabis may be effective for treating agitation, disinhibition, irritability, aberrant motor behavior, and nocturnal behavior disorders as well as aberrant vocalization and resting care, which are neuropsychiatric symptoms associated with dementia.

There was also limited evidence of improvement in rigidity and cognitive scores as assessed by Mini-Mental State Examination. The evidence from the systematic review came from four of its primary studies, whereas its remaining eight included studies did not find favorable or unfavorable evidence regarding the effectiveness of cannabinoids in the treatment of dementia. Sources of uncertainty included the low quality of evidence in the primary studies of the systematic review and the fact that the uncontrolled before-and-after study was a nonrandomized pilot study in 10 dementia patients that reported descriptive outcomes without statistical analysis. No relevant evidence-based clinical guidelines regarding the use of medical cannabis for treating dementia were identified.

3. Vitamin D has been associated with memory loss and cognitive decline. Older adults with low vitamin D levels are at higher risk of dementia and may lose their cognitive abilities faster than those who have normal levels. This is one of the several reasons why everyone, except maybe those who work outdoors year-round, should take a vitamin D supplement.

4. Vitamin E includes several compounds: d-alpha tocopherol, high gamma tocopherol, mixed tocopherols and tocotrienols. Headlines have screamed that people who take more than 400 IUs of vitamin E have a 5 percent greater risk of death than those who don’t take the supplement. Unfortunately, the studies analyzed in this report used only alpha-tocopherol, a synthetic form of vitamin E. The studies were flawed in many other ways, but the important thing to understand is that when you take a full spectrum vitamin E, you are protecting your brain, your heart, and your overall health. A recent study looked at the relationship between tocotrienol and Alzheimer’s disease. Based on its ability to act as a free-radical scavenger, the authors concluded that it has the potential to help reduce risk of Alzheimer’s. https://www.ncbi.nlm.nih.gov/pubmed/29987193

5. I gave St. John’s wort to my husband until he was in late-stage Alzheimer’s disease. By then he needed a pharmaceutical anti-depressant. But the St. John’s wort worked well for mild to moderate depression.

Here’s what we know about St. John’s wort:

Pharmaceutical drugs usually come with a long list of possible side effects. Although some natural products can also have side effects, they are not as common and are usually less severe. One thing to note, though, about natural products is that it may take longer for them to be effective.

It’s always important to read and study when caring for a loved one. Become an informed caregiver. It will help you, your extended family and the person you so lovingly devote your time and energy to. Blessings to you.


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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.

Caring for a Parent who is Resistant to Care

Upset womanIt’s typical for our parents to resist moving out of their homes if they need to be cared for or need assistance in a long-term care facility. They may think their children are bossy and forcing them into a situation they didn’t choose. People, in general, are also often resistant to having an aid or personal carer other than family in their home.

A friend of mine had to move his parents, who were no longer able to care for themselves, into an assisted living facility. His mom had broken her hip and his dad was blind. After spending a couple of weeks settling them into their new home, David’s mom accused him of kidnapping her and his dad. In the end, after David returned home, his parents found a way to move back into their condo. There are bad feelings on both sides and now David and his parents are not speaking.

When the roles of parent and child are reversed, awkward moments and emotions can arise. The adult child may feel resentment at having to provide support and/or care for the parents because the extra time detracts from his or her normal routine and work schedule. Sometimes there is a financial burden placed on the adult child. The parents may feel disempowered when their freedoms are limited or taken away. They may feel financially stressed, and not want to “be a burden.”

Here are some ways to help you navigate this touchy and stressful subject.

  • Talk with your parents’ Primary Care Physician to get a clear picture of their physical needs.
  • Although you want your parents to be safe, above all else, respect their perspective and autonomy. Listen with an open heart and mind, and share your concerns. Tell them you know that this is hard, and that you are concerned about their welfare and safety.
  • Validate their feelings. Ask non-threatening, open-ended questions about the type of care they might be willing to accept. “Mom, wouldn’t it be great if you didn’t have to cook or do laundry anymore?” “Dad, do you miss having coffee out with your friends?” Their answers will provide you with the opening to a discussion about how a caregiver or assisted living situation can make their lives, and yours, easier.
  • If finances are an issue try to enlist the help of a close friend, neighbor or family member once or twice a week for a couple of hours to assist with meal preparation, etc.
  • If this works and your folks get accustomed to having someone in their home, hire a caregiver agency to provide more care as needed.

What if you’ve tried everything you can think of and your parent is still resistant to help. Or what if your sibling wreaks havoc on what you’ve done?

If you sincerely believe that your parent’s behavior is contrary to what they typically exhibited previously; if they are unsafe in their home or are a danger to them self or others; if you have considered their dignity with respect, and you believe that their mental capacity is impaired as well as their decision making, you can activate a Medical Power of Attorney (MDPOA).

This is a legal document that authorizes someone to make medical decisions on behalf of another, only if one is already in place. If one is not in place and things are getting dire, consult with an elder attorney to determine if it makes sense to have a court appointed guardianship. This would be a last resort.

Most importantly, treat your parents with respect and honor their wishes the best that you can, always keeping their safety as a priority. Most everyone wants to stay in their home as long as possible. It’s hard bringing up this topic with our parents, but the earlier the better, especially when one of your loved one has dementia.


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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.

 

 

 

 

Did you know that napping can be an early Alzheimer’s warning sign?

Tired.

Senior sitting and sleeping. 

Researchers at the University of California (several campuses), and University of Sao Paulo recently found that if you need to nap more than usual, and if your nap time is getting longer than it used to be, it might be an early warning sign that you could develop Alzheimer’s disease.

Even if they’ve had a full night’s sleep, many people with Alzheimer’s will sleep a lot during the day. Now, based on this new finding, researchers are considering that examining daytime napping might help predict the future onset of Alzheimer’s disease.

The researchers were concerned about what comes first: sleep changes that play role in the development of Alzheimer’s or if changes in a person’s sleep pattern is indicative of the beginning of Alzheimer’s.

Dr. Lea Grinberg, senior author of the findings, which appear in the journal Alzheimer’s & Dementia, explains that her team found evidence that an entire network of neurons that keeps us awake is wiped out by the accumulation of tau proteins which form tangles that disrupt communication between brain cells.

The researchers studied postmortem brain tissue of 13 deceased Alzheimer’s patients who had donated their brain to research and compared them to others without the disease. They found that in the Alzheimer’s brains the three areas of the brain that keep us awake (the locus coeruleus, the lateral hypothalamic area, and the tuberomammillary nucleus) had lost 75% of their neurons.

Researchers found “considerable amounts of tau inclusions” in the awakening areas of the brain, the study said.

Tau is a protein whose normal function is to stabilize a particular part of the neuron in all species. In the brain of someone with Alzheimer’s, tau acts abnormally and destabilizes the neuron. The build-up of tau protein is one of the main culprits of Alzheimer’s disease.

The researchers said that it’s unclear how long it takes to notice memory loss after sleep pattern changes occur.

Sadly, the study’s lead author Jun Oh said in an article by Maria Cohut published in Medical News August 18, 2019, said that “It’s remarkable because it’s not just a single brain nucleus that’s degenerating, but the whole wakefulness-promoting network. Crucially, this means that the brain has no way to compensate because all of these functionally related cell types are being destroyed at the same time.”

As a result of this study and one in the past, she said, they have received funding to keep looking into changes in sleep patterns before memory loss begins.

The NIH and Rainwater Charitable Foundation are investing $1.4 million per year to this research group to continue their research into other areas of the brain responsible for promoting sleep and the areas that regulate circadian rhythm, as well as sleep pattern changes that occur before memory loss begins.

Until we know more, if napping is a normal part of your routine,  you don’t have to worry about taking a mid-day or mid-morning siesta. But if your pattern has changed, it might be a good idea to make an appointment with your physician to discuss your sleep habits and to rule out other medical conditions.

In the meantime, make sure your sleep hygiene is optimal. Click here for 16 ways to sleep better.

Good night, sleep tight.


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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.

The 20 most important things to consider when looking for a memory care home

seniorenheim 6The day I moved my husband into a memory care home was the second worst day of my life. The worst day was the day he was diagnosed with Alzheimer’s. And both of those days were worse than the day he died.

After the diagnosis, I didn’t waste any time getting our finances sorted out, talking to an elder attorney about options, and learning about Medicare benefits. I did, however, wait a year before I contacted that Alzheimer’s Association. That was a mistake because this amazing association offers so much good information and support. So do yourself a favor and contact your local chapter and take advantage of all the free classes and support groups they offer.

After several years of caring for my husband at home, and downsizing to a more manageable home, I was advised to start looking for a memory care home in case an emergency situation arose.  I wanted to keep my husband at home as long as possible. But things happen, and in my case, I received a serious diagnosis. My doctor said that I needed to take care of myself and I listened to him. I got recommendations about a few homes in my town, found one I liked, and put my husband on the waiting list.

Many facilities will allow you to get on a waiting list. When your name gets to the top, you might have the option to refuse because you are not ready. In this case, you can move down the list but still have priority over someone who is recently added. Ask about this option.

The home where my husband lived for two years provided good care, but did not live up to the promise of caring for him until the end of his life. In fact, the last month of his life included several moves. After being discharged from the hospital, Morris was sent to a rehab center in a nursing home. It was not a good situation. The food was horrible, and the care was sorely inadequate. After two weeks, I begged the original home to take him back. They agreed to only if I hired additional one-on-one care. I did, but the cost was prohibitive. I moved him again after finding a wonderful end-stage Alzheimer’s unit down the hall from a hospice center. Morris received excellent compassionate care there the last two weeks of his life.

Here’s list of 20 things to look for and ask in your search for a memory care home:

  1. Look at your state’s Public Health and Environment website to see a facility’s number of beds, complaints, medical director, ombudsman’s phone number, and whether the home is Medicare and/or Medicaid certified. Here you can discover things like mishandling of narcotics (oxycodone), and theft of residents’ belongings, etc.
  2. What is the staff to patient ratio? During the day? At night?
  3. Is there a RN (registered nurse) always on the premises? Is a doctor always on call?
  4. How often does a medical doctor visit the facility?
  5. What level of care does the home provide? Can your loved one stay there until the end of his/her life? What if your loved one becomes non-ambulatory?
  6. Are three meals a day provided? What about special diets such as kosher, vegetarian, low-salt?
  7. What type of training has the staff received?
  8. What is the staff turn-over rate?
  9. What is the monthly rate for housing and care? What services does that rate include?
  10. Are rooms private or semi-private? How do prices vary for each?
  11. Is housekeeping and laundry provided? How often?
  12. What programs are offered? Social, educational, outings, exercise?
  13. How secure is the unit? Are residents locked in? Is there any chance a resident can leave and wander? Has this ever happened?
  14. What happens if the resident becomes aggressive or violent? Is he or she drugged? Given a warning that he or she must move out?
  15. What is the chain of communication for letting family members know what is going on with a loved one?
  16. What is the discharge policy?
  17. Are pets allowed?
  18. Are visiting hours limited or open?
  19. What is the protocol for a medical emergency?
  20. Visit the facility and look around. Are the staff appropriately dressed? Are they warm and friendly? Is the environment pleasing and clean? Does the executive director address residents by their name? Would you be comfortable having your loved one live there, and would you be comfortable spending many hours there?

No one ever wants to live in a nursing home or assisted living facility. But when your loved one needs more care than you can provide, is a danger to him or herself, or you, the caregiver, need to take care of yourself, a memory care home can provide a warm and loving option. Good luck finding one that suits your needs and the needs of your loved one.


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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.

How dehydration can lead to delirium and other health issues

Different drinks in glass jugs on white background. Ideas for summer cocktailsIt’s hot outside and it’s easy to get dehydrated. Our body is 50-65% water. The brain, which is 70% water, 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.

Dehydration can also result in delirium. Delirium is a mental disturbance that is exhibited by a new or worsening confusion, changes in one’s consciousness or by hallucinations. It has a sudden onset from hours to days. It can be reversed but it’s easier to prevent delirium than to reverse it.

When my 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 mouth, no tears when crying, decreased urine output, sunken eyes, headache, lethargy, dark urine and extreme thirst. The mental symptoms are not as obvious, but can result in mental confusion, irritability and delirium.

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.

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

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by 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.

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).

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

Always: Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.

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—in summer and all year round.

 


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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.