Tuesday, March 27, 2012


     Mom woke at 4 a.m.  She was too restless to go back to sleep and she didn’t want to stay in bed and look at the spots on the ceiling.  She shuffled around the house in her nightgown and bare feet.  She made a cup of coffee and stared out the window into the dark until the sun came up.  I heard her moving downstairs and went down to see what was wrong.  She looked up at me and said, “It’s going to be  a long day.”  Se looked so hopeless so unhappy.
     Depression can do that to you--make you feel that you are not needed by anyone--alone--forgotten.  This is one of the most common mental health problems faced by older people.  They find themselves feeling sad, empty, alone, and they don’t know why.  Sometimes it is because they don’t feel that society needs them any longer.  They will withdraw from friends, family, and all the activities they used to enjoy.  Sometimes they will sit around all day in their nightgown or pajamas and robe, sleeping on and off.
     Depression is more than just a sad feeling for the elderly.  It can be a serious threat to their health.  When an elderly person is depressed, they are more prone to illness and infections, and when they do get sick, they don’t recover as quickly.
     As a caregiver, this can pose problems for you.  You are already overwhelmed and exhausted by the added responsibilities and you may be feeling a little resentful about the heavy demands put upon you.  You try to keep everyone else happy, but all your plans and fun activities must be put on hold.  You may be feeling a little depressed yourself.  Watch out for depression--it can sneak up on you fast.  If you have been feeling constantly tired, or having difficulty sleeping, watch out. You may also be uninterested in the things that used to bring you pleasure.  These are all clues that you may be depressed.

Wednesday, March 21, 2012


     Some of the symptoms, such as paranoia, delusions, depression, agitation, sleeplessness and anxiety, can be managed with a variety of medications.  It is also important to see that the patient gets physical exercise and social activities, which are vitally important to good physical and mental health.  Of course, good nutrition is also very important for the patient.
     Big Crosby died after eighteen holes of golf in Spain.  He had a massive heart attack--he died quickly with dignity.  He died after doing what he enjoyed most in life---playing golf.  What a way to go!
     This is not, however, how an Alzheimer’s patient goes.  Most Alzheimer’s patients will progressively get worse for seven years, sometimes as long as fifteen years.
     Alzheimer’s and Parkinson’s diseases both viciously attack the body.  Alzheimer’s ravages the brain and Parkinson’s attacks the nervous system.  Both conditions can reduce a big strapping man to a bent over, doddering old man with urine-stained pants.  The one thing we all dread can strike the ones you love so quickly, and there is little we can do about it.
     One and a half million elderly Americans are afflicted with Parkinson’s disease and four million with Alzheimer’s and these groups are growing.  Serious illness means that their “golden years” aren’t so golden anymore.
     Taking a loved one who suffers from either condition into your home can trap you between compassion and frustration.  Your life is disrupted by an incontinent person who is almost childlike, but one that you love dearly.  What do you do?
     You take them in and do the best you can for them.  If you have small children as well it makes the job even harder.  But at least you know they are safe.
     If you are lucky there is an adult day care center in your community that can help you during the day, and maybe a friend or two to take your patient on an outing once-in- awhile, to ease the day for them and for you.
     When the time comes that you can no longer give the care they need, then a special home becomes a place in which they are placed to spend their last months or years, away from everyone they love.  It may tear your heart right out of you, but at least you have the satisfaction of knowing you did everything you could for your loved one, no matter how difficult it was at the time.
     No matter whether the problem is Alzheimer’s, Parkinson’s disease, or simply old age, we are not responsible for the happiness of our aging parents any more than we are responsible for the happiness of our children, spouses, or siblings.  People are responsible for their own happiness. You can provide for some of their needs, but you can’t turn back the clock and make them young again.
     It is too bad we can’t all go like Bing Crosby did, quickly and with dignity.

Friday, March 9, 2012

     Sitting in the chair next to the window, with the sunlight warming her wrinkled face, she looks like she might be sleeping.  But, the only thing sleeping is her mind.  She is in the late stages of Alzheimer’s disease.  Forgotten are all of life’s beautiful memories that should be comforting her in her declining years.  Gone are the visions of her children playing in the yard as they grew up.  Even her husband is a stranger now.  She looks at him with vacant eyes, a prisoner in her own mind.  She just sits alone in her room day after day, unable to care for her own needs, waiting for the inevitable---death.
    It’s a devastating picture to paint, but it is true all too often with Alzheimer’s patients.  This insidious disease tears your heart out, as you watch someone you love sink deeper and deeper into themselves, until there is nothing left of a once vibrant individual.
     Alzheimer’s disease does strange things to people.  In the early stages, it can be difficult to distinguish from ordinary forgetfulness.  But, eventually it will rob your loved one of all memory, even of the day-to-day routine of living.  They will forget how to dress, wash, pay bills, or even how to figure our what that bill is for.  They won’t remember how to write a check to pay the bill.  They will ask the same question over and over again, forgetting that they already asked it once.  They will forget how to tie their shoes, or they may even forget to wear their shoes.  They will misplace things, or hide them in strange places.
     These once dynamic people are shut down by the slow deterioration of their brains.  What is Alzheimer’s disease?  It is a progressive, degenerative disease that attacks the brain and results in impaired memory, thinking and behavior.  It affects an estimated four million adults in American.
     When the first case of Alzheimer’s was diagnosed in 1907 by a German physician named Alois Alzheimer, it was considered to be a rare disorder.  However, today it is recognized as the most common cause of dementia.
     According to Merriam Webster’s Collegiate Dictionary, dementia is a condition of deteriorated mentality often coupled with emotional apathy.  My Home Medical dictionary calls it a deterioration of intelligence.  Dementia is not a disease in itself, but a group of symptoms that characterize diseases and condition.  There are other conditions that mimic dementia, such as alcoholism, drug reactions. Thyroid disease, nutritional deficiencies, brain tumors, head trauma, and infections.
     Alzheimer’s disease is most likely to occur in an older person.  Approximately 10 percent of people sixty-five years or older are affected by Alzheimer’s disease.  As a person reaches eighty-five or above, the percentage rises to 47.2 percent.
     The families of Alzheimer’s patients feel the effects of the disease too.  The emotional cost, not to mention the social and financial cost, of care for Alzheimer’s patients is very high.  Family members work hard to keep them at home, until they can no longer deal with the problems inherent to the disease.  They risk their own health just to keep them at home, instead of placing them in an Alzheimer’s unit where they are more comfortable and easier to manage.
     There is no single test for Alzheimer’s.  It takes a complete physical, psychiatric and neurological evaluation by a team of physicians to come to a diagnosis of Alzheimer’s disease.  These tests should include a complete medical history, a test of mental status, a complete blood work-up, a urinalysis a chest X-ray, an electroencephalogram (EEG), a computerized tomography (CT scan), and an EKG (electrocardiogram).  This should tell the physicians if it is indeed Alzheimer’s or if the dementia is caused by some other, treatable condition.  They can make a diagnosis that is 90 percent accurate.
     Although there is no cure for Alzheimer’s disease at this time, there are reasons to hope.  New research is ongoing and promising breakthroughs are expected.  With the pharmaceutical companies testing and working to develop new medicines to fight this debilitating disorder, there is hope that Alzheimer’s will be a more treatable disease soon.

Friday, March 2, 2012

Stoke continued

     When the right side of the brain is damaged, the left side of the body is paralyzed and the patient has difficulty with judging distance, size, position, and rate of movement.  Sometimes we tend to overlook our other abilities because we put such emphasis on speaking.  If stroke victims can talk and understand speech, we assume they are unimpaired, but it might still be difficult for them to care for themselves.
     Remember a time when you were preoccupied while walking up the stairs, and you thought there was another stair but there wasn’t?  You were jarred when there wasn’t a place to put your foot.  Or, have you ever been reading and tried to put your coffee cup on the end table and missed the edge?  These are some of the common mishaps of a right-brain-damaged victim, because their perception is impaired.  They may not be able to get their wheelchair through a large doorway without bumping the frame, or read a newspaper or add a column of figures, because they lose their place on the page.  It’s important to know their limitations so you don’t misjudge your patient or think that they are being uncooperative, unmotivated, or confused.
     Right brain damage may also cause the stroke patient to overestimate their ability to perform easy tasks.  Sometimes they are unaware of their limitations and dive right in.  However, if they act too fast they can fall or hurt themselves.
     If you suspect this overconfidence, ask them to demonstrate their task before you let them go forth.  If they can handle the task, fine, but sometimes they can’t and you have to prove it to then.
     If you are having trouble teaching them a task, slow down and talk them through it.  Words are more effective than hand motions.  Take it slow and easy.
     Stroke patients can also have visual field defects.  Perhaps their vision is only half there and they may have difficulty seeing to one side or another.  Make sure their room isn’t cluttered, since they could fall over something in their way.
     My husband had a unique problem with his vision.  One of his eyes reversed itself.  Before his stroke it was nearsighted and now it is farsighted.  He also had a cataract develop on the right eye, but even after it was removed he couldn’t see peripherally, so it made it difficult for him to read.  He would lose his place because of his tunnel vision.
     There will be more problems with behavior, depression, brooding, forgetfulness and many other things to numerous to mention.  Each stroke victim is different.  A mild-mannered man may begin cursing and an extrovert may become introverted.  It is up to us to evaluate the problems and deal with them as best we can.  Use your ingenuity.  Be sure to discuss anything you don’t understand with your physician.  He can suggest ways to deal with each unique situation as it comes up.
     Stroke leaves an enormous impact: memory is lost, routine is forgotten, emotions surface, crying is not unusual, there is sensory loss, and depression often results.
     Healing comes from within, not just healing of the body, but healing of the mind with determination and hard work. The doctors take care of the body, but the mind is a different story.  It may snap back or it may take years to bring back even normal responses.  Be patient...it’s worth all the work you do.