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Reader Question:

I have a question regarding how to handle a combative dementia patient. My husband and I care for my 51 year old daughter. She is in her 5th year of dementia and hates bath time and getting re-diapered. She is also getting more and more agitated in general.

We have zero outside help as she has no insurance and so far has been denied any government assistance.

My concerns are for her safety as well as mine… she hits and trys to bite … she poops when she gets excited and angry which is a problem when I have to put the clean diaper on her.

It takes 2 people to get her bathed and dressed and her diaper is soiled by the time I get her “anti-strip pj’s “on her!

She does have a doctor the free clinic at the county hospital system… but I have to figure out a lot of this on my own… should I ask for a mild sedative to use for her bath time… we try to bathe her 2X a day.

Thank you! Sincerely,
Yvonne

 

Hi Yvonne,

When it comes to how to handle a combative dementia patient, I am not a medical professional, so my advice is purely from my experience. I’ll do my best!

Agitation is a very common symptom with dementia. My advice is to look for both clinical and non-clinical solutions.

Non-Clinical Dementia Care

Dementia is scary for the person experiencing decline. As a person who has had a minor stroke, I experienced the tiniest touch of cognitive impairment.

I can remember looking around at my family. My head knew they were important, but I couldn’t remember why. I could see by the looks on their faces that something was wrong with me, but I couldn’t grasp what that might be. The experience was disorienting and terrifying to say the least.

I imagine this is how it is for someone experiencing dementia. So, the goal is to reduce stress and agitation while preserving safety, health and freedom.

Take note of activities that cause agitation. Does your loved one seem more agitated at night (very common) or morning. Is agitation mainly due to a certain task like meals, bathing, or bed?

Once you notice of what triggers agitation, avoid it.

I know I know, no kidding right, but stay with me.

If bath-time stresses your loved one, then consider doing it less frequently (as long as there is not a soiling issue).

Your loved one may have bathed daily for 60 years, but dementia brings many new normals. It could be time for a routine change.

I met a creative woman who COULD NOT get her husband into the shower, but he would sit with her in the hot tube where she could wash him. Small wins.

Maybe showering is out right now, but your loved one would stand for a sponge bath or wipe down with a disposable cloth. This article is about giving bed baths, but many of the same principles apply to dementia bathing.

Dementia care is less about getting the task done and more about making sure your loved one is safe, healthy, and comfortable. If it isn’t really necessary, ask yourself if it must be done.  Creative care is dementia care.

Now, lets address non-negotiable care. You cannot leave a loved one in a soiled adult diaper, but often this is a highly stressful activity for both you and your charge. Try your best to keep the environment calm. You might find that taking breaks between tasks gives you both a minute to compose.

For instance, waiting to re-diaper might give skin a chance to breath and your loved one to relax.

Try putting on a favorite song or show while completing a task that is unpleasant. Trying singing something you both loved to trigger a calmer atmosphere. Make a cold bathroom warm before shower time.

Remember, with dementia care, we go where the patient is. They rarely come to us.

Clinical Dementia Care

Sometimes, no matter how comfortable the environment, your loved one will still experience anxiety, and care will still need to take place.

This is where a close relationship with your physician is a must.

You are not a doctor BUT you are an advocate. This is one of your most important roles. The doctor may spend 10 minutes with a patient, but you see that person all the time.

If something isn’t working in the best interest of your loved one, speak up. If your doctor doesn’t like it, get a second opinion.

I would set an appointment and share your situation with your doctor. A sedative may not be what he or she prescribes. But, there are medication options that might make everyone more comfortable.

I have seen clients who hit and bite transform with the proper medications. This a journey. Meds may need to be adjusted or changed as dementia progresses. Do not hesitate to communicate with your doctor if meds don’t work or results change over time.

If you don’t feel you are getting the proper support from your doctor, request a specialist. Neurologists specialize in conditions that affect the brain. You for sure could use one of these experts in your court.

Support

Dementia care may feel lonely, but you are not alone. Often, it seems the only options are private paid care – like what Green Tree Home Care offers – and government assistance.

Unfortunately, many people fall into a care gap where private pay is out of reach and they don’t qualify for government help.

There is a large number of non-profit organizations that exist to fill in this gap!

For those caring for loved ones with dementia, the Alzheimer’s Association is an amazing resource. There should be one in your area.

In San Diego, where I am based, we have Jewish Family Service. This organization has programs to help older adults with hands on care and care management (you do not have to be Jewish to receive help).

The Parkinson’s Association also has a large presence.

These organizations can help you better understand what resources are available in your area.

There are professionals called Care Managers who help people manage the medical and non-medical ageing landscape.

They generally charge for their services unless they are connected with an organization. But, it may be worth a call to see if one in your local area has any resource ideas.

These professionals are often nurses or social workers and have a strong understanding of the local care landscape.

While there is no simple solution to how to handle a combative dementia patient. Small adjustments can have a big impact!

If you are in the San Diego, Orange County, or Riverside areas of California, please feel free to reach out to use for more help.

 

 

 


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5 activities you can continue to do even if you’re social distancing

Another wave of COVID-19 rages on.

And perhaps you have not had the chance to see your loved ones in months.

Or if you have, it has been at a distance and with masks on and/or limited contact.

Now that the new vaccines for COVID-19 are slowly being rolled out, there might be relief on the horizon for us.

But until then, we still have to practice social distancing to slow how fast the virus spreads as well as to protect vulnerable, high-risk populations.

In this post, we’ll talk about activities you can still be involved in that will help alleviate the isolation and boredom you may be feeling from having to observe social distancing rules.

5 activities to beat boredom as social distancing continues

Take a walk in nature

There is nothing like getting fresh air by walking through your local park, nature reserve, or a nature trail.

If you live in Southern California, then there is no end of places for you to go and enjoy such.

If you live in the more temperate regions of the country and already have snow, don’t let this stop you! Even a walk through your neighborhood can do so much good.

Host a virtual dinner party

Family cannot come over for a real, in-person dinner party?

You can use video call services to host your very own tech-savvy dinner party with friends and family.

Make sure to set the table and prepare your meal just as you would if people were coming over.

Not only will it provide you with a sense of accomplishment; you will also prepare your body and mind for the social event just like you would if it were in-person.

Host a virtual game night

Just like the idea above, you can host a virtual game night with friends and family over video conferencing software like Zoom.

You can even have all the in-game excitement and arguments! And you will create memories with the people you love.

Go to a drive-in movie

Tired of staying at home?

There are cities around the US that are now throwing it back to the days of drive-in movies.

You don’t have to leave your car.

You can eat all the popcorn you want, and not buy the overpriced one at the cinema!

This is an activity you can share with your loved ones – all of you can drive separately to the movie and share in the outdoor experience.

And in the end, you will derive satisfaction from enjoyed the experience with people you love.

Start a project you’ve been putting off

Whether it is a home improvement project (elders should approach these with care), a knitting project, a painting, or simply a crafting project you’ve been putting off, now is the perfect time to get started on it.

So get to it!

 

I know having to be apart from the people you love is hard.

This virus came and changed our lives for sure.

With the new vaccines, it looks like there is light at the end of the tunnel.

Until we are in the clear, however, social distancing and wearing masks will be necessary.

If you’re having a hard time coping, these activities will help take away the boredom of life with social distancing.

Photo credits SeventyFour on istock.com


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November 13, 2020 Family Caregiver0

What is temporary aphasia? Learn more about it in this post.

Aphasia is a language disorder in which a person may not be able to speak or understand speech.

Sometimes, a person with aphasia will speak but may use the words incorrectly or will have garbled speech that makes no sense.

In this post, I’ll cover what temporary aphasia is in this post, what you should know as a caregiver, and how you can help.

What is temporary aphasia?

Temporary aphasia is also called transient aphasia.

For most people, temporary aphasia will happen after they experience a stroke or when they experience a migraine.

Other health problems that may trigger the condition include:

  • A developing brain tumor
  • A head injury
  • Seizures
  • Brain infection
  • Or a progressive neurological disorder like Alzheimer’s disease

Each of these causes can impact the areas of the brain that control how we speak and understand words.

The good news, however, is that this is a problem that can be easily overcome with speech therapy and the right support.

Signs of aphasia

The following signs may indicate that your loved one is experiencing transient aphasia.

  • Sudden difficulty in getting their words out
  • Trouble understanding the words you or someone else is saying to them
  • Difficulty reading or writing
  • The affected person may speak the wrong words or unintelligible words
  • When asked to write, your loved one may write incorrect words or words that don’t make sense

While these are strong indicators that your loved one is experiencing aphasia, doctors may have to conduct an MRI exam to make a definitive diagnosis.

What can you do as a caregiver?

The first time you observe a loved one experience temporary aphasia, it will be bothersome.

Remember that for your loved one, it is bothersome as well.

Temporary aphasia usually does not require treatment. And in most cases, it may happen once and never again.

However, if the condition recurs, your loved one may need extra medical attention to diagnose and treat the underlying cause.

If your loved one has experienced transient aphasia more than once, you and your loved one can create a card that has their name and describes what temporary aphasia is. This card should also have the number and number of an emergency contact who can be reached in case you are not around.

 

 

 


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July 27, 2020 Family Caregiver0

Living with cirrhosis: risk factors, life expectancy and tips for caregivers.

Cirrhosis is a serious chronic progressive disease that affects the liver.

The on-going disease destroys the liver cells called hepatocytes.

As the disease progresses, the liver becomes scarred. And this scarring ultimately leads to liver dysfunction.

Although cirrhosis can be managed and slowed down, it is a serious illness that can lead to death.

Living with cirrhosis: what causes cirrhosis?

Most people associate cirrhosis with alcoholism.

And while this is a major risk factor for the disease, it’s not the only reason a person might have cirrhosis.

Other causes of cirrhosis include:

  • As a complication of a liver infection (hepatitis)
  • Exposure to hepatoxins (or chemicals that are toxic to the liver other than alcohol)
  • Severe, right-sided heart failure which results in an enlarged and fluid-filled liver

Thus if you have a loved one who has heart disease or has had hepatitis in the past, these could serve as risk factors for cirrhosis too.

How long can you live with cirrhosis of the liver?

Surviving cirrhosis depends on multiple factors including age, the overall health of the person and the cause of cirrhosis.

Thus how long a person can live with cirrhosis will differ from one person to the next.

There are four stages of cirrhosis.

The four stages of cirrhosis

  • During stage 1, patients lack energy and constantly feel tired. The liver is inflamed at this point and the individual may have a swollen abdomen. Cirrhosis can be reversed at this stage if a doctor detects it early and the patient makes the right lifestyle changes.
  • During stage 2 of cirrhosis, the pressure in the veins surrounding the liver begin to rise. This happens because of an obstruction in blood flow to the liver. This is called portal hypertension. With reduced blood flow and increasing scar tissue, cirrhosis could be slowed at this stage but it may not work.
  • Ascites – or fluid accumulation in the belly area – develops during stage 3 of cirrhosis. At this point, the veins are congested and so a lot of fluid gets trapped in the abdomen. More scar tissue develops in the liver. Other symptoms like itchiness, lack of sleep and weight loss happen at this stage. Jaundice also happens at this stage. Jaundice is a yellowing of the skin and tissues that happens because the liver can no longer break down a substance called bilirubin. At stage 3, cirrhosis is irreversible. And at this point, the individual becomes a candidate for a liver transplant.
  • The symptoms associated with stage 3 cirrhosis are similar to stage 4. During the final stages of cirrhosis of the liver, confusion, personality changes and hand/muscle tremors become common.

What can you do as a caregiver?

At stages 1 and 2 of cirrhosis, we can still do a lot to slow down the disease.

You can help your loved one make lifestyle changes like:

  • Quitting alcohol
  • Exercising regularly
  • Eating a balanced diet of meals
  • Restricting sodium and fluid intake (especially when ascites starts)
  • Following medication regimen that is prescribed by a qualified medical provider
  • Quitting opioid and narcotic intake
  • And even in following medication regimen, make sure you are reading labels to ensure medication will not harm your loved one’s liver.

During stages 3 and 4, cirrhosis is not reversible.

At this point, you can mainly provide supportive care to your loved one as they wait to get a liver transplant.

  • For a loved one who is confused, provide a safe environment so they don’t hurt themselves.
  • Elevate the head of the bed while they sleep. This reduces shortness of breath.
  • Monitoring your loved one’s level of consciousness.

During these stages, it might be time to consider working with professional caregivers so that your loved living with cirrhosis can get the proper care they need.

 

 


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