By Christian Warren Freed
A few weeks ago, I found myself in an interesting situation. One I had not encountered in depth before. My wife, a real estate agent, had just sold a lady’s home of 30 years up in North Hills and she roped me into helping after the sale. You see, the homeowner had advanced dementia and it was just her (77 years young) and her 85-year-old sister struggling to deal with the sale, moving to an assisted-living facility (ALF), and settling their personal finances while trying to figure out what to do with a lifetime’s worth of stuff.
I was overwhelmed by it all and could only imagine what the family was going through. Adding insult to injury, the 85-year-old’s 92-year-old husband also suffered from the same. My wife and I are helping them until their affairs are settled.
The one thing that stuck with me the most was her sister saying how bad the cognitive decline had become. I didn’t see it until the day of the estate sale when she asked me three times if I bought some of the lemonade the girls across the street were selling from their driveway—after I had a pleasant conversation with her about it.
This got me thinking. If I don’t know anything about dementia or coping with it, how many other families out there are caught short when one of their loved ones begins the slow decline? To learn more, I turned to Heather Tierney of Senior Moments Consulting.
A subject matter expert with over two decades of experience as an occupational therapist working with older adults, Heather helped me understand better what we as family members can do to ease the transition, both for ourselves and our loved ones. My initial questions were: How do we know it is time to intervene, and what we can do about it?
I learned that there are three areas that need to be identified before we can jump into any sort of care plan or diagnosis. They are typical aging, atypical aging (pseudo-dementia), and dementia.
During typical aging there is a flexibility in thinking but a need for additional processing time that can be impacted by a variety of causes, from stress and fatigue to pain. Atypical aging tends to look like dementia but is caused by treatable conditions like depression, metabolic changes, medication side effects, delirium, and more. Ruling out pseudo-dementia is an important first step in the process.
Finally, we have dementia. There are four truths concerning dementia:
At least two areas of the brain are dying.
It is progressive (keeps getting worse).
It is chronic (not treatable).
It is terminal (will result in death).
Heather explained, “Early detection of brain-related change is so important. Primary care doctors have screening tools, but it is important for a family member to mention new changes. If someone has concerns, it is best to at least get some baseline testing done for comparison from one year to the next.”
Like most troubling situations, the best time to get involved is before we have major concerns. Routine checks on older adults reveal any changes in memory or behavior and could make a difference in how we ease into the future. At first, those changes can be innocuous. During the initial stages of dementia, there will be changes in skills or behaviors. A few common signs might be an inability to think the same as normal, an inability to start tasks, being stuck in a moment of time, being unable to process information or think things through, or confusion about the past or present.
Take care to observe patterns and tendencies that seem out of the ordinary. The less tension the better, especially when it comes to maintaining good relations as the dementia strengthens.
Heather generally asks potential clients a simple question to determine how best to proceed. “It is helpful to ask, ‘is what you’re observing annoying, risky, or dangerous?’”
She goes on to explain that if the behavior observed is dangerous, then intervention is essential to protect someone. A risky behavior means intervention is still necessary to a lesser extent and now is the time to start putting a plan in place so your loved one can continue functioning independently for as long as possible. Annoying behaviors signal that it is time to re-evaluate existing judgments that have no impact on a loved one’s ability to safely live alone.
So, what can we do when it’s time to intervene? Each scenario is unique to a family. The important point is that families need to know they are not alone. Resources and professionals are available to assist and guide them through this process.
Heather details a long list of considerations to help family members decide when to step in. They include personalities, past roles, environment, socioeconomic resources, cultural influences, other medical conditions, degree of brain change, physical abilities, and support system options.
It is important to remember that this is all one giant puzzle with multiple pieces needing to be put in the right places. Being educated on brain changes empowers the family because it helps everyone anticipate and be prepared for changes.
Many people prefer remaining in the comfort of their homes, among family and a lifetime of memories. While this is often a feasible option for many years, it can sometimes become extremely challenging because family members aren’t properly educated. This is where dementia and aging-in-place education and training can be beneficial in supporting this goal.
Some examples of actions families can take involve decluttering the living space and increasing visual contrast throughout to help reduce falls. Organizing cabinets and drawers with labels to help the memory-impaired remember where things are. Using automatic pill dispensers for medications to ensure there are no mix-ups. Setting up regular transportation to prevent the need to drive, and implementing emergency calling features can be lifesaving in case of a fall.
“Thanks to modern medicine, we are living much longer, but that comes with the burden of aging bodies, aging minds, and the need for increased support for seniors,” Heather says. “The risk for developing dementia increases.”
Critical to every case, while recognizing each person and situation is, is care consulting. Numerous companies exist around the country, with plenty in our own backyard. They have all the resources we could ever want and offer strategies for supporting people with dementia. The consulting process can also prove beneficial for helping the caregiver determine the best course of action when caring for their loved one. Whether you are planning on keeping them at home or placing them in a facility, a care consultant is necessary for sustained success.
Dementia care consulting is collaborative detective work and problem solving where all parties are engaged. Consultants specialize in providing support and guidance while offering hope and strategies for dealing with difficult situations. They are an invaluable resource who also provide care training.
If you are like me, most of you don’t know the first thing about dementia care training. This is where experts like Heather can point us in the right direction. Learning how brain changes impact vision, perception, cognition, and motor functions will increase your confidence and skillsets to make positive connections with your loved one as they go through this challenging time.
Therapists are another excellent tool. Occupational therapy can be a key factor in helping someone with dementia maintain strength and function by increasing their engagement in purposeful activity. Occupational therapists can recommend adaptive equipment that will minimize the impact of aging on daily function.
Finally, there are home safety evaluations and recommendations. Care consultants will provide a detailed list of recommendations designed to make the living environment safer. While some companies can be expensive, there are plenty that do their best to remain budget friendly—especially in trying financial times.
“Families can get a head start on dementia education, strategies for safely supporting their loved one and helping them maintain the highest level of engagement in meaningful and purposeful activities,” Heather reiterates.
After all, we have loved these people our entire lives. Caring for them as their bodies and minds are changing doesn’t need to be a burden.
To learn more about dementia and what you can do to help a loved one, visit these resources:
Center for Disease Control: https://www.cdc.gov/aging/dementia/
Alzheimer’s Association: https://www.alz.org/alzheimers-dementia/what-is-dementia
For additional hands-on learning, Holly Springs will have a 5-6 session training course later this year. Go to the town’s website for more information: https://www.hollyspringsnc.gov/1806/Parks-Recreation.
