Communicating effectively wth someone with Alzheimer’s

Jennifer Harvey, RN, BFN, CDP

Co-owner and Clinical Director, Live Free Home Health Care

 

NEW HAMPTON — Caring for an individual with Alzheimer's disease isn't a walk in the park; in fact, it can be downright stressful. A person's understanding of the disease as well as attitude about the illness can have a large impact on the way day-to-day caregiving responsibilities are managed. However, just because this illness has taken over someone close to you, it doesn't have to conquer you as well.

So what do you do when your loved one blames you for something you didn't do or becomes paranoid that you are plotting against him or her? If your first instinct is to try to orient the person back to reality, you are not alone. Many family caregivers spend endless hours trying to do this, but to no avail. Their loved ones may continue to press the issue, and even become angry or hostile at the "evidence" presented to them. Fortunately, there are ways to manage daily challenges in order to minimize a caregiver's stress and improve the odds that an individual with dementia will respond positively.

 

Validation
One of the best approaches to use with people with dementia is validation – a technique that confirms their right to feel a certain way and express their emotions regardless of the situation. The validation theory, developed by Naomi Feil, suggests that an individual could be revisiting past events or trying to solve unfinished business. This helps explain why some people feel the need to go to work years after they retire or pay off a debt from decades ago. By validating their experience, you are meeting them where they are and sending a message that you still accept them no matter what. Here are a few examples of validation at work:

 

1. Scenario: Your sister says, "You stole my money! Give it back!"


Incorrect Response: "I'm sick of you accusing me every time you hide your money. You stuffed it in your drawer five minutes ago. I saw you do it, so stop blaming me."


Validation Response: "Oh no, your money is missing? I can see why you're upset. Well, don't you worry because I am going to help you look for it."


Understanding: It is common for people with dementia to hide items and forget where they are moments later. Since it can be embarrassing to admit this, individuals sometimes accuse others to take the focus off themselves. Rather than trying to deflect blame, simply let your sister know that you understand how she feels and that you want to help her resolve the situation. Then walk her over the drawer and ask her to open it. When your sister finds her money, allow her to take pride in finding it all by herself.

 

2. Scenario: Your wife says, "Get away from me, you're not my husband!"


Incorrect Response: "But I am your husband! Look at our matching wedding rings. You know, you really upset me when you don't remember who I am."


Validation Response: "You must love your husband very much. I can tell by the way you talk about him. Why don't you tell me about your wedding day?"


Understanding: Memory loss can cause individuals to forget even their closest loved ones. When your wife becomes agitated, respect her space, validate the love she feels for her spouse, and allow her to talk about "him" while you are sitting right beside her. Even though she may have forgotten you today, hearing her talk about you will demonstrate that you are still very close to her heart.

 

Redirection
Another powerful approach to utilize is redirection - a behavioral intervention that shifts the individual's focus, by distracting the person or moving away from an undesired topic or behavior to something more pleasant. Here are some examples:

 

1. Scenario: During meals, your father refuses to eat, saying, "You're trying to poison me."


Incorrect Response: "That's ridiculous! Why would I ever do such a thing? Eat your meal and stop making up crazy stories!"


Redirection Response: "Dad, I understand you are feeling afraid, but I want you to know that I would never let anything bad happen to you. You are safe with me. By the way, this meatloaf is delicious. I am having a big plate of it myself. Let's have some together and you can tell me all about the fishing trip."

 

Understanding: It is difficult, if not impossible to rationalize with people with dementia. Instead of trying to orient Dad back to reality, instill a sense of safety, and demonstrate it by eating the same meal as him. Once you've established trust, you can quickly refocus him by shifting the conversation to something more pleasant, such as a fun day he had by the docks.

 

2. Scenario: Your grandmother says, "I have to leave now. I need to pick up Jimmy from school."


Incorrect Response: "Grandma, Jimmy is a grown man. He's 60 years old. You're not going anywhere."


Redirection Response: "Oh Grandma, you have always been such a loving mother to Jimmy. Why don't you come with me to get a drink of water and tell me all about what you love to do with Jimmy after school?"


Understanding: People with Alzheimer's disease often live in the past by re-creating experiences that happened long ago. Despite the fact that Grandma hasn't picked Jimmy up from school in decades, her maternal instinct is still very strong, and she feels an urgency to follow the same routine she did while he was growing up. Take this as an opportunity to reunite your grandmother with those happy memories. She will tell you all about those wonderful times she had with Jimmy and will forget about wanting to leave.

 

Accepting the world of the person for whom you are providing care, and utilizing the communication techniques of validation and redirection will result in less stress for both the caregiver and the person with Alzheimer's. To learn more about the best techniques for caring for a loved one with Alzheimer's disease, contact Live Free Home Health Care at (603) 217-0149 or visit www.LiveFreeHomeHealthCare.com.
About Live Free Home Health Care:
Serving the Lakes Region and Central New Hampshire, Live Free Home Health Care, LLC is dedicated to providing top quality care in the comfort of home, wherever home may be. Family owned and operated, Live Free Home Health Care offers a wide range of services, from companion care and assistance with activities of daily living to skilled nursing. All care is supervised and updated by a registered nurse, who is specially trained to watch for new or changing health issues. Whether the need is for short or long term care, Live Free Home Health Care works with each client's physician to provide a continuum of care unparalleled with other agencies, and the compassionate staff promises to treat each client respectfully and like a cherished family member. Live Free Home Health Care also offers medical alert systems to provide extra peace of mind should an emergency care need arise. For further information, contact (603) 217-0149 or visit www.LiveFreeHomeHealthCare.com.

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Bone density testing reveals risk for osteoporosis-related fracture

LACONIA — World Osteoporosis Day is October 20, 2015 and LRGHealthcare wants local communities and patients to know more about osteoporosis and the risk factors and treatments available for better bone health.

Osteoporosis occurs when bones become thin and fragile. The result is that they break easily, even following a minor bump or fall from standing height. Worldwide, one in three women and one in five men over the age of 50 will suffer a broken bone (fracture) due to osteoporosis. Although fractures can occur in any part of the body, they most commonly affect the wrists, spine and hips. Fractures due to osteoporosis are a major cause of pain, long-term disability and loss of independence among older adults, and can even result in premature death.

"A balanced diet, combined with regular exercise, will help to optimize your bone health at all ages and reduce the risk of osteoporosis. The size and the amount of bone contained in your skeleton changes significantly throughout life. Likewise, as you age, the specific nutritional needs of your skeleton change too", stated Cyndee Chapin, Director of Medical Imaging, Cardiology, Community Wellness and Neurology at LRGHealthcare.

A person's bone density can be measured by a machine that uses low levels of X-rays to determine the proportion of mineral in your bones. During this painless test, you lie on a padded table as a scanner passes over your body. In most cases, only a few bones are checked — usually in the hip, wrist and spine.

Treatment recommendations are based on an estimate of your risk of breaking a bone in the next 10 years using information from a bone density test. If the risk is not high, treatment might not include medication and might focus instead on lifestyle, safety and modifying risk factors for bone loss.

LRGHealthcare offers bone density testing at Lakes Region General Hospital, Franklin Regional Hospital, and Caring for Women. For more information on osteoporosis or to schedule an appointment, please contact 527-2899.

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Estate planning and the vacation home

By Charles F. Tucker, Esq.


A camp in New Hampshire, a cottage on Cape Cod, a cabin in the Sierra, is often much beloved by a generation or two of a family. You have had great days there, you know you are not eternal, but you hope, somehow, the camp, cottage, or cabin, will stay in the family for many generations to come.
Lawyers can't guarantee it, but they can help.
Sometimes the problem is one of plenty – your children reproduce, and so do theirs, and the camp, cottage or cabin cannot accommodate them all. We, being lawyers, have ways of rationing the usage, from the very simple – Child A has it from January 1 to July 31, and Child B for the rest of the year, alternating each year, to very complex ways of bidding for weeks, or annual lotteries, for coveted weeks each summer.
And, we can offer different ways of allocating ownership, from a reasonably simple trust to a more complex corporation or limited liability company.
Issues to be resolved include who is to be able to own an interest in the place – just descendants, or widows/widowers of descendants? Can interests be transferred to others, and is the transfer to be restricted to family only?
What is the fraction of the interests needed to mortgage the premises, or to sell it?
What do you do to the interest holder who does not put in his or her share of the money needed for the new roof?
Do you do rentals to non-family members?
Are the property taxes, or maintenance costs becoming prohibitive?
Who keeps the books?
If there is more than one dwelling on the property, or, if another could be built, how do you deal with that?
If there is more than one dwelling unit, does it make sense to condo it?
If there is excess land, does it make sense to sell it to bring in money, or, try to sell a conservation easement so it won't be developed?
Frequently, all the above questions have been answered for this year, but, think ahead to when the older generation is gone, and think about the cast of characters in the next generation – how will they want to deal with this?
It is far better to deal with these issues in advance, and, as noted above, lawyers can help by asking the right questions, and then formulating an organizational structure to get it done.
Transferring a vacation home often involves complex decisions with significant tax considerations. Next month's article will briefly discuss the tax consequences associated with transferring a vacation home at death, or by sale, or by gift.

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Financial exploitation of seniors is now a crime in NH

Nancy, a widow in her 80s and living alone in the Lakes Region, was befriended by a neighbor. Lonely and desperate, Nancy accepted help from this neighbor, and agreed to, among other things, sell the neighbor all of her belongings for $1. When the neighbor was eventually reported to the police, she wasn't charged with any crimes; the case was dismissed as a "civil matter."

As Nancy's story highlights, financial abuse is not committed solely by professional scammers or criminals. Rather, many who commit elder abuse are also family, friends, caregivers and other people elders may trust. While New Hampshire Legal Assistance regularly represents victims like Nancy, the types of civil legal remedies we can pursue are limited. With police help, we were able to recover some of Nancy's treasured personal belongings. Thanks to a new law, passed with bipartisan support by our state legislature and signed by our governor, there is now recourse available for people like Nancy.

The new law creates the crime of financial exploitation, providing important protections for seniors who, because of social isolation and poor health, are often at high risk of financial abuse. The new law makes it illegal if a person knowingly or recklessly uses undue influence, harassment, duress, force, compulsion or coercion to acquire the property of an elderly adult, or uses influence or force to establish a fiduciary relationship, such as a power of attorney.

If you suspect that an elderly person is being financially exploited, call the NH Bureau of Elderly and Adult Services or your local police department.

Cheryl Steinberg is director of the Senior Law Project at New Hampshire Legal Assistance, a non-profit civil legal aid organization serving low-income and elderly New Hampshire residents. NHLA maintains five branch offices in Berlin, Claremont, Concord, Manchester and Portsmouth.

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