Category: Early Signs of Dementia

Use It or Lose It Applies to your Memory Too

I have three clients all with Memory issues that have shown a noticeable uptick in their engagement and activity. Unfortunately, it isn’t all of them so I started to see if there was any patterns that applied to all three.

In the past one to two months, all three of them have had more social engagement. They are all widowed, and live alone. None of them had previously had much social interaction due to giving up car keys, moving into a new community, or even just because for the last year they were giving care to a loved one.

When you visit with them, initially you may not even notice they have any short-term memory issues. However, if you try to have a longer or deeper conversation with them, you quickly recognize they have some memory issues. Due to changing circumstances, all three of them have had a lot more social interaction and I think that has helped them in a variety of ways.

I have noticed it in their activity, spending, and in my direct conversations with them.

Memory loss is not a normal consequence of aging. Our brains still produce new brain cells. However, once we hit 50, there is a slowing down of brain processing which we usually equate to memory loss. Eventually, you should be able to recall information, but it just takes longer.

However, we must remind ourselves that just like muscle-strength, we need to continue using our memory skills and engage in activities that stimulate our brains. It’s why I am afraid of the traditional concept of retirement and am often day-dreaming about how best to age, enjoy life, and stay engaged in meaningful ways that will challenge my brain.

After seeing this anecdotal result, I believe that every person needs to have some form of meaningful social engagement several times a week. For many older adults who want to age in place, managing this if they live alone can be a bigger challenge. In general our friend circle may be smaller and it might be harder to visit if we are no longer driving.

The answer on how to get more social engagement will vary for everyone but most communities have senior and community centers that offer ongoing classes and exercise programs for opportunities to make new friends. However, step one is to help us all recognize that your brain is a use it or lose it muscle we all need to work on continuing to stretch. Witnessed.

If you have a loved one in this situation, can you:
– Find local classes where they might meet a new friend (senior centers, community centers, and community colleges are easy places to start)
– Connect them with a local “village” that works to connect neighbors and offer both social engagement and help around the house
– Encourage them to look at moving to an adult community be it 55+, a condominium or apartment, as well as a Life Care Community
– Look at AARP that often offers a variety of social events in your community — if you are a member you will get mail or you can also download their app that features local events that are usually free
– Have friendly visitors come to the home to take them out or have a lively discussion at home about topics they love.

What I Wish I Knew When Dementia Was Diagnosed: The role of Palliative & Hospice Care (#2)

Palliative-vs-HospiceMy parents and in particular my Mom often shared that QUALITY of life was her goal, not QUANTITY. After a diagnosis of dementia which can result in death, I had an ongoing struggle with what was important to do to honor my mother’s wishes.

The lines between “palliative care” and “hospice care” are confusing but they both focus on providing comfort. Palliative care can begin at diagnosis, and at the same time as treatment. Hospice care begins after treatment of the disease is stopped and when it is clear that the person is not going to survive the illness. These lines are kinda blurry with dementia since there really is no “treatment” or “cure” (YET). 

I wanted to manage and strive for quality of life, keep Mom comfortable, but be mindful that we were not providing things that could extend her life.

When Mom started to refuse to take the anti-anxiety medication the care community was delivering, I realized that it was being delivered with a host of vitamins. Was it important to give my 80-year-old mother a multi-vitamin?

My Mom didn’t really like taking pills, so delivering 4, of which one was really important to minimize her stress became the only one I asked them to deliver. I followed up with the doctor who agreed that the other pills were not really necessary and her medication regimen was updated.

When Ensure was recommended as an addition to her meals, I asked more questions to make sure it wasn’t been forced or delivered as a meal replacement over providing her with food options she would still eat.

Apparently dementia and age can impact your taste and there seemed to be a strong preference for salty and sweet foods. She was never much of a salad or veggie person and it seemed odd to start worrying about nutrition when she often couldn’t remember names or faces. I didn’t want her to be hungry, but I also wanted to let her have some control even through her diagnosis over day-to-day choices.

My toughest challenge was when her hip broke and the doctor insisted we lift the DNR (Do Not Resuscitate) order for her so they could repair her broken joint. At 83 and very frail, there was no way she would have survived the surgery and they agreed to move her into Hospice Care. Over the previous year, she had been in and out of Hospice Care as she continued to weaken. However, with the addition of the broken hip, we now had the option to keep her comfortable with morphine that would eventually end her life.

These were difficult and guilt-inducing decisions, but I always worked to meet what I believed to be my mother’s wishes. Knowing these options may not just better serve the comfort, but also allow you to focus more on enjoying time with your loved one than managing medical matters.

Would the vitamins and Ensure prevented the eventual hip break? I will never really know but after caring for two parents now realize how important it is to let the will of the individual influence their daily choices, even after a diagnosis of dementia.

You will have a lot of options and choices to make over the course of your journey. Just know you will make the best decision you can with the information you have at the time you need to make choices for your loved one. Hospice can be a valuable option during your care journey. Reminded. 

 

There is a Statute of Limitations on IRS Refunds

timemoneyIt physically pains me to find someone, through oversight or because of overwhelming life events, failed to do what was needed to get the refund to which they were entitled to receive from the IRS.

I just learned this when a client was told by the IRS that the 2014 and 2015 returns she eventually filed were submitted too late to allow her to receive the nearly $12,000 she was entitled to receive. She thought her life partner had filed these when we started working together. Unfortunately, he never did file them or ask for an extension.

According to I.R.C. Section 6511(a) “Claim must be filed within 3 years from the time the return was filed or 2 years from the time the tax was paid, whichever of such periods expires the later, or if no return was filed by the taxpayer, within 2 years from the time the tax was paid.”  There are things like extension requests that help your timing. Check with an accountant to learn more about this if you might be in this boat.

At least half of the families I have worked with find out that taxes didn’t get filed. The early signs of dementia are subtle and the individual may believe they are doing all the right things. It usually takes a couple big financial mistakes before people realize their loved one is unable to really manage their financial affairs.

If you are not sure if the taxes have been addressed, you can request transcripts from the IRS here.

Caring for a loved one can be overwhelming. If you need some help looking into this and no one is able to help, you could find a local Daily Money Manager who can help out. If you have a lot of medical expenses, the few hundred dollars it might take to hire them to help will more than be repaid when you receive your refund. If you can’t find one in your area, let me know. There are several members of my team that can assist with this remotely.  Recommended. 

 

 

Learn How to Advocate for your Medical Needs – Healthy Habit #20

iwantanswers

The days of the family doctor are gone. Most doctors are crushed for time as they try to address your needs in what feels like a shrinking time window. The average time physicians are spending with patients is less than 24 minutes. According to The Medscape Physician Compensation Report 2017. Thirty percent of physicians spend 17 – 24 minutes with their patients. That is followed by 29 percent of physicians who are spending between 13 – 16 minutes with patients.

Here is a quick primer on 6 Ways to Be Your Own Health Advocate by Elizabeth Renter. In short, you need to arrive prepared and refuse to leave until you have a diagnosis or next step toward one. You may need to repeat this cycle if your condition persists. 

You have probably noticed that no one seems to do more than glance at the 4 (plus) pages you diligently completed before your appointment. After caring for my parents and navigating a host of doctors with them, I learned to come prepared for each appointment. I could quickly cite their health issues, medicines, and stated the reason for our visit. I learned that if the doctor in front of me could not resolve the issue, I would find a secondary resource to help.

It is now the requirement of every adult to be their own advocate. The healthcare system is unable to do that for you.

When it comes to short-term memory issues (remember this is not a normal consequence of aging) it is important to push to get diagnosed. It could be a side-effect from a medicine — and it can happen with medicines you have taken for years. If you notice a change, bring it up with your primary care physician. Some will do a screening for it, but I recommend you request a referral to a neurologist. Memory issues are not really a primary care physician’s expertise. The earlier you know you have an issue, the earlier YOU can decide how you want to live should it be permanent and should you decline.

This ideal applies to any medical issue that is impacting your quality of life. Push to find a reason and understand how it may impact the rest of your life.

If you know this is not your skillset, or are overwhelmed by other matters, consider a consultation with an Aging Life Care Manager. In minutes they would resolve issues that I failed to unravel in days when it came to caring for my parents. Visit this website to find one located near you.

Can you eventually figure it out? Most likely. I know because before I knew about Aging Life Care Managers, I was working to handle a lot of the issues as the primary family caregiver for my parents. However, I would do anything to have a mulligan and spend that time enjoying my parents’ company instead of fretting over the next medical hurdle to traverse. Wished.

Follow the Science on How Brains Age – Healthy Habit #2

followthescience

I wanted to understand how I could perhaps better recognize, prepare, and hopefully avoid the fate of my parent’s who both were diagnosed with different forms of dementia. One of the best things I did was to go through the Total Brain Health Certification. I met the founder Dr. Cynthia Green when we both appeared on The Dr. Oz Show.  Her book Total Memory Workout is a great primer on simple ways to maintain brain health and boost your memory.

The reality is that the common belief that “forgetfulness” is a normal sign of aging is false. Our brain processing slows down usually starting in our 50’s but the inability to recall information or short-term memory loss are signs of disease, not a typical reality of aging. But A LOT of people believe it and tell themselves it is normal.

If you understand how your brain ages, as well as how some of the changes in our brains actually make us MORE trusting (and why older adults are easier targets for fraud), you will be better able to plan and put systems in place to safely live well.

If you start to notice changes, you can then talk with your doctor. There are many things you can do if you catch issues early and some of them are entirely reversible.

If you have a loved one who is showing signs of memory loss, I hope you will raise the issue with them. I certainly tried with my parents. My Dad was open to pursue testing and investigate while my Mom shut down the idea that something was amiss. It took several years and many doctors before we found someone who would help us understand what was happening to our parents. Unfortunately, it was too late to do anything … and maybe there was nothing to be done. However, it would have helped if we could have talked through their wishes knowing a diagnosis of memory loss was made.

In the case of your brain health, knowing will afford you a lot more options. Recommended.

Here are a few articles to get you started:

Age-Associated Financial Vulnerability: An Emerging Public Health Issue Annals of Internal Medicine Annals of Internal Medicine – December 1, 2015

Supplements for Brain Health Show No Benefit – a Neurologist Explains a New Study The National Interest – June 28, 2019

Why It’s Easier to Scam the Elderly NPR – December 6, 2012

Difficult People and Dementia

see through boxers

When I hear the statistics about older adults living with dementia, I immediately dismiss them because I believe they are just too low. I know there are many people living with dementia that were never diagnosed and so they have never been counted.

I understand why families choose not to pursue testing. However, I also know that there are so many factors that could contribute to create symptoms of dementia that some might be living with it needlessly.

There are a host of drugs that can alone or in tandem with other drugs may imitate dementia (The Washington Post).

I recently was involved with a family who were very concerned about their father. He was explained to me as a “very difficult person.” As I met with him and the woman who helps him out regularly, it was very clear to me that he had some form of cognitive issue. However, all of those around him are just chalking up his behavior as a personality quirk. The family confirms that he did not always behave in this manner, but over the years he has got more ‘difficult’.

As I was talking with him about how I could help with some of the daily money management issues it was clear he did not comprehend where some of his income was coming from — some was from military service and had been coming to him for over 60 years. There were several small things that demonstrated to me he was having trouble comprehending and processing the information. The fact that he has been unable to pay or manage his day-to-day finances is a big clue. So often I am called after there has been a financial boo-boo that was too glaring to ignore any longer. Ideally, you don’t want to strip them of their control, but just layer in some help.

My final clue was that when I met him, he was in his boxer shorts. He lives in a high-rise complex and was down in the lobby talking to a neighbor when I arrived. As we return to his apartment, I find that I can see right through his mesh boxers to skin. I mentioned this to the woman who is helping him on a regular basis and she confirms that she will ask him to put on a second pair before they leave for lunch. He is intelligent and curious, and as a man in his 90’s, I don’t think he recognized that he is walking around in public in his underwear.

I recognize all of the reasoning we used in my family. You want to respect and honor an individual, but often, it seems to reach the point of failing to possibly address the source of the behavior changes. Maybe they are caused by medication or even hearing loss (you don’t understand what you don’t hear.) For a variety of reasons, I ask that if you find yourself in this position, you advocate to get some medical attention to eliminate possible causes for the change. Suggested. 

According to the World Health Organization: “Dementia is a syndrome – usually of a chronic or progressive nature – in which there is deterioration in cognitive function (i.e. the ability to process thought) beyond what might be expected from normal ageing. It affects memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement. Consciousness is not affected. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in emotional control, social behaviour, or motivation.”

Simple Steps to Safe Guard a Loved Ones Finances

After caring for two parents with dementia, I remind myself how much the checkbook meant to my mother. She had always managed the household finances and the suggestion that she was unable to manage a checkbook safely was something that needed to be left unsaid. I found that out after I said it a few times. ; <

The biggest problem I faced was a lost purse that contained the checkbook. She thought she left it in a cab, a store, at a bridge game … I couldn’t manage the hours each week spent looking for her purse. Today you can at least get a tile which would have been immensely helpful in keeping track of her handbag, but it wasn’t an option yet.

There are options to consider if your loved one would like to continue to manage their purchases:

  • Open up a new checking account and fund it with a small amount of money that can afford to be lost. I did this for my Mom. She had her checkbook, and I could move money into her account in small amounts as it needed to be replenished. If the checkbook never turned up or she had a check stolen we could easily close the account.
  • Consider setting up a TrueLink card. It is basically a credit card where you can set up limits on how much can be charged as well as products and services that it won’t fund. There is a fee for it, but the small expense is worth the money it will most likely save in potential losses.

Unfortunately, I have recently had clients both at home and living in communities be a victim of caregiver exploitation. One got my client to write her a small check, one purchased some face cream for my client and asked her for repayment of $85, and another apparently kept asking for gas money. Most agencies and communities require their caregivers agree to never accept money or gifts from clients. Should a client give them money, it needs to be reported to the community or agency. In the past month, I have reported three caregivers for violating this condition of employment. Sadly, I know they will just turn up at another agency.

What I struggled with was that this was one of the few remaining freedoms for my mom. She could no longer drive, or run the bridge games she loved, and that checkbook gave her an empowered sense of self. Now as a Daily Money Manager, I see all the ways that people are trying to get at the money of my clients.

Ultimately, someone needs to be vigilant about minding the finances as well as considering how to layer in these protections. A few bad apples spoil the lot. Reported.

Brain changes make ALL older adults vulnerable to fraud

Many of us with loved ones living with cognitive issues face a never ending struggle to “protect” them from harm. My siblings and I battled with our parents when we could see they were making poor decisions and were at risk of jeopardizing their life savings. My parents were angry with their over-reaching children and our opinions.

What I finally came to learn was that my parents were unable to perceive they were making poor decisions and just yearned for independence and control over their own lives.

Turns out, that our aging brains put all of us at risk to be more vulnerable as we age. You can read the full report: Neural and behavioral bases of age differences in perceptions of trust.  In summary:

“Older adults are disproportionately vulnerable to fraud, and federal agencies have speculated that excessive trust explains their greater vulnerability. Two studies, one behavioral and one using neuroimaging methodology, identified age differences in trust and their neural underpinnings. Older and younger adults rated faces high in trust cues similarly, but older adults perceived faces with cues to untrustworthiness to be significantly more trustworthy and approachable than younger adults. This age-related pattern was mirrored in neural activation to cues of trustworthiness. Whereas younger adults showed greater anterior insula activation to untrustworthy versus trustworthy faces, older adults showed muted activation of the anterior insula to untrustworthy faces. The insula has been shown to support interoceptive awareness that forms the basis of “gut feelings,” which represent expected risk and predict risk-avoidant behavior. Thus, a diminished “gut” response to cues of untrustworthiness may partially underlie older adults’ vulnerability to fraud.”

Yikes.

Right now, I’m in the midst of two battles on behalf of my clients. One overpaid for work in their home and the other where a caregiver talked her into writing a check and also stole her credit card. I was just subpoenaed for the trial and hope that the outcome will ensure this horrible human can never be hired for senior-serving employment in the future.

The loss of this internal ability means we all need to step up to do what we can to protect our elders. I sure hope someone will be there to do the same for me. Driven.

Do I schedule the colonoscopy?

poop in box memeI remember the internal debate I struggled with as my parent’s cognitive decline progressed. When they first moved into Assisted Living, they were scheduled for visits with the dentist. I knew it had been at least two years since their last exam and with a dentist visiting the facility, it was simple enough to have the staff take them down when it was time for their appointment. However, my parent’s both refused to see the dentist. We tried three different times and each time one or both of them dug in their heels and declared that they no longer needed to get their teeth cleaned. Six months later, my Dad was diagnosed with a tumor on his tongue. Would that dental visit have eased his pain or changed the outcome?

I consider this experience as one of my clients, an 85 year old who has been diagnosed with Alzheimer’s and is managing in her own home, was recommend to be screened for colon cancer using the new Cologuard kit. Cologuard is a do-it-yourself, mail-in DNA test that helps detect some colon cancers. Having just experienced this test myself, it’s not as simple as on would imagine, and does require that it be shipped back in a timely manner once you “collect” your sample. I have to say, I had a lot of fun joking around about the process and the “package” I needed to ship. Sorry to those of you who don’t like potty humor, I am a self-confessed big fan of it.

I brought up the topic to my husband because I found it tricky and wasn’t sure my client could manage the steps for the do-it-yourself part. You basically need to preset the kit in the commode for the collection, then take a sample and ship both the small sample and collection which requires a few extra steps before sealing the package. Once your package is sealed, it needs to be shipped back in 24 hours using UPS. Sounds easy, but since I just did it knew it took a little planning to complete.

As I’m wondering to my husband if my client can follow the steps, and ensure it gets shipped back in a timely manner — he is wondering what the family would do if they found out mom has colon cancer. He felt that he would probably be skipping his testing when he is 85 and battling other health issues.

Are there some things we need not test for once we reach a certain health status? Is the guide really to focus on those things that can prevent other health issues like a dental visit to maintain good oral hygiene versus testing for a cancer that may kill you when you are 85 years old? There is only the answer that is right for you.

I wondered if my Dad’s refusal to see the dentist was because he knew something was wrong and didn’t want anyone to find out or intervene. I do recall sitting with his primary care physician a few months before the tumor was diagnosed while she opened up his month and checked his teeth and tongue to see if she could figure out why he was drooling more. They chalked it up to swallowing issues related to his Alzheimer’s.

When it’s our job to monitor the health and well-being of our loved ones, when do we choose to stop the testing?  I think for all of us that answer is very different. Hopefully, you got a sense of the choices for end-of-life care your loved ones would make and can use that as your guide. Caregiving ain’t for sissies. Convinced. 

 

 

 

Driving, Dementia, and the Right to Drive

dementiasherpaAs the adult child who watched the dings accumulate on my parent’s car, and then as they continued to drive after their licenses were revoked, this topic still makes my tummy and heart ache.

However, as a Daily Money Manager, I’m now having these discussions with my clients who have hired me to help with the daily finances and bill pay usually because of health issues, and also hearing them lament over their children’s suggestion they give up the car keys.

This week, a client diagnosed with Parkinson’s and that by self-admission is having issues finding words and managing bills is very angry at her children who are suggesting she stop driving. When I asked her what her neurologist said when she asked about driving and safety, she said the rules tell him he has to write a note to rescind her license only if she is passing out. God Bless America. We have made driving a right you receive, not a right you earn and must continually qualify for.

I shared with my client that her adult children are worried for her safety, while she is fighting for her independence. I gave her some examples about how driving can be challenging because she will have to make split second decisions when she’s behind the wheel of her car.

As we discussed the topic a little deeper, she said she was going to voluntarily give up the car keys, but is now so mad that her kids are demanding she give them up, she is fighting to keep driving. My bent toward logic made me talk that through with her a little, but right now, she’s wants understanding and is devastated at the losses she is facing.

I left hoping I could wave a wand and make this easier for everyone. I can now clearly see how this topic is so difficult for every family.

I recently was introduced to Christy Turner, The Dementia Sherpa. She offers a host of great suggestions on how to better  communicate with your loved ones diagnosed with dementia, including some tips on how and when to navigate the issue with driving. Dementia just stinks. Recommended. 

Embracing the Suck of Dementia

embrace he suckApparently, this is a term that is familiar to those that have served in the military. As an Army brat with continued ties to my extended military family and familiar legacy, I hadn’t heard this term, but adore it’s simplicity and application for caregivers. In short “embrace the suck” is meant to convey that things won’t be easy, but others have been there and now it’s time to deal with it.

I remember having this sense at varied times during my own caregiving journey.

  • As I took over the finances and was feeling overwhelmed by the task, I recalled when Mom fought to maintain her checkbook and was indignant that we suggested she couldn’t manage.
  • When I found my Dad’s key wallet in my own key drawer, I reflected on how difficult it was to get them to stop driving. The DMV had rescinded their licenses yet they still kept driving. I watched as my Mom tore up the letters notifying them. Neither of them remembered being notified and thought I made it all up.
  • When I brought out a deck of cards to play with my Mom, a Bridge Life Master, and she had no interest in playing.

For all of those times when I feared for their safety and well-being, there was a moment when I recognized they no longer could or cared to try to fight for their independence. Those were the times when “embrace the suck” applied for me. My thoughts moved to new ways to engage with the individual in front of me that I often no longer recognized as Mom and Dad. Embraced.