All Home Care Matters

Today’s episode has been handpicked by our listeners. We have gotten quite a few comments on our videos wanting to know the difference between Alzheimer’s and Dementia and we are going to be talking about the differences between the two and clearing up any confusion you may have. First, we are going to discuss what Alzheimer’s is and how it differs from Dementia before moving on to what dementia is and what it can look like. Now let’s move on to the rest of the show.

According to the CDC, Alzheimer’s disease is the most common type of dementia. It is a progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment. Alzheimer’s disease involves parts of the brain that control thought, memory, and language and can seriously affect a person’s ability to carry out daily activities. Age is the best-known risk factor for Alzheimer’s disease.

Alzheimer’s disease accounts for somewhere between 60 and 80 percent of all dementia cases. As the aging population rises, more and more people are being diagnosed with Alzheimer’s. The CDC says that in 2020, as many as 5.8 million Americans were living with Alzheimer’s disease and this number is projected to nearly triple to 14 million people in the next forty years.

Individuals with Alzheimer’s can live for many years with the disease, but it does ultimately end with death, often due to the loss of the ability to swallow. On average, after a diagnosis is made, a person with Alzheimer’s usually lives for 4-8 years. However, someone with Alzheimer’s can live longer than that. Some have lived nearly 20 years after receiving a diagnosis.

Early diagnosis is key for this disease. The sooner a treatment plan can be started, the better. According to the CDC, researchers believe that genetics may play a role in developing Alzheimer’s disease. However, genes do not equal destiny. A healthy lifestyle may help reduce your risk of developing Alzheimer’s disease. If you have a family history of Alzheimer’s, make sure you inform your doctor. There are a few tests they can perform that may result in early detection.

According to the Alzheimer’s Association, Alzheimer’s is a degenerative brain disease that is caused by complex brain changes following cell damage. It leads to dementia symptoms that gradually worsen over time. The most common early symptom of Alzheimer’s is trouble remembering new information because the disease typically impacts the part of the brain associated with learning first.

As Alzheimer’s advances, symptoms get more severe and include disorientation, confusion, and behavioral changes. Eventually, speaking, swallowing, and walking become difficult. Currently, there is no cure for this disease, but there are a few ways to treat it. If you suspect that a loved one or yourself may have Alzheimer’s, speak with a doctor. They will be able to determine if you have the disease, what stage you are in, and the best course of action for you to take.

This episode is closely related to our recent mini-series on the Seven Stages of Alzheimer’s disease. We won’t be talking about Alzheimer’s nearly as in-depth as we have in our mini-series, so if you would like to learn more about Alzheimer’s, listen to the series on our website, our YouTube channel, or wherever you get your podcasts.

Now that we’ve covered Alzheimer’s disease, let’s move on to dementia.

According to Forbes, dementia is the umbrella term used to describe several diseases that cause changes in the brain that lead to memory loss and language and reasoning difficulties, ultimately disrupting everyday functioning.

The National Institute on Aging says that Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person's functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.

Dementia is more common as people grow older (about one-third of all people aged 85 or older may have some form of dementia) but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.

There are several different forms of dementia, including Alzheimer’s disease and a person’s symptoms can vary depending on the type. Let’s take a closer look at the 5 most common forms of dementia. As you already know, the most common form of dementia is Alzheimer’s.

According to Mayo Clinic, Lewy body dementia, also known as dementia with Lewy bodies, is the second most common type of progressive dementia after Alzheimer's disease. Protein deposits, called Lewy bodies, develop in nerve cells in the brain regions involved in thinking, memory, and movement (motor control).

Lewy body dementia causes a progressive decline in mental abilities. People with Lewy body dementia might have visual hallucinations and changes in alertness and attention. Other effects include Parkinson's disease signs and symptoms such as rigid muscles, slow movement, walking difficulty, and tremors.

The third most common type is Frontotemporal dementia. According to Mayo Clinic, frontotemporal dementia is an umbrella term for a group of brain disorders that primarily affect the frontal and temporal lobes of the brain. These areas of the brain are generally associated with personality, behavior, and language.

In frontotemporal dementia, portions of these lobes shrink, or atrophy. Signs and symptoms vary, depending on which part of the brain is affected. Some people with frontotemporal dementia have dramatic changes in their personalities and become socially inappropriate, impulsive, or emotionally indifferent, while others lose the ability to use language properly.

Frontotemporal dementia can be misdiagnosed as a psychiatric problem or as Alzheimer's disease. But frontotemporal dementia tends to occur at a younger age than does Alzheimer's disease. Frontotemporal dementia often begins between the ages of 40 and 65 but occurs later in life as well. FTD is the cause of approximately 10% to 20% of dementia cases.

The next form of dementia is vascular dementia. According to Mayo Clinic, Vascular dementia is a general term describing problems with reasoning, planning, judgment, memory, and other thought processes caused by brain damage from impaired blood flow to your brain.

You can develop vascular dementia after a stroke blocks an artery in your brain, but strokes don't always cause vascular dementia. Whether a stroke affects your thinking and reasoning depends on your stroke's severity and location. Vascular dementia can also result from other conditions that damage blood vessels and reduce circulation, depriving your brain of vital oxygen and nutrients.

Factors that increase your risk of heart disease and stroke — including diabetes, high blood pressure, high cholesterol, and smoking — also raise your vascular dementia risk. Controlling these factors may help lower your chances of developing vascular dementia.

The final common form of dementia is Mixed dementia, a combination of two or more types of dementia. According to the Alzheimer’s Association, In the most common form of mixed dementia, the abnormal protein deposits associated with Alzheimer's disease coexist with blood vessel problems linked to vascular dementia. Alzheimer's brain changes also often coexist with Lewy bodies. In some cases, a person may have brain changes linked to all three conditions — Alzheimer's disease, vascular dementia, and Lewy body dementia.

Researchers don't know exactly how many older adults currently diagnosed with a specific type of dementia actually have mixed dementia, but autopsies indicate that the condition may be significantly more common than previously realized.

Autopsy studies play a key role in shedding light on mixed dementia because scientists can't yet measure most dementia-related brain changes in living individuals. In the most informative studies, researchers correlate each participant's cognitive health and any diagnosed problems during life with analysis of the brain after death.

According to the National Institute on Aging, researchers have also identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include Argyrophilic grain disease, a common, late-onset degenerative disease. Creutzfeldt-Jakob disease, a rare brain disorder. Huntington's disease, an inherited, progressive brain disease. Chronic traumatic encephalopathy, caused by repeated traumatic brain injury. And HIV-associated dementia, a rare disease that occurs when the HIV virus spreads to the brain.

The overlap in symptoms of various dementias can make it difficult to get an accurate diagnosis. But a proper diagnosis is important to get the best treatment.

Now that you know the difference between Alzheimer’s and Dementia, let’s move on to some of the causes, risk factors, and prevention methods of dementia.

According to Forbes, one common myth many people tend to believe is that you can’t reduce your risk of getting Alzheimer’s disease or other kinds of dementia—you either get it or you don’t. In reality, adopting healthy habits can lower your risk of developing dementia, or at least delay the onset. “Healthy body, healthy mind,” says Dr. Richard Caselli, associate director and clinical core director of the Alzheimer’s Disease Center at Mayo Clinic in Arizona. “What we can control, we should control.” Though he adds that even a lifetime of healthy habits is no guarantee of protection.

Among the 12 factors that increase a person’s risk of dementia outlined in the 2020 report from the Lancet Commission on dementia prevention, most are within one’s control. These include hypertension, smoking, obesity, diabetes, low social contact, excessive alcohol consumption, and being physically inactive. Risk factors that we cannot control include lack of education, traumatic brain injury, depression, hearing impairment, and exposure to air pollution.

According to the Alzheimer’s Association, dementia is caused by damage to brain cells. This damage interferes with the ability of brain cells to communicate with each other. When brain cells cannot communicate normally, thinking, behavior, and feelings can be affected.

The brain has many distinct regions, each of which is responsible for different functions (for example, memory, judgment, and movement). When cells in a particular region are damaged, that region cannot carry out its functions normally.

Different types of dementia are associated with particular types of brain cell damage in particular regions of the brain. For example, in Alzheimer's disease, high levels of certain proteins inside and outside brain cells make it hard for brain cells to stay healthy and to communicate with each other. The brain region called the hippocampus is the center of learning and memory in the brain, and the brain cells in this region are often the first to be damaged. That's why memory loss is often one of the earliest symptoms of Alzheimer's.

While most changes in the brain that cause dementia are permanent and worsen over time, thinking and memory problems caused by the following conditions may improve when the condition is treated or addressed: depression, medication side effects, excess use of alcohol, thyroid problems, and vitamin deficiencies.

In most people, the cause of dementia is unknown, but that doesn’t mean there aren’t ways you can lower your risk of developing dementia. Knowing what risk factors, you have can aid in lowering your chances of developing dementia, as well.

According to the NHS, some dementia risk factors are difficult or impossible to change, like your age, genes, and level of education. The older you are, the more likely you are to develop dementia. However, dementia is not a natural part of aging and isn’t something that you should be expecting to develop. In general, genes alone are not thought to cause dementia. However, certain genetic factors are involved with some of the less common types. Dementia usually develops because of a combination of genetic and "environmental" factors, such as smoking and a lack of regular exercise. Other risk factors such as hearing loss, untreated depression, loneliness, or social isolation, and sitting for most of the day may also contribute to your likelihood of developing dementia.

Currently, there are no proven ways to prevent dementia, but doctors have a few suggestions for prevention methods. Even though you may not be able to alter your chances of developing dementia, following these suggestions can lead to an overall healthy lifestyle and can prevent many other illnesses and health issues. According to the NHS, you may reduce your risk of dementia by eating a healthy, balanced diet, maintaining a healthy weight, exercising regularly, keeping alcohol within recommended limits, stopping smoking, and keeping your blood pressure at a healthy level.

Keeping your body healthy may help reduce your risk of dementia, but you also need to keep your brain active and engaged. According to Danone Nutricia Research, the brain communicates through a vast network of billions of nerve cells. These nerve cells or neurons connect with each other via junctions called ‘synapses. Synapses allow communication between neurons and make it possible to create and recall memories.

Throughout our lives, we continually lose and re-grow these important brain connections. In a healthy brain, the number of new synapses balances the loss of old ones, allowing for a sustained net number of synapses. In a brain affected by injury or illness, such as dementia, synapses die off faster than they are created. When this happens, it becomes difficult to create and recall memories. Regularly engaging your mind may help your brain create more synapses longer. Activities like crosswords, word searches, and reading are all great ways to engage your mind. Learning new skills can also help your brain create more synapses and the repetitive information you use while learning can double as a recall exercise.

Regular physical exercise can also help you keep your mind active. Going for a few 10-minute walks a day can help increase the blood flow in your brain and in the rest of your body. Participating in social activities and maintaining regular social interaction can lower stress and depression, which can affect one’s memory. Getting enough sleep and drinking enough water can both help your ability to focus and your memory.

Mayo Clinic says that doing things like playing bridge, taking alternate routes when driving, learning to play a musical instrument, and volunteering at a local school or community organization are all great ways to help keep your brain in shape and keep memory loss at bay.

Now that we have covered the causes, risk factors, and prevention methods for dementia, last move on to the last part of today’s episode, the importance of early detection and diagnosis.

Early diagnosis of dementia is key because it allows a person with dementia to begin treatment right away and preserve their memory and overall function longer than they would be able to without early detection of the disease. Not only does early detection allows someone to start a treatment plan right away, but it also allows them the opportunity to plan for the future.

According to Queensland Health, being familiar with the signs of dementia can help people receive a diagnosis as early as possible. Early signs that a person might have dementia can include: being vague in everyday conversations, memory loss that affects day-to-day function, short term memory loss, difficulty performing everyday tasks and taking longer to do routine tasks, losing enthusiasm or interest in regular activities, difficulties in thinking or saying the right words, changes in personality or behavior, finding it difficult to follow instructions, finding it difficult to follow stories, and increased emotional unpredictability.

If you have noticed any of these signs in yourself or a loved one, schedule an appointment with your doctor. Since many of these signs are also signs of normal aging, it’s important to talk to your doctor if you think you may be experiencing the early stages of dementia. As we’ve already mentioned today, it’s better to rule out dementia now than wait for a diagnosis later in life.

If you or your loved one are having memory troubles, consider keeping a journal. Your doctor may not be able to see any issues occurring during a short visit and it can be hard to remember everything you have experienced. Keeping a journal can help you remember what you need to talk to the doctor. It can also measure the progression of any potential memory loss.

While dementia can be scary, getting a diagnosis doesn’t mean your life stops. People with dementia are still able to take care of themselves, do their jobs, and most importantly, spend time with the people they love doing things they enjoy.

Having a support group can make all the difference when living with dementia. Reach out to friends and family when you need help and accept help when offered. Keeping connected can be difficult after a diagnosis. Many people turn away from their friends and family because they are embarrassed but isolating yourself will only make things worse. 

Currently, there is no cure for dementia, but there are a few treatment options that can help preserve someone’s memory and ability to function. More research is always being done on the subject. In the next few years, there very well could be a better way to treat or even stop the progression of memory loss.

The population of people living with dementia is rising and as more and more people are diagnosed, communities are coming together to support those with dementia. Communities all over the world are coming up with ways to include those with dementia and make sure they are not left out after a diagnosis. A dementia-friendly community offers residents with dementia a safe place to engage in social activities and more even into the late stages of the disease. To learn more about dementia-friendly communities and to learn how you can help make your community dementia-friendly, listen to our episode on Dementia-Friendly Communities.

Before we end the episode, let’s have a quick recap of what we’ve covered today. Alzheimer’s Disease is the most common form of dementia, and they both result in changes in the brain that lead to memory loss and language and reasoning difficulties, ultimately disrupting everyday functioning. In both Alzheimer’s and dementia, early detection is key. Knowing the signs and symptoms of Alzheimer’s and dementia can help you get an early diagnosis and in turn, an early start at treating the disease and planning for the future.

 We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.forbes.com/health/healthy-aging/dementia-vs-alzheimers/

https://www.alz.org/alzheimers-dementia/difference-between-dementia-and-alzheimer-s

https://www.cdc.gov/aging/aginginfo/alzheimers.htm

https://www.alz.org/alzheimers-dementia/what-is-alzheimers

https://www.nia.nih.gov/health/what-is-dementia

https://www.mayoclinic.org/diseases-conditions/frontotemporal-dementia/symptoms-causes/syc-20354737

https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013

https://www.mayoclinic.org/diseases-conditions/lewy-body-dementia/symptoms-causes/syc-20352025

https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/mixed-dementia

https://www.mayoclinic.org/diseases-conditions/vascular-dementia/symptoms-causes/syc-20378793

https://www.alz.org/alzheimers-dementia/what-is-dementia

https://www.nhs.uk/conditions/dementia/dementia-prevention/

https://www.nutriciaresearch.com/alzheimers-disease/synapses-the-building-blocks-of-memory/

https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/memory-loss/art-20046518

https://www.health.qld.gov.au/news-events/news/dementia-signs-symptoms-recognise-what-to-do

Finding a caregiver for a loved one can be stressful. There are several different types of caregivers to choose from that all provide different levels of care at different price points. Today we are going to be talking about the many types of caregivers and the differences between the types of care they provide. We’ll begin with the 5 types of in-home caregivers before moving on to the other 5 types of caregivers. Now let’s move on to the rest of the show.

Before we jump into the types of caregivers, let’s briefly talk about what a caregiver is. Hopkins Medicine tells us, in simple terms, a caregiver is a person who tends to the needs or concerns of a person with short- or long-term limitations due to illness, injury or disability. The term “family caregiver” describes individuals who care for members of their family of origin, but also refers to those who care for their family of choice. This could be members of their congregation, neighbors, or close friends. Family caregivers play a significant role in health care, as they are often the main source of valuable information about the patient.

Most people will either be caregivers or need care at some point in their lives, and oftentimes they will experience both sides. According to Family Caregiver Alliance, family caregivers, particularly women, provide over 75% of caregiving support in the United States. In 2007, the estimated economic value of family caregivers’ unpaid contributions was at least $375 billion dollars, which is how much it would cost to replace that care with paid services.

Family Caregiver Alliance says that caregivers tackle a wide range of tasks. They may do household chores like buy groceries, cook, clean the house, and do laundry. They may also help with personal care, like helping a family member get dressed, take a shower, and take medicine. They can provide medical-related assistance, like helping transfer someone in and out of bed, help with physical therapy, injections, feeding tubes, and other medical procedures. They can also help a loved one make medical appointments and drive to the doctor and drugstore. Many caregivers are the go-between for their loved one and are the ones that talk with the doctors, care managers, and others to understand what needs to be done. They also spend time at work handling a crisis or making plans to help a family member who is sick and is often the designated “on-call” family member for problems.

Now that we’ve had a refresher on what a caregiver is and the importance of a caregiver, let’s move on to the types of caregivers.

There are 5 types of in-home caregivers: family caregivers, informal caregivers, independent caregivers, private duty caregivers, and professional caregivers. Each of these types provide in-home care, but the way they provide care differs.

Caregiving can be expensive and many families are more comfortable doing at least a portion of the caregiving their loved one needs themselves. According to Jevs Care at Home, family caregivers are usually unpaid family members who take care of a spouse or loved one. These caregivers are almost always related to the person receiving care in some way. We are often asked if it is possible to have some of your caregiving expenses reimbursed and it is, but on average, about 21% of all caregivers work is unpaid.

That said, you may become a paid family caregiver by working with a home care agency. You may also find local resources to help with the cost of caregiving. According to Family Caregiver Alliance, sometimes, caregiving families may obtain financial relief for specific purposes, such as for respite care or to purchase goods and services, and in some cases, pay for caregiving. In some states, there are programs that pay family members to provide care to those receiving Medicaid and in very few states there are programs available to those who do not qualify for Medicaid. It is important to note, however, that these programs vary widely, often with complicated criteria for eligibility.

The second type of in-home caregivers are informal caregivers. According to Jevs Care at Home, informal caregivers provide similar services to those of family caregivers, but in most cases, they aren’t related to the person receiving care. Usually, these caregivers have some connection or relation to their clients, which is helpful for creating the companionship many seniors seek.

According to Family Caregiver Alliance, about 44 million Americans provide 37 billion hours of unpaid, “informal” care each year for adult family members and friends with chronic illnesses or conditions that prevent them from handling daily activities such as bathing, managing medications, or preparing meals on their own.

Many people act as informal caregivers without even realizing that’s what they are doing. Neighbors, friends, and family members provide informal care through tasks like meal prep, transportation to appointments, and errand assistance. They may see these tasks as just helping out when they are really providing care.

The third type of in-home caregiver is an independent caregiver. According to Jevs Care at Home, an independent caregiver gets hired directly by the person’s family needing care and is not affiliated with a home care company. They provide all of the necessary caregiving services and work with the family to determine their loved one’s care needs. This also means there are higher risks and liabilities when choosing this route.

Independent caregivers can often be 30 to 40 percent cheaper than a home care company and have fewer restrictions than a professional caregiver does. Paying for Senior Care says that as of 2019 if an independent caregiver is paid more than $2,100 per year, they are considered a household employee, and not an independent contractor. Thus, the family hiring the independent caregiver takes on all the responsibilities of being an employer, which includes payroll and taxes and all other requirements.

As the employer, you would write a job description for a potential independent caregiver that covers the level of care and all care tasks they will be expected to perform. Paying for Senior Care suggests listing tasks such as driving or accompanying the senior to and from appointments, running errands, providing supervision and companionship, managing medication, assisting with bathing and grooming, preparing meals, and housecleaning.

The personal qualities one is seeking in a caregiver should also be covered, such as a patient individual with a cheerful, upbeat personality. Independent caregivers can provide medical care, but they often only provide personal care.

The fourth in-home caregiver, a private duty caregiver, is similar to an independent caregiver. According to Jevs Care at Home, Private Duty Caregivers typically work for a home care company or independently and alleviate the difficulties of everyday life for a senior to allow them to continue living independently in their home. Depending on their level of training, a private duty caregiver is able to provide medical, nursing, cleaning, personal, domestic, and transportation services.

The last type of in-home caregiver is a professional caregiver. According to Jevs Care at Home, professional caregivers are career caregivers, so their primary occupation is caregiving. These caregivers work with a care recipient either in their home or in a facility to ensure they receive proper care. Professional caregivers work for professional home care companies, so they are typically assigned when you hire the company. They provide everything from homemaker services to medical care if necessary.

Professional caregivers work through licensed companies and oftentimes provide more care than the other four types of in-home caregivers. Because of this, a professional caregiver costs more than other caregivers do, roughly 30 to 40 percent more. Using a home care company means that you would not have to take responsibility as the employer like you would for an independent caregiver.

Now that we’ve covered in-home caregivers, let’s move on to the other types of caregivers you should know.

Hospice caregivers are up first on our list. Hospice caregivers can provide care both at home and in a facility. Hospice caregivers can be family members or professional caregivers. According to the National Institute on Aging, hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. A hospice caregiver provides the necessary care for your loved one, while also making sure they are as comfortable as they can be.

A hospice caregiver is often part of a team. Compassus says that the hospice team arranges for the delivery of medical equipment and medications. They work with you on a schedule for visits from nurses, therapists, chaplains, social workers, and volunteers. The schedule adapts to your needs.

According to Compassus, the responsibilities of a hospice caregiver include helping patients with the activities of daily living, including bathing, dressing, feeding, and going to the bathroom. Ensuring your loved one has their prescriptions and that all medicines are given at the correct dose and time. Hospice nurses and aides can also teach proper techniques and provide basic medical care, including changing dressing, taking temperatures, and blood pressure readings. Hospice caregivers also understand how to use medical equipment, which may include oxygen machines, wheelchairs, lifts, and hospital beds. However, depending on the hospice provider and even state that you reside in – most hospice caregiver’s will visit 1-2 times a week and for a short duration of time. Many times, for families receiving hospice at home the hospice provider will recommend hiring a home care company to help with a loved one’s care needs.

If your loved one is receiving hospice care at home and needs to be transferred to a facility for pain management or any other reason, the hospice team will schedule transportation to the facility and will continue to provide care for your loved one and your family.

There may be times when your loved one is home alone and needs care and it may be unsafe for a caregiver to come to the home or a caregiver may be unable to visit. According to Jevs Care at Home, that’s where virtual caregivers come in. By using a tablet or other type of screen, caregivers interact with their clients through Skype or another form of video call to ensure their health is monitored. This type of caregiving should be supplemental to in-home caregiving but still, help in caregiving like with medication reminders or health screenings. It’s also helpful for companionship.

There are also technologies available that allow a virtual caregiver system to monitor your loved one in their home, like Addison Care. According to Addison Care, Addison, the virtual caregiver, is a state-of-the-art, 3D animated, connected caregiver designed to transform a residence into a digital Smart Health Home, providing chronic care management, rehabilitation, aging in place, behavioral health, and care coordination, for patients of all ages.

With a virtual caregiver system, you can connect devices, such as glucose monitors, blood pressure cuffs, and thermometers. The system can send alerts to you and your loved one and provides 24/7 support. Similar to life alert, if your loved one falls, a virtual caregiver system will notify emergency services. Virtual caregiving, even a system such as Addison Care, should still only be used as supplemental care and should not replace an in-person caregiver. Companionship is an important aspect of the caregiving relationship and it can be supplemented with virtual visits, but cannot be replaced by it.

Another caregiving option for your loved one that cannot be home alone is adult daycare. According to Jevs Care at Home, Adult Daycare offers the opportunity for seniors to have stimulating social, cognitive, and physical activity outside of the home for a portion of the day. If it’s possible your loved one may be unsafe alone, can’t perform daily activities, and is alone for most of the day, adult daycare may be a good option. These programs typically supplement an in-home caregiver, usually in situations where a family member, who is also the caregiver, has another job.

Not all daycare centers are the same. According to AARP, most offer therapeutic exercise, mental interaction for participants, social activities appropriate for their condition, and help with personal care such as grooming and using the toilet. Adult daycare centers differ in the specific areas of care they offer. Social centers concentrate on meals and recreation while providing some health-related services. Medical and health programs provide more intensive health and therapeutic services in addition to social activities. And specialized centers take participants who have only a particular condition, such as those diagnosed with dementia.

Depending on the type of care you are looking for and the length of time your loved one will be staying at a center, prices can vary. On average, adult daycare costs $70 a day. Medicare does not normally cover the costs of Adult Daycare, but you may find financial assistance in your area. Some veteran services may help cover the costs and local and state programs may also help pay for adult daycare.

AARP suggests looking into daycare when you start seeing signs that an older loved one is unable to structure their own daily activities when a loved one feels isolated and lonely and wishes for interaction with other older people, or experiences anxiety or depression and needs social and emotional support. You may also want to seek daycare services when your loved one has difficulty starting and focusing on an activity whether it's conversation, reading, or watching TV when they seem to be no longer safe on their own or feel uncertain and anxious about being alone.

Family caregivers also might consider adult daycare services when they need to work or be away from home for most of the day or if they are themselves experiencing ill effects such as anxiety, frustration, depression, or health problems.

Your loved one may be mostly independent and able to live alone, but still, need a caregiver to stop by for things like medication assistance. Assisted Living may be a good choice if this is true for your loved one. According to Jevs Care at Home, Assisted Living Facilities come in all shapes and sizes but are typically designed to provide a very basic level of care and assistance to their residents. These facilities offer social activities, a community setting, and other services to enrich the lives of those living there. Outside of these services, care is provided periodically and as needed, like in the case of administering medication. The assisted living staff provides care as needed and not constantly like in the case of a caregiver.

In addition to standard assisted living facilities, there are also specialized facilities, or sections of the facility, that work primarily with those who need more care. These sections are typically for those with injuries, chronic conditions, or diseases like Alzheimer’s or Dementia.

Many families choose assisted living facilities in order to help with daily living activities. Daily living activities are things that you do every day, like eating, bathing, and walking. For elderly loved ones that need help with a few of these activities every day, but do not need help with the rest of their activities, assisted living would be the perfect option. For example, if your loved one needs help walking around and getting in and out of the tub, but they can make their own meals, eat alone, and dress themselves, assisted living would allow them to maintain their independence while still having a caregiver’s help.

Medicare doesn’t usually cover any of the costs with assisted living, but just with the other types of caregiving we’ve talked about today, local agencies and services may be able to help cover some of the costs of care. Visit your local senior center to find out what programs are available in your area.

Assisted living facilities do not provide full-time care for your loved one. If your loved one needs full-time care outside of the home, a nursing home, or a skilled nursing facility, may be the type of care your loved one requires.

According to Where You Live Matters, in a skilled nursing facility, residents receive full-time care by a specially trained medical staff. People who require a higher level of medical care, either short-term or long-term, need what’s known as skilled nursing care, extended care, or long-term care. These facilities are licensed by Medicare and/or Medicaid and are focused on short-term rehabilitation and long-term medical care.

According to the National Institute on Aging, nursing homes focus on medical care more than most assisted living facilities. These services typically include nursing care, 24-hour supervision, three meals a day, and assistance with everyday activities. Rehabilitation services, such as physical, occupational, and speech therapy, are also available.

Some people stay at a nursing home for a short time after being in the hospital. After they recover, they go home. However, most nursing home residents live there permanently because they have ongoing physical or mental conditions that require constant care and supervision.

When choosing a nursing home, make sure you know what type of care your loved one needs and find a place that specializes in that care. Nursing home staff have many patients they are taking care of and, especially with the ongoing Covid-19 pandemic, it’s important to make sure your loved one is getting the care they need. We’ve talked about the importance of advocating for your loved one before, and that still remains here.

When your loved one is receiving care, not at home, there is always the possibility that their care needs are not being 100 percent met. Being an advocate for your loved one in a facility means regularly visiting your loved one and staying updated on their care plan. Having a relationship with their care team can also make it easier to stay up to date on any changes that happen with your loved one while they are in the facility.

When choosing a nursing home, you should look at reviews, talk to friends and family members that have experience with the nursing home, take a tour of the facility, and ask about waitlists for the facilities in your area. Nursing homes can be difficult to get into, especially with the continuing rise in the aging population. When touring nursing facilities, the National Institute on Aging suggests looking for Medicare and Medicaid certification, handicap access, residents who look well cared for, and warm interaction between staff and residents. They also suggest visiting a facility a second time without calling ahead. Try another day of the week or time of day so you will meet other staff members and see different activities. Stop by at mealtime. While you are there for this second visit, you should see if the dining room is attractive and clean and if the food looks tempting.

We’ve now covered all the various types of caregivers. Choosing the right caregiver for your loved one is an important task that shouldn’t be taken lightly. If someone you know is currently looking into types of care for their loved one, share this episode with them. Knowing what types of caregivers are available can help you make a more informed decision when it comes to the type of care your loved one needs.

If you or someone you know is a caregiver, visit our YouTube channel and our dedicated Caregiver Support playlist for episodes to help the caregiver.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://jevsathome.org/types-of-caregivers/

https://www.caregiver.org/resource/caregiving/

https://www.hopkinsmedicine.org/about/community_health/johns-hopkins-bayview/services/called_to_care/what_is_a_caregiver.html

https://www.caregiver.org/faq/can-i-get-paid-to-care-for-a-family-member/

https://www.payingforseniorcare.com/homecare/hiring-independent-caregivers

https://www.payingforseniorcare.com/homecare/agency-or-independent-caregiver

https://addison.care/

https://www.aarp.org/caregiving/home-care/info-2017/adult-day-care.html

https://www.whereyoulivematters.org/assisted-living-defined/

https://www.nia.nih.gov/health/how-choose-nursing-home

Today, we are going to be talking about transitioning from a short-term rehab facility back to your home. We will be discussing discharge plans, communication strategies, home preparations, and most importantly, advocacy. Now let’s move on to the rest of the show.

Rehab facilities are somewhat the norm when it comes to transitioning from hospital to home. If your loved one finds themselves in the hospital, for a scheduled surgery, an unexpected illness, or even a fall, they may be moved to a rehab facility before they are able to come home. Last year, over 530,000 people were treated in inpatient rehab facilities. According to Wauconda Care, a rehabilitation center has the goal of getting patients rehabilitated to a point where they can live and function on their own, so these facilities offer short-term care focusing on equipping patients to get back to their life at home.

Many families are nervous about transitioning from rehab back to home. Kevin Smith, President, and COO of Best of Care, Inc. gives us an example of a family experiencing the transition from rehab to home. He says that your 88-year-old mother suffers a stroke in the home she and your dad have shared for 40 years.

You rush to the hospital. Mom appears frail. Her speech is slurred. She is having a tough time moving her arms. Yet, she seems to be in good spirits. You’re thankful dad called 911, that the ambulance arrived quickly, and that they caught and treated the stroke early.

But you’re more than anxious about what comes next. The hospital’s care manager wants to discharge mom to a rehabilitation facility in three days. From there, she’ll go back home to dad… who has also become increasingly feeble.

What was a normal part of mom’s day – bathing, cleaning, cooking, doing errands, moving around the home, walking the dog – is now impossible. You know that for mom and dad to remain in their home and age in place, major changes will have to be made. But where to begin?

This scenario plays out thousands of times a week in communities across the country. Having a care plan prior to this experience can help ease anxieties and make the process easier. If you have not yet made a care plan with your aging loved ones, we urge you to make one. For help with creating your care plan, visit our website or listen to our episode, “What is a Care Plan?” on YouTube, or wherever you get your podcasts.

Back to the question at hand… where to begin? Really, the answer to this question is to begin before you start. When your loved one first enters the rehab facility, AARP says you should ask to speak with a hospital discharge planner or social worker for help planning your loved one's next steps, care, transportation to their next place, insurance coverage, and payment plans.

Next Step in Care recommends discussing the following items with the discharge planner or social worker as soon as you have the chance. With the social worker, you should discuss how much time you can devote to being a family caregiver, whether you will provide all or some of the needed care, whether you can continue to work at your job, or if you will need to take time off, whether you have any health problems or other limitations, such as not being able to lift heavy weights, whether you have other commitments, such as caring for young children, and any and all other questions and concerns you may have about being a family caregiver.

According to LeadingAge, during this time, you should also work with the rehab staff and request a home visit from the physical or occupational therapist so that they can assess the living environment and make recommendations.

Erin Wuerz, a physical therapist and rehab manager with Kindred Healthcare says that “like anything else in life, the key to success is planning ahead. Discharge planning should start upon admission, and it should be an ongoing dialogue between the family and the rehab team during the length of the stay.”

Plan ahead as much as you can. This is also why having a care plan is so important. A care plan takes away the guesswork and lets you and your loved one focus on their recovery. If your loved one is going to need additional care once they are discharged from the rehab facility, now is the time to look into care providers, as well.

Communication is key throughout your loved one’s stay in a rehab facility. Ask about your loved one’s progress daily. When tracking their progress, make sure you talk to the staff, as well as your loved one, but also be aware that your loved one may not accurately describe their progress to you. Your loved one may not be lying to you, but they most likely want to be discharged and go home and believe they are strong enough when in reality, they are not.

On the opposite side of this, Rehab Select tells us that transitioning home after a stay in a short-term rehab facility can be difficult. Recovery from a serious illness, injury, surgery, or stroke can be a long process, and the thought of going back home before they feel confident about fully managing on their own can be intimidating for your loved one and they may not believe they are ready to leave the rehab facility.

If your loved one is nervous about this transition, talk with your discharge planner or social worker about ways you can help your loved one feel more comfortable about their situation. You should also reassure your loved one that you will be there for them throughout this process, and so will their friends and family. They have a support system to cheer them on.

LeadingAge says that you and your loved one should expect things to not return to normal once they leave the rehab facility. Unrealistic expectations about being able to return to life as normal can lead to disappointment and frustration. Recovery can take a while, and in some cases such as a stroke, you may need to make modifications around the house or get extra assistance from caregivers in order to safely return home.

Recognizing that these adjustments will ultimately result in a safer and more comfortable living environment may relieve some of the stress associated with the transition.

Once your loved one is nearing their discharge date, it is time to reevaluate the discharge plan you created when they were first admitted to the facility. Now, with the help of the rehab’s discharge planner or social worker and the staff, you will need to prepare for what type of discharge your loved one will have. According to Next Step in Care, your loved one may be discharged to their home, with no needed services, to their home, with help needed from a family caregiver, or to their home, with help needed from a professional home care agency. The rehab team may also recommend your loved one receive long-term care, such as the care they would receive in a nursing home or assisted living facility.

Next Step in Care also recommends getting to know your loved one’s discharge team. Their team includes a doctor, who authorizes the rehab discharge. A nurse, oftentimes this is the head nurse of your loved one’s unit, who will coordinate any education regarding medications and other nursing issues. A social worker that coordinates the discharge, making sure that everything happens when it should. They also take care of and educate you on the many details about the facility’s discharge process. A physical or occupational therapist is responsible for evaluating your loved one’s progress in accordance with both professional standards and insurance requirements, as well as providing the therapy your loved one needs to regain their strength. The last member of your care team is you, the family caregiver. You likely are the one who knows your family member best and will be their number one supporter and advocate.

When considering any transition, it’s important to be an advocate for your loved one, and for yourself. If you are not yet ready for your loved one to come home, speak up. Needing more time to make the home accessible and safe for your loved one is something you should discuss with the discharge team and you can come up with a solution together.

There is also the possibility that the rehab facility decides to discharge your loved one before you may believe that they are ready to come home. According to Next Step in Care, sometimes the rehab program makes a discharge plan you do not want, agree with, or feel is safe. You have the right to appeal this decision and ask for a review. By law, the rehab program must let you know how to appeal and explain what will happen. Make sure the rehab program provides you with contact information for the local Quality Improvement Organization (QIO) that reviews such appeals. Appeals often only take a day or two. If the appeal is denied, then insurance will not pay for those additional days and your loved one will have to leave the facility immediately.

If you do have to appeal a discharge decision and are looking for additional support, reach out to your local senior center and elder affairs department. Both will be able to give you resources and information that can help you during the appeal process and after, whatever the decision may be. The rehab facility can also be a good resource to use, for the appeal process and for the transition home. LeadingAge says that your rehab facility can put you in touch with other community resources. Local communities have a wealth of services such as delivering meals, light housekeeping, transportation, and counseling, all of which will provide a helping hand to you and your loved one while still enabling independence.

Advocating for your loved one and yourself is such an important task that we want to make sure you are as prepared for as you can be. AARP recommends they you insist on the three “I’s”: information, inclusion, and instruction.

Our first I, Information: Obtain printed copies of all pertinent information, including your loved ones' current medications list and prescriptions, any changes to their medications, and a summary of their visit that includes their diagnosis, treatment, prognosis, surgeries, limitations, and any other pertinent information, rehabilitation recommendations, and discharge orders. You should also make note of any scheduled follow-up appointments and share this information with those who will care for your loved ones next, such as their doctors, facilities, home health aides, and professional caregivers.

Our second I, Inclusion: Proactively make certain that you are included in care planning discussions and are informed of changes and decisions. If you have health care power of attorney for your loved ones, you can make decisions for them if need be and you need to know what is happening so that you can make an informed choice.

And Lastly, Instruction: Nearly half of family caregivers are expected to perform follow-up medical and nursing tasks, so be sure to ask for detailed instructions and training, which is required by law in some states.

Now, let’s say you have received the discharge decision and you agree with it. What do you now? First, make sure your loved one’s living space is ready for them. If they live on their own, do you need to temporarily move in with them to help take care of them? You will need to ensure you have what you need at their home, a bed, clothes, food.

You will also need to make sure the living space is accessible and safe for them to get around in. For more information on making sure your home is safe and accessible for your loved one, listen to our Quick Tips episode on Aging in Place on our Official YouTube channel, our website, or wherever you get your podcasts.

Any equipment and supplies your loved one will need once they return home should already be there waiting for them before they even leave the rehab facility. You do not want to have to rush to find last-minute specialty equipment that your loved one needs, which is why it is important to obtain the necessary supplies and equipment ahead of time.

Some common supplies and equipment your loved one may need after being discharged from the rehab facility are hospital beds, recliner chairs, bedside commodes, oxygen tanks and supplies, incontinence products, skincare items, such as water-free shampoo and soap. The rehab facility may have suggestions on where you can get some of these items, so make sure you talk to them about any necessary supplies and equipment your loved one may need.

Supplies and equipment can be expensive and add up quickly. Check with your loved one’s insurance to see what supplies and equipment they will pay for. You can also find organizations in your area that can donate supplies or help you cover some of the costs in some way. Not sure who to reach out to? Start with your discharge team. They are there to make sure your loved one gets back to their best self, and getting the supplies they need will help your loved one.

When your loved one comes home, Next Step In Care says that you will likely do certain tasks as part of giving care. It is important that you know how to do these safely. Try to learn as much as you can while your family member is still in rehab. You can do this by watching the physical and occupational therapy staff as they do these tasks and asking them to watch as you try these tasks yourself.

Sometimes, the rehab staff will not teach these tasks until the day of discharge. This may not be a good time to learn if you feel rushed or overwhelmed. Learn what you can, and ask who to call if you have questions at home.

You might be told to call someone from the rehab program, a home care nurse, or other health care professional.

Speak up if you are afraid of doing certain tasks (such as wound care) or cannot help with personal hygiene (like helping your family member take a shower or go to the bathroom). Some caregivers are okay with changing their family member’s diapers while others feel very uncomfortable about doing this task.

Think about your own feelings as well as your family member’s. The rehab team needs to know what tasks you can and cannot do so they can plan for any needed help.

So far, we’ve talked about what you should do to prepare for the day your loved one leaves the rehab facility. Now let’s move on to what you should expect the day of discharge and beyond.

When the discharge day comes, you may need to pay for a service to transport your loved one home, depending on their needs. If they are unable to walk or sit, you may need to find an accessible cab, or something similar. The discharge team can help you pick the right transportation service for your loved one. Health Sense says that you will also need to have a plan for community transport such as wheelchair-accessible cabs, cars, or ambulettes (which are a specially equipped van for transporting disabled or convalescent passengers in nonemergency circumstances) for follow-up appointments with doctors in the community.

When your loved one comes home, they may have to eat a special diet and take medications. Talk to your loved one’s care team to make sure you understand your loved one’s nutritional needs and restrictions, as well as their medication schedule. Your loved one’s doctor should give you a list of medications, how long they need to take them, how often they need to take them, and how they should take them. You and your loved one should also be made aware of any side effects that their medications can cause and be on the lookout for them. If your loved one experiences any side effects while taking medications, call their doctor immediately.

Medications can also be expensive. Make sure to check with your loved one’s insurance to see what they will cover. If your loved one needs help covering the cost of their medications, again, reach out to the rehab facility and community resources for help. Some medications also have to be picked up at a hospital pharmacy instead of your normal pharmacy. If your loved one has a medication like this, make a plan of how you will get this medication and how often you have to pick it up. Some pharmacies offer delivery, as well, especially during the covid pandemic. Ask your local pharmacy and hospital pharmacy if delivery is an option for you. Getting your medications delivered can help you during this time, as it will be one less thing you will need to do.

LeadingAge says that you need to recognize that it's ok to have help and to ask for help. Some people are embarrassed about needing assistance after transitioning home, and some family caregivers think they can take care of their loved ones all on their own. It's important to be realistic about the level of care that will be required, and it's ok to have extra help. Getting help isn't a sign of weakness, but one of strength and care.

Amy Goyer, a family caregiver, recognized she needed help and asked for it while caring for her dad. She says that when her dad was discharged from the hospital with a feeding tube, she was given just a few minutes of explanation on how to deal with it. It was complicated, and they were back in the hospital multiple times when it clogged. She received help from the home health nurses, but you can bet the next time they had a hospitalization that she advocated more strongly for the information she needed to do her job as a caregiver.

At first, Amy didn’t ask for help and tried to do things on her own. Once she asked for help, she was able to better take care of her dad and gain the skills and confidence she needed to be a better caregiver.

Lastly, according to AARP, you need to be realistic about the future. Sometimes rehab facilities are unrealistic about what setting is best for our loved ones, or how much a family can handle in terms of future care. It’s up to you to stay rooted in reality. Ask a lot of questions, observe loved ones in therapy sessions, monitor their medications and assess their capabilities, and weigh it all along with their needs, wishes, and quality of life. You should also assess the home situation and potential facilities realistically. If you can’t provide all the direct care yourself, you are not a failure. You are still doing your job as a caregiver when you coordinate the care. Your loved one has a discharge team in the rehab facility, and they will still need a team once they leave. Line up the support you’ll need from care managers, care providers, family members, and friends and build your team.

Throughout the transition, make it a high priority to take care of yourself. As we have said an ample number of times and will continue saying, you cannot provide the best care if you are not your best self. While some transitions go more smoothly than others, no transition is perfect. Just do your best with the information you can gather. You can always make new decisions as the situation changes. Plan early, plan often, and be there for your loved one, because at the end of the day, that’s the most important job you have.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.aarp.org/caregiving/home-care/info-2021/transition-from-hospital-rehab-home.html

https://data.cms.gov/provider-data/dataset/ka5z-ibe3

https://waucondacare.com/2017/08/14/nursing-home-vs-rehabilitation-center-benefits-choosing-rehab-center/

https://leadingage.org/members/5-tips-transition-smooth-move-rehab-home

https://blog.rehabselect.net/transitioning-home-after-short-term-rehabilitation

https://bethesdahealth.org/blog/2019/03/14/steps-to-a-successful-senior-transition-from-short-stay-rehab-to-home/

https://www.nextstepincare.org/uploads/File/Guides/Rehabilitation/Going_Home/Rehab_to_Home.pdf

https://www.health-sense.org/discharge-time-rehab-facility-now/

The holiday season is here and it can be especially stressful for caregivers. If you are caring for a loved one with dementia, today’s Quick Tips episode is specifically geared toward making holidays enjoyable for you and your loved one. We are going to talk about how you can create a safe and calm space for your loved one, how to adapt holiday activities, ways you can celebrate with a loved one in a facility, how you can prepare for visitors, and last but not least, how to make sure you are taking care of yourself this holiday season. Now let’s move on to the rest of the show.

Decorating for the holidays can be a fun family activity, but it can also cause added stress to you and your loved one. When decorating with a loved one with dementia, Mayo Clinic recommends that you tone down decorations. Avoid blinking lights or large decorative displays that can cause confusion and avoid decorations that cause clutter or require you to rearrange a familiar room. Don’t decorate doors or pathways that your loved one uses regularly. They may get confused if things don’t look the same. For example, don’t put up an advent calendar on the refrigerator, it may cause your loved one to skip meals.

According to Mayo Clinic, you should also avoid safety hazards like candles and large decorative items. Substitute electric candles for burning candles, but if you do choose to light candles, don't leave them unattended and make sure the lighter and matches are put away. Avoid fragile decorations or decorations that could be mistaken for edible treats, such as artificial fruits. You can still display fragile decorations, but make sure they are out of reach and secured safely. If you have glass ornaments or other decorations, consider replacing them with shatterproof options while your loved one is around.

If you have a tree, secure it to a wall and make sure it doesn’t block any part of your loved one’s regular path.

Make sure you give your loved one a chance to help with the decorating. Change can be scary for someone with dementia, but they will enjoy spending time with you and the rest of the family and may enjoy finding special family decorations that have been stored away all year. If your loved one is anxious about decorating, make sure you listen to what they’re telling you and maybe choose to decorate when they are not in the room.

Decorating may make your loved one upset, but know that if decorating your home is an important tradition to your family, you shouldn’t stop doing it altogether. You can work with your family to modify traditions and decorations so that it works for your current situation.

Another way to make your space calming while decorating is to play your loved one’s favorite holiday music, or any music they enjoy while decorating. Mayo Clinic also suggests that you adjust the volume to be relaxing and not distressing.

If your loved one regularly has a hard time adjusting to small changes, try only decorating small sections of your home at a time and only making small changes within those small sections. Slowly making changes around the holidays may help ease your loved one’s nerves about the changes happening around them.

Now that we’ve given you a few tips to create a safe and calm space, let’s move on to ways you can adapt holiday activities for your loved one to enjoy.

First, you should make a list of activities you know your loved one enjoys. They may enjoy baking cookies, singing carols, knitting, watching live performances, or looking at Christmas lights. Whatever your loved one may enjoy, make an effort to include a few of those things during the holiday season and plan ahead.

If your loved one enjoys baking, Home Care Assistance recommends that you bake holiday treats. You can be elaborate or keep it simple while baking. You could prepare cookie dough and have it cut and ready for decorations, or if baking the cookies is too much for your loved one or you no longer have time, you can buy premade cookies to frost together.

Weatherly Inn says that the holidays are a time to cherish your older family member's culture and history. Get everyone in the kitchen and bake their favorite holiday treats. One way to make this experience extra special is to use your loved one's recipes. You might need to make some ingredient adjustments, but this can be a great way to encourage his or her memory. If your loved one struggles to remember ingredients or measurements, that's okay. This experience is all about fun, so keep it lighthearted (and search the internet in secret) if they're stumped.

If you normally have a holiday party, consider asking a friend or family member to host instead. Having a large crowd can be overwhelming for your loved one. Keep gatherings small and intimate and watch for signs that your loved one is overwhelmed, like not participating in a conversation. For more information on how to tell when your loved one is overwhelmed, listen to one of our episodes on caring for a loved one with dementia. You can find them on our website, our YouTube channel, or wherever you get your podcasts.

When you do have guests over, Mayo Clinic suggests that you plan a gathering at the best time of day for the person with dementia. You want to keep daily routines in place as much as possible. You should also provide a quiet place for the person with dementia to have time alone or to visit with one person at a time. If you'll be attending a holiday gathering, plan to be brief or be prepared to leave early if necessary and make sure there is a place for your loved one to rest or take a break.

Another activity that your loved one may enjoy is watching holiday movies. According to Weatherly Inn, many families make a tradition of watching their favorite holiday movies together. Try to pick some older films that might spark a pleasant memory for your loved one.

Weatherly Inn’s favorite holiday movies for seniors are Holiday Inn and Miracle on 34th Street. Holiday Inn is a popular older Christmas movie starring Bing Crosby and Fred Astaire. It was responsible for making one of the most popular holiday songs in history, "White Christmas." Miracle on 34th Street is another classic your loved one will likely remember. The original Miracle on 34th Street debuted in 1947 and starred Maureen O'Hara and Natalie Wood.

Family movie night is a wonderful holiday tradition that you can even host while social distancing! You can plan a family watch party using Facebook, or using an app like Skype or FaceTime. Socializing through a device may also be easier for your loved one than in person, too, as they may feel less pressure when they are able to be comfortable in their own home and not surrounded by bodies.

Your loved one may also be able to participate in virtual movie nights if they are living in a care facility. It may be harder for your loved one to participate in holiday traditions and activities while in a facility, but they will appreciate being included and the time you are able to spend with them.

According to Mayo Clinic, if your family member lives in a nursing home or other care facility, try celebrating in the most familiar setting. Because a change in environment can cause distress, consider holding a small family celebration at the facility instead of in your home. You may even participate in holiday activities planned for the residents. It doesn’t really matter what you do with your loved one, what matters most is that you are there.

More family and friends may want to visit during the holiday season than normal. You should try to minimize visitor traffic as best you can. Arrange for a few family members to drop in on different days, because as we have already talked about, a large group may be overwhelming for your loved one.

Whether your loved one is in living with you or in a facility, people may want to stop in for a visit. Having visitors is something for your loved one to look forward to, but it can also be stressful. In order for your loved one to be prepared for a visit, the visitor must be prepared first.

According to Mayo Clinic, before anyone comes to visit, you should provide them with an update. Let guests know ahead of time about any changes in behavior or memory since their last visit. Providing a recent photo can help people prepare for changes in appearance, as well.

It may be helpful for visitors if you offer communication tips for your loved one. You can suggest ways for guests to listen patiently, such as not criticizing repeated comments, not correcting errors, and not interrupting. Visitors can also listen to our episode on the Dos and Don’ts of Visiting a Loved One with Dementia for more information.

Now that we’ve given you a few tips and ideas on how to prepare visitors, let’s move on to the final part of today’s episode, taking care of yourself this holiday season.

The holidays can be a stressful time, even before taking care of your loved one. It is important to take care of yourself during this time and to take time for yourself to enjoy the season. Mayo Clinic recommends that you pick and choose your activities. Focus on the holiday activities and traditions that are most important to you and remember that you can't do it all. You should also set realistic expectations for what you can contribute to family holiday celebrations and delegate tasks to others when possible.

Let family and friends help with cleaning, addressing cards, and shopping for gifts. Most importantly, as we have said already, make time for yourself. Ask a family member or friend to give you a break so that you can enjoy a holiday outing without caregiving responsibilities.

We here at All Home Care Matters wish you a happy holiday and hope that these tips will help you and your loved one enjoy this holiday season.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20047715

https://homecareassistance.com/blog/7-holiday-activities-loved-one-alzheimers

https://www.weatherlyinn.com/blog/holiday-activities-for-seniors-with-dementia

Today, we are going to be talking about having a parent move in with you and your family. First, we’ll talk about how your relationship with your parent may change. Then, we’ll talk about what steps you need to take to make the transition from your parent living alone to moving in with you. Finally, we’ll end the episode on ways you can make the transition easier. Now let’s move on to the rest of the show.

We’re going to start out today’s episode with one couple’s story of living with an elderly parent. If you would like to read the story for yourself, you can find the link to A Place for Mom in our show notes.

Lynette and Marty Whiteman were getting used to losing sleep. After Lynette’s aging mother Mildred moved into their New Jersey home from her retirement community, she regularly woke the couple, asking for help at odd hours. To Mildred, the requests were urgent, but Marty didn’t see changing light bulbs or resetting microwave clocks as tasks to crawl out of bed for.

Mildred’s increasing care needs — and midnight knocks on the couple’s door — were taking a toll on the Whitemans’ marriage. Tension over caregiving roles steadily increased, while privacy decreased. Communication broke down, and stress piled up.

The Whitemans, like many adults who choose to care for aging parents, thought having Mildred in the home would not only keep her safe but lend convenience as well. They thought it would be easier than having to travel back and forth between their home and hers. As it turned out, that wasn’t the case.

“It was a great idea in concept,” says Lynette. “But we didn’t know what we were getting into.”

Caring for Mildred at home wasn’t urgent, but it seemed like a good idea to Lynette. Her mom would receive regular social interaction, and they could form a closer relationship together.

Before moving in with her daughter, Mildred had grown depressed and isolated. Her late husband — Lynette’s father — had been outgoing, and he kept the couple engaged in community life and social events. Without him around, Lynette was worried: What if Mildred became too lonely? What if she fell while she was alone?

“We figured she’d have somebody if something happened in the middle of the night, and we could help her with her bills,” says Lynette.

So, they built a small, attached apartment with a private kitchen and bathroom using some of Mildred’s savings. But the adjustment was more difficult than expected.

At first, Marty and Lynette had trouble accepting the constant late-night interruptions and repetitive dinners at home. It seemed like they’d put their lives — and their marriage — on hold to care for Mildred. However, the couple’s situation improved after they agreed to work as a team, make adjustments, and follow a few pieces of caregiver advice:

1. Don’t be afraid to ask for help.
2. Make time for everyone, including yourself.
3. Accept that some things don’t change.
4. Set boundaries.
5. Acknowledge that you’re doing your best in a tough situation.

The Whiteman’s story is something more and more families are becoming familiar with as the aging population rises. This can be an extremely rewarding experience for you and your family, but it can also be extremely difficult. There are many things you need to consider when thinking about having a loved one come live with you.

First, you should be prepared for how your relationship with your loved one will change once they are living with you, especially if you are providing any level of care for them. Cohabitating with a parent for the first time since childhood can be strange for both you and your parent.

Next Avenue says you should avoid parent-child patterns from youth. Just because you’re back living under the same roof as your parents, you don't have to share the details of your life the way you may have as a child. Laurel Steinberg, a relationship therapist and psychology professor at Columbia University, cautions adult children to not seek approval for their actions and decisions. You now pay for the roof over your head and are responsible for the day-to-day routines.

She says it’s OK to ask a parent for help or for an opinion, but you shouldn’t fall into a pattern where a parent dictates how the household should operate or expect to be privy to every decision and detail related to the household. “Parents should only offer advice when adult children ask for it,” she says.

Next Avenue also recommends that you don’t ask for permission. Remember that even though you’re a grown-up who may have grown kids of your own, to your parent, you’ll always be their little boy or girl. That nostalgia can fuel parental expectations that your relationship will revert to what it was decades earlier. Steinberg says that “adult children often fall into the habit of asking for permission when parents live with them.” Gently assert your adult independence by setting boundaries on move-in day. You can politely tell your parent that you will not be reporting in every time you leave the house or take a phone call. The goal is to establish that you’re a self-sufficient adult who loves their parent, but has their own, independent life now.”

Prior to your loved one moving in, you need to sit down and have a conversation with them and your family to go over the house rules and any moving logistics, like what your loved one can keep with them and what areas of the house will be reserved for them. You want to make sure everyone living in your house has access to a space just for them, where they can go to be alone and have privacy.

If you have a guest house, an adjoining apartment, or a room with a separate entrance, this would be the perfect place for your parent to move in to, as long as their needs allow them to be in a secluded area by themselves. If you don’t have this extra space, you should consider what options you do have. Do you have a guest room or spare room they could use? Would your kids need to share a room? Do you or your parent have funds to build a place for them?

Having an entire living area to themselves, with a bedroom, bathroom, kitchen, and living area, can help your parent maintain their independence when living with their child, and can help the rest of the family keep more of their normal daily routines the same.

Even with a separate living area, routines will have to change, and communication will be key. Having a weekly schedule can be helpful for busy families. You don’t need to tell your parent when you are going to be gone, but writing on a schedule that you will be out on Tuesday and Thursday can be a good way to let your parent, and everyone else, know you will be unavailable. If your parent is unable to drive or doesn’t have a car of their own, a schedule can also be useful to know when they will need your assistance to get somewhere, like an appointment or a social gathering.

Alert 1 says that while it may seem overwhelming at first, both you and your loved one will come to love living under the same roof again.

Your parent will be there to help with things around the house so you don’t have to worry when you get home from work. They can help get the kids ready for school in the morning and for bed at night. Your pets will enjoy having someone around more often, and your dog can get your loved one outside and exercising.

Even if you don’t need the extra babysitting, your parent can still watch the house while you get away for the weekend. They’ll be there to listen and give advice when you’re feeling lost. Instead of having to hang up the phone, you can end the conversation with a hug.

Living with your parent, you’ll be able to support and care for each other while they enjoy their golden years. After all, what else is family for?

Now that we’ve told you some of the ways your relationship with your parent can change when they move in, let’s move on to what steps you should take during this transition.

Before your parent moves in with you, AARP has a list of questions you should ask yourself:

• How will the move involve my spouse, children, and siblings?
• How will my parent’s presence affect our family routine, activities, and privacy?
• Are there any unresolved issues between me and my parent or my spouse and my parent?
• Does this mean remodeling our house or adding a bedroom or bathroom?
• Do I expect other family members to pitch in?
• Can we afford the extra expense?
• Should part of my parent’s income go toward living expenses?
• Will I need to quit work or alter my schedule?
• Will we take my parent with us on vacation or get respite care?
• Are there issues such as smoking, drinking, or pets that we need to work out?
• Does my parent have any tendencies that bother or upset me? Can they be resolved?
• How will I establish boundaries?
• How does my parent feel about moving?
• How do I feel about accepting this role?

Once you have gone over these questions yourself, you should sit down with your parent and siblings to discuss things prior to the move. According to AARP, you should talk openly about expectations, fears, finances, and any lingering issues. It may make you uneasy, but this is the prime time to work it out or readjust your thinking. Sometimes it’s as easy as telling each other what bothers you. The other person may have no idea — and no trouble making a change.

Next Avenue also suggests that you seek outside counseling to help with the transition. “Having a parent age to the point where you are now essentially the ‘parent’ can be very powerful and difficult to navigate and trigger a range of emotions,” says Sara Sedlik, a licensed marriage and family therapist in Los Angeles.

You may experience unexpected anger, sadness, dread, or guilt in this situation, which can be overwhelming.

Sedlik also says that “there may also be relief or joy to have your parent close to you. Typically, there is a mix of emotions, which adds to the confusion.”

Without properly addressing these feelings or at least being aware of them, you may experience excess stress that can show up in other areas of your life, including personal or professional relationships, work performance, or even physical health.

Your family may also benefit from a session or two of group therapy. During this time, anyone can bring any grievances or issues they foresee to the rest of the family and have a moderator there to ensure everyone is given a fair amount of time to speak and be heard. If group therapy isn’t for you and your family, you can also hold a family meeting on your own and have everyone come prepared with written questions and concerns to discuss. Make sure to include your parent, too. If needed, you can have a few sessions, one with your children, one with your siblings, one with your parent, and one with everyone all together. Breaking into smaller groups can also be beneficial if anyone has any issues they want to bring to your attention without talking to the entire family at once, as that can be intimidating.

After you have met with your family and talked about your loved one moving in with you, you will need to take a look at your current living arrangements and see what all will need to change before your parent moves in.

Alert 1 recommends answering the following questions to see what sort of improvements will need to be made to your home.

• Do grab bars need to be installed in the bathroom?
• Does furniture need to be re-arranged to make more space for walking?
• Do all of the lights work?
• Do you have nightlights in bathrooms and along hallways?
• Does your yard have hazards like uneven pavement or overgrown vines?

Before your loved one moves in, you also need to go over their care needs and discuss your boundaries. A Place for Mom says that maybe you’re comfortable cooking and doing laundry but are not as comfortable bathing your parent or helping them use the bathroom. If you are not able to provide such care, you should look into professional home care options or assisted living. If your parent doesn’t need care when they move in, you should also discuss what you would do if and when they may need care in the future. Would that role fall to you or would you hire outside help?

Once you have established what level of care your loved one needs and who will be doing what, it’s time to work on organizing your house and possibly donating items you won’t have space for.

Your loved one should have their own bedroom and, if possible, their own living room or living area to arrange as they please. It can be stressful to merge belongings together without a plan, so try to create a clear map and write down where everything will go. Make sure your parent knows beforehand how much space they will have for their belongings.

It’s important to remember that your loved one is downsizing to move in with you, so why not do the same for them? Use this time to go through and donate things you don’t use or need. This will help free up space for your loved one’s belongings and they will feel better knowing they are not alone in having to let go of things.

Once you have the space for your loved one and you have talked about care options, it’s time for them to move in! Make sure to keep a positive outlook during this time. It will help ease the transition on your parent, and after all, it should be a positive time! You get to spend more time with your parent and develop an entirely new relationship with them.

Once your parent has settled into their new living space, you can all begin to get comfortable in the new normal. Alert 1 tells us that having someone move in causes a disruption in everyday activity.  If Grandma is active and mobile, add her to the household chore list. She can help out with preparing meals, doing dishes, gardening, and walking the dog. Don’t expect her to do any heavy lifting, though. You’ll still need to take out the trash and clean out the gutters.

Once your loved one is accustomed to living with you, you can go over your list of household chores and find the best way to divide them up together. You can also revisit this list and make changes as needed. While your loved one is living with you, you should both be able to come to one another and talk about what is or isn’t working at any time and make any necessary changes.

While we hope your experience living with your loved one once again goes smoothly, we also want to prepare you for the possibility that it won’t work out. According to Aging Care, caregiver guilt can be a significant obstacle for many, regardless of the specifics of your living situation. You feel an obligation to make this work, but when an elder exhibits troublesome dementia-related behaviors, creates unsafe or unsanitary conditions, sets a poor example for your children, interferes with your marriage, or refuses to contribute to the household or see to their own care, it puts a huge strain on your life.

If you’re feeling trapped caring for elderly parents in a situation that you cannot escape, it’s time to let go of the guilt and make other arrangements. It is time to acknowledge that you did your best and explore other elder care options. These might consist of an adult daycare or professional in-home care for respite or moving your loved one into assisted living, memory care, or a nursing home.

In order to avoid caregiver guilt, an unhappy relationship, a tense household, and an overall bad experience, it’s important to make sure you follow the steps we have talked about today. And always remember to take care of yourself and reach out when you need help.

So far, we’ve talked about how your relationships can change when a parent moves in and what transition steps you should take. Before we close for today, let’s talk a little about how you can make the transition easier for your loved one.

According to AARP, your parent may struggle getting acclimated to a new living arrangement and neighborhood. You can be of assistance by helping to locate the local pharmacy, bank, faith community, recreation center, and other services they may use. If your parent is interested in independent daytime activities, you can visit a nearby senior center for information on classes and programs. If your parent requires more intensive care, assess adult daycare centers that provide rehab, meals, counseling, and therapeutic activities. If you are providing full-time care in your home, look into respite or companion services to give you a break and help your parent expand his or her social circle.

If your loved one is moving from a different area, they may need your help keeping in contact with their friends. If your parent isn’t technologically savvy, you can help them set up a video call a few times a month to catch up with their friends. If you help them with their technical difficulties, you should also be prepared to help their friends if they need it.

If your loved one is interested in learning more about using technology, you can help them find a technology class at a senior center or library that’s geared towards seniors. If you’re interested in learning about how you can use technology as a caregiver, you can also check out our episode, Technology Tips for Caregivers. You can find it on our website, our YouTube channel, or wherever you listen to podcasts.

We hope this episode helps you prepare for living with your loved one again. Following the steps and tips we’ve listed today should help you navigate this time, but don’t hesitate to reach out to your support group whenever you need. There will be hard times, just as there are when you are living with anyone else. Be patient, be kind, and have fun. Enjoy getting to spend this extra time with your loved one.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

http://www.ec-online.net/Knowledge/Articles/movingin.html

https://www.alert-1.com/blog/general/when-grandma-moves-in-making-your-house-grandmas-home/5824

https://www.aplaceformom.com/caregiver-resources/articles/living-with-your-aging-parent-doesnt-work

https://www.nextavenue.org/cope-aging-parent-moves-in/

https://www.aarp.org/caregiving/home-care/info-2018/living-with-aging-parents.html

Today, we are going to be talking about seniors and isolation. We’ll talk about some common causes of isolation, as well as the risks that come along with social isolation. Then, we’ll conclude the episode with ways that you can prevent isolation and include seniors. Now let’s move on to the rest of the show.

Socialization is an important aspect of life. It’s a part of the third level of Maslow’s hierarchy of needs, love and belonging. Only safety and ensuring one’s physiological needs, such as eating and sleeping, are more important than socialization. Lumen’s module, Introduction to Sociology, tells us that socialization is the lifelong process through which people learn the values and norms of a given society. Socialization is not the same as socializing. Socializing is to mix socially with others (for example, family, friends, neighbors, coworkers), whereas socialization is a process that may include socializing as one element, but is a more complex, multi-faceted and formative set of interactive experiences. It is also an adaptive lifelong learning experience, because society is constantly changing, and because we may find ourselves in new situations—such as a new job with different norms and values, or in a different familial role—such as that of a parent or caregiver to an older relative.

Oftentimes, we think of socialization as something children need to learn how to interact in society, but it applies to all age groups, including seniors. Asbury Communities says that social interaction has been a major part of cognitive development from the day you were born. Early relationships and interactions with parents, siblings, friends, and teachers taught you how to speak, interpret and express emotions, and expand your knowledge.

As an adult, socialization is just as important in keeping your brain active. Building social networks and participating in social activities are like exercises for your brain because they keep your mind agile and improve cognitive function.

Socialization can even help prevent mental decline and lower the risk of dementia. A 2017 study published by researchers at the Cognitive Neurology and Alzheimer’s Disease Center of Northwestern University Feinberg School of Medicine found that individuals 80 and above with the mental agility of 50-year-olds all had one factor in common: A close-knit group of friends.

Not only does socialization play an important role in cognitive function, but it  also is necessary for maintaining your mental health and keeping you happy. Even just occasional social activity can lower stress levels, decrease depression and anxiety, and improve overall life satisfaction.

Dr. Cole, director of the Social Genomics Core Laboratory at the University of California, Los Angeles, says that loneliness acts as a fertilizer for other diseases. The biology of loneliness can accelerate the buildup of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.

Now that we’ve talked a little bit about the differences between socialization and socializing, let’s move on to some of the common causes of isolation. Specifically, causes of social isolation.

Vista Springs Living says that it’s very common for seniors and older adults to avoid socializing, but why? For some, it’s because of the decreased mobility they have as they age. When it’s hard to drive or get in and out of vehicles, or if you need to use a walker or wheelchair to get around, going out and socializing becomes a demanding and laborious task.

In addition to struggling with mobility, seniors can find themselves having much less energy throughout the day and becoming exhausted quickly—making evening dinners and events tiring rather than invigorating. It also becomes more difficult to navigate unknown environments, so staying at home becomes a preferable option to going out. 

For some seniors, there are more than just physical barriers between themselves and socialization. As adults age, it can become more and more challenging to be emotionally available for family and friends. Seniors may be upset at their condition or frustrated in general, and want to avoid interactions and isolate themselves thinking that will be the better option. However, the opposite is often true.

According to Seniors at Home, older adults often experience their social worlds shrinking, as retirement, the death of friends and family, or lack of mobility make participating in social activities more difficult. For those who become socially isolated or who feel persistently lonely, the consequences can be dire and even life-threatening.

Traci Dobronravova, MSW, Director of Seniors At Home, says, “We see older adults every day who are disconnected from their community. Social isolation and the associated health risks for seniors is a critical issue facing our community.”

The covid-19 pandemic has created hardships for many during the past year and has isolated all generations. According to the Cleveland Clinic, experts have worried about the effects of the pandemic on mental health. This is especially a concern for older adults, who’ve been encouraged to be extra careful because they’re at greater risk for getting very sick with or dying from COVID-19 if they get it.

But being homebound and isolated from others can have unhealthy effects. For example, studies show that chronic loneliness can worsen memory in older adults and cause other declines in mental and physical health.

“Many seniors already deal with isolation, and we’ve seen it worsen during the pandemic,” says geriatric physician Kathleen Rogers, MD.

Now that we have discussed how social isolation, and isolation in general, can be detrimental to seniors, let’s move on to the health issues and risks that are associated with isolation.

A report by the Administration for Community Living’s Administration on Aging of the U.S. Department of Health and Human Services says that about 28 percent of older adults in the United States, or 13.8 million people, live alone. An older adult living alone is not automatically isolated, but they have a higher likelihood of being socially isolated than other age groups.

Living alone is the biggest risk factor for older adults when it comes to isolation, but according to St. Paul’s Senior Services, other risk factors include the death of one’s spouse, children moving away, a change in living environment, the deterioration of a friend network (often due to death), the fear of becoming a burden, the fear of going out and incurring an injury, difficulty communicating (i.e. language barriers and hearing problems), and illnesses (particularly dementia). Each of these factors can lead to increased loneliness in seniors and increased loneliness can, in turn, lead to a number of serious health effects.

Geographical isolation when living alone, or even with a caregiver or spouse, can make it difficult to get to appointments, run necessary errands like picking up prescription medications, and socialize in person. Technology has made it easier for older adults to meet with their doctors. Telehealth appointments, which are appointments where you meet with your doctor virtually, have been around for a few years, but have increased in popularity during the pandemic.

Telehealth appointments help older adults maintain their health but getting prescriptions is still an issue. Some pharmacies offer delivery, but only within a certain area, so seniors living in rural areas do not qualify for delivery. Companies that offer prescription deliveries may deliver to the senior, but they can be quite costly and the price of the delivery in addition to the cost of the prescription may be more than they can afford.

According to the CDC, social isolation significantly increases a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity. Social isolation is also associated with an estimated 50% percent increased risk of dementia, and the increase of dementia already increases with age.

Poor social relationships, characterized by social isolation or loneliness, is associated with a 29% increased risk of heart disease and a 32% increased risk of stroke. On top of all these, loneliness is associated with higher rates of depression, anxiety, and suicide. Loneliness among heart failure patients is also associated with a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.

If you are worried about your loved one being lonely or isolated from others, ask them if they are feeling lonely. They may not even realize they are lonely if no one presents the question to them. Your loved one may also be embarrassed to express their feelings of loneliness to you and may not tell you on their own.

If you believe that a senior in your life may be struggling with loneliness, St. Paul’s Seniors Services recommends that you look for these signs and symptoms: sadness or feelings of despair, loss of interest in hobbies, socializing, or other daily activities, lack of energy or motivation, sleep disturbances and memory problems, unexplained or aggravated aches and pains, and neglect of personal hygiene and other routines.

Identifying loneliness and isolation is just the first step. Reducing and preventing loneliness and isolation takes time and effort and the amount of socializing someone needs varies from person to person. Luckily, we have gathered a few suggestions on how to prevent isolation for you. But before we jump into ways to prevent isolation, let’s talk about a few of the benefits of socializing with friends and loved ones.

According to Psychology Today, an active social life may mean you live longer. People with more social support tend to live longer than those who are more isolated, and this is true even after accounting for the overall level of health of your loved one. Socializing also brings a higher likelihood that you will enjoy better physical health. Social engagement is associated with a stronger immune system, especially for older adults. This means that you are better able to fight off colds, the flu, and even some types of cancer.

Psychology Today also tells us that you will likely enjoy better mental health if you have a healthy social life. Interacting with others boosts feelings of well-being and decreases feelings of depression. Research has shown that one sure way of improving your mood is to work on building social connections. Some studies have even shown that socializing may lower your risk of dementia. More recently, there has been accumulating evidence that socializing is good for your brain health. People who connect with others generally perform better on tests of memory and other cognitive skills. And, in the long run, people with active social lives are less likely to develop dementia than those who are more socially isolated.

According to Home Care Assistance, socialization can increase the quality of life and promote purpose. As we have already talked about today, studies show that loneliness and senior health issues have been correlated and that loneliness is a risk factor of functional decline, and death in older people. Making sure we stay social and connected can not only extend the length of our lives but the quality of them as well.

Spending time with others helps us feel useful and that our life has a greater purpose. When we have something to do, somewhere to go, and someone counting on us, it feels good. Being around people we love makes life more fulfilling. When others count on us, we are more likely to take care of ourselves, and stay healthy for as long as we can. Both of these benefits, an improved quality of life and a purpose in life, create a cycle that encourages socialization. When we are enjoying spending time with people, we feel better, and we want to socialize more. And that cycle continues to repeat.

We’ve talked about the health issues and risks that come with isolation, as well as the benefits of socialization. Now let’s move on to how seniors, and you as their loved one, can prevent isolation.

Vista Springs Living says that there are plenty of ways for you to be social, or to help a loved one stay social as they age. Opportunities for socialization include:

Senior hobby groups (like gardening, bird-watching, cooking, or collecting clubs). Talking to others about what they enjoy and sharing in others’ enjoyment is a great way to socialize and can be a great incentive for those that may be shy or would not want to normally participate in conversations.

Volunteering is a great way for older adults to socialize and help out their community. Volunteer groups and organizations can also give a sense of purpose to older adults after retirement if they are beginning to feel lost. Helping others that are less fortunate than they are can also help put things in perspective for seniors, especially if they are helping other isolated individuals, and encourage them to participate in more social activities.

Walking or senior sports groups encourage socialization as well as physical health. Socializing while exercising can help motivate seniors to exercise, which can help improve their overall health and quality of life.

Using social media and technology can help homebound seniors connect to friends and loved ones, as well as supplement in-person visits for seniors that are unable to get out as often as they would like. Businesses and organizations have taken advantage of social media and technology over the pandemic and have started offering virtual classes, both paid and free, that seniors can take to stay involved and keep up with their favorite activities.

Speaking of activities, activity groups (like arts & crafts, movie watching, or book clubs) are another great way to involve your loved one in social activities and keep them engaged in conversation. Just like with hobby groups, activities that your loved one enjoys and can be done with, or around, other people are a great way to prevent isolation.

The last thing that Vista Springs Living suggests to prevent isolation is group health activities (like music therapy or meditation). These less intensive activities can improve your loved one’s overall health and are helpful for seniors that need any form of therapy. Water aerobics classes are a great example of this.

When seniors are self-isolating, it’s important to keep up efforts to engage them. Find out what their hobbies are and what groups are in your area that they can join. You can find groups and classes at your local senior center or library. Your doctor may also have suggestions or recommendations to prevent isolation. The CDC recommends the following national organizations for more resources:

AARP provides helpful information to seniors to help improve quality of life and provides access to Community Connection Tools.

Area Agencies on Aging, or AAA, has a network of over 620 organizations across America that provides information and assistance with programs including nutrition and meal programs (counseling and home-delivered or group meals), caregiver support, and more. The website can help you find your local AAA, which may provide classes in things such as Tai Chi and diabetes self-management.

Eldercare Locator is a free national service that helps find local resources for seniors such as financial support, caregiving services, and transportation. If you visit their website, you can also check out their brochure that shows how volunteering can help keep you socially connected.

National Council on Aging works with nonprofit organizations, governments, and businesses to provide community programs and services. This is the place to find what senior programs are available to assist with healthy aging and financial security, including the Aging Mastery Program that is shown to increase social connectedness and healthy eating habits.

National Institute on Aging, or NIA, provides materials on social isolation and loneliness for older adults, caregivers, and health care providers. Materials include health information, a print publication, a health care provider flyer, and social media graphics and posts.

So far, we’ve talked about how you can prevent isolation for your loved one, but let’s not forget to prevent isolation and loneliness for caregivers, as well.

Seniors at Home tells us that caring for a parent, spouse, or loved one is an enormous responsibility. Family caregivers often find themselves juggling their caregiving duties with paid work and raising children, leaving them exhausted and without time to enjoy hobbies or social outings. This can create feelings of loneliness and social isolation. Practicing self-care, taking a few minutes for mindfulness, seeking support, and hiring respite home care can all help family caregivers get the rest and the social connection they need.

As a caregiver, it’s important that you take care of yourself, as well. Caregiver burnout happens when you don’t make yourself a priority. Don’t hesitate to reach out for support when you need it. If your friends and family are unable to help either financially or physically, there are several community resources you can use. Talk to someone at your local senior center to find out what support is available in your area. You can also listen to any of the episodes we have done covering caregiver burnout on our YouTube channel, website, or wherever you listen to podcasts.

As we discussed earlier, the Covid-19 pandemic has worsened isolation for many seniors. Dr. Kathleen Rogers, a geriatric physician at Cleveland Clinic says that “Many seniors already deal with isolation, and we’ve seen it worsen during the pandemic. As a result, we’re seeing a lot more patients with anxiety, depression, and worsening memory loss.”

Even before the pandemic, older adults were particularly at risk for loneliness.

Dr. Rogers goes on to explain that “after retirement, people’s routines change. Their brain activity and their social interactions are different. This increases the risk of being diagnosed with anxiety and depression or both.”

As we get closer to the holidays, it’s important to keep your loved ones in mind this year, especially if they are unable to visit with you in person. Try setting up a zoom or FaceTime call with your loved one during times you would normally gather in person.

If your loved one is homebound or living in a facility, try setting up a rotating visitors list. You may not be able to visit as often as you would like, but others can visit your loved one, too. Setting up a few visits for your loved one can also give them something to look forward to if they are struggling with feelings of loneliness or depression.

There are several things you can do to prevent loneliness and isolation and we cannot fit them all in one episode. If you have any ideas or suggestions on preventing isolation and engaging seniors, leave us a comment or send us a message on our website.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks

https://www.stpaulseniors.org/senior-care-blog/the-negative-health-effects-of-loneliness-in-seniors/

https://www.simplypsychology.org/maslow.html

https://courses.lumenlearning.com/wmopen-introtosociology/chapter/socialization/

https://www.asbury.org/blog/why-is-socialization-important-for-brain-health/

https://www.vistaspringsliving.com/blog/why-socialization-is-important-for-aging-adults

https://seniorsathome.jfcs.org/five-facts-about-senior-isolation-that-might-surprise-you/

https://health.clevelandclinic.org/pandemic-isolation-can-be-especially-hard-on-older-adults/

https://www.psychologytoday.com/us/blog/living-mild-cognitive-impairment/201606/the-health-benefits-socializing

https://homecareassistance.com/blog/health-benefits-of-socialization

https://www.cdc.gov/aging/publications/features/lonely-older-adults.html

We have been going through the seven stages of Alzheimer's over the past few episodes and today's episode is going to be a recap of all seven stages and what you as a caregiver should do throughout each stage. If you know someone that has recently been diagnosed with Alzheimer's or has a loved one with a new diagnosis, this could be a good episode to share with them, as well. For more in-depth information on each individual stage, please listen to our recent episodes on the Seven Stages of Alzheimer's. Now let's move on to the rest of the show.

The National Institute on Aging tells us that Alzheimer's disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. In most people with the disease - those with the late-onset type - symptoms first appear in their mid-60s. Early-onset Alzheimer's occurs between a person's 30s and mid-60s and is very rare. Alzheimer's disease is the most common cause of dementia among older adults.

Alzheimer's is currently the sixth-leading cause of death in the United States and nearly 6 million Americans are living with Alzheimer's right now. Scientists are still unsure of what causes this progressive disease, but they are actively learning more about it and trying to develop a cure. There might not be a cure at the moment, but there are treatments that can be helpful in slowing the progression of the disease.

Some treatments are only effective during the first few stages of the disease, so it's important to talk to a doctor as soon as you notice any signs or symptoms of Alzheimer's. Early detection of this disease really can make all the difference.

According to the CDC, Alzheimer's disease is not a normal part of aging. Memory problems are typically one of the first warning signs of Alzheimer's disease and related dementias. In addition to memory problems, someone with symptoms of Alzheimer's disease may experience one or more of the following:

• Memory loss that disrupts daily life, such as getting lost in a familiar place or repeating questions.
• Trouble handling money and paying bills.
• Difficulty completing familiar tasks at home, at work, or in leisure time.
• Decreased or poor judgment.
• Misplacing things and being unable to retrace steps to find them.
• Changes in mood, personality, or behavior.

All of these signs can also be signs of normal aging, which is why it can be hard to spot the disease in the beginning. Talk to your doctor if you notice any of these signs. There are a few tests they can run to see if someone has Alzheimer's or not.

Similarly, if Alzheimer's runs in your family, talk to your doctor to see if you have any genetic markers that can put you at a higher risk for developing Alzheimer's. The CDC also says that getting checked by your healthcare provider can help determine if the symptoms you are experiencing are related to Alzheimer's disease or more treatable conditions such as a vitamin deficiency or a side effect from medication. Early and accurate diagnosis also provides opportunities for you and your family to consider financial planning, develop advance directives, enroll in clinical trials, and anticipate care needs.

According to Penn Medicine, just like with many other diseases, changes in the brain that are related to Alzheimer's begin before symptoms are noticeable. Dr. David Wolk, MD, co-director of the Penn Memory Center, says that "This time period - often called 'pre-clinical Alzheimer's disease' - likely begins 10 or 15 years before people have symptoms. Currently, there is no treatment for this pre-clinical stage, but we hope in the future that we will have medicines that can halt the progress before people have symptoms and prevent the disease."

It is rare to detect the disease in stage one, but it can happen. People found to have Alzheimer's during this stage are diagnosed through medical history, EEGs, genetic testing, physical examination, MRIs, CT Scans, PET Scans, neuropsychological examinations, or a combination of any of these exams. At this stage, someone with Alzheimer's will have no impairment and will exhibit normal behavior. It will be impossible to tell they have Alzheimer's from simply observing them.

A BioSpace article tells us that jumping into stage 2 will show very mild changes in behavior. The symptoms can be simple and are usually not caught by doctors. Simple signs such as misplacing objects or trouble finding the right words to say may be a sign that someone is in the second stage. During stage two, all of the signs and symptoms of Alzheimer's mimic the normal signs of aging, and since they are only shown to be very mild, most people will assume they are only experiencing normal aging and not Alzheimer's.

Stage three is where we begin to physically see the signs and symptoms of Alzheimer's. According to Alzheimer's.net, at this stage, the family members and friends of the senior may begin to notice cognitive problems. Performance on memory tests is affected and physicians will be able to detect impaired cognitive function.

People in stage three will have difficulty in many areas including finding the right word during conversations, organizing and planning, and remembering the names of new acquaintances. People with stage three Alzheimer's may also frequently lose personal possessions, including valuables.

Dr. Wolk says that "For many, this stage brings noticeable changes, and it will become harder to blame it on age. It's common to be diagnosed in this stage because this is when a person's daily routine becomes more disrupted."

Penn Medicine also states that this stage may bring about more anxiety for your loved one, and some people may even deny that anything is wrong. These feelings are normal, but not talking to a physician will only allow symptoms to get worse. The best way to keep symptoms at bay is to talk to your loved one's physician about treatment options, including medications, and care planning.

If you suspect your loved one may have Alzheimer's or another form of dementia, keep a written record of signs and symptoms you notice and when you notice them. This record can be helpful for their doctor since they most likely will not be able to witness any bouts of forgetfulness themselves.

When the disease progresses further, you will be able to notice some level of cognitive decline in your loved one. Many people are diagnosed either at the end of stage three or the beginning of stage four.

According to Seniorlink, stage four comprises what is clinically described as early-stage dementia. A person with early-stage dementia (in stage four of the seven-stage model) will experience increased forgetfulness, often forgetting recent events, as well as difficulty concentrating, difficulty with problem-solving, and difficulty managing finances. They may have challenges when traveling to unfamiliar areas alone, and they may have difficulty performing complex tasks or organizing and expressing thoughts.

People in stage four may also be in denial about their forgetfulness and other symptoms, and as socialization becomes increasingly difficult, they may begin to withdraw from family and friends. In stage four, a healthcare provider can easily identify cognitive decline in an examination and interview with the patient. The average time spent in this stage is approximately two years.

In this stage, someone with Alzheimer's is still able to do things on their own and most likely do not need day-to-day help. In stage five, however, VeryWell Health says that some assistance with daily tasks is required. Problems with memory and thinking are quite noticeable, including symptoms such as an inability to recall one's own contact information or key details about one's history, disorientation to time and/or place, and decreased judgment and skills in regard to personal care. Even though symptoms are worsening, people in this stage usually still know their own name and the names of key family members and can eat and use the bathroom without assistance or with very little assistance. Each case of Alzheimer's is different, so the amount of help your loved one will need at any stage is hard to anticipate.

Penn Medicine says that until now, your loved one may have been able to live on their own with no significant challenges. You may have dropped in to check on them every so often, but for the most part, they were able to function without your regular assistance. In this stage, your loved one will likely have trouble remembering people that are important to them, such as close family and friends. They may struggle with learning new things, and basic tasks like getting dressed might be too much for them.

Emotional changes are also common during this stage, including:

hallucinations, which are seeing things that aren't there, delusions, or false beliefs that they believe to be true, and paranoia, which is the feeling that others are against them. If your loved one is experiencing any of these symptoms, they may be able to take medication that can help. Make sure you keep their doctor updated on any new developments so that they can make sure they are able to provide the best care they can to your loved one.

Stage six, also known as a severe cognitive decline, is where many individuals with Alzheimer's find themselves unable to live alone. Dr. Wolk says living on your own requires you to be able to respond to your environment, like knowing what to do if the fire alarm goes off or the phone rings. During stage six, this becomes difficult for people with Alzheimer's. Your loved one will be experiencing more significant symptoms at this time, which impact his or her ability to manage their own care and they will be more dependent on others.

VeryWell Health tells us that stage six is often the most difficult stage for caregivers because it's characterized by personality and behavior changes. In addition, memory continues to decline, and assistance is required for most daily activities. The most common symptoms associated with this stage include reduced awareness of one's surroundings and of recent events, problems recognizing one's spouse and other close family members, although faces are still distinguished between familiar and unfamiliar, sundowning, which is increased restlessness and agitation in the late afternoon and evening, difficulty using the bathroom independently, bowel and bladder incontinence, suspicion and paranoia, repetitive behavior (verbal and/or nonverbal), and wandering.

Most people with stage six Alzheimer's require 24/7 care. There are many types of care that can help your loved one, as well as yourself. There is 24-hour care, where professional home care provides trained staff to be with your loved one at all times. With this type of care, you could also provide some of the care and the company could help you supplement the time you are unavailable if that is something you are interested in. There are memory care units in facilities that are equipped to help your loved one live in a safe environment. If you would like to learn more about 24-hour care and live-in care, you can listen to our recent episode on that topic. We have also talked about other types of care in previous episodes. You can find all of our topics and episodes on our website, YouTube channel, or wherever you listen to your podcasts.

The final stage, stage seven, is a lack of physical control. According to Penn Medicine, Alzheimer's destroys brain cells, and eventually, this can cause severe mental and physical impairment. Your loved one's body may begin to shut down as their mind struggles to communicate and delegate tasks effectively. At this point, your loved one's needs will significantly increase. They may need round-the-clock care for help with walking, sitting, personal care, and eventually swallowing.

Because of their reduced mobility, their body can also become vulnerable to infections, such as pneumonia. To help avoid infections, keep their teeth and mouth clean, treat cuts and scrapes with an antibiotic ointment right away, and make sure they, and anyone they will be in contact with, including yourself, get their flu shot each year. Protecting your loved one from the flu can help lessen their chances of developing pneumonia, which is one of the highest causes of death during this stage.

In stage seven, death is unfortunately inevitable. The best thing you can do for your loved one is make them as comfortable as possible. They will need your help to move and to do everything else at this point. You will want to make sure they are moved every two hours to prevent bedsores and also ensure they are getting the fluids and nutrition they need. They won't need as much food and nutrients as they used to at this stage. When they become stationary, they don't use as much energy, but they will still need to eat, so make sure they get nutrients in their body, even if they no longer eat on their own. Choking is another risk factor in this stage. Be careful around mealtimes and make sure their mouth is clear of food, too.

Visiting a loved one with Alzheimer's can be difficult, especially if they are in the later stages, but it's still important to visit them, even if they don't seem to recognize you or pay attention to your visit.

DailyCaring gives us a few items we can do to create a visiting plan. They say to limit visitors to one or two people at a time. Too many people can be overwhelming. Schedule visits for the time of day when your loved one is usually at their best and minimize distractions by keeping the environment calm and quiet. Turn off the TV or loud music and ask any non-visitors to go to another room. Tell any visitors your visiting plan ahead of time so they will know how to interact with your loved one to make the most of their time.

There are many ways you can connect with your loved one during a visit. You can make a memory book, play games, or listen to music. We recently did an episode on How to Talk to Loved Ones with Dementia if you would like to learn more about how to talk to your loved one during your visit. This would also be a good episode to send to other visitors or people that are nervous about visiting.

Your loved one isn't the only one affected by this progressive disease, you are, too. As the disease progresses and their needs and level of ability and independence change, yours change, as well. It is important to assess your situation at all stages and determine when you need help. Caregiver burnout will happen if you are not taking care of yourself correctly, which can be hard to do when you are taking care of someone else.

To avoid caregiver burnout, reach out to your support group and ask for help. If you need a day off, let them know. Having even a few hours to yourself can help you come back and be ready to continue providing care. If it's hard for you to get away, try scheduling time for respite care in advance, or sign up for an adult daycare program. If you're interested in learning more about preventing caregiver burnout, we've done quite a few episodes covering the topic. Check out our website for more information.

If you or a loved one has been diagnosed with Alzheimer's, you may be wondering what the next steps are and where you should go from here. The first thing you should do after getting diagnosed is research the disease and listening to this episode is a good place to start! Next, you should sit down with your family and anyone else you want to include and make your future plan. This plan is not going to be set in stone. You can change and adjust it along the way as you see fit, but being able to talk to your family about your wishes while you have the mental capacity to do so will help you and them later. They won't have to second guess themselves when they make decisions for you if you have already talked about it beforehand.

If you are still working, now is also a good time to talk to your employer and create a work plan. This plan should include ways you can do your job as the disease progresses, as well as an exit strategy. You can also start looking into financial planning at this stage. With the help of a lawyer, you should decide who you want to be in charge of your finances and healthcare decisions when you are no longer able to control them yourself.

You don't have to make all of these plans at once, either. You have time to plan, but the more you plan now, the more you will be prepared for later.

As the disease progresses, you will also want to make sure your living space is safe. You should remove items on the floor that could cause you to trip, like rugs and footstools, and install handrails in stairways and bathrooms. You should also ensure there is bright lighting throughout the home. As we get older, it gets harder to see in dim light. Having bright lights can help you see where you are going better and prevent you from falling.

There are several clinical trials happening right now that are focusing on Alzheimer's. You can talk to your doctor about getting on a clinical trial or contact an Alzheimer's Disease Research Center for more information.

We hope that learning about the seven stages of Alzheimer's and some of the strategies we mentioned can help ease your mind. If you are worried about how Alzheimer's will affect you and your loved ones, consider joining a support group or talking to a therapist. You can find a support group through your local Alzheimer's Association or Senior Center. Talking to someone in a similar situation can be helpful.

An Alzheimer's diagnosis is not the end of all things. Many individuals with the disease live up to twenty years after a diagnosis. More and more people are being diagnosed as the aging population rises, too. With a larger number of people living with Alzheimer's, the concept of dementia-friendly communities has been gaining popularity. For more information on dementia-friendly communities and how your local community can work on accessibility for those with dementia, visit our website or YouTube channel to listen to the episode we did on dementia-friendly communities.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.nia.nih.gov/health/what-alzheimers-disease

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

https://www.cdc.gov/aging/aginginfo/alzheimers.htm

https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers

https://www.biospace.com/article/the-seven-stages-of-alzheimer-s-disease-explained/

https://www.alzheimers.net/stages-of-alzheimers-disease

https://www.seniorlink.com/blog/the-7-stages-of-alzheimers

https://www.verywellhealth.com/alzheimers-symptoms-98576

https://dailycaring.com/visiting-someone-with-alzheimers-dos-and-donts-for-visitors/

Today, is the third installment of our Seven Stages of Alzheimer’s series. On this episode we will be discussing the final stage, stage seven. The final stage of Alzheimer’s is often referred to as end-stage Alzheimer’s. First, we’ll discuss what happens during this final stage and how you, as a caregiver, friend, and family member can support your loved one during this time. Then, we’ll move on to how you can prepare yourself for what will happen. Finally, we’ll talk about the importance of a support system and asking for help. Now let’s move on to the rest of the show.

Alzheimer’s is a progressive disease that ultimately ends in death. This seventh and final stage is scary. Caring for a loved one with late-stage Alzheimer’s is difficult and impossible to do alone. We want to stress the importance of reaching out to your own support group when you need help. And, if you are finding yourself unable to take care of your loved one on your own, talk to your doctor. Depending on how much time your loved one has left, your doctor may suggest hospice care, a memory care facility, or professional home care. Taking care of a loved one with Alzheimer’s is difficult, but it can be even harder in this final stage, so make sure you are doing what is best for you, as well as what is best for your loved one.

According to Senior Link, stage seven is the final stage in the progression of Alzheimer’s disease. At this stage, most people lose their ability to speak or communicate and they often require assistance with most of their activities, including things such as toileting, eating, dressing, and bathing. Because people in stage seven often lose psychomotor capabilities, which is what helps someone think and act upon that thought, they may be unable to walk or require significant assistance when walking. On average, this final stage lasts two and a half years and ends when the person struggling with the disease passes away.

Alzheimer’s disease is a progressive disease that gradually worsens over a period of four to twenty years. On average, however, most people live between four and eight years following a diagnosis. The progression of the disease is different for each individual person, but family members and caregivers should familiarize themselves with the typical stages that occur throughout the progression of the disease. It’s a challenging road to travel for both the person with Alzheimer’s disease and those who love them, but knowing what to expect can help to ease some stress and uncertainty.

Crossroads Hospice and Palliative Care states that it is important for caregivers to know when an individual with dementia is close to the end of their life because it helps ensure they receive the right amount of care at the right time. It can be difficult to know exactly when this time is due to the variable nature of dementia’s progression, but understanding common end-of-life symptoms of seniors with dementia can help. However, it cannot be overstated that symptoms, progression, and signs of Alzheimer’s can vary widely from individual to individual. A well-respected and renowned dementia expert that we work closely with has summed up the comparison of dementia patients perfectly when she explains to families that “when you see a person with dementia, you’ve only seen that one person.” Again, this is because it can vary widely between individuals.

In the final six months, many people with Alzheimer’s are diagnosed with life-threatening conditions, such as cancer, congestive heart failure, or COPD and they tend to have an increase in hospital visits and admissions. In the final two or three months, someone with Alzheimer’s will also lose their ability to speak. They may be able to speak short sentences at a time during the start of this period, but they will only be able to utter one or two words at a time if any by the end. They will also experience difficulty swallowing. Choking and aspiration is a very large concern during this final stage of Alzheimer’s. They will also lose the ability to walk or sit up without assistance. If they haven’t already, they will also begin experiencing incontinence.

In the final days and weeks leading up to the very end, your loved one will have increasingly cold hands, feet, arms, and legs. They will also lose their ability to swallow. Many people with Alzheimer’s pass away due to this reason. Many people with Alzheimer's see an increase in restlessness and agitation, as well as an increase in the amount of time sleeping or being unconscious. And finally, they will experience changes in breathing, possibly due to the inability to swallow. They may take shallow breaths or stop breathing for short periods of time.

If your loved one begins experiencing any of the symptoms we just listed, speak to your doctor about your loved one’s end-of-life plan. Patients with dementia are eligible to receive hospice care if they have a diagnosis of six months or less to live if the disease progresses in a typical fashion and these symptoms typically appear when someone with Alzheimer’s has six months or less left. Talk to your doctor and a hospice professional about how they can help provide added care and support for your loved one during this extremely hard and upsetting time.

Right now, Alzheimer’s is the sixth-leading cause of death in the United States and unfortunately, there is no cure for this disease as of yet. If you are currently dealing with this disease, either with yourself or a loved one, know that you are not alone. Over five million Americans are living with Alzheimer’s. Join a support group in your area to connect with others in your situation or consider going to therapy. Find whatever works best for you and your family. You can also call the Alzheimer’s Association’s hotline anytime, at 1-800-272-3900. They have a lot of resources and knowledge to offer.

Crossroads Hospice and Palliative Care also says that perhaps the hardest thing for families is when a loved one with dementia is no longer able to eat or swallow. Because an individual with dementia is unable to understand the benefits of feeding tubes or IV drips, they will often be incredibly distressed and attempt to remove them, causing added pain and risk of infection. Instead, focus on keeping the individual comfortable. Supporting them with mouth care to prevent their mouth from becoming dry will allow them to make their final transition in peace.

Now that you know what will happen to your loved one during the seventh and final stage of Alzheimer’s, let’s move on to how you can help your loved one during this time.

The Alzheimer’s Association says that as the disease progresses and intensifies, around-the-clock care is usually required. During the late stages, your role as a caregiver focuses on preserving their quality of life and dignity. Although a person in the late stage of Alzheimer's typically loses the ability to talk and express needs, research tells us that some core of the person's self may remain. This means you may be able to continue to connect with your loved one throughout the late stage of the disease.

At this point in the disease, the world is primarily experienced through the senses. You can express your caring through touch, sound, sight, taste, and smell. You can try playing their favorite music, reading portions of books that have meaning for them, or looking at old photos together. You can also make one of their favorite foods. Try rubbing lotion with a favorite scent into their skin and brushing their hair. Sitting outside together on a nice day can also be a way to engage them and spend time with them.

If your loved one is living in a facility, the best way to help them is to visit them, even if it is difficult for you. A touching story we read that we hope can help you and your family have a sense of hope during this time, is that of Tony Hawke, the skateboarder, and his mother. In a blog post for Alzheimer’s Association, Tony Hawke wrote that when he visits his mother now, she doesn’t recognize him. Sometimes there is a slight glimmer in her eye, sometimes she babbles incoherently, and sometimes she uncontrollably bursts into tears.

On this particular day, they mostly sat in silence. He gave her updates on their family and fed her Coca-Cola through a straw every few minutes (which she still loves, even in her catatonic condition). But then he noticed her fingers twitching. He’s not sure for how long; maybe they’d been moving the whole time and he wasn’t paying attention.

As he watched, he was reminded of her habit of typing unconsciously throughout his life. And even though it may have only been her body (yet again) betraying her, it gave him comfort knowing that perhaps she is still in there somewhere typing away about her life, her experiences, her feelings, and their current conversation. Most of his visits end with a feeling of despair and impending finality, but on this day, he left with a sense of hope.

You can find the entire story written by Tony Hawke in our show notes for this episode. If you have time, we highly recommend reading it. It can be helpful to see what someone else in a similar situation is going through.

If you are currently experiencing the early stages of the disease, we know you probably don't want to think about this last stage yet, but now is the time to talk about end-of-life care and any wishes your loved one may have for when the time comes. It is better to create a plan with your loved one than to second guess your own decisions later. If you decide to be the primary caregiver during this final stage, there are several things you can do to help make your loved one as comfortable as possible, and after all, that’s all you really can do at this stage.

One of the most important daily caregiving tasks during late-stage Alzheimer's, according to the Alzheimer’s Association, is monitoring eating. As a person becomes less active, they will require less food. But, a person in this stage of the disease also may forget to eat or lose their appetite. Adding sugar to food and serving them their favorite foods may encourage eating and their doctor may even suggest supplements between meals to add calories if weight loss is a problem.

The Alzheimer’s Association also says that difficulty with toileting is very common at this stage in the disease. The person may need to be walked to the restroom and guided through the process. Incontinence is also common during late-stage Alzheimer's and is something your loved one will likely experience. For more information on toileting, you can listen to our recent Quick Tips episode on Helping in the Bathroom. You can find the episode on our website, on our YouTube channel, or wherever you get your podcasts. You can also find more episodes on Alzheimer’s and dementia on our YouTube playlist.

During this final stage, your loved one will have decreased mobility and will likely be unable to stand or sit up on their own. Being bedbound or chairbound can introduce new health risks for your loved one. Make sure to move your loved one every two hours to prevent bedsores and improve their blood circulation. Helping them do muscle exercises can stop their joints from freezing, but make sure you consult their doctor before doing any exercises with them. Similarly, make sure you have proper training on how to lift your loved one so that you do not injure them in the process or yourself. A nurse or a physical therapist can teach you how to properly lift someone, but for now, know that you should never lift someone by pulling on their arms or shoulders.

Your loved one will be more vulnerable to illnesses and infections during this stage. It is important to keep their mouth and teeth clean and clear to reduce the risk of bacteria that can cause pneumonia. The flu can also lead to your loved one getting pneumonia. Make sure you, your loved one, and those in close contact with them get the flu vaccine to lower their risk of developing pneumonia. Finally, treat cuts and scrapes immediately and call their doctor if they have a deep cut or if it doesn’t heal.

The Alzheimer’s Association states that communicating pain becomes difficult in the late stages of the disease. If you suspect that your loved one is in pain or is suffering from an illness, see a doctor as soon as possible to find the cause. In some cases, pain medication may be prescribed.

To recognize pain and illness, look for physical signs. Signs of pain and illness include pale skin tone, flushed skin tone, dry, pale gums, mouth sores, vomiting, feverish skin, and swelling of any part of the body. You should also pay attention to nonverbal signs. Gestures, spoken sounds, and facial expressions (wincing, for example) may signal pain or discomfort. And you should be alert to changes in behavior. Anxiety, agitation, trembling, shouting, and sleeping problems can all be signs of pain. If you suspect your loved one is in pain, call their doctor immediately. They can help make your loved one comfortable with medication.

Now that we’ve covered how you can help your loved one during this stage, let’s move on to how you can prepare yourself for what happens during this stage and after.

The National Institute on Aging says that Dementia causes the gradual loss of thinking, remembering, and reasoning abilities, making it difficult for those who want to provide supportive care at the end of life to know what is needed. Because people with advanced dementia can no longer communicate clearly, they cannot share their concerns. Is Uncle Bert refusing food because he’s not hungry or because he’s confused? Why does Grandma seem agitated? Is she in pain and needs medication to relieve it, but can’t tell you?

As these conditions progress, caregivers may find it hard to provide emotional or spiritual comfort. How can you let Grandpa know how much his life has meant to you? How do you make peace with your mother if she no longer knows who you are? Someone who has severe memory loss might not take spiritual comfort from sharing family memories or understand when others express what an important part of their life this person has been. Palliative care or hospice care can be helpful in many ways to families of people with dementia.

Sensory connections—targeting someone’s senses, like hearing, touch, or sight—can bring comfort. Being touched or massaged can be soothing. Listening to music, white noise, or sounds from nature seem to relax some people and lessen their agitation.

There are many things you can do to prepare yourself for this final stage of Alzheimer’s. As we mentioned earlier, during the first few stages of Alzheimer’s, you should make an end-of-life plan with your loved one so you can know how to best uphold their wishes. If you didn’t make a plan early on, it’s not too late to create one now. You may not be able to include your loved one while making their plan, but you can sit down with your family and caregiving team to create a plan together.

When making an end-of-life plan, think about what you think your loved one would want, but also consider what is best for them. You also have to think about what is best for you during this time. If you think your loved one would want to stay in your care at home, but you cannot take care of them by yourself anymore, that is something you need to seriously consider. Ultimately, you are trying to make your loved one as comfortable as possible during this last part of their life.

The National Institute on Aging also tells us that quality of life is an important issue when making healthcare decisions for people with dementia. For example, medicines are available that may delay or keep symptoms from becoming worse for a little while. Medicines also may help control some behavioral symptoms in people with mild-to-moderate Alzheimer’s disease. However, some caregivers might not want drugs prescribed for people in the later stages of Alzheimer’s. They may believe that the person’s quality of life is already so poor that the medicine is unlikely to make a difference. If the drug has serious side effects, they may be even more likely to decide against it.

When making care decisions for someone else near the end of life, consider the goals of care and weigh the benefits, risks, and side effects of the treatment. You may have to make a treatment decision based on the person’s comfort at one end of the spectrum and extending life or maintaining abilities for a little longer at the other.

With dementia, a person’s body may continue to be physically healthy while his or her thinking and memory are deteriorating. This means that caregivers and family members may be faced with very difficult decisions about how treatments that maintain physical health, such as installing a pacemaker, fit within the care goals.

Now that we’ve talked some about how you can prepare yourself for the final stage, we’re going to move on to the final part of this episode, which is what happens after.

The National Institute on Aging states that many family members taking care of a person with advanced dementia at home feel relief when death happens—for themselves and for the person who died. It is important to realize such feelings are normal. You may feel guilty that you are feeling relieved, and that’s normal, too. Calling the Alzheimer’s hotline or joining a local support group may be beneficial after your loved one has passed on.

After your loved one is gone, don’t forget to celebrate their life and remember that Alzheimer’s wasn’t their identity. Remember the person they were before the disease set in. Look over scrapbooks you made together and photo albums or other items that remind you of them.

The National Institute on Aging says that hospice—whether used at home or in a facility (such as a nursing home)—gives family caregivers needed support near the end of life, as well as help with their grief, both before and after their family member dies. If you used hospice during the final stage, they can be another great resource you can utilize even after the passing of your loved one.

Many people find it helpful to get involved after their loved one is no longer with them. Joining an Alzheimer’s advocacy group or donating to a research center are both good ways to stay involved in the Alzheimer’s community. You can also offer support and help to other families if you want to. You are in a unique position to help others that are currently going through what you have been through. Offering support to others can also help you reclaim a sense of purpose if you are struggling after losing your loved one.

This stage and this disease are hard to go through and impossible to go through alone. Reach out to your loved ones and your community for support. There is no cure now, but one day soon, we hope we will be able to End Alzheimer’s together. Visit the Alzheimer’s Association website to learn more about their End Alzheimer’s campaign.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.seniorlink.com/blog/the-7-stages-of-alzheimers

https://www.crossroadshospice.com/hospice-resources/end-of-life-signs/dementia/

https://www.alz.org/help-support

https://www.alz.org/help-support/caregiving/stages-behaviors/late-stage

https://www.alz.org/blog/alz/october-2018-(1)/tony-hawk-shares-his-personal-alzheimer-s-story

https://www.nia.nih.gov/health/end-life-care-people-dementia

Today, we are continuing with our Seven Stages of Alzheimer’s series. Last episode, we discussed what Alzheimer’s is and some of the common signs and symptoms, as well gave a brief overview of the seven stages. We went a little more in-depth with the first two stages and today we are going to be moving on to stage three.

But first, we’ll discuss how stages one through three are seen as the early or mild stage of Alzheimer’s and what mild Alzheimer’s can look like. After that, we’ll jump straight into talking about stage three Alzheimer’s – mild cognitive decline. Now let’s move on to the rest of the show.

There are a few different models of the progression of Alzheimer’s disease. The seven-stage model we are looking at in this series, the five-stage mode, which combines a few stages of the seven-stage model, and the three-stage model, which is what you may be most familiar with. The three-stage model shows the progression as being mild or early-stage, and then it goes on to the mid-stage, ending with late-stage dementia or Alzheimer’s.

When talking about the first three stages in the seven-stage model, what we are discussing today, it is easiest to relate them to the preclinical stage in the three-stage model. The preclinical stage is Alzheimer’s before it has been diagnosed, which is why it isn’t listed as a stage in the three-stage model. In the model we’re discussing today, a diagnosis usually happens during the third stage – mild cognitive decline, which triggers the transition to stage four – moderate cognitive decline. Now, this isn’t the case for every single person with Alzheimer’s. Not everyone is diagnosed this early. But, according to the National Institute on Aging, a new study has found that half of the people living with Alzheimer’s may have mild Alzheimer’s rather than moderate or severe cases. Researchers studied a sample of one thousand people and found that among people with Alzheimer’s disease, 50.4 percent had mild disease, 30.3 percent had moderate disease, and 19.3 percent had severe disease.

According to the Senior Link, the preclinical stage of Alzheimer’s makes up the first three stages of the seven-stage model of Alzheimer’s. During these stages, a person is not considered to have Alzheimer’s until they have an official diagnosis. During these early stages, many of the signs and symptoms of Alzheimer’s can easily be confused with signs of normal aging.

As we discussed last episode, there are no signs of the disease being displayed in stage one. There are changes happening in the brain, but nothing physically telling of the disease. A WebMD article explains that Alzheimer’s disease usually starts silently, with brain changes that begin years before anyone notices a problem. When your loved one is in this early phase, they won't have any symptoms that you can spot. Only a PET scan, an imaging test that shows how the brain is working, can reveal whether they have Alzheimer's.

The second stage, where some symptoms may start to appear, masks itself as normal aging, especially since most cases of Alzheimer’s happen in older adults. As we age, forgetfulness begins to become a part of our daily lives. Forgetfulness also happens to be one of the most noticeable symptoms of Alzheimer’s. Most of the time, a friend or family member may notice signs or symptoms during this stage before a person with Alzheimer’s does. WebMD also says that you still might not notice anything amiss in your loved one's behavior, but they may start developing small signs or symptoms, things that even a doctor is unable to catch. This could include forgetting words or misplacing objects. At this stage, subtle symptoms of Alzheimer's don't interfere with their ability to work or live independently. It’s also important to keep in mind that these symptoms might not be Alzheimer's at all, but simply normal changes from aging.

Stage three is usually where you can start noticing the signs and symptoms in a loved one with dementia. A neuroscience blog for Penn Medicine states that common difficulties in this stage go beyond forgetting names and misplacing objects. Your loved one may have trouble remembering recently read material, such as books or magazines, or they may find remembering plans or organizational tasks becoming increasingly difficult. They may also have more difficulty retrieving a name or word and experience challenges in social settings or at work.

This stage may bring about more anxiety for your loved one, and some people may even deny that anything is wrong. If you or your loved one have noticed any of these signs or symptoms, you should schedule an appointment with their doctor. These feelings of anxiety are normal, but not talking to a physician will only allow symptoms to get worse. The best way to keep symptoms at bay is to talk to your loved one’s physician about treatment options, including medications, and care planning. Early detection is key for this disease, the earlier it is diagnosed, the longer you loved one will be able to maintain their independence and enjoy a fulfilling life.

Now that we’ve gone over the basics of the first three stages of Alzheimer’s, let’s take a closer look at the changes that happen between stages two and three.

Alzheimer’s News Today tells us that patients with Alzheimer’s disease experience a slow progressive decline in memory and cognitive ability, among other symptoms, due to the spread of damage in the brain. Between stages two and three, changes in a person’s abilities or behavior may only be minor. As a result, the symptoms may not be noticed as a sign of Alzheimer’s, and may not be noticeable to others, except those who are close to the patient, like family members and close friends, which we have already talked about today.

Alzheimer’s News Today also says that people with early-stage Alzheimer’s are mostly independent and can usually perform the same actions they could prior to the onset of the disease, such as driving, working, and engaging in social activities. At stage three and moving into stage four, however, they may need assistance with some of the more complicated tasks. The most common feature of mild Alzheimer’s is lapses in memory and concentration, making it more difficult to recall recent events and to learn new things.

Alzheimer’s affects everyone differently. WebMD says that the stages don't always fall into neat boxes, and the symptoms might vary, but they can be a guide and help you plan for your loved one’s care. The symptoms your loved one may experience will differ from those that other people living with Alzheimer’s experience and some symptoms may not appear until the later stages of Alzheimer’s, or not at all. Once a symptom is evident, however, it tends to worsen with time. Although in some cases, some symptoms may disappear in later stages, such as irritability.

During stage three, the symptoms that your loved one were showing in stage two become more prominent and are more easily distinguishable between the signs of normal aging. WebMD states that there is no cure for Alzheimer's disease, so it can help to know what to expect so you can plan to meet your loved one’s needs in each stage.

According to Senior Link, since there is no medical consensus for Alzheimer’s stages, as there is with something like cancer, it is important for caregivers to be aware of the individual symptoms and situation that their patient or loved one is experiencing. While healthcare providers may refer to a patient’s condition as “late” or “early” stage, any specific stage is less important than the context and understanding of what this means for care going forward.

Senior Link also says that learning about the stage of Alzheimer’s disease that a loved one is experiencing helps provide perspective and context. This knowledge makes it easier to have conversations with doctors about the patient’s condition and how to approach future treatment options. Understanding the later stages of the disease also helps when planning for lifestyle changes, new equipment, and other items that may be needed. One of the other major benefits in understanding the overall progression of Alzheimer’s disease is preparing for future living arrangements, such as a memory care community or professional home care, that could become a preferred option during later stages of the disease. Because the cost of dementia care is high, families should begin planning as soon as possible following a diagnosis.

The Alzheimer Society says that the early stage of Alzheimer’s disease, also referred to as “mild Alzheimer’s disease”, marks a beginning that will bring with it significant changes for your loved one and the people that care about them. They will likely retain many of their abilities and require minimal assistance during this third stage. They may have insight into their changing abilities and therefore, can inform others of their experience of living with the disease and help to plan and direct their future care.

They may also be feeling overwhelmed and apprehensive about the future. It is normal for both you and your loved one to have many mixed emotions including feelings of grief and sadness. Many people are concerned about how the changes will affect them, how they will plan for the future, and how they will get the help and information that they need.

If you or your loved one are worried about how to handle some of the common symptoms of Alzheimer’s, the Alzheimer Society has a handy chart that you may find useful. We have a link to the document in our show notes if you would like to look at it yourself, but we’re going to be going over it here, as well.

If your loved one is experiencing some forgetfulness, try using labels, notes, calendars, alarms and timers, and pill dispensers to make their day easier. You can also create a memory station by the phone to post emergency numbers and people that they contact frequently.

Is your loved one having difficulty learning new things and following conversations? Try breaking tasks into smaller steps. Make sure you, and your loved one, acknowledge their limits. Knowing where to stop can be hard but setting boundaries ahead of time can save you time and frustration later. When visiting with groups, try to keep the size of the group as small as possible. The larger the group, the more confusing it can be for someone with Alzheimer’s to follow the conversation. Have a conversation with your loved one to understand what they need in order to participate in conversations. They may need to take more frequent breaks or rests or need to write things down to follow a conversation. Having this conversation with your loved one can make sure they have all the tools they need to participate in and enjoy a conversation and keep up with their social life.

Your loved one may have difficulty concentrating or have a limited attention span. Try picking activities that are manageable by them and do only one thing at a time. Listening to audio books or music or watching movies can also help them practice concentrating. Make sure they have the option to take breaks and be careful to avoid overstimulation. Following a daily routine can also help your loved one concentrate on tasks better.

Many people with Alzheimer’s develop problems with orientation, getting lost, and following directions. If this happens to your loved one, you can schedule rides with family and friends or call for a cab. When the time comes, make sure to have a conversation with your loved one about their ability to drive. During the early stages of Alzheimer’s, many people are still able to drive, but everyone is different. If it is unsafe for them or others on the road, your loved one should not be driving.

Communication difficulties are something many with Alzheimer’s face. Make sure that your loved one has enough time to talk or think through their answer. Inform friends and family that your loved one may be slower to respond, but to make sure to not try to fill in the silence between their responses. Go with your loved one to their appointments or make sure someone else is able to go with them if you are unable to make it. Your loved one may need someone there to help communicate for them and add much needed clarity that they may not be able to do themselves.

If your loved one is currently working, they will want to have a plan for when they have difficulty handling problems at work. It’s important that they are realistic about their abilities and that they don’t try to push themselves too hard. When necessary, they should also talk to their manager about reducing their hours or finding new tasks and opportunities. The part that they will need your help with the most is planning for a time when they will not be able to work. You can help them determine at what point they will step away and make a financial plan for that time, as well.

You loved one may experience mild coordination problems at times. You will want to make sure that they have safe and secure handrails and grab bars available. You should also make sure that their living space is free from items that may cause tripping hazards, like rugs. Brighter lighting can also help them to see better and make it easier, and safer, for them to get around.

If your loved one has an impaired ability to perform challenging cognitive tasks, again, discuss their abilities and limitations with them. Help them with tasks but try not to do the tasks for them. If they do a task, but it isn’t done quite how you think it should be done, don’t correct them, unless it could be dangerous or unsafe for them or someone else. If they don’t want to do tasks or get frustrated easily, focus on tasks you know they can manage and enjoy. Completing a task successfully can increase their self-esteem and help improve their mood.

We’ve already talked about mood shifts, depression, passiveness, and withdrawing from social situations and hobbies in previous episodes so we are not going to be going over these strategies, but you can see what the Alzheimer’s Society suggests by finding their link in our show notes.

Now that you’ve heard some strategies that you may find useful during stage three and beyond, we’re going to hear from people that have been diagnosed with Alzheimer’s and what they want you, as a caregiver, family member, or friend, to know.

One person, in regards to having a conversation and getting details of a memory wrong, says please don’t correct me. I know better – the information just isn’t available to me at that moment. Another says remember, my feelings are intact and get hurt easily. A third says try to ignore off-hand remarks that I wouldn’t have made in the past. If you focus on it, it won’t prevent it from happening again. It just makes me feel worse.

You may find that your loved one says the wrong word when referring to an item. For example, they may call a watch a hand clock. Another person with Alzheimer’s says I usually know when the wrong word comes out and I’m as surprised as you are.

I need people to speak a little slower on the telephone, one says. While another says speak to me clearly, one thought at a time; don’t ask a question when you can provide a statement.

Some people become confused at times. One person that experiences times of confusion says I may say something that is real to me but may not be factual. I am not lying, even if the information is not correct. Don’t argue; it won’t solve anything.

In group settings, someone with Alzheimer’s recommends that you please keep an eye on me because I can get lost easily! But please don’t shadow my every move. Use gentle respect to guide me. Another person says that if you can anticipate that I am getting into difficulty, please don’t draw attention to it, but try to carefully help me through it so nobody else will be aware of the problem.

When talking with your loved one with Alzheimer’s, there are many times where you can both accidentally offend or hurt the other’s feelings. One person living with Alzheimer’s says sometimes you give me the message that you think I am faking these problems. What you don’t see is my terrible confusion and my hurt knowing how you feel. Another person says I don’t mean to frustrate you. I know you get impatient and tired of telling me things, three times in a row. Please be patient.

People with Alzheimer’s also say they want you to ask them what they think or want. Don’t assume that you know and ask them in a straightforward language when you have their attention.

The most important quote we found is believe I still love you, even if I am having trouble showing it. You loved one is going through a lot of changes and struggles, and the change in dynamics of your relationship with them may be confusing, but they still love you, even if it becomes harder for them to tell or show you.

The Alzheimer’s Society says that despite your best efforts, caring for someone with dementia becomes harder as the disease moves on, and the person you are caring for becomes more dependent on you. This is a time when many family members need more support for themselves. Our goal is to be a place of support for you during this difficult time. We hope that this episode has helped you learn more about the third stage of Alzheimer’s and how you can support your loved one with Alzheimer’s through this stage of mild cognitive decline and into the next four stages.

If you would like to learn more about Alzheimer’s and how you can prepare now to support yourself or a loved one later, check out our website for resources. You can also visit your local senior center or the Alzheimer’s Association to see what help is available in your area. You can also check out our Alzheimer’s and Dementia playlist on YouTube for a complete list of all the episodes we have done on this topic.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.nia.nih.gov/news/half-alzheimers-disease-cases-may-be-mild

https://www.seniorlink.com/blog/the-7-stages-of-alzheimers

https://www.webmd.com/alzheimers/guide/alzheimers-disease-stages

https://www.pennmedicine.org/updates/blogs/neuroscience-blog/2019/november/stages-of-alzheimers

https://alzheimer.ca/sites/default/files/documents/progression_early-stage-3.pdf

https://alzheimer.ca/en/help-support/im-caring-person-living-dementia/what-expect-persons-dementia-progresses

We want to thank you for joining us for another Quick Tips episode of All Home Care Matters. Today, we are talking about how to stay warm, stay safe, and stay active this winter. Winter can be beautiful, but dangerous for seniors. We want to make sure you can enjoy this cold weather safely! Now let’s move on to the rest of the show.

If you’ve been listening to the podcast for a while, you probably heard our episode on extreme heat. If you missed the episode, you can find our episode, Keeping Seniors Safe in the Heat, wherever you listen to your podcasts and also on our YouTube channel. In this episode, we talked about how our natural ability to regulate our body temperature diminishes as we age and seniors may have trouble cooling themselves off when exposed to heat for too long. Because of this, seniors often experience heat stroke and sickness. It’s no different when it comes to colder weather.

According to the National Institute on Aging, older adults can lose body heat fast—faster than when they were young. Changes in your body that come with aging can make it harder for you to be aware of getting cold. A big chill can turn into a dangerous problem before an older person even knows what's happening. Doctors call this serious problem hypothermia.

Hypothermia is what happens when your body temperature becomes critically low. For an older person, a body temperature of 95°F or lower can cause many health problems, such as a heart attack, kidney problems, liver damage, or worse. Being outside in the cold, or even being in a very cold house, can lead to hypothermia.

How cold is too cold? It can be hard to tell yourself if you are experiencing hypothermia. We found Bob’s story from the National Institute on Aging that illustrates how one senior experienced hypothermia. Bob says that Vermont winters can be very cold. Last December, he wanted to save some money so he turned his heat down to 62°F. He didn't know that would put his health in danger.

Luckily, his son Tyler came by to check on him. Tyler saw that his dad was only wearing a light shirt and that his house was cold. Tyler said he was speaking slowly, shivering, and having trouble walking. Tyler wrapped him in a blanket and called 9-1-1.

It turns out that Bob had hypothermia. His son's quick thinking saved his life. Now on cold days, he keeps his heat at least at 68°F and wears a sweater in the house.

Bob’s story luckily has a happy ending, but if his son hadn’t stopped by, it may have ended very differently. Hypothermia can happen when you least expect it. Knowing the signs ahead of time could save your life.

According to HealthInAging.org, the warning signs of hypothermia include cold skin that is pale or ashy, feeling very tired, confused, and sleepy, feeling weak, problems walking, and slowed breathing or heart rate. If you notice any of these signs, call 911 immediately and try to warm up.

HealthInAging.org also recommends taking the following precautions to prevent hypothermia:

• Stay indoors (or don’t stay outside for very long).
• Keep indoor temperature at 65 degrees or warmer.
• Stay dry because wet clothing chills your body more quickly.
• Dress smart – protect your lungs from cold air and layer up! Wearing 2 or 3 thinner layers of loose-fitting clothing is warmer than a single layer of thick clothing. Think about getting your thermals!
• When going outside during the winter, make sure to wear a hat, gloves (or preferably mittens), winter coat, boots, and a scarf to cover your mouth and nose. You should also keep a backup of these items in your vehicle in case of an emergency.

Another major concern for seniors during the winter is frostbite. According to The AGS Foundation for Health in Aging, extreme cold can also cause frostbite, which is damage to the skin that can go all the way down to the bone. Frostbite usually affects the nose, ears, cheeks, chin, fingers, and toes. In very bad cases, it can result in loss of limbs. People with heart disease and other circulation problems are also at a higher risk of getting frostbite. To protect against frostbite, cover up all parts of your body when you go outside. If your skin turns red or dark or starts hurting, go inside immediately. You should also know the telltale signs of frostbite: numbness, skin that’s grayish-yellow or ashy, or skin that feels hard or waxy.

If you think you or someone else has frostbite, call for medical help immediately. A person with frostbite may also have hypothermia, so check for those symptoms, as well.

Seniors should also be cautious when walking outside. Snow and ice can make the ground hazardous by covering up cracks and making slick spots. Dr. Stanley Wang, a physician at Stanford Hospital in Palo Alto, California recommends older adults wear shoes with good traction and non-skid soles and stay inside until the roads are clear. Replacing a worn cane tip can make walking easier, and older people are advised to take their shoes off as soon as they return indoors, because often snow and ice attach to the soles and, once melted, can lead to slippery conditions inside.

For more information about reducing your risk of a fall, you can listen to our episode on fall safety tips. If you don’t have time for a full episode, we also have a quick tips episode on fall prevention. You can find these episodes on our website, our YouTube channel, and wherever you get your podcasts.

Seniors should also be cautious shoveling snow. No one really enjoys this task, but it can be dangerous for older individuals. If you have heart problems, trouble balancing, or are feeling weak, you should avoid shoveling snow. If you have any health issues, ask your doctor if it is safe to shovel snow.

During the winter, it’s nice to sit in front of a fireplace or a heater, but make sure you are properly taking care of these heat sources to prevent fires and carbon monoxide poisoning. Make sure to properly vent and clean your fireplace and appliances and know the warning signs of carbon monoxide poisoning.

According to HealthInAging.org, carbon monoxide poisoning can cause headaches, weakness, nausea or vomiting, dizziness, confusion, blurred vision, and loss of consciousness. Carbon monoxide poisoning is also behind several ghost sightings. Many people that believed they were living in a haunted house actually were suffering from carbon monoxide poisoning. Pacific Heating and Cooling warns that if you are hearing and seeing things, feeling zapped of energy, and sense a strange presence at home, it may be due to a carbon monoxide leak. If you suspect you may have a gas leak in your home, evacuate your home and call 911 immediately. You should also have a carbon monoxide detector in your house since we can’t detect it ourselves.

If anyone in your family is showing any signs of carbon monoxide poisoning, you should also get them to the emergency room as soon as possible. According to Pacific Heating and Cooling, even small amounts of carbon monoxide can cause irreparable damage, including brain and organ damage. See a doctor immediately if there is any evidence of carbon monoxide leaks in the home.

Now that we’ve told you all about staying warm and staying safe this winter, let’s move on to the final part of our episode, staying active.

It may be harder to exercise in the winter when you can’t walk outside as often, but you should still exercise in other ways. Signing up for indoor classes is a great way to exercise and socialize during the winter. If you don’t want to leave your home to exercise, you can take a virtual class or use items around your home to work out.

The Mayo Clinic suggests doing some of the following in your home workout routine:

• Use cans of soup or water bottles as hand weights.
• Go from a sitting to a standing position out of a dining room chair two to three times in a row instead of just once.
• Walk up and down a hallway or large open space.
• Go up and down your stairs multiple times.
• Turn up the music and dance in your kitchen.

Staying active doesn’t just mean exercising. You should keep up on other social activities, as well. If you normally go for walks with a friend, consider walking around an indoor mall. Going to the movies or a museum is a great way to get out of the house and both of these activities can be done solo or with a group.

Whatever you do, don’t let the cold weather stop you from doing what you enjoy. As long as you bundle up and listen to your body, you can still enjoy the cold weather. Just remember to stay safe, stay warm, and stay active.

We want to say thank you for joining us here at All Home Care Matters, All Home Care Matters is here for you and to help families as they navigate these long-term care issues. Please visit us at allhomecarematters.com there is a private secure fillable form there where you can give us feedback, show ideas, or if you have questions. Every form is read and responded to. If you know someone who could benefit from this episode, please share it with them.

Remember, you can listen to the show on any of your favorite podcast streaming platforms and watch the show on our YouTube channel and make sure to hit that subscribe button, so you'll never miss an episode. We look forward to seeing you next time on All Home Care Matters, thank you.

Sources:

https://www.hchcares.org/wp-content/uploads/2016/09/wintersafety_tips.pdf

https://www.healthinaging.org/tools-and-tips/tip-sheet-winter-safety-older-adults

https://www.nia.nih.gov/health/cold-weather-safety-older-adults

https://www.care.com/c/winter-safety-tips-for-seniors

https://www.pacificheatingcooling.com/2018/12/27/carbon-monoxide-hauntings-co-furnace-safety/

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ways-for-seniors-to-remain-active-this-winter