Monthly Archives: June 2016

Dementia and Sexuality

June 30, 2016Aging Parents, Alzheimer's, Dementiaaging adults, Experts in Aging Well, Intimacy, Sexuality Callie Daters

Sex and aging adults. It’s the butt of all too many jokes — dirty old men…rigid or sex-starved women…wrinkled bodies…impotence. But as we live longer and social mores evolve, aging adults are becoming more vocal about sexual needs and intimate relationships well past the age of 60. Indeed, sexuality is a core human quality, essential to a fulfilling relationship. While illness and infirmities may change the way older adults express their sexuality, the need for intimacy does not fade with age.

Touchy Topics: Dementia and Sexuality in Aging Adults

By Deborah Liss Fins, MSSW, LICSW, CMC, Aging Life Care Association™ Member
and Fellow of the Leadership Academy

When a loved one develops Alzheimer’s or another form of dementia, sexuality and the ability to express sexual desires can change radically. For a partner or spouse, as well as for adult children and caregivers, this can lead to much confusion, concern, embarrassment, and, sometimes, resentment or guilt.

It’s the Disease, Not the Individual, Causing Changes in Sexual Expression

What’s important to remember is this: Dementia is a symptom of various brain diseases. As the brain changes, so might behavior. Sexual expressiveness is one behavior that might change, but the individual is not acting intentionally. Understanding the dementia process will help all involved to respond in ways that are truly helpful to the patient and those close to him or her.

Dementia can Affect Sexuality and Relationships

Some individuals may lose interest in sexual relations. Others may lose sexual inhibitions and become overly interested or insistent about having sexual relations with a partner or others. For the patient’s partner, either situation can be deeply upsetting, prompting feelings of rejection or isolation on the one hand, or fear of sexual abuse and a need for new boundaries, on the other. Regardless, the partner needs support, and an opportunity to gain insight into his or her reactions as well as coping skills.

It is also possible, however, for sexuality to continue despite dementia. For some couples, this intimacy may be the only form of communication left in a relationship.

Shaming and Blaming Don’t Help

For adult children, coming to terms with a parent’s sexuality, especially when his or her inhibitions are lowered due to changes in the brain, can be confusing and deeply challenging. Knowing what to say or do when your parent forgets how to behave in public and begins to undress or masturbate, or uses vulgar language or becomes sexually aggressive, takes insight and practice — and a lot of patience.

Again, it is essential to remember that it is the disease causing the inappropriate behavior. Use this as a framework before responding, to maintain your equanimity and avoid overreacting. Shaming, ridiculing, arguing or yelling at your parent will not teach her to change her behavior; more likely, it will only make the two of you feel worse.

Try a Little Tenderness

A more effective approach is to be matter-of-fact and caring. You can gently remind your parent that the behavior is inappropriate in public as you guide him to a private space or simply distract him.

There may also be some very practical reasons that your parent’s sexual behavior has changed. For example, if she suddenly begins to undress, she may be tired and think it’s time for bed, or feel constricted in too-tight clothes, be too hot, or need to use the toilet.

A parent with dementia who becomes sexually aggressive toward others, such as fellow residents in a nursing home, may just be confused and mistake someone else for a spouse or sexual partner.

On the flip side, a sudden loss of sexual desire for a spouse may be due to illness, hormonal imbalance, medication side-effects, depression, or sensing the emotional withdrawal of the other partner.

Get the Support that You and Your Parent Need

Any sudden, dramatic change in sexual expression merits a medical evaluation. Sexuality and the need for physical connection are very basic human drives and a fundamental expression of the need for affection.

If, however, you find that dealing with your parent’s sexuality is simply too difficult, get help — both the emotional support you need to sort out your own feelings and establish appropriate boundaries, as well as the responsible care that your parent needs to feel safe, supported, and able to maintain healthy relationships.

Aging Life Care Professionals™ can help you understand your loved one’s behaviors and help you handle the challenges that may come with caring for someone with dementia. For an expert near you, visit aginglifecare.org for a searchable directory.

About the author: Deborah Liss Fins has over 35 years of experience in aging life care issues. She is the President of Deborah Fins Associates, PC in Worcester, MA. Debbie is a member of the Board of Directors of the Aging Life Care Association™ and co-chair of the Education Committee. Follow her on LinkedIn and Twitter @DeborahFinsALCM or email her at DLFins@finseldercare.com. Deborah Fins Associates has a presence on Facebook – we invite you to like our page.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

image: Copyright: <a href=’http://www.123rf.com/profile_leaf’>leaf / 123RF Stock Photo</a>

How Aging Adults Can Beat the Heat

June 28, 2016Aging Wellbeat the heat, hydration, summer safety Callie Daters

With temperatures already breaking 100° in parts of the country, the dog days of summer are here and it will only get hotter. This raises some concern for keeping safe and cool, especially among senior citizens. Aging adults, in particular, may be at higher risk of heat-related maladies as they are less likely to sense and respond to changes in temperature. Additionally, as we grow older, our bodies become less efficient at regulating body temperature. Certain health conditions and medications can also make it more difficult for the body to regulate its temperature or to perspire.

Surviving the Dog Days of Summer

by Lindsay Rosoff, LMSW, Aging Life Care Association™ Member

While a simple rise in temperature may not seem like a health threat, according to the National Weather Service, heat is one of the leading causes of weather-related death in the United States, causing hundreds of fatalities each year.

Fortunately, there are several things we can do to stay safe and cool, even in the midst of summer’s hottest days.

Stay hydrated

Just as our sensitivity to heat dulls as we age, so does our awareness of thirst. This, along with our body’s ability to conserve water as we grow older, put seniors at greater risk of dehydration. Summer heat adds to the risk, because on hot days, the body loses water more quickly. Here are some tips to staying hydrated this summer.

Don’t wait until you’re thirsty to take in fluids. If you’re thirsty, you’re already dehydrated.
Avoid caffeine and alcohol as these can cause the body to lose even more fluid.
Eat lots of fresh fruit, a wonderful source of fluids – not everything has to be water.
Add fresh lemon or lime to your water to add a little flavor.
Use water to dilute fruit juices, making them last longer and increasing your fluid intake.
Get creative! Make “mocktails,” like non-alcoholic daiquiris and pina coladas.

If you are on a fluid-restricted diet, consult your physician about how to get the fluids you need during the hot summer months.

Other tips to beat the heat

Here are some other ways to beat the heat this summer:

Keep your home safe and comfortable by running the air conditioning during the hottest parts of the day and by letting in cool air in the early morning and late evening hours. If you need financial help to keep you home cool, contact the Low Income Home Energy Assistance Program.
If your home isn’t air-conditioned, take a break during the hottest part of the day by going to a movie, shopping at an indoor mall, or visiting a library.
Dress in lightweight, light-colored, and loose-fitting clothing, make of natural fabrics, like linen or cotton.
If you must go outside (gardening, errands), plan this for the early morning hours, when it’s coolest.
Supplement your diet with folic acid – a new study from Penn State showed that folic acid can enhance blood vessel dilation in older adults, which may help them to avoid heat-related issues such as heart attacks or strokes.
Take a cool shower or bath.
Get plenty of rest.

If you do experience problems …

If you or a loved one experiences heavy sweating, weakness, a fast and weak pulse, nausea or fainting, this could be a sign of heat exhaustion. In this case, move to a cool location as quickly as possible. Lie down, loosen clothing and apply cool, wet cloths to as much of the body as possible. Sip some cool water.

Heat stroke is a more serious situation and is characterized by a body temperature above 103 degrees, hot and red skin, a rapid and strong pulse, or unconsciousness. In this case, call 911 immediately. Before paramedics arrive, move the person to a cooler environment, apply cool cloths, but do NOT give them fluids.

Enjoy your summer!

With a little diligence and preparation, everyone should be able to enjoy these dog days of summer safely. If you are concerned about a family member, neighbor, or loved one, consult with an Aging Life Care Professional™.

About the author: Lindsay Rosoff, LMSW, Care Manager with ProperCare of Austin, TX, seeks to help older adults meet the challenges of aging with independence and dignity. She has extensive experience with dementia and Alzheimer’s disease and leads several support groups in the Austin community. Thank you to ProperCare and IlluminAge for the use of this blog post.

This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

Talk to Me: Communication and Alzheimer’s

June 17, 2016Alzheimer's, Dementiacommunication, Experts in Aging Well, memory loss Callie Daters

No matter the level of one’s memory loss, stage of Alzheimer’s disease, or type of dementia, human connection and communication is important to overall well-being. Communication requires patience, understanding, and good listening skills. But often, even the most well-trained or educated caregiver gets frustrated or avoids communication altogether. During Alzheimer’s and Brain Awareness Month, Aging Life Care Professionals™ are sharing stories and tools to help caregivers better care for someone with Alzheimer’s.

Thoughts from an Aging Life Care Manager™

by Tracey A. Olson, LSCW, MSW, MBA, CASWCM – Aging Life Care Association™ Member

Keep-away is a game that was played in my neighborhood as a kid. I didn’t like it very much. One person would throw a ball to someone else, over the head of a person in between. The person in the middle rarely stood a chance of intercepting the throw; they were hopelessly excluded.

As I accompany older adults to the doctor’s office, I often see the same thing happening. The doctor talks to me, but not the patient. The patient is left in the middle, feeling excluded and left out of the exchange. This happens far too many times, and it doesn’t seem to matter if the patient is able to understand the situation or not. Even when an older adult is able to make their own decisions, they are often not spoken to directly.

Let’s say the patient has memory loss and they will not be making their medical decisions alone. The patient should still be addressed directly. It is important to include the person in the conversation — it is their health, their life.

Now, when this happens, I look at the person instead of the doctor so that the doctor will catch on. And if the doctor doesn’t’, I say “Please address Jean.” There should be no games of keep-away at the doctor’s office.

This is not unique to doctors’ offices. While my client Jean can communicate and understand in the moment, she doesn’t remember conversations. Before our visit to the doctor, I met with Jean at her home to explain the upcoming appointment. As we were meeting, Jean’s caregiver said, “Don’t bother. She won’t remember anyway.”

The caregiver made the comment in front of Jean as if she wasn’t even there. Jean deserves respect as a person, and a patient, even if she is going to forget our conversation minutes later. In the moment, Jean could hear what was being said and possibly understand the meaning. She could have been part of the discussion.

Every person, regardless of memory or condition, deserves to be looked at in the eye and addressed directly. If they are able to communicate, I believe having a conversation gives a sense of comfort in the moment. That comfort is worth having the conversation, even if it isn’t remembered.

The Alzheimer’s Association offers these tips for best ways to communicate with someone with Alzheimer’s or dementia. Visit their website for more on Alzheimer’s and Communication.

Identify yourself.
Call the person by name.
Use short, simple words and sentences.
Speak slowly and distinctively.
Patiently wait for a response.
Repeat information or questions as needed.
Turn questions into answers.
Avoid confusing and vague statements.
Turn negatives into positives.
Give visual cues.
Avoid quizzing.
Write things down.
Treat the person with dignity and respect.
Convey an easygoing manner.

If you need help caring for someone with Alzheimer’s, dementia or memory loss, turn to an Aging Life Care Professional who has the experience to advocate and plan for the best possible care.

About the author: Tracey Olson, is an Advanced Professional Aging Life Care™ Expert, and a Licensed Clinical Social Worker, Masters Level. Tracey takes a strengths perspective – not just identifying and focusing on needs, but also on strengths – when working with older adult clients and their families. Tracey’s independent care management practice, AgeWell Solutions, is located in the Chicago suburbs.

The 7 Biggest Myths about Elder Abuse

June 13, 2016Elder AbuseWEAAD2016 Callie Daters

World Elder Abuse Awareness Day was launched in 2006 on June 15^th by the World Health Organization. Elder abuse is one of the most overlooked public health problems in the United States. Victims of abuse are three times more likely than those who weren’t mistreated to die prematurely. Learn how to identify those at risk and what to do if you are concerned about a vulnerable adult.

World Elder Abuse Awareness Day

By Jullie Gray, MSW, LICSW, CMC – Aging Life Care Association™ Member and Fellow of the Leadership Academy

Perceptions people have about elder abuse are usually wrong. That’s disheartening because the way we think about elder mistreatment affects our ability to recognize the signs of abuse and our sense of urgency and commitment about stopping it.

Let’s take a look at the most common myths and learn the facts.

Myth #1 – Elder abuse occurs mostly in nursing homes.

Even though elder abuse does occur in nursing homes, it most often happens at home, behind closed doors in every community, regardless of socioeconomic status.[1]

Myth #2 – Strangers and paid caregivers are the ones preying on older people.

It’s heartbreaking, but most vulnerable adults are abused by a known, trusted person – usually a family member. Abuse is frequently cloaked in a shroud of family secrecy that sometimes makes detection very difficult.

Myth #3 – The bad guys always get caught.

Criminal prosecutions of abusers are actually the exception rather than the rule because most victims don’t tell. They’re afraid, embarrassed or simply unable to report any wrongdoing to authorities.

Myth #4 – If there are no bruises or physical signs of abuse, there is nothing to worry about.

When thinking about abuse, nearly everyone immediately pictures bruises, broken bones and other types of physical cruelty. However, neglect and self-neglect are the most common types of abuse. Emotional abuse and financial exploitation happen frequently too. None of the typical forms of abuse result in obvious outward signs such as black eyes, welts or broken limbs. If you are only looking for the physical signs of abuse you will inadvertently overlook the vast majority of cases.

Myth #5 – Caregiver stress causes elder abuse.

Caregiving by its very nature can be stressful – but stress doesn’t cause elder abuse. Most stressed caregivers do not harm the person they care for. By focusing on caregiver stress as an explanation, we tacitly excuse inexcusable behavior. Using “stress” as a rationale also shifts the focus to the abuser and away from the victim by evoking a perception that if the older person was just easier to care for, not sick, and not so demanding, the abuse would never occur.[2]

Myth #6 – Elder abuse happens to men and women equally.

Elder abuse happens most often to women, but plenty of men fall victim too. Regardless of gender, those with some type of cognitive impairment are at greatest risk of being abused.

Myth #7 – It’s not that big of a deal.

Elder abuse is one of the most overlooked public health hazards in the United States. Victims of abuse are three times more likely than those who weren’t mistreated to die prematurely. The National Center on Elder Abuse [3] estimates that between two to five million elderly Americans experience some form of abuse each year. It is believed that for every one case of elder abuse, neglect, exploitation, or self-neglect reported to authorities, about five more go unreported.

Observing signs of abuse

Since a victim may not be able to report abuse, it’s up to others to observe the signs and intervene.

Physical indicators can suggest abuse is occurring

Injuries that are inconsistent with the explanation for their cause
Bruises, welts, cuts, burns
Dehydration or malnutrition without illness-related cause

Behavioral signs shown by the victim indicating possible abuse

Fear, anxiety, agitation, anger, depression
Contradictory statements, implausible explanations for injuries
Hesitation to talk openly

Patterns seen in caretakers who abuse

History of substance abuse, mental illness, criminal behavior or family violence
Anger, indifference, aggressive behavior toward the victim
Prevents victim from speaking to or seeing visitors
Flirtation or coyness as possible indicator of inappropriate sexual relationships
Conflicting accounts of incidents

Signs a vulnerable person is being financially exploited

Frequent expensive gifts from victim to a caretaker or “new best friend”
Drafting a new will or power of attorney when the victim seems incapable of drafting legal documents
Caretaker’s name (or the name of the victim’s “new best friend”) is added to the bank account
Frequent checks made out to “cash”
Unusual activity in bank account
Sudden changes in spending patterns

What to do if you identify someone at risk

We all need to vigilantly look for abuse around every corner of our neighborhood and in the care facilities we visit. One problem, though, is that our culture has taught us to avert our eyes, cover our ears, and mind our own business.

If you are concerned about a vulnerable adult, call 911 or your local adult protective services agency.

Many families also contact Aging Life Care Professionals™ who can provide an unbiased look at the situation, facilitate family meetings to discuss concerns and provide information about care options or ways to approach the situation.

These dedicated professionals understand the laws concerning elder abuse in the state where they practice and can help navigate complicated bureaucracies, act as an advocate for the older person and help develop a safe plan of care. They work hand in hand with adult protective service caseworkers, police departments and elder law attorneys to ensure the safety of the older person and to coordinate appropriate services.

It is human nature to want to put our heads in the sand and change the subject to something more pleasant. But if we identify and report abuse when it occurs, we can stop the cycle and protect our most vulnerable elders.

About the author: A Fellow of the Leadership Academy, Jullie Gray has over 30 years of experience in healthcare and aging. She is a Principal at Aging Wisdom in Seattle, WA. Jullie is the President of the National Academy of Certified Care Managers and the Past President of ALCA. Jullie Serves on the King County Elder Abuse Council in Washington State. Follow her on LinkedIn and Twitter @agingwisdom, or email her at jgray@agingwisdom.com. Aging Wisdom has a presence on Facebook – we invite you to like our page.

[1] https://www.justice.gov/elderjustice/research/

[2] Brandl, B. & Raymond, JA. Generations. American Society on Aging. Fall 2012. Vol 36. No. 3. http://www.ncall.us/sites/ncall.us/files/resources/32_39_Gene_36_3_Brandl_Raymond.pdf

[3] http://www.ncea.aoa.gov/

Traumatic Brain Injury (TBI) and the Aging Adult

June 10, 2016Aging Life Care Professionals, Alzheimer's, Caregiving, Dementia, Traumatic Brain InjuryAlzheimer's & Brain Awareness Month, TBI, Traumatic Brain Injury Callie Daters

According to the Alzheimer’s Association, research has linked moderate and severe traumatic brain injury (TBI) to a greater risk of developing Alzheimer’s disease or another type of dementia years after the original head injury. TBI affects not only professional athletes but also many older adults as a result of a fall or auto accident.

Find Help Adjusting to Life with a TBI

As part of Alzheimer’s and Brain Awareness Month, ALCA is sharing the results of a survey that takes a closer look at cases of TBI being managed by Aging Life Care Professionals. The survey of aging experts illustrates the prevalence and causes of TBI among the aging population and identifies the challenges associated with their care.

Sixty-three percent of surveyed Aging Life Care Professionals™ said their caseloads include individuals with TBI. Although Aging Life Care™ experts typically care for aging adults, the survey revealed that at least one provides services for a nine-year-old child. The majority of cases (96%) included adults in the 41-80 age range. The overwhelming cause of these injuries was falls (52%) and auto accidents (51%). Other causes included other accidental blunt trauma (28%), sports-related injury (8%), and violence (7%).

The strategies for treatment most in demand from clients, according to those participating in the survey included:

Advocacy
stress relief for family
therapy/support

Ranked closely behind:

assistance with placement (i.e. nursing home, assisted living, memory care)
communications
stress relief for families
financial planning
managing the relationship role changes

Aging Life Care Professionals also collaborate with other professionals in caring for TBI clients, primarily physicians and physical, occupational, or speech therapists. Also consulted were neuropsychologists, attorneys, caregiver agencies, and mental health providers.

The biggest challenge for families whose loved one has suffered a TBI was overwhelmingly identified as issues relating to behavior changes and accepting the “new person,” a “new personality, a “new normal.” One respondent identified it as, “The loss of role of the person who used to be more capable … and the strain of the ongoing demise of the person.” This type of loss has been called an “ambiguous loss” (a term coined by family therapist and author Pauline Boss). It means “having the person’s physical presence but psychological absence. The person is there, but emotionally or cognitively missing.”

“Aging Life Care Professionals know the local resources and specialists that can help TBI patients find a ‘new normal’,” says Dianne McGraw, President of the Aging Life Care Association. “From coordinating services to offering caregiving coaching, we give families the tools they need to live an optimal life.”

If you need help navigating care options or need strategies to manage the adjustments to daily life, find an Aging Life Care™ expert near you at aginglifecare.org.

When the Spouse Left Behind Has Dementia…

June 7, 2016Alzheimer's, Dementia, Grief and LossEndAlz, Loss of a Spouse Callie Daters

There are creative and effective ways to help an aging parent, family member, or loved one who suffers from Alzheimer’s disease or dementia cope with the loss of their spouse, according to a survey of Aging Life Care Professionals™. Remembering that there are different stages and types of dementia, making sure the surviving spouse does not become socially isolated, and not rushing other major changes in their lives are among the top expert recommendations.

How to Help Loved Ones with Dementia Cope with the Loss of a Spouse

June is Alzheimer’s and Brain Awareness Month and the Aging Life Care Association™ (ALCA) is sharing helpful information from ALCA members to help families facing one of the most difficult of these challenges. ALCA polled 288 Aging Life Care Professionals™ from across the country asking them to identify the most effective strategies for helping a loved one with dementia cope with the loss of their spouse.

The top six strategies identified by the aging experts are:

1. Remember there are many different stages of dementia. Your loved one’s capacity for understanding, coping and grieving can be very different depending on their stage of dementia. (Identified by 96% of survey respondents )

2. If your loved one’s response to reminiscing about their spouse is positive, share old photos and memories. (88 %)

3. Make sure the surviving spouse is not socially isolated. Schedule visitors on a regular basis and help them keep up with any normal social routines they have. (85%)

4. Reassure them there are people who care about them and will care for them. (84%)

5. Don’t rush big changes. It may make sense for them at some point to move to a facility or closer to family; but, if possible, give them time to adapt so there aren’t too many major life changes at once. (81%)

6. If they choose to be included in mourning rituals for their spouse, make sure there is someone overseeing this so if the situation becomes too stressful they can leave. (78%)

“With the rising rates of Alzheimer’s disease and dementia, families are increasingly confronted with this difficult challenge,” said Emily B. Saltz, MSW, LICSW, CMC . “Our survey shows that knowing your loved one’s stage of dementia and respecting individual differences are key,” added Ms. Saltz.

Many of the Aging Life Care Professionals surveyed expressed strong views about the need for tailoring your response to the individual, both in terms of their stage of dementia and their personality. Some individual comments included:

“As each person is unique, each person with dementia is unique. Recognize your loved one’s values, personality and culture.”
“There are varying types of dementia, some affecting short term memory more than others and each type has a different appropriate response.”

Other Aging Life Care experts surveyed by ALCA shared additional tips, including:

“Do not underestimate their ability to understand, at an emotional level, what they cannot express verbally.”
“Take cues from the affected person. If they are not aware or focused on the loss, do not remind or instigate a conversation about the loss.”

To find an Aging Life Care Expert near you, search an online directory of professionals at aginglifecare.org.

June is Alzheimer’s and Brain Awareness Month

June 2, 2016Aging Life Care Professionals, Alzheimer'sAgingWell, EndAlz Callie Daters

June is Alzheimer’s & Brain Awareness Month. This month, the Aging Life Care Association™ (ALCA) recognizes the work of The Alzheimer’s Association to “uncover the truth about Alzheimer’s Disease.” As the #EndAlz campaign shines the spotlight on Alzheimer’s Disease, the ALCA blog will share information and resources to help support caregivers and family members impacted by Alzheimer’s or dementia.

Caring for Someone with Alzheimer’s? Find Support from an Aging Life Care Manager™

Caring for someone with dementia can test even the strongest of relationships. The anxiety, agitation and erratic behavior often associated with dementia may be hard for a spouse or adult child to understand or manage.

If you are caring for a loved one with dementia, it is important to look for help and support from others. Asking for assistance or support does not make you less of a caregiver. In fact, it enables you to be a better caregiver. Your local Alzheimer’s Association is a great resource for information and support groups, and many communities have an Area Agency on Aging that may direct you to support services in your area.

Aging Life Care Managers™ are also an excellent source of information and support. Working with families, the expertise of Aging Life Care Manager provides the answers at a time of uncertainty. Their guidance leads families to the actions and decisions that ensure quality care and an optimal life for those they love, thus reducing worry, stress, and time off of work for family caregiversAging Life Care Managers work with families to find solutions to caregiving challenges and can help you

Aging Life Care Managers work with families to find solutions to caregiving challenges and can help you understand your loved one’s dementia and associated behaviors.

In this story, Aging Life Care Association member Gretchen Napier, BS, MS, CMC shares how her involvement saved a marriage and allowed the family to spend quality time together during the last year of their father’s life.

If you are caring for a loved one with dementia or know of someone who needs help, contact an Aging Life Care Manager. You can find an expert in your area at aginglifecare.org.