Decorations and Dementia: A Few Things to Consider

I would like to welcome my friend and colleague Rev. Katie Norris, a guest blogger for us this month. Rev. Katie and I collaborated on a book called Creative Connections that will be available through Health Professions Press by April 2015. Christmas is just around the corner. Many of us are excited to decorate our homes and spend time with our families. For families living with dementia, the holidays can create additional stress and sadness. Persons with dementia may not be able to participate in the gift choosing, or house decorating any more. Persons with dementia may not even recognize their family who come to visit. Rev. Katie brings up some important points in this blog that remind us to view the world through the eyes of someone with dementia.

My Mom has always decorated our house for the holidays. At Christmas we had a huge tree with more ornaments than should have been put on it. She hung green garlands with red berries around the doors and put electric candles in every window of the house. She had two life-sized wooden Nutcracker cutouts and a beautiful Santa statue. And of course, we always switched out our daily dishes to the Christmas Spode, and made sure the tablecloth matched the plates.

My Mom has had Lewy Body dementia for eight years, and for many years we kept up all of the decorations in the house. First with Mom helping us decorate, and now we take care of it because she no longer can. After a while, the amount of decorations decreased, not only because it was a lot of work, but also because people with dementia function best in a clutter-free, familiar environment. Noticing that fewer decorations made Mom’s living space easier to function in helped me see the many issues that can come up when we think about decorating a house or care community for people with dementia. I wanted to share some of the issues that can happen with decorations in the hopes that you can asses how many decorations would work for your loved one with dementia in order to help them have a pleasant holiday season.

Decorations can make a once familiar space very unfamiliar. Knick-knacks, trees, holiday cards on the mantle, statues, etc… all add clutter to the environment. A distracting and unfamiliar environment can increase agitation and bring about some negative behaviors.

Decorations can make it harder for a person with dementia to find the items they use every day, and can decrease their independence. For example, a simple snowman shaped soap dispenser may be so unfamiliar, that your loved one stops washing their hands, or it makes the sink look so different that they can no longer turn on the water.

There are also many safety issues with decorations. A cute holiday throw rug is perfect for ending up with a fall and broken hip. Food shaped decorations can lead to an attempt to eat the item and are a choking hazard.

Lights on a Christmas tree cast shadows and can make it harder for a person with dementia to see and function in a room. Twinkling lights are highly distracting and jarring. This can not only lead to falls, but it can trigger or worsen the visual hallucinations often found in dementia. We also tend to use a lot of electrical decorations at the holidays, and the cords can increase the risk of falls.

Decorations can also increase behavioral issues. If the person with dementia feels the decorations should not be there, you may end up with negative behaviors, such as throwing the decorations in the trash, or your loved one rearranging all the decorations. It could even increase or trigger wandering outside of the house. If the house looks so different to them, they may think they are not in their own home and thus try to leave. Going after them and trying to convince them that this is their home can lead to arguments, or physical behaviors such as pushing or hitting.

Be careful when changing the plates and utensils you normally use. My Mom loves the Spode Christmas pattern and we used to change out our daily plates for the Spode every year. However, a patterned plate is cluttered and can cause frustration and picking at the plate after their food is already eaten. The pattern can also make it hard for a person with dementia to see what is food, and what is not. If they are unsure, they may just not eat, which is very common for people with dementia. Solid colored plates that have high contrast to the food you will be eating is best. For instance, turkey and mashed potatoes are hard to see on a white plate, but you could eat those items on a green plate. Fancy utensils may not only be uncomfortable because your loved one is not used to them, but also because they may be harder to hold if the handles are carved and curved, or very delicate.

When considering whether or not to decorate for the holidays, it is very important to know your loved one well. They may not be at a point where decorations make the house unfamiliar, and in fact, if you did not decorate, they may feel that is too much of a change. Assess whether or not you need to bring out all the decorations, or just some really important ones. In any stage of dementia though, decorate in the least cluttered way possible. For example, don’t tack holiday cards on the wall, or arrange them in the middle of your kitchen table.

It may also be good not to decorate in places where the person with dementia takes care of activities of daily living. Leave the decorations and changes out of the bathroom, kitchen table, bedroom, and around their main sitting or working area.

Think about the reason for your decorations and what you want to get out of decorating. Many of us are attached to tradition and decorating. We do it because it is a way to express love and care for our family and friends. It is a way to make our time together more festive and beautiful. If decorating the house brings more confusion and discomfort to our loved one with dementia, we have defeated the purpose of the meaning of the decorations. Rather than increasing joy and interaction, we increase confusion, which then can drastically increase feelings of worthlessness in our loved one.

Any event is about the relationships we foster, and the quality of time we get to spend with each other. Assess if your decorations meet the needs of your family interactions at this time, taking into consideration the changes brought about by dementia.

To start, I would suggest picking a few of your most favorite decorations and see if putting those up do not change the environment too much for your loved one, and work from there. This way you can still create the holiday atmosphere and keep your loved one comfortable and safe.

Blessings,

Rev. Katie

Why is Montessori Successful with People with Dementia?

“The essence of independence is to be able to do something for one’s self.”

People with dementia are often confronted with what they are no longer able to do or understand. In turn, the Montessori principles are designed to focus on what they are still capable of doing. This person-centered way to approach dementia focuses on the person's capabilities, grabbing their interest, and showing them respect. All Montessori principles have been designed to work with a certain type of memory (implicit or procedural), that is less affected by dementia. Implementing the practices of Montessori with older adults with dementia has also been shown to increase engagement in activities and positive moods.

We know that people with dementia need structure and order in their environment and activities, and often become upset when changes are made to their surroundings. The Montessori principles supports this desire of structure in that the materials are taken from the everyday environment and each lesson/ task is taught at its simplest level. Additionally, using the Montessori approach with people with dementia has been useful in assessing their cognitive, motor, and sensory functioning as well as social skills.

Who was Maria Montessori?

In a few weeks I’ll be visiting Sydney, Australia to attend and teach at the Montessori Environments for Dementia International Conference. In the time leading up to the conference, I thought I would share with you some information about the Montessori philosophy and why it is successful for people who are living with dementia. 

  

“The environment must be rich in motives which lend interest to activity and invite the child to conduct his own experiences.”  Maria Montessori

 

Who was Maria Montessori?

 

Maria Montessori, acclaimed for her revolutionary educational methods, was born in 1870 in Italy. Having an immense thirst for knowledge from early childhood, Maria entered an all-boys technical school at the age of 13 and from there gained admittance to the University of Rome’s medical school.  After graduating in 1896, Maria became the first female doctor in Italy, paving the way and becoming a role model for women of all ages.

Specializing in pediatrics and rehabilitative medicine, Maria opened a childcare center in 1907. She designed learning materials and a classroom environment around the children’s natural desire to learn. She believed that education is a natural process carried out by the child and is not acquired by listening to words but by experiences in the environment.  Her school rapidly became a success and by 1910, Montessori schools were renowned worldwide. The “Montessori Method”, as it is now called, is used as a way to approach dementia care.

 

Tips for Better Communication

            For all of us, not just someone with dementia, the ability to communicate and express our needs is of utmost importance. In order for someone with dementia to have a good relationship with a care partner, healthy and frequent communication is a key ingredient. If your loved one with dementia begins to lose social skills, he or she might become more withdrawn or isolated. As the person without dementia, you are the one capable of understanding and changing your approach when it comes to communication. If your loved one with dementia is having increased difficulty communicating, capitalize on what skills remain to compensate for any lost abilities. Think about what has changed and what is preserved.

 

 

Below are some simple strategies to help encourage communication and connect with your loved one with dementia more effectively:

 

Always speak respectfully using adult language.  As a professional care partner, refrain from using childlike speech and always treat a person with dementia as an adult. There are other ways to convey affection without disparaging the person with dementia. Smile, address the person by name, and shake his or her hand instead.

 

Keep the pitch of your voice low.  Sometimes when a person doesn’t immediately understand, we have a habit of speaking louder to get our point across. Raising your voice only distorts speech and will more often than not upset the person being spoken to. To keep communication from getting difficult, speak in a warm, friendly manner.

 

Be aware of body and facial gestures and expressions. People with dementia pay attention to nonverbal messages of all kinds. Use these effectively to further encourage communication. The opposite is also true. As a care partner, pay attention to your partner’s body and facial gestures as well. Their nonverbal messages will communicate what they are not able to communicate verbally. In addition, eye to eye contact represents that their attention is focused on you.

 

Keep the conversation going. When speaking to someone with dementia, it is up to you to keep the conversation going. Introduce topics that he or she is familiar with or enjoys to talk about. Do not worry about their responses, just be happy to engage with them.

 

Do not ignore rambling. Remember that rambling speech is a form of communication too. Even if it seems like gibberish, listen for key words and pay attention to any form of nonverbal communication.

 

Avoid arguing, quizzing, or confronting. Having conversations that include these types of communication will often make the person angry or confused. Accept person with dementia’s values, beliefs, and reality. Doing so will reduce negative communication.

 

Use a prompt to get the conversation going. A prompt as simple as eye contact or saying the person’s name is an easy way to get their attention. When giving an instruction, be very specific and demonstrate exactly what you would like the person to do.

 

 

            By combining all of these strategies, your loved one with dementia will want to participate in conversations more and as a result be a happier individual.

 

© Jennifer Brush, may not be reprinted or distributed without permission

 

Good News about Medications for Dementia

                                          

I am pleased to introduce you to Rachel Wynn, MS CCC-SLP is speaker, writer, activist, and speech-language pathologist specializing in geriatric care. I invited her to share some of her thought about about medications and dementia.  She blogs at Gray Matter Therapy, which strives to provide information about geriatric care including functional treatment ideas, recent research, and ethical care. Find her on Facebook, Twitter, or hiking with her dog in Boulder, CO.

 

Let me just state my bias up front. In my personal life, I avoid taking medications. Rather than take pain reliever for a headache, I drink water. The headache is likely due to dehydration (which is common at high altitude) or sinus distress (and water thins mucous being produced). I avoid medications, but I am not anti-medications. In fact, I take a medication every day and will likely for the rest of my life, because my body requires it. Personally, I believe medications aren’t often necessary, especially as the first intervention.

 

As a speech-language pathologist, it is not within my scope of practice to give recommendations regarding medications. However, it is within my scope of practice to understand how medications affect the body, especially when there may be side effects impacting cognition or swallowing.

 
Medications but no therapy?

One of the things I have found quite concerning is meeting someone new to my care community and seeing the list of medications they are on. They may be on a cholinesterase inhibitor and antipsychotic medications for dementia, but they have never participated in any therapy (speech-language pathology, occupational therapy, or neuropsychology). This is concerning, because there are so many benefits to therapy throughout the course of dementia.

 

In the earlier stages, therapists develop individualized compensatory strategies and routines to help people maintain their independence as long as possible. In the middle to late stages of dementia, therapists work on changing the environment to increase a person’s independence and quality of life. These interventions don’t cure dementia (but neither do any of the current medications on the market); however, they are individualized to help improve quality of life, independence, and safety without side effects.

Antipsychotic medication effects in the elderly

Antipsychotic medications are not without side effects. Common side effects of antipsychotics in the elderly include [1]:

• anticholinergic reactions
• parkinsonian events
• tardive dyskinesia
• orthostatic hypotension
• cardiac conduction disturbances
• reduced bone mineral density
• sedation
• cognitive slowing

We rightfully spend great time and energy on fall prevention efforts. How many of those antipsychotic side effects would contribute to an increased risk for falls? Most of them. Besides falls, in people with dementia sedation and cognitive slowing would complicate matters. Yet, these are very common side effects.

 
CMS sets goal to move away from antipsychotics

Given my stance on medication, especially in the treatment of dementia, I was very pleased to see this press release from the Centers for Medicare & Medicaid Services [2]. The press release states the goal CMS set to reduce use of antipsychotic medications in nursing homes by 25% by the end of 2015 and 30% by the end of 2016. This is excellent news.

 

Want even better news? Patrick Conway, MD and CMS chief medical officer said, “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are - for many people with dementia - behavioral and other approaches to provide this care more effectively and safely.” (emphasis mine).

 

As an advocate for person-centered healthcare, Dr. Conway’s words make my heart happy. He said, “Ultimately, nursing homes should re-think their approach to dementia care, reconnect with the person and their families, and use a comprehensive team-based approach to provide care.”

 

Way to go CMS! Now let’s chat about how CMS reimburses for these therapy services that can achieve excellent results without the side effects of antipsychotic medications…

 

References:

1. Masand, P.S. (2000). Side effects of antipsychotics in the elderly. Journal of Clinical Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal. Newsroom Center. CMS.gov, 19 Sept. 2014. Web. 19 Sept. 2014.Psychiatry, 60(8), 43-49.
2. Centers for Medicare & Medicaid Services. National Partnership to Improve

 

 

I Care Wins Gold Medal!

I Care by Brush & Mills Wins Award

in 2014 National Mature Media Awards Program

 

I Care: A handbook for care partners of people with dementia was a gold medal winner in the 23rd annual National Mature Media Awards Program.

 

The program, presented by the Mature Market Resource Center, a national clearinghouse for the senior market is the largest of its kind.  The 23^rd annual National Mature Media Awards recognizes the nation’s finest marketing, communications, educational materials, and programs designed and produced for older adults.

 

I Care received a Gold Award in the category of Healthcare Book. The awards were created to annually recognize the best materials produced for those who are 50 and older, the nation’s fastest-growing population group.

 

“We were delighted to take part in the Mature Media Awards Program this year, and were

honored to be selected as a winner,” says Mills and Brush.

 

Gold, Silver, Bronze and Merit certificates were awarded in 29 categories. Categories included marketing communications, publications, educational/training programs, editorial and art/design. Entries included brochures, newsletters, magazine and newspaper articles, web-based and mobile resources, radio and television advertising, books, and annual reports. The winners were selected by a distinguished panel of judges from across the United States, which represent years of expertise working in the mature market.

Simple Tips for Care Partners - Ideas for Taking Care of YOU!

During difficult times, it can be hard to think about anything other than what’s going on, but try not to become so consumed by stress that you overshadow your needs for well-being. Try modifying schedule to include time to take care of yourself. Beginning today, carve out some free time for just for YOU. Even if your loved one with dementia only requires minimum assistance right now, schedule some time to do something that is important to you. Try to schedule time once a week, at a minimum, though most people will need more. No one should have less. Stay consistent for your sake, but more for the sake of your loved one with dementia.

 Pick a day and time each week. Hire a companion or ask a friend or family member to stay with the person while you go out and do something on your own. Make sure that time is spent doing things that will refresh you. Many care partners feel guilty for leaving the person at home while

they go out and visit with friends, attend a book group, or participate in a sport they enjoy. It is critical to realize that if you are not happy and healthy, you can never be an effective care partner. If you don’t take breaks for your enjoyment, you will experience resentment, anger, and fatigue.

Here are some ideas:

• Tap into your higher power. Spiritual practice provides a sense of inner peace, a feeling of being centered and calm. Make time every day, even if it is only five or ten minutes, to pray, read spiritual passages, sing your favorite hymn, or participate in a religious ritual that is meaningful to you.
• Meet a friend for coffee.
• Take a weekly exercise class.
• Join a book group.
• Get a haircut or a manicure.
• Take a walk in the park.
• Play with your grandchildren.
• Check out some books or take a free class at the library.
• Go to the movies.
• Attend church.
• Write in a journal.
• Talk with someone in person, by phone, or through the Internet.
• Don’t give up activities that are important to you.
• Eat nutritious meals.
• Get plenty of sleep.
• Participate in a sport you enjoy

Think Positive Thoughts

 Many people find that saying positive affirmations or mantras throughout the day helps reduce stress and fatigue. A mantra is a sound or words that are used to help create focus during meditation. Many people find repeating mantras to be a helpful stress-reduction technique, whether or not they meditate. Create your personal positive mantra or affirmation, and repeat it frequently. Research has shown that positive thoughts and emotions change the neurochemicals in the brain that affect our mental, physical, and spiritual health. Saying an affirmation an affirmation first thing in the morning starts you off in a positive mood and affects your decision-making for the day. If you forget to do this when you get out of bed, don’t worry; mantras are helpful in stressful situations too. An affirmation could help prevent you from lashing out at someone and bring you back to a calm state.

 Some mantras that others have found effective include:

• This too shall pass.
• Tomorrow is another day.
• With God, all things are possible.
• I will accept the things I cannot change.
• I will look for the good in every day.
• Life does not have to be perfect to be wonderful.
• I have much to celebrate.
• I believe I can be kinder to myself.
• My pace is perfect.
• I am in control of my thoughts.

I realize this is all easier said than done, but if you start today and gradually make a bit more time for yourself each week, you’ll be happier, healthier, and a much better care partner.

© 2014 Jennifer A Brush, may not be reprinted or distributed without permission

The Importance of Personalization in Long Term Care Communities

The Importance of Personalization in Long Term Care Communities

By Jennifer Brush, MA, CCC/SLP

An individual's possessions represent a lifetime of memories, achievements and activities. It is vital that new residents be allowed to bring some of their favorite and special items of furniture and belongings with them when moving into a residential setting. Care communities can recognize the importance of these belongings by not treating them as objects we allow residents to bring with them, but as part of the right to continue to create an environment that they find suitable and worth living in (Calkins, 1997). More and more care communities are implementing policies that not only allow, but encourage possessions to be moved in with residents including beds, furniture, art, and memorabilia. Personal items and decorations should be able to be stored and displayed both in bedrooms and common areas that are shared with other residents.



Personal possessions also aid staff on their journey of getting to know the residents, their tastes, family, and special memories of travel and a well lived life. This is even more important in the case of those suffering from communication difficulties such as dementia and expressive aphasia.  Often persons with communication impairment cannot tell their own life story, travel memorabilia and family photos can communicate, to some extent, about the past.



One of the key reasons for personalization of a person’s environment is to help them remember people, places and objects by compensating for deficits in declarative memory. Having familiar items around makes it feel like home and provides more distinctive spaces, providing orientation cues for all individuals. For example, one will recognize a favorite chair and be able to experience the joy of leaning against the much loved cushions in the sitting room, or sipping tea out of one’s own china cup can make a huge difference to someone’s feeling of well-being.



Displaying personal items in a lit glass display case next to the bedroom door can help residents find their room. The more significant the objects or the stronger the memory associated with the objects, the better these objects assist people with locating their room (Namazi, Rosner, and Rechlin 1991).  Some researchers have found that using a large photograph (8 by 10) of the person helped in locating their rooms (Nolan et al, 2002).



One option is to ask the resident’s family to bring a picture from home to hang on the bedroom door. It can be an earlier picture of the resident or a photo from a special occasion like a wedding. Often, a person will not recognize a current picture, but will recognize a favorite pet, childhood home, or other object such as a trophy or favorite knick-knack from home. Whatever items you decide to use for personalization and orientation, make sure you test for recognition by the resident.  Ask the person if he knows who or what is in the picture, if he likes the item, or if he would like to have it on his door. The person should always have a choice in how his room is decorated and what pictures are displayed.




So, take a walk down memory lane and gather some favorite bits of the past, personalization is a wonderful way for an individual to feel more connected with their new home and have better orientation in a different environment.  



(c) 2014 Jennifer A Brush.  May not reprint or distribute without permission

More Praise for I Care

Thank you to Martha Stettinius, author of Inside the Dementia Epidemic: A daughter's memoir, for her thoughtful review.

5.0 out of 5 stars Essential Reading -- The Best Description Available of Why It's Important to be a "Care Partner", July 1, 2014

By 

Martha Stettinius

This review is from: I Care: A Handbook for Care Partners of People with Dementia (Kindle Edition)

According to the authors, a "care partner" is someone who receives as well as gives care and affection. While care “giving” can seem one-sided (and never-ending), a care “partnership” is reciprocal and rewarding. "When someone helps care for someone else, we call him or her a caregiver. This is a natural title and one we all understand; however…this title implies that there is nothing left for the person with dementia to contribute.”

Too often we assume as caregivers that a person with dementia is “gone” or incompetent. A person living with dementia is still “here,” still capable of experiencing a full range of emotions, needs, likes and dislikes. They can usually continue to make some decisions in the early stages of dementia, and then, through the final stages of dementia, share love and affection, even if it’s just holding hands or offering a hug or a smile.

Care partners learn, over time, how to support their loved one as a whole human being, not as a dementia “patient.” Care partners also learn—and this is no small thing—to pay attention to their own needs, to care for themselves. The one-sided nature of care “giving” can encourage people to become martyrs and do too much, while care partnerships encourage people to balance their partners’ needs with their own.

“I Care” includes many well-written stories by people who see themselves as care partners. These anecdotes are some of the best parts of the book. One husband of a woman with Alzheimer’s, for example, writes that “dementia has not robbed” his wife “of her personality, and it has not robbed us of each other. We have simply become partners.” His explanation of how they became care partners is quite moving.

Elsewhere in the book Brush and Mills share excellent tips about how to communicate with a person with dementia, find meaningful activities, and encourage socialization. One of my favorite parts is a sample letter in which a care partner writes to her husband’s friends, reassuring them that they are still a vital part of her and her husband’s life, and encouraging them to continue to visit.

Much of the dementia care information in “I Care,” such as tips for making your home safer for a person with dementia, can be found in other guides, but the authors bring a certain hopefulness and lightness of spirit, and specific clinical observations of care partnerships, that make their book unique.

If you have been diagnosed with dementia, care for a person with dementia, or work with people with dementia, “I Care” is one of the best descriptions you will find of care partnerships, and essential reading.

I Care Receives a 5 Star Review!

I Care Reviewed By Suzanne Cowles for Readers’ Favorite

"I Care: A Handbook for Care Partners of People with Dementia by Jennifer Brush MA and Kerry Mills MPA is an informative medical guide that focuses on the caregiver. The number of people suffering from Alzheimer’s disease and the seven associated dementias is rapidly increasing each year. This puts a strain on those who care long-term for the demanding needs of adults who slowly lose the ability to care for themselves. Transitioning for caregiver to care partner begins with a change in attitude, adjusted expectations and dispelling useless negative emotions. Using real-life examples, Brush and Mills foster hope in a constructive way to maintain life balance, minimize stress and sustain a fulfilling relationship. Packed in seven chapters are practical advice and an appendix with emergency contacts template, subjects to discuss with the physician, a long-term care checklist, questions for the insurance company, a daily behavior log template and a home safety checklist.

Brush and Mills, in I Care: A Handbook for Care Partners of People with Dementia, provide sources of help, define the physiological brain changes in the patient, explain techniques to practice memory retention, and lay out the steps to estate planning for future medical care. Their combined thirty-two years of health care experience and education shed light on debilitating brain dysfunction and offer the tools necessary to manage the patient while caring for the self. If you know someone who suffers from dementia, this motivational book will inspire you to embrace a changing dynamic and focus on the quality of today."

Caring for Your Loved One with GRACE

I am pleased to welcome Melissa Cohn Bernstein, one of our guest bloggers this month.  Melissa and I have collaborated on online learning projects together for a number of years.  Melissa owns Dynamic Learning Online, an excellent source of continuing education for health care professionals.

 Thank you Jennifer for inviting us to Guest Blog for you!

As an Occupational Therapist, married to a Geriatrician, many of our discussion revolve around the care and needs of the senior population.  My husband’s book, I’ve Got Some Good News and Some Bad News YOU’RE OLD, Tales of a Geriatrician, provides many “lessons learned” from the thousands of patients he has treated in his 30 years of practice. He developed the acronym  G.R.A.C.E. leads to a happier healthier life.

What does G.R.A.C.E. stand for?

G stand for Goals, R for Roots or DNA, A for Attitude, C for Companionship and E for Environment.
He observed from his patients who have lived happy, healthy, and long lives, that the traits of GRACE had been incorporated into their lives.
G-having Goals or a purpose in life leads to greater satisfaction and fulfillment.
R-knowing your Roots or DNA is critical to understanding your genetic makeup and what risks or benefit you can derive from your heredity.
A-having a positive Attitude and being grateful, showing gratitude for what you have leads to greater enjoyment and experiences in life.
C- Companionship and connections to others is a critical factor in forming supportive and loving relationships.
E- Environment is what you do to live a healthier life, such as eating, exercising, sleeping and listening to your physician’s advice.

GRACE plays an important role in caring for loved ones, especially someone who has memory impairment or Dementia.  Having clearly defined Goals or a purpose for each day provides much needed structure, an essential component for an individual who is bombarded with distractions daily.  Roots, in this case family structure or family tree, denotes  knowing who your family is,  and that you can count on them to assist and provide much needed respite and support.  Family can also be loosely interpreted to include local friends and your support system as well.   Having a positive Attitude is essential in surviving the marathon of living and sustaining a loved one with Dementia.  Included within the trait of attitude is gratitude since without it we become less human.  Companionship and Connection with our loved one brings us back to the depth of our love within the relationship, and it becomes the glue that holds us together through difficult times.  Connections within our community enable us to seek and obtain much needed physical and emotional support.  Keeping the Environment safe and uncluttered helps prevent injuries and reduces distractions both of which are detrimental to the individual with dementia.  Providing a healthy environment includes a healthy lower carbohydrate diet, physical activity/exercise, and good sleep habits.

It is important to remember the 5 characteristics of GRACE when caring for a loved one with memory impairment or dementia.   Whether it is in the early stages and in a home environment, or in the later stages where the loved one resides in an assisted living facility or nursing home, they all need a little GRACE.

How are you applying GRACE in your life and the lives of your loved ones?
We are happy to hear from you!

Here’s to aging GRACEfully!
© 2014, Melissa Cohn Bernstein, OTR/L, FAOTA
Dynamic Learning Online, Inc.
melissa@dynamicgrp.com

David Bernstein, MD, FACP
Physician-Author-Public Speaker
david@davidbernsteinmd.com

Facing the Challenge of Good Nutrition as We Age

I am very pleased to introduce you to our guest blogger this week, Kathy Birkett, RDN.   Kathy is a registered and licensed dietitian nutritionist with over thirty years of experience helping patients, clients and their family members achieve healthy lives through nutrition. She has provided nutrition advice to people in a variety of settings, including hospitals, rehabilitation and skilled long term care nursing facilities, home-based care, hospice, education, wellness centers and fitness facilities, touching thousands of lives with her knowledge and caring approach.  Kathy has a wonderful website full of information that will help all of us, at any age.  Please visit http://www.nutritionforthehealthofit.com to learn more.

Facing the Challenge of Good Nutrition as We Age

By Kathy Birkett, RDN

As a dietitian, I know the value of good nutrition from beginning to the end of our lives. There is no point in our lives that we can stop and rest on our laurels when it comes to eating well and being well nutritionally.

What I also know from experience working with many clients of all ages is that the physical results of poor eating habits will haunt us throughout our lives.
Research shows us clearly that when we are not making wise food choices it will impact our heart health leading to stroke and heart disease as well as contribute to several forms of cancer, diabetes and obesity. Chronic disease in our nation and actually globally has recently been defined by the World Health Organization as causing 6 out of 10 deaths around the world. The very sad reality of that statistic is that good nutrition is not that difficult and death from nutrition related chronic disease is preventable.

Aging Impacts on Nutrition

It is true that as we age, our bodies’ age too and our nutritional health can be affected.
Unfortunately, our bodies’ do not need any fewer nutrients as we age at a time when our intake tends to decline due to a number of factors.

• Difficulty chewing. Often our teeth become an issue that leads to food choices that are not the most nutritious. We may have missing teeth, dental caries or ill-fitting dentures which might be causing mouth sores that mean older adults begin restricting harder to chew items including protein foods and fresh fruits and vegetables. These foods are key nutrient sources that are hard to match when eliminated. There are many texture changes that can be made while still eating the healthy foods their bodies require.

• Perceived out of budget cost of nutritious foods. When older adults feel the pinch of a fixed income that may cause them to choose between medications, housing, electricity and food, they often tend to buy ‘cheaper’ food items like canned soup and ignore the fresh fruit and vegetables and meats that seem costly. Unfortunately they may be costing themselves poor health and more healthcare costs in the long term.

• Taste changes. Many older adults experience taste changes perhaps due to the many medications they take or dry mouth. They become disinterested in eating because it doesn’t taste like they remember or doesn’t bring them satisfaction.

• Lack of energy. Many older adults tell me that they tire quickly so don’t enjoy grocery shopping, food preparation or clean up so they look for ways to avoid it. They buy standard items like coffee, milk, bread and canned foods they can carry and then go home. They don’t want to cook for themselves and don’t enjoy eating by themselves. They don’t want to bother with the trouble. Many also tell me that they didn’t do anything during the day to work up an appetite which leads to further decreased intake. The result is a vicious cycle of weight loss, lack of energy, loose dentures and frailty leading to poor health outcomes.

• Restrictions of a medical condition. Many seniors have told me that over the years in order to follow different health messages they have become very restrictive in their food choices. They actually become afraid to eat food with fat or sugar or other “bad” foods. Unfortunately, many get to the point that they now are eating only a dozen items which limits the nutritional content of their diet resulting in poor nutrition and worsening of their medical condition. Often I end up telling them to forget following a diet and start eating to get calories, protein and nutrients that they are sorely missing.
• Dementia. Cognitive impairment that is progressive can lead to poor nutritional intake. As the memory loss worsens many older adults fight against meal time; become easily distracted by noise, patterns, smells, or other people nearby; forget how to use utensils or even how to chew and swallow; think they have already eaten; are unable to express desires of hunger and thirst and even to recognize them; allow agitation to inhibit intake; and eventually are not alert enough to eat. There are numerous strategies that a caregiver can employ to overcome food-related issues created by dementia. Many are quick fixes that can be accomplished easily.

Nutrient Needs for Aging

Seniors (all of us over 50) need calories to fuel our bodies to keep them functioning properly as well as give us plenty of steam to keep the machine working for all the activities we plan for the day.
Most seniors begin cutting down on portion sizes and even skip meals altogether at a time when calories are still needed and more importantly protein is needed to maintain strong muscles. Muscle wasting or sarcopenia in our seniors has become all too common resulting in falls and injuries from those falls.

Not eating enough or avoiding some foods could mean that an older person misses out on necessary vitamins, minerals and fiber too. Older adults need calcium and vitamin D for strong bones that could help prevent fractures. They need B vitamins especially B12 since it becomes more difficult to absorb as we age. Even with a diet rich in B12 your senior may need to talk with the doctor about a supplement. Potassium is also an important part of a healthy diet for seniors combined with reducing sodium will help manage proper blood pressure. Fiber is essential for good bowel health, relieve constipation in addition to benefiting many chronic diseases such as heart disease and diabetes. Let’s not forget water. Many older adults who are not fans of drinking plain water, who don’t want to go to the bathroom often or who don’t feel thirst simply don’t drink enough each day. Medications can also contribute to dehydration.

Eating more nutrient dense foods making every bite seniors eat count should be a focus of our overall health and treatment plan. It takes some thought and planning to find foods that are nutritious and delicious that provide a powerful punch of nutrients every day.
Ways to Get a Nutrition Punch!

• Drink water every time you use the restroom. Drink throughout the day especially if you are out in the heat or taking a medication that causes water loss.

• Add protein sources that are easy to eat such as scrambled eggs, egg salad, chick peas, beans, hummus, peanut butter, cottage cheese, Greek yogurt, protein fortified water, low fat milk, gelatin, smoothies, boiled meats, canned salmon or tuna, custard and puddings.
• Talk with your doctor about the potential need for B12, vitamin D or calcium supplements in case you can’t get enough in your diet.

• Add calorie sources if you are having trouble losing weight that will not increase the volume of food you need by using spreads, mayonnaise, sour cream, gravy, syrup, jelly, nut spreads as part of your recipes and on top of what you eat now.

• Consider a nutritional supplement in addition to your current meal plan NOT as a replacement of what you now eat. You may want to consider having a meal delivered each day if cooking is a problem. Not only will congregate senior programs deliver but local restaurants will too!

• Skip the ‘junk’ food like chips and Danish in favor of whole, healthy foods. You will see that they are not going to break your budget.

• Look for fortified foods that will give you more nutrition with each serving such as fortified orange juice, cereals, breads and other products with added calcium, vitamins and protein.

Eating should be a pleasurable experience not a battle ground. Caregivers can help their senior loved ones make a few changes and perhaps some wiser choices. Investigate reasons why they may not be eating as well as they could because there may be a way to correct it and get them back on the road to health so that they can enjoy each day to the fullest!

© 2014 By Kathy Birkett, RDN, this may not be preprinted without permission