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

Tips for Making Family Mealtime Gatherings Easier to Swallow

Jennifer Brush, MA,CCC/SLP with Karen Betz

Summer holidays, cookouts, and family picnics can be hard on someone who has a swallowing problem.  This week I have asked Karen Betz to serve as a guest for our blog.  Karen recently started a business called Smoothe Foods.  Karen was a caregiver for both of her parents. Her father is her inspiration for creating Smoothe Foods. 

He had Alzheimer’s with complications including dysphagia, which is the medical term for a swallowing disorder. Karen’s detected he was not eating because he could not swallow regular foods. Karen and her mother fed her father baby food which was neither nutritionally sound nor designed for adult consumption. Needless to say, it was emotionally degrading for her father as well as for other family members. Unfortunately, many family members people do not detect this and believe their parent does not want to eat. This leads to malnutrition, dehydration and ultimately a visit to the emergency room. Karen’s mission is clear; offering people a wonderful pureed meal, especially when they have so few options, has been a passion of hers for years. Serving the unsung foodie, the forgotten community - is her pleasure.

“You really love me, don’t you?”

“You really love me, don’t you?”

By Kerry Mills

My weekly visits to the Convent are where I can usually count on having at least one of the highlights of my week.  This Convent is where the retired sisters are living, and about eight months ago I started training the staff and creating a program for the sisters.  There is one part of the home that is set aside for those who need a bit more attention due to their cognitive impairment.  It is in here that my favorite little lady lives.  I will call her Sister Martha.  She is very witty, super sweet and full of compliments.  She can also be the first to resist care if she is approached the wrong way.   I think the meanest thing she ever said to a staff member was, “You bum!”  Her heart is so sweet, you just want to hug her!

Like many people who suffer with Sister Martha’s condition, she is very forgetful and often can become sad, or afraid of the whereabouts and therefore the safety of her parents and brother, who have long since passed away.  She can become suspicious of those who want to help her get ready for the day.  The moment she hears the word “shower” she becomes defensive and will not get up off her chair or out of her bed.  She loves to compliment the other sisters and the staff.  She loves to read whatever is put in front of her.  She loves to eat, and more than anything, she likes to laugh.

This week, as I walked into the living room and saw my sweet friend, I went over and kissed her on the forehead.  She looked up at me and said, with a serious face and eyes glued to mine, “You really love me, don’t you?”  “Of course I do!” was all I could say, as I sat down next to her and we held hands.  

Sister Martha was having a bit of a rough morning.  She thought that everyone was going to die.  Where this thought came from we don’t know.  She has many fears like this.  I assured her that I would keep her safe, and sat with her for a short while.  This led to some small talk, and then to big laughs about silly stuff.  The staff had already put on her favorite DVD, an Irish singer who Sister Martha felt she knew so well because, according to her, he visited every day!  When I returned an hour later, Sister Martha was singing along and was as happy as could be.  The staff, like every other day, knew how to assure her they would keep her safe; they knew how to engage her in things that would take her mind off of her fears, because they knew her.  They listen to what she says and therefore can provide more comforting responses.  

We cannot always fix the issues that our loved ones with dementia are dealing with, but we can certainly love them and make sure they know that they are not alone.  And with this as your aim, I am confident you will do more for your loved one than you can even imagine!

Living with Purpose

Living with Purpose

By Jennifer Brush, MA, CCC/SLP

Each and every one of us likes to feel that we are needed.  We like to help out, make a difference and be useful.  Helping others adds purpose and meaning to our life.  Completing a job-well-done gives a boost to our self-esteem.  People with dementia have the same desire to contribute to their household or the community; the need to be productive doesn’t end once someone has a diagnosis of dementia.  In fact, people in the early stages of dementia who are aware that they are having difficulties with word finding, memory, have an incredibly strong desire to be needed by others.  As they struggle to communicate and remember daily information they need to have tasks at which they succeed.  They require positive reinforcement that they are valued.  Although people with dementia may not be able to contribute in exactly the ways they could before, there are still so many things they can do.
My friends Angela and Jeff come to mind.  Jeff has moderately advanced dementia and his speech is very limited.  He has great difficulty communicating his needs to his wife Angela.  However, he still has a desire to do things for her.  He enjoys clearing the table and washing the dishes after meals.

Because this has always been part of their routine-she cooks and he cleans up-it’s familiar and comfortable to him.  One daily ritual they’ve had for years is a 10:00 AM coffee break and snack in the living room.  Jeff will put placemats on the coffee table, get out the cream and sugar, and fold the napkins.  Angela makes and serves the coffee and then Jeff cleans up.  In a life filled with daily challenges to communicate, being able to helpful and complete these tasks for his wife truly makes Jeff feel good.

If you care for someone who has dementia, try to think of small ways throughout the day that they can help you or others and make that part of the daily routine.  People with dementia will have less anxiety and confusion throughout the day if their daily routine is consistent.  Look for opportunities to involve others outside of the family unit so as friends, colleagues, or church members.  Being able to socialize has significant implications for quality of life.  Maintaining meaningful relationships with staff, family, friends, and visitors, in large part, is based on being able to communicate.  People with dementia who experience language impairment are more likely to become socially withdrawn unless caregivers help them to remain active.

Here are some ideas of helpful tasks you may want to incorporate into the daily routine of someone with dementia:
• Set and clear the table
• Wipe the table and wash the dishes
• Help prepare meal by washing fruits and vegetables or mixing ingredients
• Read to a child
• Read the mail to a spouse
• Teach child to play a game
• Walk or feed a dog
• Brush a dog
• Sweep, dust, vacuum
• Rake leaves
• Plant flowers
• Weed garden
• Fold laundry
• Take a meal to a friend
• Visit someone who is home bound

Make sure to say “thank you” for the help you do receive.  A hug, pat on the back, or praise for a job well done are all great way to acknowledge someone’s contributions.  Ralph Waldo Emerson wrote, “The purpose of life is not to be happy. It is to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”

The Joy of Discovering Preserved Abilities

In honor of Better Hearing and Speech month, I’d like to say a few words about communication and the relationships we have with our loved ones with dementia.   I’d like to share a story with you.  Last year I worked with a client who lived with frontotemporal degeneration.  I made a once weekly home speech therapy visit to help her with communication skills and to find ways for her to become engaged again with her family and friends.

Frontotemporal degeneration is a progressive deterioration of the temporal and frontal lobes of the brain. These areas of the brain play a significant role in decision-making, behavioral control, emotions and language. This degeneration of the brain can cause a language disorder called semantic Primary Progressive Aphasia (PPA).   The distinguishing feature of semantic PPA is difficulty generating or recognizing familiar words. Some individuals have difficulty recognizing familiar objects and faces as well.  Fluent, spontaneous speech is preserved, especially in early stages of the disease.  Word-finding and naming deficits are common.  Neuroimaging studies reveal loss of brain volume, blood flow, and/or neural activity in the left temporal lobe of individuals living with semantic PPA.

My client, Gina (name changed) had been living with PPA for several years and by the time I met her, she was speaking only automatic greetings and phrases such as “That’s okay.”  Gina was unable to answer even the simple yes or no questions that I asked.  Because Gina could not communicate her thoughts and needs to her family she became withdrawn and depressed.  She sat in her favorite chair for hours every day and her family took over all of the cooking and household chores that she used to complete on her own.

When I first met with Gina and her family, I asked them a few questions:
“What are some things that have always been important to Gina?”
“What did Gina enjoy doing most during the day?”
“How do you think Gina would like to spend her time now?”
I learned that Gina’s religious practices were central to her sense of wellbeing.  Her son indicated that each night the family took turns sharing their blessings of the day with each other and saying a meal time prayer of thanks.  Gina had not been able to participate for many months.
Next, I spent time with Gina to discover her preserved abilities.  During the speech-language evaluation, I learned that Gina could read and sing, and that she loved to do both!  When I work with clients, I learn about their skills, interests, and abilities and use those to compensate for their deficits.  I collaborated with the family to write blessings, prayers and favorite hymns in large print so that Gina could read them.  Through practice, repetition, and encouragement, Gina began participating in the dinnertime sharing of daily blessings by reading a preprinted note card of her choice.  She began singing with music the family played throughout the day and the expression of sadness gradually began to fade from her face.

As a result, the whole family dynamic changed.  After several weeks of educating the family about what Gina could do, rather than focusing on what she couldn’t do, Gina was participating in chores, singing throughout the day, and reading labels we made for common household items to express her choices and needs.

Communication takes many shapes and forms, just like us.  Throughout life, all the little things accumulate and make a relationship with our loved ones what it is. Don’t forget those little things; savor them. Find joy in the little things and your relationship will prosper.  Look for the person within, not the dementia.

© 2014 Jennifer A Brush, do not copy or distribute without permission