Dementia: A Focus on the Good

Today was a good day. I had the privilege of spending 3 hours with my grandparents at their assisted living home in Southern California, after not seeing them since September of 2010.

I was happy to find their health and cognition was better than I expected. (I always imagine the worst as I live at a distance and phone calls are difficult due to hearing.) Although my grandmother (who has dementia) could not remember some things we brought up (her former job, my husband’s grandmother), she did remember me and told me how happy she was to see me. She even told me she loved me as she patted my arm. It was about 2.5 hours into my visit at that point, and came as a complete, but wonderful surprise.

This is what fascinates me about dementia and Alzheimer’s. I recently read a book about Oscar, the cat that seems able to predict death in a dementia ward of a skilled nursing facility. The geriatrician who wrote the book interviews families, and all the families commented on the selectivity of their loved ones’ memories. For many, feelings seem to be immune to the memory barrier of dementia. One particular family spoke of how when their mother and aunt ended up with dementia and were in the nursing home at the same time, they decided to place them in the same room because they’d always been close and lived together in the past. Although the sisters could not recall their own names, or each other's, somehow the feelings they’d had toward each other remained. Their rapport and connection was apparent even during the throws of dementia.

I often waiver between regrets, wishing I done more with my grandma while she was cognizant, wishing I’d listened more closely, recorded more stories, never been a rude and rotten teenager. I must live with all these regrets, but somehow today it felt that her dementia has bought me the forgiveness I was never able to allow myself. She can’t remember the bad; she just remembers the good. It’s a lesson to me. There are so many things I would be wiser to let go of.

I am grateful for what I have learned in how to deal with dementia. During my visit today, I didn’t correct my grandmother. When she said, “I don’t know”, I said, “That’s okay” or “It’s not important.” When she clapped her hands or drummed her open palm on the table, I made eye contact and smiled. I believe what I have learned of dealing with dementia allowed this visit to be one of the best visits I’ve had with my grandmother since dementia took hold.

Independence vs. Assistance

The elderly should be mindful of how much help they accept and caretakers should be cautious of offering too much help are the fundamentals of an idea called “wise independence”. Ruddick (1999) describes the idea of wise independence as “the capacity to plan and control one’s life, combined with the willingness to acknowledge one’s limitations and accept help in ways that are gratifying to the helper.” The elderly person and his or her caretaker should “create between them and for each other a workable balance between letting go and holding on, assertion and acceptance, intervention and letting be” (Ruddick, 1999).

A real risk exists when people let go of their independence to become too dependent on caregivers. Ruddick (1999) explains that, “a caring person should know that if she hovers and insists she may encourage in the person she cares for a despairing acquiescence that is as life-ending as the ‘fall’ she would prevent” (p. 58).

Clark (2003) experienced this situation with her mother who moved into a “nursing home for a few weeks rest.” Although her mother, in her late 70’s, had suffered debilitating arthritis for many years that was so bad that “she probably would have been confined to a wheelchair”, her independent life prevented it. Clark (2003) explained how “her [mother’s] need to do for other people was so great that she kept pushing herself, forcing activity on those aching joints willing them to function.” However, shortly after Clark’s mother entered the nursing home, she witnessed a drastic decline in her mother’s energy. Clark (2003) described that “as soon she began to take it easy, everything in her body slowed up…She could no longer take care of others” and she died a few weeks later.

A similar decline is occurring in an elderly relative who recently entered a retirement home. Pedro, who is in his mid 80’s, lived independently as a retiree without any caregiving assistance until two years ago when he suffered his first fall. Pedro. tripped over his rambunctious dog, Nero, and suffered a minor injury. Since then, Pedro began to accept the help of a caregiver. As Pedro began to increasingly rely upon his caregiver he did less for himself. He delegated errands, shopping, house care, yard care, and personal budgeting to his caregiver and thus began to require even more help until he moved into a retirement home in June this year. Since his arrival at the retirement home he has fallen multiple times. The last fall resulted in a broken elbow. He has since been hospitalized.

When Ruddick (1999) explains that “both living and caring well involve a changing process of adjusting, accepting and appreciating the living and caring that remains possible,” (p.58) I see how a lack of “wise independence” negatively affects the elderly. I believe that Pedro’s comfort level with caretakers just minutes away has led him to be less cautious when walking or moving about his apartment. In this sense, Pedro is becoming even more dependent on the caretakers and much less independent. I now fear for Pedro’s health, that it might decline even further now that he has no requirement to care for himself.

Wise independence is not merely just an encouraging idea; it is a vital component in the health and longevity of the elderly. Caregivers and the elderly must be mindful of the independence vs. assistance balance, so they do not create excessive vulnerability and dependence on the caregiver(s).

Reference:
Clark, M. H. (2003). Kitchen Privileges. New York: Simon & Schuster, Inc.
Ruddick, S. (1999). Virtues and Age. In M. U. Walker (Ed.), Mother Time. Women, Aging, and Ethics. (pp. 45-60). Lanham: Rowman & Littlefield Publishers, Inc.

All content © Village Memorial. 2009-2010.

Impairments = Missed Opportunities

Reduced mobility creates hardships for seniors interacting with the world around them. When one experiences falls, broken hips, broken wrists, lower back pain and or a reduction in or cessation of driving, opportunities for interpersonal communications diminish.

My grandfather developed severe back pain brought on by a crushed disc in his lower back earlier this year. Lower back pain in the elderly is common, as a recent national survey proved that in “patients aged 75 and older…back pain is the third most frequently reported symptom” (Bressler, et. al., 1999). His back pain caused him trouble walking and difficulties rising from chairs, walking up stairs, walking to the phone, and getting in and out of vehicles. Additionally, just a few months prior, he suffered a fall that resulted in a broken wrist. The broken wrist reduced his ability to write and in combination with the loss of mobility from the lower back pain, he experienced a lack of communications with family and friends.

While the impairments in the ability to walk and write do not initially sound related to traditional communication barriers like hearing or vision losses, they have affected my grandfather’s ability to do many things related to interpersonal communication. He is no longer able to walk to the phone fast enough to answer it. When he finally does receive a phone call, he seldom holds the phone for long because of the pain in his wrist. When someone comes to his front door, he seldom makes his way across the house to open the door quickly enough. He no longer writes letters or sends birthday cards to friends and family. These impairments have led him to hire a caregiver to run errands for him, drive him and write out checks for him, though the caregiver’s assistance does not improve his communications with outside family, friends or society.

Further compounding the lack of communication that my grandfather experiences with avoiding calls and not writing, is the fact that he has ceased driving due to the lower back pain. Now that he must rely on the caregiver’s schedule for transportation, it has lessened his opportunities for outings and social interactions. “The older person who reduces or ceases driving bears the brunt of the changes that occur in terms of monetary, social, psychological, and emotional costs” (Burkhart, 2007). Knopp (2009) notes, that “isolation and loneliness experienced by nondriving seniors can result in deteriorated physical and mental health.” Plus, older drivers who generally drive on six outings per week usually reduce outings down to two per week when they become reliant on receiving rides from others (Burkhart, 2007). Hence by discontinuing driving, my grandfather has lost additional opportunities to engage socially with others outside his home.

Sadly, the number of seniors who do not drive is not as uncommon as one might think. “SCOPE, the community planning group, cites national research indicating that about 21 percent of Americans age 65 or older don't drive and that, on any given day, 50 percent are home-bound due to lack of transportation options” (Knopp, 2009).

Falls in the elderly are also not uncommon. Warshaw (2006) reports that “after age 85, over half of women will suffer a fall” while “31 percent in the 80- to 84-year age group” of men experience falls. The complications from falls include fractures of the hip, and forearm [or wrist] (Warshaw, 2006). Earlier this month, the Pope at age 82, fractured his wrist when he fell (B92.net, 2009). A good friend, Marie, who was in her mid-70’s when she fell on pavement broke both her wrist and hip. “Because bones become brittle with age, fractures are common among the elderly” (Joseph, 2008). Interestingly, Warsaw (2006) also points out that “after a few falls, some people become so frightened and anxious that they will not attempt to stand even when there is adequate help and support.” As people become afraid to stand or walk after falls, they are not likely to return to outings that require walking or standing which also decreases their opportunities for interpersonal communications with friends, family and society.

When Marie experienced the impairments of a fractured wrist and broken hip, I witnessed a loss in her interpersonal communications. Like my grandfather’s experience, Marie’s reduced mobility in walking and writing, resulted in her not taking telephone calls, seldom answering the door and the end of her writing to friends and family. Additionally, Marie had been a very social person before her accident and had engaged in many senior group tours overseas and spent much of her time out with friends shopping and dining out. Her reduced mobility led to the end of her overseas vacations as well as her social outings with friends.

When looking at the losses of mobility from back pain, falls, broken wrists and broken hips, compounded with the cessation of driving, it becomes clear that seniors and the elderly lose opportunities for social engagement as mobility is reduced and they become increasingly homebound. Thus, even impairments unrelated to hearing and sight can equal losses in interpersonal communications for seniors and the elderly.

References
Bressler, H., et. al. (1999, Sep., 1). The Prevalence of Low Back Pain in the Elderly: A Systematic Review of the Literature. Lippincott Williams & Wilkins, Inc. Retrieved from: http://journals.lww.com/spinejournal/pages/articleviewer.aspx?year=1999&issue=09010&article=00011&type=abstract

Burkhart, J. (2007, Jan. 30). Mobility Changes: Their Nature, Effects, and Meaning for Elders Who Reduce or Cease Driving. Ecosometrics Incorporated. Retrieved from: http://trb.metapress.com/content/dlk6vw1r15245554/

Joseph, T. (2008, July 28). Colles’ Wrist Fracture. Medicine Plus. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/000002.htm


Knopp, T. (2009, July 12). Nonprofit service helps seniors retain mobility. Herald Tribune. Retrieved from: http://www.heraldtribune.com/article/20090712/COLUMNIST/907121023/2080/OPINION?Title=Nonprofit-service-helps-seniors-retain-mobility.

Pope Falls and Suffers Broken Wrist. (2009, July 17). B92.net. Retrieved from: http://www.b92.net/eng/news/world-article.php?yyyy=2009&mm=07&dd=17&nav_id=60560

Warshaw, G. (2006, Apr. 10). Falls and the Elderly. University of Cincinnati. Netwellnes.org. Retrieved from: http://www.netwellness.org/healthtopics/aging/faq9.cfm

All content © Village Memorial. 2009-2010.

Unethical Publication Subscription Practices

On my last visit to my grandparent’s house I discovered many duplicate copies of Reader’s Digest. Apparently my grandmother was receiving multiple subscriptions concurrently. As the name and address information on the mailing labels was exactly the same I could not understand why the magazine had not added the additional subscriptions to one subscription, instead of sending several copies each month.

Confusion relating to magazine subscriptions is not hard to understand. I have received multiple requests for renewals with many of the publications I’ve subscribed to even after paying to renew them. However, when magazine subscriptions are foisted upon the elderly who spend much needed fixed income dollars on lengthy subscriptions that outlive them, we must demand accountability of these publishers.

A recent article I read in AARP’s Bulletin called “Outrage: A Runaround for Magazine Refunds” really hit home. Mr. Grantham found upon his father’s death (at age 93) that the poor man had subscribed to TV Guide through 2017 and U.S. News & World Report through 2023. “Grantham’s father would have been 108 years old by then” (Diament, 2009).

Even more disturbing than the fact this elderly man was duped into buying years of subscriptions was the fact that his son, upon his father’s death, was only able to cancel the subscriptions but not able to obtain a refund for the unsent (350 to 400) issues. Apparently the fact that “Grantham’s father purchased them through contracting companies, not directly from the magazines” (Diament, 2009) is the excuse given for the lengthy delay in refund.

The good news was that Mr. Grantham was able to secure an immediate refund from Newsweek magazine. A quick search online turned up other publications that offer refunds for unsent subscriptions: PC Magazine, Better Homes and Gardens, American Craft Magazine and others as well as magazine vendor: magazines.com.

Diament, M. (2009). Outrage: A Runaround for Magazine Refunds. AARP Bulletn retrieved from: http://bulletin.aarp.org/yourmoney/scamalert/articles/what_an_outragea_runaround_for_magazine_refunds.html

PC Magazine: https://www.zdmcirc.com/zdmcirc/default.asp?LK=popunder&I=ibmp
Better Homes and Gardens: http://au.lifestyle.yahoo.com/b/better-homes-gardens/1227/faqs/
American Craft Magazine: https://www.ezsubscription.com/acc/subscribe.asp?key=7809DP
Magazines.com: http://www.magazines.com/help/uninterrupted_subscription_service

All content © Village Memorial. 2009-2010.