Archives September 2017

By Meredith Kimple

Many older people find it difficult to get an adequate amount of sleep at night. In a previous post, we explored some of the reasons for this change; an older person’s circadian rhythm (sleep-wake cycle) may be disrupted, they may wake frequently to urinate, or they may not receive enough exposure to sunlight during the day. While elderly insomnia is certainly not an uncommon occurrence, we should never dismiss this condition as “normal” or “inevitable.” Sleep impacts our overall health, and there are steps we can and should take to ensure our older loved ones are getting enough rest during the night.

But what about our older loved ones who live with Alzheimer’s disease?

Alzheimer’s can have a significant impact on a person’s ability to sleep well, due in part to a condition known as “sundowning.” Sundowning often occurs in the late afternoon and early evening, when the sun begins to set; when sundowning, a person with middle or moderately advanced stage Alzheimer’s tends to become more restless, agitated, aggressive, and confused. They may experience intense mood swings, pace aimlessly around the house, accuse family members and friends of being “imposters,” or convey a general sense of suspicion towards their surroundings.

Caring for a loved one who is exhibiting sundowning behaviors can prove challenging in and of itself, but when their agitated state prevents them from sleeping at night, it can take a considerable toll on our own health and peace of mind as their caregivers. Not only does sundowning exacerbate restlessness and disturb a person’s sleep-wake cycles, but sleep troubles can also, in turn, lead to and worsen sundowning behaviors. You might say that, to an extent, sleep issues and sundowning are two interconnected problems; though it goes without saying that there is no all-in-one solution to these complications, there is the possibility that in minimizing our loved ones’ discomfort and helping them sleep better, we might at least improve their quality of life.

The following are just a few ways we can combat sundowning restlessness and other factors that inhibit sleep.

1. Create a Schedule

Frequently, sundowning is a reaction to new or unexpected stimuli, like unfamiliar places, activities, or things. For our older loved ones who have Alzheimer’s disease, there is a great deal of comfort in what is familiar; making a schedule and helping them stick to it will establish a sense of order and routine in their ever-changing lives. Having a set time for sleeping and rising may help them grow accustomed to sleeping at night and gradually recalibrate their shifted sleep cycles.

2. Shorter Naps

Many people with Alzheimer’s will sleep for a considerable portion of their daytime hours, in the form of long, unplanned naps. While naps are not bad, they can interfere with our loved ones’ sleep cycles; the more they sleep during the day, the more trouble they may have sleeping at night. If they are tired from exercising or the physical strain of moving, they can still take naps, but these should be limited to about 30 minutes at most.

3. Let There Be Light

Light is a very important component in our sleep cycles; the presence or absence of light signals to our biological clock that we should be awake during the day and asleep at night. Keeping the house light and bright from the moment they wake up and dimming the lights closer to their bed time can help to gradually adjust our loved ones’ circadian rhythm (their sleep-wake cycle). Light also helps when our loved ones are displaying sundowning behaviors; darkness and shadows can sometimes agitate, scare, or disorient them, so keeping the house bright in the early evening may somewhat alleviate their symptoms. At night, keep their bedroom partially lit, either with a dimmer, a lamp, or a few nightlights; this will keep them from panicking if they wake in the middle of the night and become disoriented in the darkness.

4. Make Healthy Choices

As with many of the topics we discuss on this blog, exercise and a nutritious diet are a great place to start when we want to improve our older loved ones’ health. Light exercise, like a short walk down the street, dancing to music, or swimming early in the day can help keep them active and awake; because it will tire them out, they may find falling and staying asleep at night an easier task. Sugar, caffeine, alcohol, and large meals should be limited, particularly before our older loved ones go to bed, as they can lead to nighttime restlessness and agitation.

5. A Comfortable Environment

Make sure your loved one’s sleeping environment is cool, quiet, and comfortable. If you keep the temperature too warm or too cold, they might find it difficult to fall asleep. If they like to fall asleep to the sounds from the television, quietly enter their room and turn it off before you go to bed; the bright lights and loud noises may make it difficult for them to stay asleep. Keep precious and sentimental items close by, and surround them with their favorite things to put them at ease.

These are simply a few suggestions, but the solution to your older loved one’s sleep difficulties and sundowning may not be so straightforward. Sometimes, restlessness and poor sleep at night are caused by other medical conditions, such as sleep apnea or a urinary tract infection. Do not hesitate to speak with your loved one’s doctor about their sleep troubles, because there may be something else going on for which an effective treatment option might be available.

While coping with the stress of caring for our loved ones who have Alzheimer’s, it may feel as though we as their caregivers are helpless. Not only in watching them struggle, exhausted, through day after day of disheartening losses, but in our own fatigue and anxiety as we try to give them the very best care. Helping our loved ones sleep will also help us sleep, and this will enable us to better provide them with the attention and love they need.

By Meredith Kimple

When an older loved one is diagnosed with dementia or Alzheimer’s disease, we must prepare ourselves for a thousand changes. Among the many difficult adjustments we make to preserve a sense of normalcy, perhaps one of the most challenging is finding engaging activities for our loved ones.

Your parents and grandparents may once have enjoyed playing instruments, watching movies, reading novels, solving crossword puzzles, cooking, or dancing. However, cognitive impairment often renders these and other activities either too difficult or entirely impossible; tasks that require concentration, coordination, and memory may become a source of frustration and confusion rather than enjoyment.

While we all want our older loved ones to participate actively in the world around them, finding such opportunities isn’t always an easy undertaking. For those of us who care for someone with Alzheimer’s or dementia, it can be extraordinarily difficult to balance the demands of daily life with supervising and entertaining our loved ones. Activities that they once enjoyed, the activities that we first attempt, may no longer provide them with a sense of fulfillment.

Whether you’re facing this challenge for the first time or are convinced you’ve tried everything, hopefully the following list will give you some fresh ideas.

1. Household Chores

While many of us would agree that household chores don’t exactly scream “fun”, they can provide our loved ones with a genuine sense of accomplishment. When we ask our parents or grandparents to assist us with these daily responsibilities, we give them an opportunity for active participation in their environment. Being allowed to contribute can make them feel useful and necessary, and this does wonders for their self-image. The trick is finding tasks that are easy enough for them to complete, which will depend largely upon the severity of your older loved one’s cognitive impairment. Watering the plants, setting the table at meal times, collecting the dirty dishes, polishing silverware, dusting, sweeping, and making their bed are just a few examples of tasks that are simple and straightforward; you may have to help them complete these assignments, or even “re-do” them, but the important thing is that your older loved one feels included.

2. Organization

One popular activity for those who have dementia or Alzheimer’s disease is the sorting and organization of various objects. Give them a box filled with different colored beads, miscellaneous buttons, or coins; have them sort these items into groups based on similarity. This activity not only offers them a clear, specific objective, but also engagement with colors and textures that stimulate the senses, which can help to keep them interested for a prolonged period of time. You can also have them organize mismatched pairs of socks, or have them help you sort papers and old photos.

3. Food Preparation

Depending on the degree of their cognitive impairment, your loved one may be able to prepare simple dishes with your help and supervision. For their safety, do not let them use a knife, the stove, or the oven by themselves; there are plenty of recipes that do not require the use of these appliances, but you will have to help them measure, cut, and cook. If you don’t have the time for them to assist you with meals, or you are concerned about their cleanliness, assign them responsibility for preparing their own afternoon snacks. Peanut butter on celery or crackers, pre-sliced veggies and dip, and instant pudding mix are all easy and safe to prepare.

4. Arts and Crafts

Painting, knitting, scrapbooking, decorating ornaments, and other crafts are an excellent way for our older loved ones to express themselves. If they are not interested in creating their own art, coloring books are a great alternative; they don’t have to come up with an idea for the picture, but they can color the printed image however they’d like. These activities can be performed alone or with the whole family, so they’re incredibly versatile.

5. Music

Music not only stimulates the mind, but also brings old memories to life. If your older loved one used to play an instrument or simply loves listening to music, putting on a favorite CD or the radio can provide hours of relaxation. While you can certainly play music that has lyrics, classical or instrumental music may be the more relaxing option, since there are no words for them to follow.

6. Images

It’s difficult to see our bookworm loved ones struggle to finish novels; being unable to follow or remember the details of a story may make reading a frustrating task. Instead, provide them with books of photos that pertain to an old interest or a favorite place; there are plenty of subjects to choose from, including kittens, Renaissance paintings, and the Irish landscape. If they remember family, or even if they don’t, you can give them family photo albums to look through. Magazines and catalogs with plenty of pictures are also a great choice.

7. Videos

While you probably do not have the time to sit and watch television with your senior loved one all day, taking an hour or half an hour to spend with them may make this solitary activity more fun. Sitcoms, game shows, and nature documentaries do not rely on a plot or complicated story, so these may be better options. Old home movies are another great way to relive memories; your senior loved one may not remember everyone or everything they see, but they’ll still enjoy watching these filmed moments (especially cute baby videos). If you see a funny YouTube or Facebook video, share it with them! They may not understand what is happening, but the important thing is that you make an effort to include them in something you enjoyed.

8. Outings

Sometimes, the best thing is just to get out of the house and go do something fun! Bring your older loved one with you to run errands, like grocery shopping or picking the kids up from their various activities. If you have the time, take them window-shopping; smell candles and soap, touch interesting fabrics, and admire sparkly jewelry. Stores provide a lot of interesting sights and textures, and walking around from aisle to aisle gets in a bit of exercise too! Visit botanical gardens, the planetarium, or have a picnic in the park.

Finding fulfilling activities for our cognitively impaired loved ones is no simple task. We may find that at first they love one activity, only to watch them grow disinterested as they experience further cognitive decline; or, like most of us, they still crave variety. Through the unsettling changes that Alzheimer’s disease and dementia bring, one of the most important things we can do is to reinforce our older loved ones’ comfort and sense of self-worth. It is beyond painful to watch the people we love standing in a confused daze, bored, isolated, and at a complete loss for how to spend the hours we race through; there is a sense that they have infinite time, and nothing to fill it.

As challenging as finding ways to include them can be, leaving them lost and detached from their surroundings is twice as difficult. We should strive to provide them with plenty of opportunities through which to interact with the world, and to feel a sense of pride in their accomplishments. When they complete or contribute to a task, no matter how small, we should cheer for them, and cheer loudly.

In the mad scramble for normalcy, we tend to forget that “normalcy” is itself merely a series of adjustments. Instead of futilely wishing for things to remain the same, let’s focus on giving our older loved ones a sense of belonging, through every adjustment.

By Meredith Kimple

Stroke affects more than 700,000 people in the United States each year. It is currently the fifth leading cause of death, killing more than 130,000 annually, and is the leading cause of adult disability. While strokes can happen at any age, they are most prevalent among the elderly. Despite our society’s awareness of the prevalence of stroke, we may not know how best to help our senior loved ones prevent or recover from such life-altering attacks.

What causes a stroke?

A stroke occurs when blood is unable to reach an area of the brain. Deprived of the necessary oxygen, the brain cells in the affected region begin to die, resulting in various degrees of brain damage or, in a worst-case scenario, death. Though not all stroke survivors are crippled by their accident, an estimated 2/3 of survivors are left with some sort of disability.

There are two types of stroke. The first, Ischemic Stroke, is the more prominent of the two (approximately 80% of cases) and has a greater impact on the elderly. Ischemic Stroke occurs when a clot blocks the blood flow to a certain area of the brain; these clots may originate in the brain or, in some cases, they travel to the brain from a different part of the body. The second type, Hemorrhagic Stroke, occurs when a blood vessel bursts or leaks; this excess of blood places immense pressure on the brain, depriving certain areas of oxygen. Though not nearly as common as Ischemic Stroke, Hemorrhagic Stroke is more likely to prove fatal.

Stroke’s prevalence among older individuals depends upon several factors. Perhaps the most likely explanation is that the longer we live, the more chronic health conditions we acquire. For instance, diabetes, high blood pressure, heart disease, cardiovascular problems, and high cholesterol can all increase a person’s risk of having a stroke. However, certain aspects of an older person’s lifestyle can also contribute to their risk of stroke; a poor diet often exacerbates the aforementioned health conditions and, coupled with a lack of physical activity, can lead to weight gain. Many older people find exercise extremely difficult, making them more likely to live a sedentary life.

Given these conditions, we might mistakenly assume that there is little that can be done to prevent stroke in our older loved ones. While there is no foolproof method by which we can entirely protect them from stroke, there are steps we can take to help them lower their risk.

1. Encourage Healthy Eating

Your senior loved one may find grocery shopping and food preparation physically difficult, time-consuming, and expensive. Instead of eating a balanced diet full of fresh fruits and vegetables, they may choose quick, instant options like microwave meals or fast food. Help them come up with a plan; you could help them find simple, healthy recipes, assist them in making their grocery list and doing the shopping, or brainstorm new ways to make food prep easier.

2. Get Them Moving

In previous blog posts, we’ve addressed the challenges seniors face when it comes to regular, effective exercise. Physical limitations can force older people into a sedentary life, which in turn increases their risk of developing severe health problems. Talk to your senior loved one about seeing a physical therapist, who will help them devise an exercise regimen that is tailored to their needs. You can also suggest more gentle forms of exercise, like Tai Chi and swimming.

3. Reduce Smoking and Alcohol Consumption

Both smoking and excessive alcohol consumption increase a person’s risk of stroke. If your senior loved one frequently smokes or drinks, voice your concerns to their regular physician. A doctor may be able to have that difficult conversation with them, relieving you of the burden; the advice of a professional may seem less judgmental and prove more effective in the long-term.

4. Manage Other Health Conditions

Make sure that your senior loved one is taking their medication. Diabetes, high blood pressure, high cholesterol, and heart disease all require careful monitoring; life can be busy and overwhelming, and our senior loved ones may forget to test their blood glucose levels or check their blood pressure. They may view such necessary maintenance as a hassle, or find the process too involved. If you notice or strongly suspect that they are neglecting their health, consciously or unconsciously, do not hesitate to make your concerns known.

These are just a few of the steps we can take to lower our senior loved ones’ risk of having a stroke. However, if your senior loved one does have a stroke, knowing the signs and symptoms is of the utmost importance. The following commonly precede a stroke event:

• Numbness in the face, arm, or leg, usually on one side of the body.
• Sudden changes in eyesight, including blurred and blackened vision.
• Difficulty speaking, particularly slurring words.
• Confusion and difficulty understanding.
• Sudden, severe headaches, vomiting and / or dizziness.
• Difficulty walking, impaired movement and loss of balance.

It goes without saying that when a stroke occurs, time is of the essence. The longer the affected area of the brain is deprived of oxygen, the more damage is done. Recovery is possible, but it can be extremely difficult, particularly on the elderly. If you notice any of the symptoms listed above, do not take any chances; caution is always prudent, and in the case of a stroke, it can mean all the difference in the severity of their injury. It can mean the difference between life and death.

Stroke is sometimes, though not always, fatal. Survival is often accompanied by significant physical and cognitive changes; depending on which area of the brain was affected, a person may now struggle with speech impairment, limited motor function, or the loss of certain senses. Recovery is a slow, strenuous process of adjustments and, of course, frustrations. As their loved ones, we can and should provide them with all the love and support they need as they adapt to these enormous changes.

Though we have no way to guard our older loved ones from stroke, it should comfort us to know that there are actions we can take to improve their overall health that will also lessen their risk. We must recognize that a healthy lifestyle is often more than a simple matter of choice; living healthily is far more complicated for the elderly, but we can help them by providing the resources and encouragement necessary to transform a seemingly unattainable ideal into an accessible reality.