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Archive for the ‘
Alzheimers Disease/Dementia ’ Category
Introduction
The fastest growing segment of the population in the United States are seniors over the age of 85. Older persons in the United States are faced with many challenges.
According to The Merck Manual of Geriatrics, Americans over age eighty-five account for about 12 percent of all elderly. This figure is expected to rise to 18 percent by the year 2040. The average number of years a person can be expected to live fairly free of physical or cognitive disability is 77 for men and 81 for women. This has many implications for the needs of or increasing older population.
Due to innovations in medicine, pharmacology, and other healthcare services, mortality and morbidity rates are declining. As a result, hospital stays have been sharply reduced, prompting an expansion of needed community-based services. This includes skilled and home-attendant, social work and psychiatric supports, senior centers and adult day health care programs, medical care, hospice care and more.
Due to increased longevity, seniors are often faced with inadequate savings and income because of increasing cost of living expenses. This is a stressful situation as well a serious threat to independence. High insurance co-payments, spend-downs (jargon), and prescription costs can be an obstacle to needed medical care.
The following illustrates an example of the special needs of the older client:
Mrs. R. is a 79-year-old divorced immigrant. She had been hospitalized several times to treat depression. Because she was feeling stressed by immigrating to this country and also felt depressed, she sought help at an outpatient clinic. Mrs. R. told the psychotherapist that she had been having trouble getting out of bed and carrying out her normal daily routine.
Mrs. R. received individual psychotherapy and medication management to address her depression and enable her to resume the tasks of daily living. Although she became psychiatrically stable with improved daily functioning, her medical health deteriorated. Mrs. R. was diagnosed with hepatitis C, high blood pressure, and asthma.
Since beginning chemotherapy treatment for hepatitis, her depression worsened. This is a common problem in the elderly where medications can have psychiatric and physical side effects. This can further impair functioning and complicate diagnoses and treatment. In this case, Mrs. R. stopped taking her psychotropic medication, her severe depression returned and a prolonged psychiatric hospitalization followed.
How Social Workers Help
A social worker helped Mrs. R. in the following ways.
- Collaborated with the patient's various medical and psychiatric providers.
- Monitored Mrs. R's medications and made sure she took them correctly and on schedule.
- Linked Mrs. R. to a Medical Day Program who could provide daily medical and social and support as well as attend to her activities of daily living.
Collaboration and coordination was key to the success of this individual. Social workers routinely assess, intervene, and link patients like Mrs. R. to the services they need.
A Look Toward the Future Needs of the Elderly
Increased Adult Day Medical as well as Social Programs can improve the provision of daily medical oversight, bathing, and meals to insure proper nutrition, cognitive remediation, and social supports. They also serve as respite care for caregivers. Spirituality is often overlooked. Exploration into clients’ beliefs and faith can be an excellent source of support and can be incorporated into the social work interventions
Cognitive Remediation is a growing need as well. For the elderly the three D’s are “Delirium," “Dementia” and “Depression." Each is prevalent, and negatively impact on daily functioning and quality of life, emotionally and physically. Services in medical and mental health programs need to increase focus on improving cognitive skills and helping clients cope and adapt to declining cognitive functioning.
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Susan Winston, LCSW, is a social worker. Ms. Winston has been practicing social work as a clinician and program director since 1978 in a variety of community based mental health and substance abuse programs. Currently she runs a large mental health program in Queens, New York that serves a significant elderly population.
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Introduction
A geriatric care manager is a professional who specializes in assisting older people and their families with long-term care arrangements. Care managers have a minimum of a bachelor's degree or substantial equivalent training in gerontology, social work, nursing, or counseling.
As a care manager, I conduct in-home or facility assessments (evaluations) to develop a care plan including a client's needs for community resources such as home care services, home-delivered meals, emergency response systems, etc.
An older person may need to move into a retirement community, adult care home, memory-care or assisted living or a nursing home. I also review financial, legal and medical issues and make appropriate referrals for specific follow-up. I provide crisis intervention to clients and their families locally and abroad to make certain the clients' needs are being met and communicate with families. I specialize in identifying problem areas such as declining health or cognitive functioning including mental health and dementia needs.
Arizona has many older individuals who moved from other parts of the country for the warm climate. After living in Arizona for 15-30 years, they may be hesitant to relocate to colder climates to be closer to family as their health needs change. After an onset of an illness, they may not be in a condition to even consider a move. Also, during many conversations with older individuals, they have shared that they do not want to be a burden to their families and respect their adult children and extended family have "their own lives". This creates a dilemma for the older person to decide to stay in Arizona with only informal support at best vs. a move to their community of origin. They may also be faced moving near family, which may be in a community unfamiliar to them.
The Social Worker’s Role
As a social worker who is a care manager, my role is to support and empower these individuals who are "aging in place" and making all attempts to remain independent and residing in their own homes. I believe in the least restrictive setting and strive to coordinate services for individuals to maintain this living environment as long as possible. Often, safety issues, health and personal care needs, behavioral and cognitive problems, and costs can make this a challenging task.
I provide personalized services to my clients and feel I contribute to enhancing their quality of life through consistent intervention. The personalized service is a major component to care management services, as I know their families, routine, medical condition, care needs, etc. and after rapport building, it can be a beneficial professional exchange.
A Social Worker’s Fiduciary Duties
A "stepping stone" from care management can involve legal or court intervention for appointment as a fiduciary. A fiduciary is defined by the Arizona Fiduciaries Association, Inc. – An Affiliate of the National Guardianship Association as "someone who accepts the responsibility for taking care of the needs or property of another person for the benefit of that person. The fiduciary serves in a role of trust. This is crucial when the person receiving services is frail, vulnerable and incapacitated. A private fiduciary is a non-family member who serves professionally for a fee and who must be certified by the state."
In a state like Arizona with a large population of older individuals, memory impairment due to dementia such as Alzheimer's disease is prevalent. There are older individuals who have no children or are estranged from children or extended family. Their siblings are also elderly, may have health issues, and often reside out-of-state. Fiduciary services may be necessary in these situations to assist in the protection and well being of the vulnerable and/or incapacitated older adult.
Through court appointment, a private fiduciary can serve as guardian and/or conservator and make decisions regarding where the individual lives, medical intervention, and/or handling of their finances and property. The guardian handles affairs related to "the person" and the conservator handles "finances and property". This legal appointment carries a great deal of responsibility and liability. Private fiduciaries are used primarily when a family member or "interested person" such as a long-time close friend is unable to serve in this role. The court favors family members unless contraindicated or an "interested person".
The Sun Cities areas of Arizona have often promoted a strong sense of neighborhood as the individuals often watch out for one another in a supportive way. The 75-year old married couple may observe daily to ensure their 85-year old widowed neighbor with health issues takes in her newspaper daily. Churches and synagogues have also provided a support network. Often times, however, individuals may require more ongoing or specialized care than these support networks can provide. A neighbor may return to the Midwest for the summer months and the older individuals are left with no support as a result. A care manager and/or private fiduciary may then become involved.
Isolation can also be problematic as the individuals may have been active when initially retiring and moving to Arizona. After the death of a spouse, no connection with church/synagogue or neighbors and declining health, the individual's homebound status may go undetected. A phone call from an extended family member out-of-state with no visits may not obtain the "true picture" as older individuals want to provide the impression that all is going well possibly fearing forced intervention or loss of their independence.
As a care manager and/or private fiduciary, the "whole picture" can be seen. It may initially be similar to putting pieces of a puzzle together especially if the individuals have memory impairment. Serving clients in these roles are best met using a "team approach" and acknowledging each team member's role in the client's life. This team may consist of the primary care physician, consulting specialists, family/friends, home health agency personnel, church or synagogue personnel, attorney, bank trust officer, etc. All have a significant role in serving the clients. A care manager and/or private fiduciary may act in a pivotal role in seeking out all the disciplines for their input for the best interest of the client. A care manager and/or private fiduciary ensures that follow-through is completed and that an individual care plan is devised and followed for each client.
Serving clients in these roles of a care manager and/or private fiduciary can be very rewarding to the professional. Ensuring quality of life for the clients in a safe, least restrictive setting is the goal to providing these services. Advocacy for these individuals is not only an art; it is the true base for being an effective care manager and/or private fiduciary.
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Introduction
Over the past few years, Alzheimer’s Disease screening tests have become available to consumers. Licensed clinical social workers who have special training in genetic counseling can help individuals or family members who are interested in these tests. Below is a fact sheet from the Alzheimer’s Association briefly describing the various screening tests.
A screening test is a preliminary procedure administered to distinguish individuals who may need further evaluation for a disorder from those who are less likely to need additional testing. Familiar examples of screening tests include Pap smears, mammograms, and kits for collecting small stool samples to be examined for hidden blood. Most such tests are administered under the supervision of a health care professional who orders the test, communicates the result, and discusses appropriate next steps.
Test developers, health care facilities, and other sources are marketing a growing number of screening tests directly to consumers. Some of these tests are offered on a "self-referred" basis—individuals taking the test do not need a physician's order for it, and the testing facility reports the results directly to the examinee. Self-referred testing is a controversial practice. It is lucrative for facilities administering these tests because consumers must pay for them directly. Insurance plans generally do not pay for self-referred procedures, so facilities offering them can set their own price and require payment in advance.
The Alzheimer's Association has received numerous questions about two dementia screening tests recently marketed directly to consumers. One is the Early AlertAlzheimer's Home Screening Test, available in pharmacies and from a Web site. The other is the Minnesota Cognitive Acuity Screen (MCAS), sold by telephone and through a Web site.
The Alzheimer's Association believes that no single dementia screening procedure is a meaningful substitute for established diagnostic criteria for Alzheimer's disease administered by a skilled physician. Although these screening tests do not claim to offer a definitive diagnosis, any test that may plant the idea of a serious illness in a test-taker's mind has the potential to cause great psychological distress. The whole process of assessment, diagnosis, and diagnostic disclosure should be carried out within the context of an ongoing relationship with responsible health care professionals. Here are some relevant facts about each of the tests currently generating frequent questions:
- This test, marketed by FMG Innovations, Inc., sells for around $15 – $20 in pharmacies and on the Internet.
- It is packaged in a small box that contains an instruction sheet, a pencil, and a booklet with 12 "scratch and sniff" odor strips. Examinees are instructed to scratch each strip to release the smell, then circle one of four words that best describe the odor. Choices include "cinnamon," "dog," "soap," "garlic," "motor oil," fruit and floral fragrances, and a variety of other scents.
- Correct answers are provided in an answer key at the back of the booklet. Examinees with four or more incorrect choices are advised to consult their physician.
- The instruction sheet states, "Smell loss is among the first signs of Alzheimer's disease. Experts recommend screening for smell loss once a year after the age of 65." It is true that there are legitimate scientific investigations exploring a possible link between smell loss and Alzheimer's disease, but the relationship has not been confirmed or quantified. No currently accepted diagnostic criteria for Alzheimer's include evaluation of smell, and there is no recommendation for annual smell testing from any recognized authority involved in establishing clinical guidelines.
- Many factors other than Alzheimer's disease can impair smell, including current smoking or past smoking, certain drugs, a wide variety of medical conditions, and individual differences in sensitivity to odors.
- Medical and diagnostic equipment, including products marketed directly to consumers, is regulated by the Center for Devices and Radiologic Health (CDRH) of the U.S. Food and Drug Administration (FDA). According to a CDRH spokesperson, the Early Alert smell test has not been cleared or approved for marketing.
- The MCAS is sold by telephone and over the Internet for $95 by Nation's CareLink, a care management firm specializing in geriatric assessments.
- The test consists of a 15-minute question-and-answer telephone interview administered by a registered nurse who asks test-takers such questions as their name, address, and birthday, what day it is, and how they would handle an emergency such as a fire in their home. Examinees are also asked to repeat a six-digit number, to remember 10 words, and to tap on the telephone when instructed. Nurses score each examinee, and those whose scores fall below certain levels are considered to need monitoring or to have "failed" the test.
- The test's developers recommend annual testing. This recommendation does not reflect a policy established by any recognized clinical guideline.
- The chief use of the MCAS has been for commercial rather than clinical purposes—the test was developed by Nation's CareLink as a risk management tool to help insurers avoid issuing long-term care policies to individuals judged likely to develop dementia.
- The MCAS Web site describes the test as "98.1 percent effective in identifying cognitive function." In support of this statement, MCAS cites an article published by the test's developers in the October 2000 edition of the journal Neuropsychiatry, Neuropsychology, and Behavioral Neurology. The abstract of this article on PubMed, the on-line literature database for the U.S. National Library of Medicine, concludes with the developer's own statement that "The Minnesota Cognitive Acuity Screen (MCAS) should undergo further study in unselected elderly populations to better understand its value as a screening tool." The PubMed database contains no additional articles about the test.
To receive information about other important issues related to Alzheimer's disease, please call our Contact Center at (800) 272-3900 or visit the Alzheimer's Association Web site at www.alz.org.
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Introduction
Thousands of social workers in the United States who help individuals with Alzheimer’s disease or dementia and their families every day in many different settings. Below are tips for anyone who is caring for somewith with Alzheimer’s disease.
Trying to communicate with a person who has Alzheimer’s disease can be a challenge. Both understanding and being understood may be difficult.
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Choose simple words and short sentences and use a gentle, calm tone of voice.
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Avoid talking to the person with Alzheimer’s disease like a baby or talking about the person as if he or she weren’t there.
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Minimize distractions and noise–such as the television or radio–to help the person focus on what you are saying.
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Call the person by name, making sure you have his or her attention before speaking.
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Allow enough time for a response. Be careful not to interrupt.
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If the person with Alzheimer’s disease is struggling to find a word or communicate a thought, gently try to provide the word he or she is looking for.
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Try to frame questions and instructions in a positive way.
While some people with Alzheimer’s disease don’t mind bathing, for others it is a frightening, confusing experience. Advance planning can help make bath time better for both of you.
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Plan the bath or shower for the time of day when the person is most calm and agreeable. Be consistent. Try to develop a routine.
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Respect the fact that bathing is scary and uncomfortable for some people with Alzheimer’s Disease. Be gentle and respectful. Be patient and calm.
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Tell the person what you are going to do, step by step, and allow him or her to do as much as possible.
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Prepare in advance. Make sure you have everything you need ready and in the bathroom before beginning. Draw the bath ahead of time.
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Be sensitive to the temperature. Warm up the room beforehand if necessary and keep extra towels and a robe nearby. Test the water temperature before beginning the bath or shower.
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Minimize safety risks by using a handheld showerhead, shower bench, grab bars, and nonskid bath mats. Never leave the person alone in the bath or shower.
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Try a sponge bath. Bathing may not be necessary every day. A sponge bath can be effective between showers or baths.
For someone who has Alzheimer’s disease, getting dressed presents a series of challenges: choosing what to wear, getting some clothes off and other clothes on, and struggling with buttons and zippers. Minimizing the challenges may make a difference.
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Try to have the person get dressed at the same time each day so he or she will come to expect it as part of the daily routine.
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Encourage the person to dress himself or herself to whatever degree possible. Plan to allow extra time so there is no pressure or rush.
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Allow the person to choose from a limited selection of outfits. If he or she has a favorite outfit, consider buying several identical sets.
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Arrange the clothes in the order they are to be put on to help the person move through the process.
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Provide clear, step-by-step instructions if the person needs prompting.
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Choose clothing that is comfortable, easy to get on and off, and easy to care for. Elastic waists and Velcro enclosures minimize struggles with buttons and zippers.
Eating can be a challenge. Some people with Alzheimer’s disease want to eat all the time, while others have to be encouraged to maintain a good diet.
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Ensure a quiet, calm atmosphere for eating. Limiting noise and other distractions may help the person focus on the meal.
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Provide a limited number of choices of food and serve small portions. You may want to offer several small meals throughout the day in place of three larger ones.
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Use straws or cups with lids to make drinking easier.
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Substitute finger foods if the person struggles with utensils. Using a bowl instead of a plate also may help.
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Have healthy snacks on hand. To encourage eating, keep the snacks where they can be seen.
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Visit the dentist regularly to keep mouth and teeth healthy.
For more information, go to www.alzheimers.org/careguide.htm
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Alzheimer's Association
The Alzheimer's Association, the world leader in Alzheimer research and support, is the first and largest voluntary health organization dedicated to finding prevention methods, treatments and an eventual cure for Alzheimer's. For 25 years, the donor-supported, not-for-profit Alzheimer's Association has provided reliable information and care consultation; created supportive services for families; increased funding for dementia research; and influenced public policy changes.
www.alz.org
Alzheimer's Resource Room, U.S. Department of Health and Human Services
The Alzheimer’s Resource Room is where families, caregivers, and professionals can find information about The Alzheimer’s Demonstration Program, including: where you can turn for support and assistance, and providing services to caregivers.
www.aoa.gov/alz/index.asp
American Medical Association-Dementia Resources
The AMA Web site devoted to providing information on dementia and relevant services.
www.ama-assn.org/ama/pub/category/4789.html
CareFinder
The Alzheimer’s Association’s CareFinder is on online tool to help those affected by Alzheimer’s disease find good care in their community. The Web site has sections on Planning Ahead, Care Options, Coordinating Care, and Support and Resources.
www.alz.org/carefinder/index.asp
MetLife Since You Care Guides
Since You Care are a series of guides which provide practical suggestions and useful tools on a variety of specific care-related subjects including Alzheimer’s Disease.
www.metlife.com
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As we age, most of us will experience temporary memory lapses. We may forget names or telephone numbers and have difficulty finding the right word, which can be annoying, but certainly not life threatening. More serious memory problems and behavioral changes that interfere with daily life are not normal and may indicate a brain disease called dementia.
Dementia is a group of symptoms caused by changes in brain function, according to the National Institute on Aging. Alzheimer's disease, the most common form of dementia that is seen in older adults, is a progressive brain disorder that affects memory and reasoning and the ability to learn and communicate.
The onset of the disease is gradual, so older adults, their families, and even their doctors may not initially consider early symptoms as a possible form of dementia. Once diagnosed with the illness, people with Alzheimer's live an average of eight years, although they can live as long as 20 years with the disease, depending on the age at diagnosis and the severity of other health problems.
Alzheimer's is most common in people over age 65. An estimated 4.5 million people in the United States have been diagnosed with Alzheimer's.
The Alzheimer's Association estimates that by 2050, the number of people with the disease could increase to range from 11 to 16 million.
The disease is often categorized into early, middle, and late stages. Not everyone with the disease will develop all of the symptoms or experience a decline in the same amount of time. The Alzheimer's Association describes the stages in terms of symptoms.
- Frequent memory loss: forgetting recent events and conversations
- Problems with language: forgetting simple words or making up words as substitutes
- Difficulty performing everyday tasks, such as cooking or paying bills
- Disorientation to time and place: forgetting where they are, how they got there, and how to get home
- Mood changes: rapid mood swings for no apparent reason
- Personality changes: becoming unusually angry, irritable, quiet, or confused
Difficult behaviors: paranoia, wandering, repeating questions, hallucinations, agitation
- Loss of reading and writing abilities
- Loss of coordination
- Difficulty recognizing family and friends at times
- Progresses from needing reminders regarding personal care to needing assistance with personal care
- Loss of ability to walk, communicate, and to recognize people and objects
- May lose ability to swallow
- Incontinence
- Spends majority of time sleeping
Alzheimer's disease cannot be diagnosed with a single test or procedure. Instead, the disease is diagnosed through comprehensive neurological assessments and a medical evaluation. Physicians will rule out other potential causes of dementia symptoms, including depression, malnutrition, or side effects from medications.
There is no known cure for Alzheimer's, but several medications have been developed recently for people in the early stages of the disease to aid in slowing down the progression of the disease. However, the new medications are not effective for everyone.
Depression, anxiety, unpredictable behavior, and other emotional and behavioral symptoms can also be treated with medication to help improve the quality of life of people with Alzheimer's and their caregivers.
According to the Alzheimer’s Association, early-onset is a diagnosis of the disease when the person is younger than 65. A small percentage of individuals are diagnosed in the 40′s, 50′s and early 60′s. Individuals with early-onset may be employed, have children living at home and face issues such as ensuring financial security, obtaining benefits, and helping children cope with the disease.
Watching a loved one slowly deteriorate from one stage of Alzheimer's to the next can be devastating for family members. Caregivers must adjust over time as the needs of the person with Alzheimer's disease change, cope with challenging behavioral changes, and experience the heartache when their loved one no longer recognizes them.
Nearly all Alzheimer's caregivers report that they frequently experience high levels of stress, and nearly half suffer from depression, according to the Alzheimer's Association. Caregivers often ignore their own health needs due to the demands of their caregiving role.
To reduce caregiver stress, the Alzheimer's Association offers these suggestions:
- Learn about the disease: symptoms, behavioral changes, and stages
- Find classes that will teach you how to control unwanted behaviors and improve communication
- Find a support group in your community for information and emotional support
- Establish a social and emotional support network of people you can count on to help in times of need
- Plan ahead for legal and financial issues
- Take care of your own physical and emotional needs
Social workers who work in health care settings, social service organizations, and private practice are trained to assist caregivers with family needs during this difficult time. They can arrange for in-home services, coordinate care among medical professionals, and direct caregivers to various community resources, particularly respite care, which is necessary to reduce caregiver stress.
When caregivers care for themselves, seek help, and participate in support groups and classes, they are more equipped to provide better care and to care for their loved one at home through the later stages of the disease.
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Introduction
If York’s close-knit community of bridge players were a family, then Charlotte Roseman would be its grandma. But she’s not the type of grandma who forgets your name and sits meekly in a corner. No, Roseman is the type of grandma who welcomes you warmly to join her for a game of cards — then soundly beats you, all while maintaining a polite and delighted smile.
Roseman, who recently turned 90, has played bridge for more than 50 years. During that time, she tutored or played cards with just about every other player in the county, says Marti Ronemus, owner of the Bridge Boardroom in Springettsbury Township
“Charlotte has done more for bridge in York County than anyone else because of her love for the game and willingness to share that love,” Ronemus says.
Roseman, however, says bridge has done more for her than the other way around. She credits bridge for keeping her mind sharp and her memory clear.
“It is fascinating; it’s energizing; it’s healthy. That’s true,” Roseman says. “It’s great for your brain.”
Maintain Your Brain
Experts tend to agree. The Alzheimer’s Association’s “Maintain Your Brain” campaign lists playing games to keep brains active and engaged as a way to help ward off disorders like Alzheimer’s. Along with that, the association also says connecting with others socially can help prevent dementia. Being a part of local bridge clubs has afforded Roseman both.
Keeping a brain healthy means treating it a bit like a muscle, says Lynn Stern, a senior clinical social worker with Turner Geriatric Clinic, University of Michigan Geriatrics Center in Ann Arbor, Mich., and co-author of “Improving Your Memory: How to Remember What You’re Starting to Forget.” Brains need regular exercise, she says.
“Whatever you do is helpful,” says Stern, adding that having an upbeat attitude like Roseman’s is also important. “If you don’t try these things, you’re just giving up.”
Playing Bridge Is Exercise for the Brain
After a half-century of playing, Roseman still buys books and studies the game.
“I believe people sometimes lose interest at some point in life when they shouldn’t,” Roseman says. “But bridge … just keeps me moving. There isn’t an end to learning how to be a better bridge player. You can always improve yourself.”
Playing bridge requires strategy, mathematics and socializing, Ronemus says. Plus, if you’re playing in the Bridge Boardroom, it requires thinking while under the distraction of laughter, cheers and talk from other players.
Part of the challenge to bridge is the never-ending possibilities. Millions of scenarios are dealt with each deck of hands. Ronemus says that there are more decisions in a hand of bridge than in a game of chess — plus players have to deal with partners.
“What makes bridge personally exceptionally challenging is that it is so multidimensional. Math is important. You also have to work with the psychology of the people you are playing against,” Ronemus says. “You have to know who you can take advantage of and who you can’t. You have to have a great sense of proportion.”
While activities like playing bridge may help prevent dementia, it is important not to blame those who already have it by thinking that if only they had been more active, more social or more inquisitive they could’ve stopped it, Stern says.
“You can’t negate the piece that’s just your brain. Alzheimer’s disease is a disease,” she says. “Nothing is going to stave it off completely.”
But if you’re looking to improve your memory, don’t wait until you are a senior citizen, Stern says.
“I don’t think that this is an aging issue, but it is something that aging people worry about,” Stern says.
Roseman was 35 years old when she started playing bridge at the Red Lion Country Club. She began playing the three-hour games once a week, then three times and eventually four times a week. She started teaching others how to play in 1967.
As a director at the Board- room, Roseman also was responsible for getting the players to the right table on time, setting up a game and refereeing any issues that arose. As a player, she continues to be fascinated by what 52 cards can offer.
Roseman once called Ronemus at 10:30 p.m. because she had a hand she didn’t know what to do with. “She picks up a hand and falls in love with it,” Ronemus says.
Ronemus agrees with Roseman that bridge may be the ticket to keeping a strong memory. “My brain would’ve turned to pudding years ago if it weren’t for bridge,” says Ronemus, who adds that when she doesn’t play for a couple weeks, she has trouble staying focused through the whole three-hour game. “It’s not that you forget how to play the game, but you lose the ability to focus.”
Roseman has no intention of testing that theory. She plays about twice a week and continues to teach private lessons. And, despite being 90 years old, Roseman says there is no end in sight to her bridge playing.
After all, she says, her great-grandmother lived to be 92. “We live 10 years longer now, so I’ll be around until 102,” she says. “How do you like that?”
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Introduction
Most of what you read, hear, and think about Alzheimer’s disease (AD) typically focuses on the long-term course of the illness. In the early stages, however, people have only mild memory loss and confusion. While significant challenges arise, there are also many remaining capabilities. Now, a specialized support group program brings hope and help to individuals in the early stages of AD and their family members. These support groups teach people how to live, not how to die with AD — and help family members to grieve and go on.
People diagnosed early in the course of the disease rarely have opportunities to get their questions and concerns addressed. They often become isolated and stigmatized, even though they may be quite healthy and functional for a number of years. For example, while many can no longer work, they typically live at home, do their own personal care, and continue to enjoy many pleasurable activities.
Support Groups for Individuals With Alzheimer’s
In support groups, these individuals get information, share feelings, and experiences with others in a similar situation, and learn coping strategies — much like people facing any other illness. Issues in common include losing a driver’s license, adjusting to increasing dependency, and changes in relationships with family and friends. They also discuss what is going well in their lives, and how to maintain that for as long as possible. As one gentleman put it, “I want people to know — I’ve got a lot of life left!”
Support Groups for Family Members
Family members of those with early AD meet in a separate support group at the same time and location. They focus on caregiving issues unique to the beginning of the illness, such as restructuring household responsibilities and questioning when to assist the person with AD and when to encourage independence. Occasionally the concurrent support groups meet jointly, allowing all participants to interact together.
People with AD have reported an increased understanding and acceptance of memory loss, and improved mood and morale from the camaraderie of support groups. Family members report feeling less isolated, gaining knowledge about coping, and realizing the need for future planning that includes the person with the disease, which is no longer possible in its later stages. Additionally, caregivers learn about the range of services available throughout the course of the disease sooner than they might otherwise.
To join the group, people must be aware that they have AD and be willing and able to discuss their experiences. A careful screening process is recommended to select appropriate participants. In addition to the cognitive and social skills required for the group, an accurate diagnosis is important. Dementia refers to symptoms of confusion and memory loss, and may be caused by such treatable things as depression, vitamin deficiencies, or medication interactions. Only those with a progressive, irreversible dementia would be eligible for this support group, which in addition to AD may be caused by conditions like Parkinson's disease and stroke.
Support Groups Led by Social Workers
While many self-help groups can be capably led by volunteers or paraprofessionals, this specialized support group is best led by professional social workers. The complex group dynamics, communication challenges, understanding of the disease, and discussion of intimate issues are most effectively facilitated by someone with experience in group work, dementia care and mental health. Licensed professionals or those with access to clinical supervision (as well as specialized orientation and training) are typically the most capable leaders of early stage support groups.
Some people may choose not to participate in support groups, so other early stage program models have developed, including cultural, recreational, educational, and vocational opportunities. This reflects the many ways in which a person with early AD has multidimensional needs and talents. Additionally, as people progress beyond the early stages of the disease, they can transition into day programs, which provide supervision and activities for those who are more impaired. Ideally, this transition is handled gradually, involving and continuing to respect the person with dementia, and offering ongoing support.
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Tags: alzheimer's, support group
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Alzheimers Disease/Dementia, Seniors And Aging, Your Options |
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