Monthly Archives: February 2017

Shrinking and Cluttered Closets in Dementialand

I don’t often get the opportunity to chat with people in the very early stages of dementia. The nature of what I do more typically puts me in the presence of caregivers and–when I am with people who have dementia–those who are in need of extensive care. However, sometimes I get the opportunity to chat with an individual who I certainly would not have identified as having dementia had they not told me of their diagnosis.

Jackie (not her real name) was such a person. A petite woman who looked to be in her early 50’s with a blonde bob haircut and funky glasses, she struck up a conversation with me at a senior fair where I had earlier presented on family dynamics and caregiving. I expected her to tell me that she was a caregiver for a parent, but she told me that she had recently been diagnosed with younger-onset Alzheimer’s. I asked how she had been adjusting to her diagnosis, not knowing if this was the appropriate way to phrase the question.

She shrugged and told me she wasn’t okay but that her life wasn’t over either. She said she was working on adjusting to this disease rather than fighting it. She believed working with it rather than against it would work best. I liked her perspective, so I asked her to tell me more.

“I had to give up some stuff, so I gave up taking care of things others can take care of themselves,” she said.

She gave me an example.

She used to pack a suitcase for her husband when he traveled for work. Before her diagnosis, she was feeling increasingly tired and frazzled. Her husband was headed out of town, and she decided she wasn’t up to packing for him.

“You know what he said?” she asked me. “He said, ‘No problem.'”

And I guess it wasn’t a problem.

“So he’s perfectly capable of packing his own suitcase?” I inquired. She laughed.

She explained that he often forgot his toothbrush…his deodorant…his razor…(which he could easily buy at his destination). And that he didn’t know how to fold his clothes so they didn’t wrinkle.

“But,” she told me, “The world didn’t end. Wrinkled clothes don’t kill a man.”

(The next time my husband walks out of the bedroom headed to work in wrinkled clothes and I debate whether to say something, I’ll remember that phrase. Wrinkled clothes don’t kill a man.)

She also explained that she no longer gets up early when her kids and grandkids visit to make them breakfast. She knew she would have a limited amount of mental and physical energy, and she felt like getting up a little later made for a more pleasant day for everyone.

“You know what?” she asked. “They just eat cereal. They’re fine with it.”

Jackie told me that it took an Alzheimer’s diagnosis to put her in a position to stop feeling obligated to do things that her family members could do for themselves.

“I thought that my family would fall apart if I didn’t do all these little things for them. Turns out, they can take care of themselves,” she said.

All of us have limited time and energy. All of us have to decide how we want to spend that limited time and energy.

Jackie decided she didn’t want to spend it packing a suitcase for her husband and getting up early to make a huge breakfast for her family. More power to her.

Whether or not we have an Alzheimer’s diagnosis, we can consider whether or not we are spending our time and energy in ways that work for us. I should add that energy doesn’t only represent physical energy. We are talking emotional, mental, spiritual energy as well.

My husband was talking recently about conceptualizing how we spend our efforts as a closet. Once the closet is full, we can’t fit anything else in. Some of us can do more than others, but we can all only do so much.

If you know me at all, you know I do well with literal rather than figurative. However, this closet deal really spoke to me. When I am asked to join a committee or take on a new project, I think of my closet. If I say yes, do I need to throw something else in the proverbial goodwill pile to make room for the new endeavor? Do I have to make a decision to be less invested in something I’m already doing? Will I end up jamming everything into the closet and being less proficient at everything I do?

Here are some of the things in my conceptual “closet” in no particular order:

  1. Writing this blog
  2. Teaching my college classes
  3. Overseeing interns
  4. Speaking engagements
  5. Taking care of our dogs and cats
  6. Watching “The Bachelor” (most weeks this is a two hours commitment!)
  7. Keeping the house clean-ish
  8. Doing Next Level Extreme Fitness
  9. Going to athletic events at our university
  10. Being on boards/committees on campus and in the community
  11. Making overnight oats every night for my husband and me
  12. Administrative responsibilities at work
  13. Working on research articles
  14. Running–when it’s nice outside
  15. Visiting memory care community, adult day centers, and nursing homes
  16. Serving as NCAA Faculty Athletics Rep at our university
  17. Advising Family Service and Gerontology majors and mnors

Some weeks my closet seems pretty dang full. (To be fair, other weeks are a bit more sparse.) A few months ago, I felt like I was having trouble keeping my closet manageable. Everything was overflowing. I felt like the door wouldn’t even shut, so something had to change.

I could have quit teaching my college classes. I could have just gone MIA on campus. I could have stopped coordinating the Gerontology major. No more responding to emails from other areas of the university or turning in reports about the major. I could have not shown up at speaking engagements. Because these are responsibilities related to my paycheck and my professional reputation, tossing them out of the closet didn’t seem like a good option.

I had to look elsewhere to make a change. For years I had taught fitness classes at our community rec center. I quit.

Could I have given up “The Bachelor” instead? Yep, but I didn’t. Could I have decided to keep the house less clean?  Definitely, and I’m not a clean freak anyway. I could have even chosen to forget about this whole blogging endeavor except that I recently invested in a whole year of an upgraded membership to WordPress so you all wouldn’t have to see ads. I guess I have to blog another year to make that worthwhile.

I have a limited amount of time and energy to spend as I wish, and teaching fitness classes is what I pitched out of my closet for the time being. It’s the decision I made. Someone else might have made a different decision. Someone else is not me.

If I were diagnosed with Alzheimer’s or another disease, my time and energy would be more limited, and I would likely have to make more decisions about what I throw out of my closet. (If you are following me with this whole closet analogy, picture that closet getting smaller.) This is what I see people in the early stages of dementia doing whether or not they realize it.

You can also picture that shrinking closet for someone who has depression, cancer, or fibromyalgia. The more limits life puts on us, the smaller that closet gets. As health declines, the closet may be 10% of the size it used to be. It’s increasingly important to evaluate what the heck you are trying to manage in that shrinking closet.

It’s adaptive to acknowledge that your closet is no longer the size of the one Mr. Big built for Carrie on Sex & the City. It’s a closet you’d find in a studio apartment in downtown Chicago. Accept it, and evaluate its contents. You can focus more positively on what is left in your closet when you throw out things that are no longer working for you.

I should also add that an empty closet is…empty. Even a tiny closet needs some contents. We must have something we perceive as meaningful in which to invest ourselves. When we lose that, we lose our purpose.

Sometimes you find, like Jackie did, that giving up some of the things in your closet isn’t as traumatic as you might predict. Many of us, Jackie and myself included, think we are irreplaceable. I didn’t know what my fitness class participants would do without me. You know what? They still exercise–just with a different instructor. I miss them, but they are fine.

Similarly, Jackie’s husband is able to manage to pack for work trips on his own. Even a crisis like forgetting a toothbrush isn’t really a crisis. And although Jackie’s family enjoyed the breakfast she made, they are fine without it as well.

I once spoke with a woman who had cancer about the minimal energy she had while doing chemo. I remember her telling me that she couldn’t do everything so she had to choose what was most important.

“But really,” she told me, “that’s what I should’ve been doing all along.”

So here goes my attempt at something poetic and meaningful, keeping in mind I’m notably bad at poetic and meaningful.

Whatever life throws at you, may you keep your closet full but not cluttered. We can’t control everything about our lives, but we can control where we invest our time and effort. We can’t invest time and effort in everything. We may have less to invest than we’ve had in the past. Invest it in the right things for you. Don’t let how other people organize their closet make you feel like you’re organizing yours wrong. They aren’t you. They may have a bigger or smaller closet, and they may have different priorities.

For now, I’m keeping The Bachelor in my closet. Don’t judge.

 

 

 

Dementialand and Nursing Homes and Dying OH MY! (A.K.A. When Your Presentation is Postponed Due to Lack of Interest)

About a month ago, I was contacted by our university’s honors program and asked to do a program for something called “Pizza with a Prof.” The professor (in this case, me) gets to choose a topic to talk about while the students listen and eat pizza. I was assured the prof would get some pizza, too. And, hey, I rarely turn down free pizza–unless it’s from Domino’s.

I thought I’d talk about some of my favorite gerontology-related topics. And–time to get excited here, folks–I put together a short Powerpoint presentation complete with a few photos of some of my favorite people, Drs. Elisabeth Kubler-Ross and Alois Alzheimer.

I chose a title for my presentation: “Nursing Homes, Dementia, Dying, and Other Non-Depressing Topics.”

For some odd reason, I thought this title would draw the interest of quite a few students. It would also show that I had a sense of humor. I anticipated that lots of students would sign up. I was wrong.

The presentation was scheduled for last Thursday. I received an email on Wednesday postponing it due to lack of interest. Only five people were planning to attend.

I had planned a presentation that broke college students could not be bribed into attending. I mean, college students love pizza. And not even the power of free pizza could get them to show up to listen to my presentation. Wrap your brain around that.

My gerontologist heart broke.

Okay, I’m exaggerating. My feelings weren’t hurt, and I didn’t take it personally. Maybe being confronted with one’s own aging process and mortality during lunch isn’t up everyone’s alley, even if the pizza is free.

My friend, Jessica, who coordinates the honors program, said maybe the day just didn’t work well for students. She said, “Your topic is awesome.” Of course, she’s one of my best friends. What is she supposed to say? Students don’t want to hear about death and nursing homes while they eat? That I only talk about totally depressing things?

I’m thinking a presentation titled “Cute Kittens and Funny Memes” might have garnered more interest. Or maybe a Powerpoint on the history of the Obama-Biden bromance.

My area of work as a gerontologist isn’t usually that interesting to people…until it’s really interesting (and relevant) to people. Dementia is boring. Dementia is sad. It’s something we don’t want to discuss. And then it all changes when someone we love has dementia. That’s when I get late night Facebook messages (which I don’t mind, by the way). That’s when people want to take me out for a glass of wine or a latte and talk dementia. Things become interesting when they matter to us. We care about issues when those issues impact us and the people that we care about.

Many of my college students are not comfortable with discussing death. I’d say it’s because they are 18 to 23 years old, but it’s not. I know people much older who are not comfortable with the topic of death. When I do presentations and cover issues related to dying, I see a certain percentage of my audience become visibly uncomfortable. Over time, I’ve learned to become comfortable with their discomfort.

I once had a lady tell me that the information I discussed on end of life issues was useful, but it was just too early in the day to think about such things. She recommended I not talk about death before 3 pm. I told her I’d take that under consideration. (In my defense, I was speaking at a “Families and End of Life” symposium that she had registered to attend.)

Aging is a topic of irrelevance to many people because they cannot wrap their mind around the idea that they will someday be old. It’s not complicated–we all get older (unless we die, of course, which I think is way worse than getting old). However, it’s difficult for most of us to fully grasp that we may someday be the older person who is limited in movement or cognition. We might be the older person who lives at a memory care community, assisted living, or nursing home.

We relate to kids because we are all former kids. In fact, I once heard a six-year-old tell a four-year-old, “I know what you are going through. I used to be four years old.”

None of us are former old people–save those of you who might have been reincarnated. I know what it’s like to be 10, 16, and 19. I don’t know what it’s like to be 79, 86, or 90. Sometimes it’s easier to pretend I’ll never get there and live in denial of the aging process. (I should add that it’s easier to accept the aging process when I see older adults who are healthy and thriving. Although they are typically not my “target” population, there are a lot of them out there.)

As much as I talk about dementia…as much as I talk to people with dementia…as much as I talk to loved ones of people with dementia…I am in denial that I could at some point have dementia. Logically I know it could happen to me, but it won’t happen to me.

When I chat with someone who has dementia, I’d like to tell you that I’m empathetic because I know that someday I could be that person, but I don’t think I really know I could be that person. If I’m being completely honest, I think a little bit of denial is protective for me in this case. If it were constantly in the back of my mind that I could experience dementia, I’m not sure I could hang out with people who have dementia.

I know that the population of individuals with dementia is a population I could join at any point, but it’s just one of those things that won’t happen to me…even though I know it could happen to me. I push any thoughts of being diagnosed with Alzheimer’s, Lewy-Body, or Frontotemporal dementia out of the realm of possibility, and I’m pretty effective at keeping those thoughts buried. I manage to think about dementia without constantly confronting the possibility that I could have dementia at some point.

I can’t judge college students for not wanting be in an environment that forces them to confront death and dementia. I don’t want to confront my own death and potential dementia either. I’m just really good at pushing it out of my mind at will.

My presentation has been rescheduled for this Wednesday. Maybe the last date happened to be a day that just didn’t work out with people’s schedules. Maybe the students planning the presentation didn’t do enough marketing the event. Or maybe I should change the title to “Who’s Going to Get the Final Rose on This Season of the Bachelor and Some Pics of Pug Puppies.”

And when they show up–BAM–switcharoo.

Nursing Homes, Dementia, Dying, and Other Non-Depressing Topics.

Let’s see how fast they can run carrying their free pizza.

 

 

 

Two Damn Nancy’s in Dementialand: A Love Story

If you know me, you know I’m not much of a romantic. However, it’s almost Valentine’s Day. And I’m going to tell you a love story.

Maybe it’s not a traditional love story. But a love story nonetheless.

I met John and Lynn (not their real names–and I’ve changed some details here) at a nursing home that I visited to do a series of trainings. John was in his late 50’s and had younger-onset Alzheimer’s. Lynn, his wife, had married him only a few years early. A second marriage for both of them, they had looked forward to retiring together and traveling the world. Instead, they sat in the lounge at the end of a dim nursing home corridor. She was watching Judge Judy. He was sitting in a wheelchair holding a stuffed bear like a baby.

John’s first symptoms of Alzheimer’s had baffled both of them. A female friend came over for dinner one evening, and he kissed her goodbye–on the lips–quite passionately. When Lynn asked him about it later, he denied it ever happened. Soon, his supervisor at work was calling Lynn to ask if he might have come to work drunk. The diagnosis, Lynn told me, was a relief.

Lynn explained that she kept John at home as long as possible, but they didn’t have enough money for in-home caregivers and she couldn’t afford to quit her job at an insurance agency. Also, John had made her promise that she’d place him a nursing home when it was time…and that she wouldn’t feel guilty.

About the time he moved into the nursing home, he stopped recognizing Lynn. Actually, he started calling her Nancy, which was his ex-wife’s name.

At one point, the real Nancy came with Lynn to visit John at the nursing home. (Interestingly, they were pretty good friends.) They were both curious about how John might respond.

“Holy shit!” he exclaimed in all seriousness. “It’s two damn Nancy’s! What the hell am I gonna do now?”

Lynn and Nancy laughed until they cried, and they started jokingly calling themselves the “two damn Nancy’s.”

As his Alzheimer’s progressed, John spoke sparingly. A friend’s toddler had visited with a teddy bear, and John seemed to find comfort in holding and stroking the bear. Lynn bought him his own stuffed bear. Then a lion. And a bunny. Soon he had a dozen stuffed animals carefully arranged in a recliner in his room. Lynn called it “his zoo.” He rarely spoke to people. He more frequently spoke to his zoo.

After John had been in the nursing home a couple of years, Lynn was diagnosed with stage 4 cancer. Surgery and chemo limited her visits with John. She encouraged Nancy to go see John. After all, Lynn told me with a laugh, they’re interchangeable.

Treatment wasn’t effective for Lynn, and she enrolled in hospice. With limited time left, she got to work. Neither she nor John had any children, so she worried about who would be there for him at the end of his life. She compiled a bunch of information–financial, health, etc.–and made a handbook. She gave it to Nancy, who promised she’d be there.

In the midst of her own terminal cancer diagnosis…sitting next to a husband who doesn’t know who she is and intermittently mutters non-sense to a stuffed bear…as she trains her husband’s ex-wife to care for him after she’s gone…somehow Lynn is okay.

Maybe she is a wise Zen-type person who has found inner peace. Maybe it’s her faith. Maybe she’s on some awesome painkillers. I want to ask, but I don’t know how to phrase the question. Whether it’s Zen, faith, or painkillers, I want some.

Lynn knows John won’t miss her when she gone. She considers this a blessing.

“They won’t tell him when I die,” she says. “He won’t understand so there’s no point. He won’t have to be sad.”

Then she says something that I haven’t stopped thinking about: “The best thing is that he won’t even notice I’m not around anymore.”

I feel like there’s a love story in there somewhere, right?

 

 

How Emotion Lasts Longer than Cognition In and Out of Dementialand

Have you ever been in a bad mood and can’t put your finger on why?

Have you ever been pissed off  but are unable to say why you’re mad if someone asks?

Have you ever told someone you had a bad day but upon further questioning couldn’t explain why your day had been so bad?

Have you ever had an argument with a friend or family member that had you all riled up–although you couldn’t really remember what the argument was actually about?

That’s because emotion often lasts longer than cognition. Something puts you in a bad mood, and you stay in that bad mood long after you’ve forgotten what put you in that bad mood.

(I recently read something that asked: “Did you really have a bad day or did you have a bad five minutes that you allowed to ruin your whole day?” For me, the answer is usually the latter, but I’m working on it.)

Nowhere is this more true than Dementialand. This is why it’s important to start an interaction with someone who has dementia in a positive manner.

If I approach an individual with dementia and startle them…if I get upset with them for misidentifying me…if I raise my voice because they don’t respond to my greeting…if I do anything to increase their level of anxiety at the start of the interaction…the emotion this evokes stays with the person long after the memory of the moment is gone. Emotion lasts longer than cognition.

The “start-up” of an interaction is important (and this isn’t just true in Dementialand). Keep in mind that increased anxiety is related to decreased cognitive clarity. If we agitate someone, we should expect that their ability to think clearly will be compromised (again, not only true in Dementialand). If I yell at my college students before they take a test, I would expect them to not do well on the test. If I approach someone with dementia in a way that provokes anxiety, I would expect that they might be unable to respond to my questions. If I cause someone anxiety, they struggle to think clearly–even if after they’ve forgotten exactly what caused that anxiety.

Keep in mind that emotions are chemical reactions. The chemical reactions don’t stop when an individual can’t remember what caused them.

A few ideas for positive “start-ups” when interacting with someone who has progressing dementia:

  1. Approach from the front to give someone the maximum likelihood of recognizing you.
  2. Move slowly. The dementia brain takes longer to interpret visual data. You can make it easier for someone with dementia by avoiding spastic and sudden movements, which can provoke agitation.
  3. Say your name even if you think they know who you are. Many people with dementia have anxiety when they can’t remember who someone is but are too embarrassed to admit they don’t know the person.
  4. Wait for a cue (verbal or non-verbal) before moving into someone’s personal space.
  5. Remember that a person may struggle to understand words but can likely still interpret non-verbals. A smile goes a long way.
  6. If you greet someone and they don’t respond immediately, be patient. Don’t raise your voice in an attempt to get their attention or elicit a response. People with dementia take longer to interpret a greeting and formulate a response. Also, make sure you accept both verbal and non-verbal responses.
  7. When walking into someone’s house or bedroom, consider knocking as a courtesy. (This is an especially good idea when walking into someone’s room at a nursing home. We don’t generally take kindly to visitors walking into our bedrooms unannounced–people living in nursing homes are no different.)
  8. If the person seems distressed, appear concerned rather than overly happy. You want to show you are paying attention to their emotions. You can start with something like, “You seem angry to me” or “It sounds like you’re sad today.”
  9. Resist the temptation to get right in someone’s face if they are struggling to acknowledge you. It’s intimidating. (Do you like people up in your face?)

When I give tips like these, please don’t think my advice is from the perspective of a person who has these skills mastered. Sure, I know them and teach them. Yet, every time I interact with someone who has progressing dementia I could do something better.

In fact, I’ve started working on a series of posts that I might title something like “epic fails” and focusing on my own contributions to negative interactions with people who have dementia. When it comes to dementia, I’ve said the wrong thing only a million times. I’ve triggered meltdowns. I’ve caused stress and anxiety. I’ve made people cry. I’ve been cursed at and called names that would make frat boys blush.

Much of this could have been prevented had I changed my approach.

And in future posts you will get to read all about it….