2011 18th Annual Education Conference on Alzheimer’s Disease

From the Education Conference held on March 2, 2011, below a poem by Sherry Smelley and click here for Grief Inventory

I will always remember…..

I will always remember my childhood porch swing, good times with my sister, climbing trees in the bayou, dancing with my mother when I was 7, Christmas morning, the way you helped me love thunderstorms, and singing in the church Jesus Loves Me and God Loves Me.

I will always remember the aromas of grandmas cooking and the smell of fresh cut greens, the smell of roses, and newborn babies, and the smell of Christmas trees.

I will always remember my pets, my dogs, my cats and the grace they brought to me, and the feeling I had when I had to put them down.

I will always remember my closest family and friends, trips to Hawaii, Maui, Yellowstone, the Rocky Mountains, and the Smokey Mountains, the turning of fall in New England, visiting Turkey, the Niagara Falls, and the door handle at the LSU dorm.

I will always remember my grandparents and the love they showed me, my grandfather hands, her rubbing my eyebrows, my grandmother rubbing my eyes, times I spent at their farm and their house, playing jacks with my grandmother and how pretty she smelled, and how they were both beautiful inside and out.

I will always remember my father and his smile, the twinkle in his blue eyes, they way he danced on his feet, his feelings of me not to marry someone with baggage.

I will always remember my mother and her laughter and her smile, her love, the girl talks we had, and her combing my hair.

I will always remember meeting my spouse and his face and his smile, my wife’s face and eyes the day we got engaged, my wedding day and my 2^nd wedding.

I will always remember the birth of my children, their love and their laughter, and what they have taught me, and the birth of my daughter and son.

I will always remember the night my grandma said goodbye, the day my son died, my mother before Alzheimer’s set in and the night she died. I will always remember you.

Wandering

Behaviors That Often Precede Wandering
Two behaviors that typically occur before wandering are pacing and disorientation. If a person with dementia has a need, he is often unable to verbalize that need and will exhibit a sudden change in behavior instead. Check for clues that may indicate an unmet need.

• Ensure that appropriate fluids are offered at regular intervals throughout the day.
• He/she may be hungry if a mealtime is near.
• He/she may pull at clothing if needing to use the toilet.
• Check to see that clothing is suitable for the environmental temperature.
• Consider pain medication if appropriate.
• Providing a calm, predictable, and relaxed atmosphere may decrease anxiety.
• Sudden increased disorientation, or delirium, may indicate an infection or medication reaction, so notify the healthcare provider if the change in behavior persists or is cyclic.

Watch for Patterns of Wandering in People with Alzheimer’s
Many people with Alzheimer’s disease have a pattern to their behaviors. By watching for patterns, caregivers may be able to distract the person with specific activities at those times. Watch for triggers in addition to physical needs above, such as the time of day and environmental changes. Many people with dementia tend to become increasingly agitated in the transition between daylight and darkness, a condition known as Sundowners syndrome. A new or change in a familiar environment may result in increased agitation – it is helpful to introduce changes slowly if possible. For example, brief visits to a future home or with a new caregiver may be helpful to help prepare for the change. If the behavior seems to be related to medications, immediately notify his or her healthcare provider.

Safety Suggestions for Those Who Tend to Wander Away From Home
Fewer than 4% of people with dementia can find their way home unassisted. This presents a major safety challenge, especially during weather extremes because a person with dementia may be inadequately dressed for environmental conditions. People with Alzheimer’s may be quite lucid at times and may be able to disarm many safety devices, so always ensure that the person with dementia is properly supervised.

• Place a large sign on exit doors saying “Stop” or “Do Not Enter.".
• Hide doorknobs with a color-matched cloth or a curtain.
• Keep temptations, such as keys, out of sight.
• Install motion sensors or a device that will alarm if an exit door is opened.
• Provide reassurance and redirect conversations if he appears anxious or insists on “going home” or “going to work," or attempts to fulfill former responsibilities.
• Keep a recent photo and detailed physical description of the person readily available.
• Utilize programs designed to help track someone who is lost, such as MedicAlert+SafeReturn and Project Lifesaver International.

Ed Picard
Respite Center Coordinator

Finding Happiness…Today

Carol Fitch, a caregiver for her mother with Alzheimer’s, has so graciously allowed for me to share her heart-warming story. Her words show that a person can find happiness and comfort in present-day living, even when journeying with a loved one with Alzheimer’s.

Rashida Keith, MPA
Program Coordinator

An Angel Named Prissie
by Carol Wilson Fitch

I believe that angels appear in many different ways. I have probably been the very cause of some guardian angels asking for early retirement after being assigned to watch over me. But once again, I have been blessed with angel. One that I call my special Christmas angel, named Prissie.

You see, the past several months have been very difficult for me. After going through a tough time at work last year, I thought things would settle down and I would get back to renovating my old house (which I desperately want to finish). But late one Sunday night in August, my 86-year old mom, who has Alzheimer’s, broke her leg as she was getting out of bed. Little did I know from that moment on my life would change dramatically as I made the 911 call. After major surgery and a rehab stint, my mom was discharged from the hospital to come back home to recuperate.

Since my mom has Alzheimer’s, the operation and all that went with it accelerated her already declining mental condition. She could not remember she had broken her leg nor could she remember her surgery or hospital stay. Her sundowning had grown increasingly worse. Keeping her still with her leg propped up was quite an additional challenge in caring for her. At night I would sleep on couch cushions on the floor beside her bed to keep her from getting up. During the day I would block her chair in a reclined position so I could leave the room long enough to do something as simple as getting the mail. After about a month of sleep-deprivated caregiving, I realized that I could not continue doing this. My muscles were hurting from the lack of rest, my mind was hurting from the stress of coordinating and financing care while I worked, and my spirit was plummeting.

After being convinced that full-time care was the only option, on September 27th, my mom went to live at a nursing facility. Next to burying my dad in 1991, this was the saddest day of my life. I had lived with my mom for over eleven years, and had been taking extended care of her for the past five years after she was diagnosed with Alzheimer’s. I had utilized the support and resources of Alzheimer’s Services in Baton Rouge, read numerous books, attended many seminars and educational conferences, and talked to a lot of people who had been in the same situation of caring for a loved one with Alzheimer’s disease. But nothing prepared my heart for the devastated feeling of not being able to give my mom the complete care she needed at home as she was moved out of the place she had lived for the last 35 years. That evening as I unlocked the door to our home, I knew that I was beginning the long and painful journey of saying goodbye to the mom whom I had spent so many wonderful times.

The Christmas holidays were approaching, which is my mom’s favorite time of the year. My mom loves Christmas more than any person I know. She always thought the house could use another string of lights or the tree could use more ornaments or the mantle could definitely have more Santas. I would come home from work to find Christmas music playing at an almost intolerable level and her making fruitcakes or candy for everyone she knew. Getting into the spirit of Christmas was an intense struggle. Many lonely times I would find myself just wishing for the next year when I would have my house renovated and decorated for Christmas. Some days I just wish it were January.

Then on November 6th my life changed again. My daughter and I drove to my brother’s home in Lafayette to pick up my new dachshund puppy. I had already made a couple of trips to see her and had given her the name “Prissie”. She was now six weeks old and the cutest puppy I had ever seen. I was so excited that I cried with happiness as I held her.

To say that Prissie makes me smile is an understatement. She makes me laugh and act silly. She cheers me up when I’m down. She makes me get up when I don’t feel like moving. She gets into EVERYTHING and the entire house has become her playroom. Nothing is safe if it exists in any space of six inches off the floor. Then a friend of mine mailed Prissie a Christmas dress and asked me to take her picture wearing it. Nothing could ring truer than the saying that “a picture is worth a thousand words”. There is no way I could look at the above picture of this adorable puppy in her Christmas dress and not smile.

I decided to “pay forward” the smiles that Prissie gave me, so I sent this picture to my family and friends as my annual Christmas card. The results of the smile meter registered off the scale! My phone did not stop ringing with comments of how cute she was all dressed up for Christmas. And though Alzheimer’s robbed me and my mom from doing our normal Christmas traditions together, God sent Prissie to help lift my spirits. I did not realize this puppy would become my Christmas angel! Also know that while you are enjoying her picture, she is probably enjoying chewing on my slippers!

In the Twilight Zone of a Full Moon

“There is a fifth dimension beyond that which is known to man. It is a dimension as vast as space and as timeless as infinity. It is the middle ground between light and shadow, between science and superstition, and it lies between the pit of man's fears and the summit of his knowledge. This is the dimension of imagination. It is an area which we call ‘The Twilight Zone’.”

Such was one introduction by creator and writer, Rod Serling, at the beginning of his American anthology television series, The Twilight Zone, which ran for five seasons in the early 1960’s. Rod Serling’s creativity in the series mixed fantasy and science fiction, suspense and oftentimes, horror, and usually ending with an unexpected twist.

Using those descriptions…mixed fantasy, science fiction, suspense, horror, unexpected twists….I find myself thinking how these particular adjectives frequently and oddly correlate to and/or describe the behaviors of an Alzheimer’s patient during the time of a full moon, and how these individuals succumb to a twilight zone of their own.

Nonsense? Many people people think the numinous powers of a full moon provoke erratic behaviors. The link between the full moon and highly irregular behaviors was even acknowledged in the 1600’s by Sr. William Hale, a distinguished British physician and medical biographer, as he wrote, “The moon has a great influence in all diseases of the brain, especially dementia.”

The phenomenon is quite debatable, but anyone working with or caregiving for Alzheimer’s patients knows something goes peculiarly awry in the waxing and waning of a lunar effect. Alan M. Beck of Purdue University conducted a longitudinal study to examine the lunar influence and the intensity of behaviors in individuals with Alzheimer’s disease. In his research, he examined wandering, anxiety, physical aggression and verbal confrontation. His study concluded that individuals with Alzheimer’s disease did, in fact, exhibit significantly more erratic behaviors during periods of the full moon, and that these behaviors were of greater duration during that time.

The explanation for this erratic behavior/full moon paradox is believed to be linked to the moon’s gravitational pull that produces the earth’s ocean tides. Since 60-70% of the human body is water, then the moon must be responsible for this particular effect on the human body, in a similarly dramatic and rhythmic fashion as the ocean tides. Skeptics like Robert Todd Carroll of The Skeptics Dictionary web site, however, respond and debate this explanation. “Given the minute and bounded mass of fluid contained within the human body, compared to the enormous and free-flowing mass of ocean water, and given the enormous distance to the moon, the lunar pull on the human body is negligible.

Nevertheless, many who deal with Alzheimer’s patients are die-hard believers in the lunar influence and have come to anticipate the unpredictable behaviors in their loved ones during that time. The onset of the “twilight zone” in the wandering, aggression, and mixed fantasy/paranoia behaviors become more intense at the onset of a full moon. Knowing the particular times of these full moons could be very helpful and prepare the caregiver for “things to come,” per se, so that these behaviors could be addressed by redirection, participation in other activities, or perhaps as a last resort, mild medication. It is something to think about and also observe. The dates of the upcoming full moons are January 18th, February 18th, and March 18th. During those days, be specifically mindful of your loved ones’ behavior and assess it.

Rod Sterling talked about the “fifth dimension,” and how traveling to a twilight zone “lies between the pit of a man’s fears and the summit of his knowledge.” Whether the full moon sends an Alzheimer’s individual into that fifth dimension or not, it stands to reason that you could probably draw some conclusion regarding the abnormally erratic behavior of the individual with Alzheimer’s disease during that time.

Unexplained occurrences. Unexpected twists. Mixed fantasy. During a full moon, you may just be watching a live telecast in your own home of “The Twilight Zone.”

--Dana Territo, Director of Services

Music Therapy at Charlie's Place

Music is an important part of the day at Charlie’s Place. After lunch, we retire to the living room for a singalong to familiar tunes from yesteryear. People from the community come periodically to share their musical talents with us. We have dubbed ourselves “Charlie’s Place Glee Club” and give ourselves a rousing round of applause after every song fest. Some of us sing while others clap, sway, hum, dance, or smile. Our dear veterans often stand and salute to our patriotic songs. We find that music, after a busy morning and tasty lunch, is a great way to relax.

Marcia L. Kirk
Respite Center Coordinator Assistant

Hydration for Alzheimer’s Patients

Caregivers should be mindful of hydration when dealing with their loved ones with Alzheimer’s Disease. Since your loved one has Alzheimer’s, he/she may forget to drink or not realize that they are thirsty. Their medications can also be dehydrating; for example, blood pressure drugs could dry them out even if they drink some water. And vomiting or having diarrhea for more than a day can cause dehydration in Alzheimer’s patients, as it does with anyone else.

Simply saying to them, “drink something” may not help. They may not follow through. If you make it easier for them by handing them a glass, they are more likely to drink. (watch them and remind them to sip it.) Fruit has a lot of water in it, too, so if they don’t want to drink water or juice, offer an orange.

Signs of dehydration in anyone include being more confused or lethargic than usual. The person’s sodium level goes up and confusion results (which also happens when sodium is decreased). But in someone with dementia, this change may be hard to notice. Still, watch for changes relative to how they usually behave. If they seem even more mixed up or lethargic than usual, and if they also feel warm to the touch, alert your doctor. Sometimes people for whom this is a recurrent problem need to have an IV put in temporarily.

Ed Picard, Respite Center Coordinator
Charlie’s Place Respite Center