Music Therapy and Dementia by Rashida Keith

For most people, music is often an enjoyable art. This makes it a medium of therapeutic value, holding a unique place among the arts with its fun and entertainment.

Almost everyone has associations and emotions tied with music. Many people can recall a certain situation when they heard this music and how it made them feel. This is part of the reason why even those who are deeply demented are still able to respond to music.

The elderly population is one of the most common groups of people that music therapists often work with. When it comes to dementia, music therapy is one of the most successful interventions. It can serve a means of communication for those whose function of language has become challenged or almost totally lost. The elements of music, such as rhythm, pitch, and melody are all processed by many different parts of the brain, rather than just one center of the brain, as in language.

Millions of Americans suffer from memory trouble, but there is more that you can do more to help yourself or your loved one. Music in the home or on-the-go can stimulate the mind and exercise memory. It is meant to provide meaningful activity for those suffering with memory loss.

Apart from the obvious enjoyment of music, some music therapists identify four main benefits for those with dementia:
1. changes in facial expression and tension
2. increased eye contact
3. vocal activity
4. physical movement

Music therapy can be a dynamic approach in the care of people with dementia. It can help to soothe, calm, and comfort an agitated person. It can make them feel more secure and connected through smiles and laughter. Try it for yourself. See what you .

Be a VOICE for Alzheimer's by Dana Territo, Director of Services

In the United States, there are currently 5.4 million Americans living with Alzheimer’s disease, and the disease currently affects nearly 40 percent of the population aged 85 and older. Roughly 13.2 million older Americans are projected to have Alzheimer’s disease or related dementia disorders by 2050.
The U.S. Department of Health and Human Services (HHS) is working to identify how to prevent ADRD (Alzheimer’s disease and related dementia disorders), and to address the challenges faced by people with these conditions and their caregivers. The National Institute on Aging leads the National Institutes of Health’s efforts in clinical, behavioral and social research into Alzheimer’s disease, aimed at finding ways to treat and ultimately prevent the disorder. The Centers for Disease Control and Prevention is working to implement the Healthy Brain Initiative, including assisting with monitoring the public health burden of cognitive impairment and enhancing understanding about how diverse groups perceive cognitive health. The Administration on Aging Alzheimer’s Disease Supportive Services Program is helping to create responsive, integrated, and sustainable service delivery systems for people with dementias and their caregivers.
In January, the National Alzheimer’s Project Act was signed into law after being passed unanimously through Congress. It is a law that requires the creation of a national strategic plan to address the rapidly escalating Alzheimer’s crisis and it will coordinate Alzheimer’s disease efforts across the federal government. The National Alzheimer’s Project Act (NAPA) creates an important opportunity to build upon and leverage HHS programs and other Federal efforts to help change the course of ADRD. The law calls for a National Plan for ADRD with input from a public-private Advisory Council on Alzheimer’s Research, Care and Services. The Advisory Council will make recommendations to HHS for priority actions to expand, coordinate, and condense programs in order to improve the health outcomes of people with ADRD and reduce the financial burden of these conditions on those with the diseases, their families, and society.The National Alzheimer’s Association is seeking feedback about what should be included in the national plan so that they can make recommendations to the U.S. Department of Health and Human Services. Have a VOICE in Washington D.C., by offering your opinions and sharing your challenges. The questionnaire takes just a moment and can truly make an impact in the fight against Alzheimer’s disease. You can go to http://napa.alz.org to learn more about the issue and to share your feedback.

Effects of Alzheimer's on Activities

As Alzheimer’s progresses, it can affect the person’s ability to enjoy and tolerate once pleasurable activities. It is hard for us as caregivers to see such activities produce confusion, fear, or discomfort. It may become necessary to avoid over-stimulating places where there is a lot of background noise including multiple people talking at the same time, cheering, chairs scraping on floors, loud music, flashing lights, or people moving about quickly, to name a few.
Simple activities seem to be most successful. Following are a few examples:
· Trips to a nursery to look at flowers
· Walking through a small, quiet grocery store
· Visiting a farmers’ market when crowds have subsided
· Watching old movies at home
· A short walk
· Visiting a pet store
· Stopping at a local bakery
· Going to an ice cream shop
· Stopping at a local park
It is important to remember that Alzheimer’s can cause a person’s abilities and emotions to fluctuate daily. Be aware that it is OK to modify, postpone, or eliminate activities as necessary.
By Marcia Kirk
Respite Center Coordinator Assistant

Keeping Cool in the Summer Months

Elderly people (that is, people aged 65 years and older) are more prone to heat stress than younger people for several reasons:

• Elderly people do not adjust as well as young people to sudden changes in temperature.


• They are more likely to have a chronic medical condition that changes normal body responses to heat.


• They are more likely to take prescription medicines that impair the body's ability to regulate its temperature or that inhibit perspiration.

Heat Exhaustion
Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.
Signs and Symptoms of Heat Exhaustion
Warning signs vary but may include the following:

• Heavy sweating


• Paleness


• Muscle Cramps


• Tiredness


• Weakness


• Dizziness


• Headache


• Nausea or vomiting


• Fainting


• Skin: may be cool and moist


• Pulse rate: fast and weak


• Breathing: fast and shallow

What You Can Do to Protect Yourself
You can follow these prevention tips to protect yourself from heat-related stress:

• Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)


• Rest.


• Take a cool shower, bath, or sponge bath.


• If possible, seek an air-conditioned environment. (If you don't have air conditioning, consider visiting an air-conditioned shopping mall or public library to cool off.)


• Wear lightweight clothing.


• If possible, remain indoors in the heat of the day.


• Do not engage in strenuous activities.

My Trip - By Barbara Auten

As a long distance caregiver I struggle with many challenges, even with 7 brothers and sisters to help with my mother’s care. My mom fell in April for no apparent reason. After four days in the hospital the doctors could find no neurological reason and no real physical damage. But a four day stay in the hospital had a huge impact on my mom. She lost 25 pounds that week and was weak after lying in a bed for four days. I cried when my sister described her crawling up the stairs to her bed when they came home. It broke my heart to imagine the scene … this vibrant pillar of a woman who just 3 years ago was hiking in Northern Canada at age 84.
I knew I had to make the trip to see her and could not delay any longer. I made plans to visit for Mother’s Day and invited my daughter, Maureen, so we could all celebrate this special day together. It was a shock to see mom had shrunk. Her height had always towered mine yet now I am 2 inches taller than her. Her clothes hung on her diminished frame yet her feet were so swollen she could only wear slippers. I was afraid to hug her too hard but wanted to hold her in my arms forever. I had four short days to spend with her and help my sister who is her main caregiver.
Mom’s balance was “off” due to her weakened state and loss of weight yet she fought using a walker or cane. She insists she doesn’t need her bedroom moved to the first floor. I was relieved that she allowed me to have an additional railing installed on the stair well so she has adequate support … for now. How long will it be enough?
I anticipated Mother’s Day starting out with Mass and brunch with the family but was heartbroken to hear mom say she wouldn’t be going to church. Church was her life, the parish secretary had just requested her bio for a feature they wanted to do on her. The Bishop’s Committee had recently recognized her for 50 years of service. When I reminded her of the award she looked confused and asked, “What’s Bishop’s Committee?” So … the whole family gathered to celebrate the day and the matriarch, 5 of the 8 children and spouses, grandchildren and great-grandchildren filled the house. She was surrounded by family and for the most part could remember almost everyone. This was her element … family …she loved being surrounded by them and thrived on their presence but after an hour I could see the confusion in her face and knew it was exhausting her. We sat quietly that evening, Maureen, myself and Mom piecing together a puzzle over light conversation. She didn’t remember everyone being there that afternoon.
We saw the Neurologist Monday afternoon after dropping Maureen at the airport. Mom lost another point on her memory screening. The doctor had not received her records from the hospital. We discussed her medications and considered changing to the Aricept 23 but were told the insurance wouldn’t cover it. If we chose to pay privately it could cost several hundred dollars per month. I asked for an extension on her physical therapy as she was still weak after the hospital stay. The swelling in her feet and ankles remained a problem but isn’t going away. The compression stockings were still her best defense. The doctor renewed her prescriptions and we left hoping she wasn’t too tired to shop for shoes that would fit her feet and offer her a solid foundation. We managed to find 2 pair and even got a compression stocking aid to help her get them on. Anyone who has ever had to use them will know what a struggle this can be!
So for 2 more days we cooked and cleaned and talked. She was not happy that we put so much in piles for a garage sale but knowing she wouldn’t remember in a few minutes we kept on. It was obvious she was growing stronger since I’d arrived and she was eating better. My brother who lives with her and is developmentally challenged tries hard but sandwiches just don’t make a healthy meal twice a day, everyday. I filled the freezer with nutritional meals for two hoping they will actually reheat them for dinner. I convinced my sister that it was time to consider outside help, a sitter to relieve her of some of the burden. Even 4 children in town are not able to juggle being there for her. I’d spent nearly every waking hour with her for four and a half days, I’d filled the freezer, I’d installed the railing, I’d seen her doctor, she had new shoes, clean clothes and been bathed. I felt I’d done everything I could in that short time. We’d spent many hours just talking as I cooked or cleaned or drove the car. I hugged and kissed her good-bye trying to remain upbeat more for her sake as I walked to the car. My sister forgot something and ran back in the house giving mom time to walk to the door, to look one more time. She stood there … not with a blank stare … but a forlorn look knowing it may be the last time she saw me. It wrenched my heart … the picture of her standing in that doorway looking so frail and lost will forever be etched in my mind.

Creating Comfort with In-Home Care

It is quite normal for a family caregiver to feel some anxiety when a new person comes into the home to provide assistance, especially so because many caregivers have genuine concerns toward ensuring that the best possible care is provided to their loved one affected by dementia. When considering outside assistance, caregivers should make themselves comfortable in asking some or all of the following questions, prior to selecting an Independent or Agency Provider. This will help to decrease anxiety and promote an overall sense of comfort for everyone, especially for the individual being cared for. Below are some questions that a caregiver may consider.
Questions for an Independent Worker/Caregiver:
1. What kind of work experience do you have in caregiving?
2. What specifically makes you qualified to work with my loved one?
3. Are you comfortable dealing with my loved one’s emotional and/or mental changes?
4. Why are you interested in this type of work?
When asked upfront and respectively, these kinds of questions can create a dialogue for asking and answering all kinds of questions, while also setting an expectation for the kind of care that is sought and deserved.
Questions for an Agency:
1. What kind of background check is performed on the workers?
It's commonplace for employers to do criminal background checks on potential employees. Since trust is critical when hiring someone to help inside of your home setting, a background check can be a valuable screening tool.
2. Do you check your workers' driving record and driver's license?
If you need someone to drive your loved one, even occasionally, it is important to know what kind of driver you may be hiring. Car insurance requirements may differ from state by state. It is advisable to check with your local Department of Motor Vehicles (DMV) to see the requirements of your state. If the worker may be driving yours or your loved one’s car, check with the insurance company to find out how to include new drivers.
3. Are your workers bonded?
If someone is bonded, their work is basically insured and your loved one will be covered, in the event that the worker breaks or steals something. Bonding coverage varies, so you can ask for details. It's a level of reassurance that can make a difference; however, it is not necessarily essential to good care.
Do you provide any training for your workers?
If so, ask the agency whether training is done once or on an ongoing basis.
Are the healthcare workers your employees or independent contractors?
Some agencies function more like job referral services, linking independent workers with jobs, rather than managing their own employees. With independent contractors, you will likely be required to do more paperwork and supervision. It is a good idea to be clear about this from the very start.
What kind of supervision do you provide?
How often does the agency check in with its workers…daily or weekly? Is someone available to provide expertise or extra assistance, if needed?
How do you handle a worker's sick days, vacation days, and holidays? Will you automatically send a replacement worker?
Everyone needs breaks and time off, including yourself and those you may hire. Caregiving can be physically and emotionally demanding. Find out how agencies cover for worker absences and what's required from your end.
What's the turnover rate of your workers?
Do you think your employed caregivers enjoy their jobs? Do you offer benefits? It is hard to be certain that you will receive an honest answer, but it never hurts to ask. But, remember that one simple truth prevails: People who are happy with their work make better employees.
How do you handle conflict between a client and worker?
It helps to know how much support you'll get from an agency, should a conflict arise. Does the agency mediate conflicts, and if so, how? Is the agency flexible about changing workers, if things don't improve?
Do you have other people that I can talk to about their experiences?
It is perfectly ok to ask for several references. This is one of the best ways to get a sense of how an agency has performed over time.
Do you accept payment from insurance companies?
If your loved-one has long-term care insurance that pays for the cost of in-home care, you may want to make sure that the agency accepts this kind of payment. If not, you are likely better off using one that does.
What kind of service agreement is required?
This will help you to learn of any requirements or commitments on your end, as well as flexibility of services provided.
Will you take care of all required payroll paperwork?
A significant amount of paperwork may be involved when employing someone, covering such matters as taxes, Social Security, and disability. One benefit to hiring from an agency (and the reason it's usually more expensive than hiring independently) is that an agency will normally do this for you. However, it never hurts to double-check to see.
Are you Medicare certified?
Medicare certified agencies are eligible to be paid through Medicare, the government's health coverage for persons over 65. To become Medicare certified, an agency must meet federal standards for patient care.
Can my loved one and I interview candidates and give input on the choice?
The more control you and your loved one have over choosing an in-home health worker, the better you will feel about your choice. Agencies approach this differently, so you may need to ask.

I's All About Perception

At a neighborhood Walmart store recently, a sluggish looking middle-aged man approached me and asked for money to buy milk and bread for his family. He held out his sullied hand and showed me a few dollars and coins he had collected. Without hesitation, I reached for my purse and then gave him a few dollars. Isn’t that what it’s all about – helping thy neighbor? As I was checking out, however, I noticed the same man putting his milk and bread on an unattended counter and walking away, putting his newfound cash flow in his pockets. I watched him as he cautiously looked around him, and as he turned, his eyes met mine. He hung his head and left the store.

Such stories are numerous, and such events advance the human perception of would-be beggars and affect us in ways that make our emotions teeter from guilt to frustration and from sympathy to exasperation.

Human perception is the psychological definition of what we perceive, which despite what some people believe is not always the same as what truly is. In other words, we tend to perceive things the way we want rather than how they are really happening. Our perceptions are based on our life experiences; therefore, the perceptions of two people of the same situation are unlikely to be the same.

I was thinking of “Perception” and how most of the world looks at individuals with Alzheimer’s disease. I believe there is a kind of social stigma about the disease. The individual tends to “hide” the disease as long as he/she can. The family tends to stay in denial with others, using all kinds of creative cover-ups to mask this devastating brain disorder. And with the growing statistics of Alzheimer’s – 5.5 million people now in the U.S.-- the community and the world at-large still seem hesitant to forcibly confront this flooding river called Alzheimer’s disease.

Albeit the denial, the guilt, the discounting that this disease is going to “flood” most everyone’s lives in the very near future, the individual with Alzheimer’s is losing himself and “unlearning” everything he did in his lifetime. The individual’s memory wanes and their loved ones grapple with what once was and will never be again. And, then comes PERCEPTION. That individual CAN’T function, CAN’T have a quality of life, and CAN’T “enjoy” any activities. And last of all, the best thing for that individual is peace and calm and minimal stimulation….just keep them comfortable.

Perception. No two people perceive the same thing, yet the perception of this individual with Alzheimer’s is NOT what is truly happening. Yes, the disease is terminal. However, the disease can prevail for a very long time. Having the perception that the individual with Alzheimer’s has no quality of life, that he should be kept quiet with no activities and no purposeful stimulation, are a few perceptions society needs to change.
For those of you who watch Donald Trump’s “Apprentice” on television, country music star, John Rich, had this to say about his perception of his teammate, Lil’ Jon, a musician and rapper. "I'm very proud of what he [Lil’ Jon] accomplished. He raised a lot of money for his charity but he also successfully broke down a stereotype about guys like him -Rappers. Guys that dress like him. I know that was very important to him, not everybody that dresses like me or you do these certain things that they are stereotyped with and I know that was huge to Lil Jon and he definitely accomplished that." Lil’ Jon accepted the invitation on the show not only to raise money for his dedicated charity, but also to show viewers that Rappers are not all ignorant or on drugs. Perception.
An LSU service-learning student commented to her instructor that she had a prior mental picture of visiting the clients at Charlie’s Place and she was rather fearful. She thought the environment would be quiet, with the clients more or less “watching the grass” grow. However, she was surprised to learn how much joy and fulfillment the clients at Charlie’s Place exuberated, the atmosphere one of security [from an outside world that judges], and that people with Alzheimer’s disease can actually have enjoyment in their lives. Perception.
The stereotypical perception of Alzheimer’s blocks our awareness that the person with the disease can actually have some fruitful and productive time before the disease, like any other, progresses to end-of-life. Though we have to re-introduce ourselves (often) to the person with Alzheimer’s, this new relationship can be one of incredible gratification and lead to a whole new understanding of the disease, which can then begin to change our own PERCEPTION and that of others.
French painter, Robert Delaunay, once said, ‘Our understanding is correlative to our perception.” Once we wholly understand Alzheimer’s and that the individual with the disease can be a productive member of society, that he can have a quality of life, and once we are open and honest about the disease itself, then we can begin to change perceptions about Alzheimer’s disease, and the people diagnosed, in our community and in our world.
Dana Territo
Director of Services