A Caregivers Asks: Does Anesthesia Make Dementia Worse?

It can. It doesn’t always. This ambiguous response is true of many questions regarding what happens when someone has Alzheimer’s disease or one of the many other forms of dementia. What is true for one person is not true for many others.

Some factors that can have an effect on whether or not someone experiences cognitive decline after general anesthetic are:

Age – The older we are, the more vulnerable we are to side effects of anesthesia. Our brain, like the rest of us does not respond in the same way it once did.

Medical Conditions and Medications – The more health issues one has and the more medication one requires the greater the chances of cognitive decline with the added stress of surgery.

Loss of Blood – Blood loss during surgery can reduce oxygen flow to the brain resulting in cognitive impairment.

Type of Anesthesia Needed and What Procedure has to be Done – Depending on the circumstances, the surgeon may need to use heavy sedation over a relatively long period of time increasing the chance of a negative reaction.  For less extensive procedures, he or she may opt for a spinal block and twilight sleep. Doing this could lessen the risk of cognitive decline.

Pre-existing Dementia – Dementia is a devastating brain disease and any procedure that causes increased stress on it could result in changes in function.

###

It is important to note that often the cognitive changes seen immediately after surgery and anesthesia are temporary. For some patients there can be a partial return to pre-surgery state with more minor losses remaining.

It is also important to speak openly about your concerns and to work with the physician to formulate the best plan for the needs of the person requiring surgery. Despite the risks, the procedure may have to go forward in order to save the person’s life. And remember, the surgeon and medical staff want the best possible outcome as much as you do, and will do their best for their patient.

For more information on anesthesia and dementia click on the following links: http://health.sunnybrook.ca/brain/surgery-and-dementia, https://www.scientificamerican.com/article/can-general-anesthesia-trigger-dementia/; https://www.dementia.org.au/files/helpsheets/Helpsheet-DementiaQandA20-Anaethesia_english.pdf

Bobbi Carducci The Imperfect Caregiver

A Caregiver Asks – How Do I keep Dad From Driving?

We all know that eventually the day will come when it will no longer be safe to drive however, the word eventually means we don’t have to face it for a long time.  Unfortunately for some, it comes sooner than we think and under circumstances we didn’t consider when first taking the wheel and heading off down the road.

When someone has dementia or has had a stroke or traumatic brain injury, that day can arrive sooner than cognitive impairment can process the change or how much danger they can be to themselves and others. This often leads to denial, anger, and a lot of lashing out at the person standing in their way.

When that day comes for your loved one:

Try to include him in the decision process. Have someone he trusts with sit with him and go over the dangers in continuing to drive. Deciding on his own is better for him than having his licensed revoked due to an accident. Even if he was not at fault he could be sued resulting in not only losing his license but serious financial loss as well.

It’s important to understand that this is an issue that must be addressed. Check with your local and state police for information on the law in your area. In many places, if you are aware the person in your care has cognitive impairment and you know they are driving, it could put you and your assets at risk.

Here are some suggestions on what to do when faced with this issue:

  1. Let him know you are on his side. You are not taking this from him. “Dad. I know this is important to you and always were a good driver. Let’s see what we can do about this.” Then call his doctor.
  2. Have the doctor speak with Dad. Some people are conditioned to follow a doctor’s advice.
  3. Once confirmed by the doctor that he should not be driving and he still insists on getting behind the wheel, arrange for him to “lose” his license. (Hide it.)
  4. Again. Let him know you are on his side. “I’ll call the DMV and make an appointment so you can get a new one.” Inform the person you speak with that he has dementia. Arrange for him to have a driving test. If he resists remind him that this is a chance to show them he can drive. When he fails the test, let the DMV revoke his license. Be supportive when he gets upset. “I know this is hard and you are angry. I would be angry too.” Acknowledge his feelings and his right to express them.
  5. If he still insists on driving, keep all keys where he can’t get them. If possible move the car somewhere he can’t see it.

A driver’s license represents independence and freedom. We drive out of necessity and we drive for fun. No longer being able to get in the car and go can require a mourning period. Validate his feelings of loss.  If his anger spirals out of control go into another room and lock the door until he calms down. If necessary, call law enforcement to assist you.

Note: The regular contact form will not post. To reach me send an email to:  bcarducci@Comcast.net

www.bobbicarducci.com 

 

Dementia and SEX – Let’s Be Honest It Happens

Dad’s behavior is becoming more erratic as his dementia advances. His former mild manner is long gone replaced by outbursts and suspicion that come with sundowning each day.

The man you have known all of your life, the man who would never think of stepping out of line or behaving in an inappropriate manner with women, has suddenly started exposing himself to you and every other female he comes in contact with. He may express his desires in the crudest terms there are.

Shocked and horrified you may wonder, “Is this a side of him he kept hidden all these years? If so, I have no idea who my father really is.”

Or: You enter your mother’s room to say goodnight. She has thrown off her blanket and removed her underwear. Her back is to you. It takes a few seconds for you to understand what she is doing.

Your reaction may be, “Oh my god, Mom would never do that!”

Or: You arrive to spend time with a spouse in a memory care facility and walk in on him or her in a passionate embrace with one of the other residents. You are hurt and angry. Feelings of betrayal and jealousy take your breath away.

How could the one who promised to faithful until death do us part betray you when you are sacrificing so much to make sure they get the best possible care?

What is going on? How can you ever face this person? Do you even want to? What can you do about it?

Dementia is a devastating brain disease. If the part of the brain where inhibitions are stored is affected acting out sexually may happen. The libido remains strong throughout life, for women and men with dementia included. The difference now is that their brain is damaged. They don’t understand that their behavior is not appropriate.

So what are you, the caregiver, to do?

First and foremost, protect yourself. If there is any hint of danger go to a place of safety. Lock yourself in the bathroom, run to a neighbor, call 911 if necessary. Make sure you tell the dispatcher that the person acting out has dementia so officers understand what is happening and why.

If there is no danger to you or others, simply close the door and walk away allowing him or her the privacy they deserve and you the time to work thorough your feelings.

Understand that people with dementia often forget their actions as soon as they occur. It would be helpful if you could find a way to do the same. If you can’t, feel free to vent here. You are not alone. The Imperfect Caregiver has lived it and is here to help. 

For more information on sex and dementia go here: http://bit.ly/2wBy3Dp

Show Don’t Tell – A Writer’s Advice For Caregivers

For writers, show don’t tell is the difference between: “John was being aggressive. Jane was frightened.”

And: “Stop! It’s me, Jane. I’m your daughter.” Jane ducked as the antique lamp whizzed through the air, missing her head by less than inch.

In the first example family members are left to fill in the details of what is going on. In the second one we see that John is out of control and Jane is in real danger. We feel for her and we want to help her in some way.

Showing your distant family members what you are dealing with on a daily basis may elicit a very different response than your telling them about the vile language your mother spews at you when you try to get her to eat. Or how she refuses to bathe or change clothes and hits when you try to calm her. They insist that the sweet woman they know would never act like that. You must be making it up.

You could provide example after example of the chaos dementia causes. How exhausting it is to be sleep deprived for months. How mean someone who raised you can be. How desperate you  are for a bit of understanding, a moment of peace and still they don’t get it.

So often I hear caregivers say, “Only someone who has done this can really understand what it is like.”

It’s true. What dementia does to a person cannot be expressed in mere words. So what can you do?

Show them.

Use the video camera on your cell phone as a way to communicate with your family. Brief clips of every day behavior can be emailed in moments. Show the anger and aggression, the refusal to eat and bathe. Let your family see what happens when their loved one is hallucinating and how dangerous things can get. Show your family how hopeless you become. How much you need help and understanding.

Nothing I suggest works for everyone  but at least your family will have seen for themselves what it’s really like to be a caregiver. It can’t hurt. Might help.

 

 

 

Bath Time In Dementia Land

Does this sound familiar?

“Dad, it’s time take a shower.”

“No.”

“Come on, really? You haven’t washed in over two weeks.”

“Not true. I took a bath yesterday.” (He didn’t, he only thinks he did.)

“How was it?”

“Wet and cold.”

“I’ll make sure the water is nice and warm. I’ll even put the towels in the dryer so they feel nice when you get out.”

“People don’t have to take a shower all the time. You think a bath is so great you take one.”

“I did. Don’t I smell nice?”

“Who cares about smell? Women smell nice. Men smell like they smell. All my life I work hard.”

“Yes, you did. And after working hard you washed yourself.”

“In the Old Country I took a bath on Saturday night. Had to be clean for church on Sunday. My mother always had the hot water ready.”

Hearing Dad talk about the Saturday night ritual in Italy as he was growing up gave me an idea.

“That’s right,” I said. “Saturday is the day to get clean for church in the morning. I forgot.”

“I remember everything. It’s a good thing I’m here,” he huffed. “I watch the news now.”

Yes, it’s a very good thing you are here,” I replied.

That evening, after helping him eat his dinner I warmed some towels, put the shower seat in place and turned on the water in the shower. Once it was nice and warm I entered Dad’s room.

“What’s up?” he asked.

“It’s Saturday. Time to get cleaned up for church tomorrow. I have the hot water ready.”

“It’s a good thing you didn’t forget. My mother always said, “Cleanliness is next to Godliness.”

I helped him rise and pull his T-shirt over his head and said a silent thank you to his long deceased mother for the night before church routine she instilled in him so many years ago.

After that, whenever her needed a bath or a shower it became a Saturday in our house no matter what the calendar said. And even without going to church the next day, my prayers were answered. Dad was clean again.

Early in his time with us Dad would always take a shower and shave before seeing a doctor. Later, when he began to balk at the Saturday night ritual, I’d tell him his doctor wanted to see him in the morning. Soon after taking a shower he would forget what I’d told him and was content watching television in clean pajamas.

Another caregiver I spoke with told me about someone she cared for who had spent their entire career in the military. Being told an inspection was scheduled for the next day always inspired him to make sure his room and his person would pass muster.

Not everything I tried  worked every time. However, I really appreciated the times when something I did resulted in even a very small success.

Was there a recurring occasion or event when your family member always wanted to look his or her best? If so, please share it here. It might help you and another caregiver avoid some of the intense stress that often happens at Bath Time in Dementia Land.

 

A Fearsome Intimacy

Caregiving Fearsome Intimacy

When we hold our infants in our arms we are filled with awe and hope for the future. We envision a life of promises fulfilled. We never picture them feeding us, holding our hand to keep us from falling, or changing our underthings. I couldn’t type the word diapers. The thought of losing my dignity to such a degree is truly fearsome. In my mind I hear the words, “It’s enough to scare the pants off me.” The irony makes me shudder and chuckle at the same time.

The caregiver and the cared for locked in a fearsome intimacy. I don’t know where the quote above came from. If I did I would give credit here. What I do know is those five simple words speak a devastating truth.

 

Get Enough Rest, Really People?

caregiver-stress

Tips on how to recognize and cope with caregiver stress appear on almost every caregiver website, blog, and column. Too bad none of the advice works.

Click on the link below to learn why.

Why Caregivers Ignore All That Good Advice About Dealing with Stress and What You Can REALLY do to help.

 

 

What We Have is a Failure to Communicate

failure-to-communicate

You spend hours, days, weeks, months, years, becoming more and more isolated as caregiving takes over your life. Well intentioned friends and family who offered to help in the beginning drop out of your life as they tend to their own families and jobs.  When they do come to visit they see Mom or Dad on their best behavior. Somehow he or she is able to connect with reality long enough to convince visitors they are so much better than they really are.  They may even accuse you of abusing them or robbing them causing distrust and confusion within the family.

If only your visitors could see your parent beg to go home for hours or cower in fear because they no longer know who you are.

Fortunately there are now ways to make that happen and I encourage you to use them especially if your family members are too far away to visit often. They may not be able to come in and relieve you but they might be able to help in other ways once they see how much you are doing every day.

Don’t let distance keep family in the dark. The more they know the better chance you have that someone will step up to help.

Communication is key, no matter how you make it happen. Use any and all resources available to you including one or more of the ones listed below.

I urge you to take full advantage of video chatting to share your experiences and make it far more difficult for others to say, “I wish I had known how hard it was. I would have been there for you.”

Listed below are a number of resources to keep communication open.

Nucleus

Skype,

FaceTime,

Glide,

Tango, etc.

Email

Phone

Facebook

If you are using, or have used, any of the resources listed above to reach out to family and friends please share your thoughts on how well it works or worked for you. I look forward to hearing from you.

 

A Teen Encourages Others to Help

The following is a guest post by  Minaal Khan, an 11th grade student at John Champe High School in Aldie, VA.

As teenagers in the age of technology, we need to be less materialistic and spend time with people as well as our favorite devices. People are who make the world a better place and who provide beneficial social interactions. We need to stop ignoring people and start using devices less often. Helping people can make you a better, worldlier person. This will make you truly appreciate the world. Hearing about someone else’s life can inspire you and may even change you for the better.

Teenagers need to start giving back to the community and helping others. We are at the age that will define us as adults. If we do not start giving back now, we will never do it as adults. We need to be thankful that we are healthy and appreciate what the generation before us has done to ensure that we are raised properly. They left us a great world that we can make even better by spreading kindness and selflessness. Everyone deserves to have someone help them when they are in need, so we should be kind and care for people who may have neurocognitive disease.

Caring for people with Alzheimer’s helps you feel accomplished as you do something good in the world. It also reassures the person you were caring for that there is hope and kindness left in our world when so often all we see on the news is violence.

Caregiving is an act of kindness that the other person will remember and builds self-esteem. It does not require you to sacrifice several hours, you can also spend time with your friends or family.

Helping someone who has Alzheimer’s will also help the family of the person who has Alzheimer’s because they will know that someone is taking care of their loved one. They will not have to worry about finding a reliable caretaker which increases the cost of care.

Caregiving is extremely rewarding and can change the lives of many people, the caregiver, the person with Alzheimer’s, and the family of the person with Alzheimer’s. It also gives you a sense of accomplishment because you have made a change in someone’s life. We need to help others as much as we can.

 

4 Reasons People with Dementia Hate to Shower & How to Fix It

shower-head

1. You asked: When asked a yes or no question a person with dementia may not understand the question and automatically answer with a resounding NO to avoid agreeing to anything they may not want.

Why? Because it’s one of the first words we learn when beginning to speak. It’s short and powerful and it works if we repeat it often enough. Instead of asking, get everything ready and then gently say, “Your shower is ready,” and lead him or her into the room.

2. Room Temperature: When preparing the room make sure it is very warm. It may feel like a sauna to you but to someone who is frail it could still feel chilly. Make sure the water is warm also but make sure it isn’t hot. Test it as you would before bathing an infant. Have plenty of soft, warm towels at hand. Warming them in the dryer just before shower time is a good idea.

3. Modesty: Most of us have some body issues and are reluctant to have others see us naked and this could be especially true of an elderly parent being bathed by one of their children.  It’s perfectly okay to wrap a towel around their chest and one over their lap and bathe them through the towel. They maintain their dignity, stay warm, and get clean all at the same time.

4. It’s Scary: Imagine sitting naked on an uncomfortable seat in a little room with sounds echoing around you. You’re not sure why you are, how you got there, or what’s going to happen. Then all of a sudden something starts falling out of the sky and hitting you on your head, chest or back.

Dementia affects vision as well as memory and other functions. The person in your care cannot see the water falling from the shower head. It’s confusing and frightening and they want nothing to do with it. (Note:  The next time you shower pay attention to the water flowing from the shower head. How well can you see it?)

To help alleviate the fear and confusion use a hand- held shower head and start at their feet, moving very slowly up the legs, talking softly as you go along, have their favorite music playing if you can. Let them wash themselves as much as possible.

When bathing is complete wrap them in warm towels even before leaving the shower and remain in the warm room until they are complete dry and clothed.

Will this work all the time for everyone? Probably not. There will come a time when showers and baths are no longer possible and bed baths are the best you can do. Until then,  try some of these suggestions they may make things just a little bit easier for both of you.

Previous Older Entries