Wednesday, 27 April 2016

Care Partner Wednesday--Are You Ready to Scream?

Are you ready to scream. cry, laugh hysterically, pound nails into a board and check into a hotel for a few days? Possibly all at the same time? You may be care partner for an anxious elderly person.

Anxiety is an umbrella term for many clinical disorders, and I am not qualified to expound on them. Besides, that would be boring. The bottom line is, if you are dealing with this, you are stretched beyond your limits, and "working on your last nerve." You are beyond frazzled, and might be feeling a little guilty for how many times you lose patience.

For your loved one, connecting with a geriatric psychiatrist, through a referral from your GP, is essential. There are drugs and counselling which may lessen the symptoms and increase the coping mechanisms. Nothing works all the time, and sometimes life is going along fairly well and an event like a toilet that won't flush (see can become a problem of epic proportions. Finding the right drug at the right dosage takes time. But it starts with the right doctor.

But what about you?

As you navigate the unrelenting, exhausting journey of being the care partner for an anxious elderly person, you need resources. Lots of them.

Here are a few to add to your arsenal:

1) As much as you can, accept it for what it is. Medications will help, counselling may give some hope, and there may be other strategies that provide some stability, but there will be many times when your loved one's response is over the top and makes no sense.

Maude's daughter has a cold, so she hasn't come in for a few days. Maude is convinced her daughter is dead and the family is keeping it a secret from her.

Grace is getting treatment for macular degeneration, and the doctor is pleased with how her eyes are improving. Grace doesn't hear the positive and worries incessantly that she is going to lose her sight.

Betty is compulsive about cleanliness, and worries the whole day on shower day about who is going to give her the shower, and if they will know her routines. Even when familiar staff arrive, she worries.

You aren't likely to change these stressors, and the sooner you accept that this is how it is, the less you will be driven crazy.

2) Don't get drawn into arguing or reasoning.

The way I imagine it, the mind of the anxious person can be functioning normally, and then it bumps into one of the situations that cause stress. A reasonable mind with reasonable thoughts is suddenly filled to overflowing with exaggerated thoughts, crowding out all reason. Over-the-top statements, such as 'my daughter might be dead because she had a cold,' make sense to them. Don't try to reason, and definitely don't ridicule. Instead, make statements of fact, but don't argue.

"Your daughter has a cold. You can phone her tomorrow." Keep it simple, firm and don't argue. Arguing will frustrate you and it won't help.

3) Look after you. This journey you are on isn't easy, and some days you feel worn down before you're finished your first cup of coffee. You need to look after you. Get away, even if it's only for a few hours. Have friends in to lighten the mood. Eat right and get some form of exercise. Be good to yourself.

4) Find a sounding board. You need someone to talk to. Someone who will listen, even if your stories today sound much the same as yesterday. Someone who will listen, and not try to solve the unsolveable.

5) Laugh. Never at, but sometimes there is an opportunity to laugh with. Regardless, when the ridiculousness of it all overwhelms, go for a walk and laugh. It will restore your sanity.

Anxiety is all about me. The anxious person is consumed with the minutia of their lives, and often can't see beyond themselves. For this reason alone, their care partner needs to care for themselves, so they have something to give at the end of the day.

Interact with us: What helps you survive the ups and downs of being care partner for an anxious elderly person? What works?

"Anxiety does not empty tomorrow of its sorrows, but only empties today of its strength" Charles Spurgeon

Wednesday, 20 April 2016

Care Partner Wednesday--Death by Toilet

Anxiety is nothing to laugh at.

Anxiety--real anxiety in the form of an anxiety disorder--can be something to cry over, stomp your feet in frustration about, tear at your hair when it is happening and leave you wanting to bang your forehead against a wall.

Let me be specific. I am talking about an anxiety disorder in an elderly person, and the reactions I am describing are those of the care partner. Anxiety of this type requires patience beyond anything you have ever experienced before, wisdom that would rival Solomon's and a sense of humour. The latter is not only essential, but is often the care partner's salvation.

Margaret has an anxiety disorder. She has some memory loss, but not dementia, and can still defeat all foes at cribbage on a good day. She is on several medications for this, and many days she functions well and has a decent quality of life. She enjoys her friends, her family and her life. But there are a whole series of issues that can trip her into anxiety mode. Just a few of these are
*any physical ailment, even the most minor
*an appointment, especially a medical appointment, outside the building
*any new care partner who isn't totally familiar with her routine
*any aspect of washing. She is obsessive about cleanliness.

Now, it seems there is a new issue. Or perhaps it had never occurred before, so I didn't know it was an issue. I do now.

It began one morning after breakfast when Margaret came to me with a wild look in her eyes saying her toilet wouldn't flush. I removed the tank, thinking it would be an easy fix and one I'd performed many times in the staff washroom. However, the do-hickey (please excuse my use of technical terms) which performed the flushing action was completely broken off. The repair was beyond my limited ability. I put in a requisition to the maintenance department.

Margaret began to pace the hall. To the nursing station, to my desk, to her room. Look in the hall for the maintenance guy, back to my desk. It was during one of these visits that she told me she couldn't "go" anywhere else.

I'll admit it. I was getting a might anxious myself.

The nurse and I chatted while Margaret had her lunch. The nurse had a walkie-talkie, and I suggested she call the maintenance guy after he finished his lunch at 1:00. At 1:01, after three visits to my desk post-lunch, I dialed her extension. "Have you called him?" No, she hadn't yet. "Please. Do. It. Now."

About 1:30 he arrived. Then he left. It wasn't fixed. Had he gone to get a part?

He had, but he didn't seem to grasp the seriousness of the situation. When he hadn't returned by 3:00 (or so I thought) I asked our receptionist to radio him again. "Oh, it's all fixed." was his glib reply. I ran down to the room to try it, with Margaret hovering near me. True, the do-hickey was replaced, but the tank wasn't filling, so it wouldn't flush.

Now Margaret was in full anxiety mode. Her head filled with the problems she could see, driving all reasonable thought out of her head.
"What if everyone leaves me and I'm all alone and there's no toilet?"
"I need a private caregiver tonight because my toilet is broken."
"Nobody cares about me because they aren't fixing my toilet."

And so on.

I knew that the maintenance guy leaves at 4:00, and it was now 3:30.  I was preparing to lie prostrate across the doorway, refusing to allow him exit until he fixed that toilet. I wanted to see a flush and I wanted to see it now!

Margaret was pacing, talking to anyone who would listen about her toilet. She was short of breath. At one point, she phoned her daughter for the umpteenth time. As her daughter listened to Margaret's scrambled, breathless thoughts, she said, "Mom, you've got to calm down. Everyone is doing the best they can. If you keep this up, you are going to have a heart attack, and I will have to tell everyone it was death by toilet!"

She was hoping to lighten the mood, but Margaret was not amused. In her tone you could almost hear the pursed lips and see the deep frown. "Well that's what you'll have to tell them, then." The phone hung up rather suddenly.

The end of this story is not nearly as dramatic as the rest. The maintenance guy came and figured out the problem, I didn't have to lie prostrate across the door, and Margaret went happily off to dinner, the epoch of the toilet nearly forgotten.

Most of the advice I have for care partners in dealing with someone who has an anxiety disorder is focused on taking care of yourself. Come back next week for some practical thoughts on surviving an issue such as "death by toilet." *

Have you ever faced severe, unreasonable anxiety in a loved one you care for? How did you handle it? Share some of your strategies with us.

"My body thinks something is gravely wrong, but my brain doesn't have a clue what to do about it, so it starts racing to the worst possible conclusions."

*story shared with permission. Names changed.

Wednesday, 6 April 2016

Care Partner Wednesday--The Big Lie(s)

I lie.
Every day.
It's shocking, really.

Here's an example of one of my lies from today:

Dr. M.: Have you seen my wife?
Me: I saw her at lunch. (That was true.)
Dr. M.: Do you know where she is now? I can't find her.
Me: She's running some errands (not true), but she will be back at dinner.(true.)
Dr. M.: Where does she live?
Me: I'm not sure (not true) but I know she will be back to have dinner with you. (true)


J.: I want to pick some things up at the grocery store.
Me: Oh my, it's so cold out there. Could we wait and see if it warms up tomorrow?
 (It's cold, but I've seen much worse, and I have no intention of going to the grocery store today or tomorrow, either.)


L: I need to leave. My parents will be looking for me, and my father will be mad.
Me: Why don't you stay and have dinner with us? It's all made.
L.: I can't. I don't want my father to be mad at me.
Me: I'll call them. (I pick up the phone and pretend to dial.) Hello? Yes, I just wanted to tell you that L. is here at Christie Gardens, and she is going to have dinner. Is that alright? Okay, I'll tell her.
(to L.) They said to enjoy your dinner and they'll see you later. (I hang up the phone.)

So what is happening here?

Communication with someone with dementia.

The most important thing in communication is hearing what isn't said. Peter Drucker

In the first conversation, Dr. M. has just moved in, and is in a transition time. He needs reassurance. If I were to tell him what floor his wife lives on and he set out to find her, not only would he get lost, but it would increase his anxiety (and hers!) Each day he is making more connections on this floor. After our conversation, he happily went down the hall, the stress of looking for his wife gone for the moment.

J.  has a private companion who goes to the store with her once a week, and they buy clothes or the occasional edible treat.  If J. went to the store by herself, she would get lost. I was able to distract her as we talked about something else, and the trip to the grocery store was forgotten.

L.'s parents have been dead for decades, but her reality is that she is a young girl, and she needs to be home for dinner. By entering her reality and "talking" to her parents, I relieved her stress and anxiety. She happily ate her dinner, and forgot all about going "home" after.

The basic principals are:

  1. Think like the person with dementia. What might relieve their anxiety?
  2. Be creative. 
  3. If something doesn't work, try something else.
  4. Enter their reality. Where are they? L. saw herself as a young girl at home with her parents. This is common as short-term memory fades, and the memories of long ago become more real.
  5. Don't correct. ("Your parents have been dead for years.") This will shock and upset, and is never helpful.
  6. Don't reason. You can seldom out reason someone with dementia.
  7. Don't argue. You probably won't win, and you'll both get frustrated. In the end, they will be convinced you are wrong.
  8. Divert, if possible. Make use of that short attention span and try to turn the conversation to other things.
Communication with someone with Alzheimers is challenging and hit and miss. You won't score every time. But when communication happens, it's pure gold!

What has worked for you? Share with us some of your communication strategies.