Wednesday, 22 January 2020
I'm not a doctor. Or a nurse. I come to the topic of the use of medications from a purely social standpoint. Even though I worked in a medical environment for over 20 years, I need to start with that disclaimer, and be careful that I don't come across as an "expert opinion." From a medical aspect, I'm no expert.
What I bring you is the opinion of a care partner who has seen multiple families and situations and had some experience with both medical and non-medical interventions.
When dealing with anxiety, there may be many small issues which might not "cure" the situation, but which could improve some aspects of it. As with many problems, it often takes a many-pronged approach, and it's best to look at the least invasive first.
Become a student of your elder. What makes them more anxious, and what helps them calm down? Loud noises or bright lights were both triggers to my friend from last week. Social situations stressed her out, even something as simple as a group getting together for tea. Any large group gathering was out of the question. We learned she was happiest sitting in the dining area in a dim corner. (Actually, she was happiest stretched out on her bed, but I suggested we keep that activity to night time.)
Another anxious resident flourished with routine. If her care partner called in sick and she had someone unfamiliar, no matter how kind and caring, disaster followed. She once had to leave the table because a service provider sat with her table mate and a cheque was written. "Doing business" at a meal escalated her anxiety until she had to leave. It's not always possible to control the environment, and sometimes you get surprises as I did that day, but knowing and watching for trigger points can help.
What helps your elder, and what sends them into an anxious spiral?
A few years ago, I knew it would be an effort to get my anxious friend to participate in an outing. I also knew that if I continued to encourage and support, she would go and have a wonderful time. It was worth all the effort to see her enjoy herself.
One day that changed. On a picnic excursion to a park one summer, her anxiety never abated and we all returned exhausted. That day I realized we had turned a corner and that became her last trip. Be aware of the many variables which can change the outcome.
Cognitive-behavioural therapy is usually only helpful to elders who don't suffer from dementia. It involves talking with someone who is trained in these skills and who can help them develop coping mechanisms which can be used in times of stress. Breathing techniques, therapy to discover underlying causes and other relaxation skills can be taught and these approaches can help in times of high stress.
Medication shouldn't be the first or only solution, but it can be effective in controlling anxiety. However, there is no "magic pill." Did you hear me? Medication can help, but it isn't magic. The groups of medications usually used are anti-depressants, anti-anxiety medications and sometimes
beta-blockers. The best approach is to start low and go slow. The lowest dose of the medication is given at first, and the doctor slowly titrates the dosage up until a therapeutic dosage is found. The doctor is dependent on you, the care partner, to give an accurate account of how the anxiety is being affected by the drug.
So many factors can affect how the drug works. Other medical conditions, infections, interactions with other drugs. Doctors also need to be aware of how older bodies process medication and watch kidney function and other issues. All drugs have side effects and together you need to weigh the final outcome. It's tricky.
Another medication which is a relative newcomer is CBD--medical cannabis. Whatever your views on this, it is often effective in reducing anxiety in the elderly. It can be used on its own or in combination with other drugs. Unlike the others, the side effects are fewer and the effects last only a few hours. As such, it's another possibility.
Anxiety can be more crippling than polio. In looking for a solution, the goal is always the same. What intervention or combination of choices will bring the best quality of life? A smile, a relaxed game of cards, an easy conversation with joking and laughter. These are the rewards for an unrelenting search for answers.
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Care Partner Wednesday--The Truth About Interventions For Anxiety
Wednesday, 15 January 2020
Immediately after lunch finished, it began.
"Who's looking after me tonight?"
I told her the name of her full-time, regular care partner who would arrive at 3:00 p.m.
"What's she going to do?"
The same things she does every night. Get you ready for bed.
"What if she won't look after me?"
It's her job to look after you, but she also loves you and wants to see you comfortable.
"What if she doesn't come?"
She will be here. She arrives at 3:00.
"Do I have a shower tonight?"
No, no shower tonight.
"Who's looking after me tonight?"
At other times, the conversation would be:
"I need to wash my hands."
We just washed them a few minutes ago.
"But I touched something."
You aren't eating, so they are fine. We will wash them just before you eat.
"I need to wash my hands."
If we washed them again, a few minutes later, the conversation would start again.
Another version is:
"I need to see the doctor."
The doctor isn't here right now, but he sees you every time he's in. Why do you need to see him?
How are you sick?
"Just look at me. I'm sick."
What do you think is wrong?
"I can't look after myself."
It's been that way for a long time. You're not sick, you're 93. Often when you get older, you need some help. That's normal.
"I need to see the doctor and go to the hospital."
My friend had the unfortunate combination of dementia, depression and an anxiety disorder. Dementia and depression fueled the anxiety and sometimes sent it spiralling out of control.
Depression and anxiety in the elderly can often be seen as they deal with accumulating losses. Loss of abilities, health, friends and changes in their living situations all can lead to feelings of sadness. These normal emotions can be coped with and overcome with proper supports. But if anxiety escalates to beyond normal, extra help must be offered.
The Problem With Diagnosis
Anxiety hides behind many other labels, making it difficult to diagnose. Often related to a severe life change like the death of a spouse, it can be mistaken for grieving. Someone with obsessive-compulsive disorder may have dealt with it to some degree all their lives and changes just passed off as "that's Grandma." Many people deal with phobias of some kind, so seeing new ones emerge or present ones escalate may not be immediately evident. People with social phobias may be seen as shy or socially awkward, but it's seldom understood as more than a peculiarity. Some of the symptoms which accompany anxiety, such as panic attacks, poor sleep, headaches and breathlessness can be part of many diseases. Or, some could be a natural part of ageing. Can you understand how diagnosis and treatment can be elusive?
The Problem With Assumptions
People dealing with anxiety are often convinced of two truths.
This is normal, or at least my normal.
There's no way to make it better.
The problem with these "truths" is that they aren't true. If you assume what you're going through is normal and not fix-able, you accept it as your lot in life. What a sad, defeated way to live when resources are available.
The Problem With Anxiety
Do you suspect your elder may be coping with more than normal anxiety or depression?
The first step is to observe. Spend some time with them on several occasions. Symptoms or behaviours can be hidden in brief encounters, but not with repeated exposure. Talk to friends (carefully and discretely) sharing your concerns. Write down what you are seeing and look for patterns.
If your suspicions are confirmed, have a conversation with your elder. Although there may be denial and resistance, come at it from a position of love. "Mom, I've seen you struggling in these ways and I know there are ways to help with that." It may take several conversations and the need for reinforcements, such as other family members or friends, but persist.
The next step should be a visit to the doctor. Even if they regularly see a physician and take medication for anxiety or depression, this is an important step. The doctor may not be aware of recent changes, and medications are tricky. Different medications, dosages and timing can all change the outcome. He/she may need to refer to a specialist or do tests to rule out other medical conditions.
Sometimes pinning down the cause and finding help for anxiety can feel like pinning jello to the wall. This can be the case for doctors as well because the number of variables remains vast. The outcome, a better quality of life, is worth the journey.
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Care Partner Wednesday--Unlock the Mystery of Anxiety and Find Hope
Wednesday, 8 January 2020
"You had one job..." Did you know there are whole web sites of people's blunders? We relish each other's mistakes, although I'll admit most are hilarious, or embarrassing.
- A bag labelled "ice" that's full of popcorn
- a cup with its handle on the inside
- a sign which says OEPN
- a clock hung upside down (how do you even do that?)
- the African-American baby doll waving its little white hand.
Care partners almost certainly have more than one job, but the sense of responsibility and the fear of failure can be intense.
The job didn't come with a rule book and learning it can feel like groping in the dark.
Just when you get a handle on it, things change.
Caring for an elderly loved one can be a roller coaster of good and bad days when you aren't sure of anything.
Factors such as medication changes or infection can change everything.
Your heart breaks for the issues they face but the right direction isn't always clear.
"You had one job..."
Care partners sometimes deal with tremendous insecurity and guilt. They question whether they are making correct decisions. They worry about the future and feel secret fears about their ability to stay the course. Anxiety can overwhelm.
Care partner anxiety is insidious. Yesterday things were going well, but one questionable decision, a small crisis and a sleepless night and confidence and coping skills flee.
Here are a few tools to pack in your arsenal and pull out when your confidence is scraping the bottom and your anxiety is high.
Before things get to crisis mode, gather a support group. Yes, I know, I harp on this all the time. Caring feels lonely on good days and when a crisis hits, you need at least one other person to lean on. Better to have a whole group you meet with regularly to learn, share and support each other.
I can hear you saying, "I can't leave the house to go to a support group." Yes, you can, but for now, Google and find one online. You'd be amazed at how close you can feel to people who live across the country and you've never met. A side benefit comes from your ability to provide support as well. An amazing feeling.
The old adage "Knowledge is power" still holds true. Ask your new support group friends where they go online for information about whatever issue you find challenging at the moment. Do a Google search. Check out Amazon for books on the subject. Check out your local library. Be discerning of course, and use reliable sources, but learn.
If you only gave your car a few gallons of gas at a time, how well would it run? We all know the importance of rest, but the realities of life and its demands get in the way. Lack of sleep is one issue, but another is the weariness that comes from dealing with chronic conditions. Sometimes you need to get away, sometimes you need sleep, sometimes both. Look for one afternoon or evening a week to get out of the house and do something entirely different. If this means hiring help or using respite, consider it a wise use of resources.
Coping day-to-day can feel tedious. Plan something fun for you and your elder, but adjust your expectations so if it doesn't produce the joy you hoped for, you aren't devastated. Keep it simple.
Every year at Christie Gardens, we have a picnic. Although it sounds complicated, it simply means taking everyone to the park across the street. We also haul the bbq, and although we bring sandwiches
Fill your arsenal today with these tools to tackle your anxiety tomorrow.
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Care Partner Wednesday--4 Smarter Ways to Conquer Care Partner Anxiety