Doris Bersing, PhD
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Preparing Your Home for Alzheimer’s: Tips and Advice for Caregivers

When caring for a loved one with Alzheimer’s disease or other type of dementia, the safety around the home is a very important issue. Caregivers, here you can find some tips and advice in regards to keeping your home safe.

Some Facts About Alzheimer's Disease

Today,  about 5.4 million Americans suffer from Alzheimer’s disease, with the majority of them being aged 65 or older. Safety at home is a very critical issue when caregiving for somebody with Alzheimer’s disease. Safe at Home is the key. Progressive Alzheimer’s disease makes it impossible for people with it to take care of themselves. Many of them require care 24 hours a day, seven days a week. In order to make that possible, many people with Alzheimer’s move into a loved one’s home for caregiving.

Alzheimer’s disease is a severe form of dementia associated with memory loss as well as the loss of other cognitive abilities. The symptoms can be serious enough to eventually interfere with daily life. If a person is experiencing Alzheimer’s, you may start to notice:

  • Changes in personality and interests.
  • Difficulty making decisions.
  • Problems concentrating and general cognitive struggles.
  • Long-term and short-term memory loss.
  • Confusion with places, people, and timing.
  • The inability to complete tasks that require sequential steps, such as getting dressed or making a meal.

Caregiving for a person with Alzheimer’s disease is not easy. It’s difficult to watch people you love deteriorate and grow unable to do even the simplest things they used to enjoy. However, taking in people with Alzheimer’s gives them the opportunity to spend the rest of their lives surrounded by the people who love them while enjoying comfort and care. In order to make your home as safe as possible for a loved one with Alzheimer’s disease, you’ll want to make a few preparations around the house.

Their Private Room: A Place to Escape

One of the utmost important things about caregiving for people with Alzheimer’s is preserving their dignity and showing them respect. Loved ones need a room of their own where they can have privacy and a place where they can escape the noise and confusion of outside. Their room should be safe, comfortable, and easy for them to move around in. Provide them with all the things they love whether it is a stereo for music, books, blankets, or a television. Remove hazardous decorations that can break or shatter upon impact. It’s also helpful to give them a room on the first floor near a bathroom for accessibility.

Bathroom & Kitchen Safety

The bathroom and kitchen are the most dangerous rooms in the house. If you are taking in Alzheimer’s patients for the long term, it may behoove you to accommodate these rooms for them with a remodel. To do this, you have to take cost into consideration. For instance, the average cost to remodel a kitchen is $19,589. There are several ways to modify your kitchen for safety. Considering the amount of dangerous tools and materials in the kitchen, locks on drawers and cabinets containing these things can prevent loved ones from hurting themselves. Some people also put locks on the refrigerator as the disease progresses. If the room contains steps or stairs, a safety ramp with rails to hold on to can help your loved one navigate the area safely.

When changing your bathroom, it’s important to make it accessible for loved ones while reducing hazards that can lead to a fall. Grab bars or side bars near the toilet and tub can help them get up and down safely and with ease. Label all water faucets clearly so they know which one controls hot and which controls cold. A scalding burn can be a devastating injury. Finally, make liberal use of non-slip mats, stools or chairs, and lighting.

If you are one of the millions of Americans who takes in loved ones suffering from Alzheimer’s disease, you’ll need to prepare your home to make a safe, comfortable environment. Providing them their own room is paramount; it’s important to respect their privacy and preserve their dignity. You may also want to consider making renovations or modifications in the kitchen and bathroom. These rooms are important but contain plenty of hazards you want to avoid.


Ways for Seniors to Improve Mental and Physical Health

Easy Ways for Seniors to Stay Healthy

In a time where daily stress is almost a given, it’s important for us to take care of ourselves.

Seniors, especially, need to find healthy ways to cope with stress and anxiety as well as ways to actively improve physical and mental well-being. Fortunately, there are many ways to do that, and most of them are more simple than you might think. Here are a few of the best.

Engage in daily exercise

Exercise is important for everyone, but for individuals over the age of 50, it’s imperative. Getting in at least thirty minutes of workout time every day will help improve your mood and overall health, and it might be a good way to socialize, as well. Start a walking group with friends or neighbors, or invite your spouse or coworker to a swim aerobics class. Having someone to talk to will make you look forward to working out rather than dreading it.

Consider a pet

If you don’t already have a pet, consider getting a dog or cat. Animals can help reduce anxiety and even lower blood pressure, and they are wonderful companions. Dogs are also great motivators on days when you don’t feel like exercising, because they’ll always be up for a walk!

Stay in touch

When life gets hectic, we sometimes forget to stay in touch with loved ones. Make it a point to sit down and write a letter to someone you care about, or give them a call. Set aside time on a specific day every week to do it so you’ll have no trouble remembering.

Eat well

Your diet can have a very specific impact on your health and how you feel, so make sure you’re not overloading on refined sugars and carbs, which can make you feel sluggish. Lots of leafy greens, fish, nuts, and fresh fruit will go a long way toward helping you feel better in every way.

Get some rest

You might think you’re getting enough sleep, but if you feel tired all day it’s possible you need to take another look at your habits. Are you lying awake for a long time at night? Taking long naps during the day? Try staying away from the television, computer, or smartphone for an hour or two before bedtime. Instead, read a book or take a long hot shower. Get yourself relaxed before bed to ensure you’ll sleep and feel rested when you get up.

Get creative

For retirees, especially, the days can seem long and uninspired. If you find yourself feeling unfulfilled, try a new hobby. Get creative and take up a painting class, or try gardening or woodworking. Allowing yourself to create things and try something new will open up a whole new world, and you may just find happiness there.

Staying active and keeping your mind healthy and alert will ensure you’ll be feeling good and ready to tackle anything, no matter what your age is.


Thinking of Dementia and Identity

DB smTime goes by and I realized, I am getting old-er …although it is not a discovery, it is for sure, a daily fact. One that shows on the mirror more often than before. Always when thinking about getting older, given my line of work (gerontology, among others), I think: what if…what if I get dementia?

Most of us spend a big part of our life searching for meaning, trying to find our identity, and although Thomas Szasz said in The Second Sin (1973) said “…the self is not something one finds, it is something one creates…” we set ourselves for the pursuit of that elusive identity and our meaning as human beings. What is life all about and overall what is our role in life? What do we really live for? Who are we?

We pass many of our prime years looking for our identity, fighting for one, trying to assert one if we are ever given a glimpse of it, wrestling to have our needs met and to have our dreams come true. That search for identity comes sometimes in a puzzle of circumstances, challenges and exploits, and like the overprotected Nemo, we need to swim the oceans of uncertainty and grow until finding ourselves

Through the journey in search of our identity, we attempt to unfold our potential, our desires, and to adjust at the best of our abilities to the challenges of daily life. We build our life upon joys, shadows, and sorrows and fill that life with the mementos and the facts we carve in our memory, those we gathered throughout our journey but one-day, zas! You are diagnosed with dementia. There you are, all of the sudden lost, confused and soon to be stripped, if not of your identity, at least, officially, of your mind.

I know, hopefully, we all have been lost in our minds out of excitement, passion, or love and yet, after the diagnoses you will not be lost in your mind, anymore, since now, your are losing yours. Of course, we could discuss what really mind is, there is so much more to the mind than the cognitive aspect of it and yet for any purpose is THAT mind the one holding your memories, mementos, treasures, pains, and joys that is ready to go with the wind. Well in reality, with the plaques and tangles created in your brain, in a certain time you will not even remember the time of diagnosis. Just as Clark Gable stated while playing Rhett Butler in Gone with the Wind, stated, you may well say: Frankly, my dear, I don’t give a damn….” But he clock is ticking.

Professionals will offer all what they have. They talk and teach how to calm you down, how to deal with your mood swings and your challenging behaviors but do they really know what we are going through, what you are going through? Do they know that you are going through the tunnel, in and out of the darkness, the uncertainty with the challenge of living an existential tale of the here and now, for which, you did not sign up and for which, effectively you have never practiced. Then come the drugs, the optimism, the clinical trials, the walking to fund more research, hopefully before it is too late for you. Looking now for a different meaning. There is so much that is done, said, so much still to do and yet nobody really knows what you are going through.

We try and theorize about the phenomenon, the neurological, psychological, emotional, and practical side of it, even the spiritual side of it. Needless to say, we appreciate all the nice legitimate attempts people make writing new books about breakthrough treatments and findings; they present lectures, write articles about you but what if you could really explain how it is to know that your life is slipping away, fading away? What if you had a voice? What if they found a cure?

I wish I could be more helpful, but I really do not know how it is, all is in my best efforts to explain a phenomenon, I can only observe and witness with powerlessness, compassion and horror. I do not have dementia and I wonder if I had it how I would feel? What would it be like? Again, I do not know but if I could, if I were you, I would not like to go there. That said, I hope I would react calmly and with patience for myself, although I doubt it but let the journey continue and keep on swimming.

For now, I find some solace and motivation to keep ‘on swimming in Thoreau’s wisdom:

“…I went to the woods because I wished to live deliberately… only the essential facts of life, and see if I could not learn what it had to teach, and not, when I came to die, discover that I had not lived. ~Henry David Thoreau, 1854


Resilience: The Client as an Active Agent of Change

Copyright : johan2011
Copyright : johan2011

Accepting we clinicians are not as mighty power as we , sometimes, want to believe, and as much of a blow to our egos, it can be, there is a fact we need to recognize as such: human resilience and people’s self-healing powers count for positive outcomes after traumas and strenuous circumstances, equally effectively or more than proven therapeutic approaches.

A very respected and renowned colleague of mine, Dr. Arthur Bohart always reminded me and anybody who wanted to listen to his revolutionary opinions in regards to the effectiveness of some therapeutic approaches or the best personality traits for a successful clinician, that human beings are more resilient that what we want to account for and that the theory of some approaches being more effective than others are more of a myth than a fact since for Dr. Bohart” the “client acts as a self-healer” and human resilience counts for more of the positive outcomes in therapy. So, what is the clinician’s role? In a way, we therapists are a catalyst or better said a witness to the self-healing process. A guide to educate and share the process with the client. In an article published in the Journal of Psychotherapy Integration, Vol. 10, No. 2, 2000, he describes the dominant “medical” or “treatment” model of psychotherapy and how it puts the client in the position of a “dependent variable” who is operated on by supposedly potent therapeutic techniques. Next I argue that the data do not fit with this model. An alternative model is that the client is the most important common factor and that it is clients’ self-healing capacities which make therapy work…” Read his article

The same concept works with the forgotten population, the older adults and elders. Resilience and aging: it’s a favorite theme of gero-psychiatrist Helen Lavretsy, MD, MS. It’s the subject of her new book, Resilience and Aging: Research and Practice and the theme of a symposium at the APA Annual Meeting in New York City. In a recent podcast, she talks briefly about interventions that can help bolster resilience and help older people recover quickly from adversity. Listen to her podcast

 

Resilience and aging: it’s a favorite theme of geropsychiatrist Helen Lavretsy, MD, MS. It’s the subject of her new book, Resilience and Aging: Research and Practice and the theme of a symposium at the APA Annual Meeting in New York City.Here, she talks briefly about interventions that can help bolster resilience and help older people recover quickly from adversity. – See more at: http://www.psychiatrictimes.com/apa2014/strategies-bolstering-resilience-older-adults#sthash.LuOVSHfT.dpuf
Resilience and aging: it’s a favorite theme of geropsychiatrist Helen Lavretsy, MD, MS. It’s the subject of her new book, Resilience and Aging: Research and Practice and the theme of a symposium at the APA Annual Meeting in New York City.Here, she talks briefly about interventions that can help bolster resilience and help older people recover quickly from adversity. – See more at: http://www.psychiatrictimes.com/apa2014/strategies-bolstering-resilience-older-adults#sthash.IleQ1IGr.dpuf


Elders, Mental Illness, and the Expertise Gap

Copyright : fotoluminate
Copyright : fotoluminate

The US population is aging rapidly. Advances in medicine have led to the expectation that the US population of seniors will grow from12.4 Million in 2000 to 19.7 million in 2030 (US Census data). As the oldest baby boomers become senior citizens in 2011, the population 65 and older is projected to grow faster than the total population in every state. Twenty-six states are projected to double their 65-and-older population between 2000 and 2030. The impact of this anticipated population increase, which has been described by some as an “age wave” and by others as an “aging tsunami,” would be felt in every aspect of society. This “tsunami” predicts that humane healthcare will soon be financially out of reach or simply unavailable for tens of thousands of elderly Americans. There is an urgent need to expand training opportunities for geriatric care providers to meet the growing demand for psychological, medical, and social services. Older adults are commonly represented in the current literature as presenting co-morbidity of many conditions and illnesses about what we will talk a little more further along but we need to  say that meaningful and engaging aging happens as well but it is often underscored. A great number of older adults lead a meaningful life, a healthy one where they take advantage of  exercising, changing dietary patterns, seeking information, relying on spirituality and/or religion, and engaging in life, I would also like to stress the positive coping skills of many other older adults.

However, mental health issues among the elderly have reached epidemic proportions and are expected to worsen in the next few decades.  Elders with mental illness find more difficult dealing with adjustment in lifestyle, such as isolation or loss of independence, and this is complicated by medical conditions or physical diseases. The most common diagnoses in gero-psychiatric patients include depression, dementia, psychosis and anxiety.

Elderly suicide currently accounts for 20% of suicides in the U.S. – the highest suicide rate in the country compared to other age categories.[1] One in four elderly over 85 years old is diagnosed with dementia and one in two with Alzheimer’s Disease.[2] A landmark report estimated that by 2030 the number of elderly who suffer from a mental illness will grow to approximately 15 million;[3] and in California alone the projected number of elderly persons diagnosed with depression will reach 1.2 million by 2025.[4] A lack of access, education, and awareness lead many older individuals and their doctors to accept depression and mental illness as a normal part of aging when it is not. Among the elderly, mental health conditions are frequently untreated or inappropriately treated; more than one in five older persons with mental disorders are given an inappropriate prescription and are at increased risk for inappropriate medication treatment.[5] As a result, many older persons with mental disorders have a lower quality of general health care and associated increased mortality.[6]

However, researchers expect there will not be enough gero-psychologists trained to handle the increasing demand for psychological services from this age group. The National Institute on Aging estimates that 5,000 full-time, doctoral-level gero-psychologists will be needed by 2020 to accommodate the increasing demands of aging baby boomers. In 1991, slightly more than 700 psychologists who spent at least half of their time working with older adults were listed in the National Register of Health Service Providers. Along with the need for more gero-psychologists, the number of adults with mental disorders and behavioral health problems in 2030 is expected to reach 15 million–four times the prior census. In addition, older adults have the highest rates of suicide of any age group.

Experts agree that adequate staff is the most important factor in good patient care. However in spite of the growing demand for elder care, the education system and the pool of medical and mental health care providers with appropriate geriatric training are extremely inadequate.[7] A lack of training and institutional support has resulted in the 27% decline in certified geriatricians since 1998.[8] In 2005, there was one geriatrician for every 5,000 Americans 65 and older.[9] Nationally, geriatric mental health specialists comprise one of the smallest groups of health care professionals. By 2010, an estimated 5,000 psychiatrists, 19,000 gerontological nursing specialists, and over 50,000 social workers will be needed to provide mental health care for elderly patients.[10]

The “expertise gap” is among the greatest challenges to mental healthcare for the elderly,[11] and the effects are already apparent in many regions of the country where two out of three skilled nursing facilities failed to meet the state’s minimum nursing staff requirements[12] and a majority of surveyed primary care physicians considered themselves only “somewhat” (66%) or “not very” (20%) knowledgeable about geriatric mental health issues.[13] Even many specialists, internists and emergency room doctors said they felt “unprepared” to deal with depression and other mental health and end-of-life issues of elderly patients.[14] Of the 145 medical schools in the United States, only 9 have departments of geriatrics; most teaching hospitals graduate internists with as little as six hours of geriatric training. Only about 10% of U.S. medical schools require course work or rotations in geriatric medicine. While many more offer geriatric courses as electives, fewer than 3% of medical school graduates choose to take those courses. In nursing there is no gero-psychiatric certification and only one-third of masters level programs offered a course in aging.[15]

The integration of mental health services in the system of care for the elderly has proven to raise the quality of care to patients and support the larger network of care facilities to increase access to, and build capacity in mental health services. Research demonstrates that the integrated mental and medical health service arrangement achieve a higher level of access to mental health care[16] and is associated with better health and treatment outcomes at a lower cost.[17] Traditional models of service and professional training programs are frequently costly, disjointed and ineffective due to their inability to incorporate contemporary research findings and evidence-based practices into usual care.[18]

There is an undeniable need for professionals who would develop a humanistic and comprehensive approach to care for elders and to see the aging process as a fulfilling part of life as well as to offer a different, humanistic approach to approach aging and to treat those older people afflicted with Alzheimer’s and other dementias, and mental challenges, while implementing the best practices with seniors diagnosed with these phenomena. These professionals will challenge their attitudes towards aging and their attitudes for working with older adults. They will attempt to develop a humanistic-existential perspective to the creative and meaningful phases of aging and the possibilities of growth and development in later life. In particular, they will be able to articulate the relationship of the humanistic tradition to this specific subject and the importance for a new paradigm that encourages unfolding wellness versus the Cartesian dichotomy of mind-body separation.

Wellness is an alternative to the split between health and illness because people move along the continuum toward optimal wellness at each stage of life by way of their own efforts. As Dr. Judah Ronch says in his book Mental Wellness in Aging: “… People have more options than to be sick or healthy; they do not have to be sick in order to take advantage of the means to improve wellness. …this is an especially important outlook for aging as a process — people can have an array of illnesses as they age and yet enjoy wellness and a good quality of life.”

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References

[1] Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. US Department of Health and Human Services & SAMHSA, 2005

[2] The Mental Health Workforce: Who’s Meeting California’s Needs? California Workforce Initiative, February 2003

[3]Consensus Statement on the Upcoming Crisis in Geriatric Mental Health: Research Agenda for the Next 2 Decades, Archives of General Psychiatry, 1999

[4] The Mental Health Workforce: Who’s Meeting California’s Needs? California Workforce Initiative, February 2003

[5] Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. US Department of Health and Human Services & SAMHSA, 2005

[6] Ibid.

[7] Consensus Statement on the Upcoming Crisis in Geriatric Mental Health: Research Agenda for the Next 2 Decades, Archives of General Psychiatry, 1999

[8] Wanted: Geriatricians. Dani Dodge. Ventura County Star, September 5, 2004

[9] Geriatrics Lags in an Age of High-Tech Medicine. Jane Gross. The New York Times, October 18, 2006

[10] The Mental Health Workforce: Who’s Meeting California’s Needs? California Workforce Initiative, February 2003

[11] Bartels, Stephen, et al. Evidence-Based Practices in Geriatric Mental Health Care. Psychiatric Services, Vol. 53, No. 11, November 2002

[12] Nursing homes: Stronger Complaint and Enforcement Practices Needed to Better Ensure Adequate Care. U.S. General Accounting Office (Testimony before Senate Special Committee on Aging), 1999

[13] Halpain, Maureen, et al. Training in Geriatric Mental Health: Needs and Strategies. Psychiatric Services, Vol. 50, No. 9, September 1999

[14] Decision Making at a Time of Crisis Near the End of Life. David E. Weissman. The Journal of the American Medical Association, October 13, 2004; 292: 1738 – 1743.

[15] The Mental Health Workforce: Who’s Meeting California’s Needs? California Workforce Initiative, February 2003

[16] Bartels, Stephen, et al. Improving Access to Geriatric Mental Health Services: A randomized trial comparing treatment engagement with integrated verses enhanced referral care for depression, anxiety, and at risk alcohol use. American Journal of Psychiatry, Vol. 161, No. 8, August 2004

[17] Bartels, Stephen, et al. Evidence-Based Practices in Geriatric Mental Health Care. Psychiatric Services, Vol. 53, No. 11, November 2002

[18] Ibid.

[19] Ronch, Judah L. &Goldfield, Joseph A. (2003). Mental Wellness in Aging: Strengths-Based Approaches. Baltimore, MD. Health Professions Press, 2003


Therapy for the Elderly

Copyright : Aaron Amat
Copyright : Aaron Amat

Many of us have the impression that old people are sad, depressed, and/or grumpy but it turns out not to be particularly accurate. Many older adults and seniors can lead a very happy life. However, what about those who had experienced multiple losses, heartaches, and little access to therapy?

Moreover, for many of the elders with whom I work, emotional distress is their own business, sometimes a source of shame, and for sure something not to share with “strangers” like the therapist.  Others think therapy is for young or younger people to what even Sigmund Freud noted that around age 50, “the elasticity of the mental process on which treatment depends is, as a rule, lacking,” adding, “Old people are no longer educable.” (Never mind that he continued working until he died at 83.) and as an article in The New York Times by states: “…In years past, too, there was a sense among medical professionals that a patient often could not be helped after a certain age unless he had received treatment earlier in life… ‘that’s been totally turned around by what we’ve learned about cognitive psychology and cognitive approach — changing the way you think about things, redirecting your emotions in more positive ways,” said Karl Pillemer, a gerontologist and professor of human development at Cornell, and author of “30 Lessons for Living.”

Treatment regimens can be difficult in this population. Antidepressants, for instance, can have unpleasant side effects and only add to the pile of pills many elderly patients take daily. Older patients may feel that they don’t have the time necessary to explore psychotherapy, or that it’s too late to change.

But many eagerly embrace talk therapy, particularly cognitive behavioral techniques that focus on altering thought patterns and behaviors affecting their quality of life now. Experts say that seniors generally have a higher satisfaction rate in therapy than younger people because they are usually more serious about it. Time is critical, and their goals usually are well defined. Read Ellin’s  article


The Forgotten Elders: They Also Benefit From Psychotherapy.

Elder WomanGeorge Kraus, a geriatric clinical psychologist debunks the stereotypes about working with elderly populations, and shares his discovery of the joy and gratitude that come from intimate contact with wise elders. He, wisely, address three important myths regarding psychotherapy and/or counseling with seniors:

  • Myth #1: Psychotherapy with the elderly is time wasted, because the elderly client has so little time to enjoy any gains that might be made.
  • Myth #2: The grief, loss, and somatic and socioeconomic burdens of the elderly are too excessive to warrant believing they could get better.
  • Myth #3: Old people are staid in their ways; they are too stubborn to change. Dr. Kraus emphasizes the fact that In America, “…we honor the young for their beauty, strength, and vitality. However, in other places on the globe, old men and women are objects of veneration. This leads to a curious consequence: the less we acknowledge what can be respected, admired, or even venerated in the parents and grandparents of the world, the more we make ourselves orphans who lose a piece of our faith, security, and connection to a past that we risk repeating. This has been part of my joy in working with older adults: I am able to honor them, to sit at their feet, marvel, and learn. As their therapist, I have become their faithful student, their privileged witness, and my life is ever richer because of it…” Read his article


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