How to Survive Caring for a “Challenging” Elder And Recognize the Early Signs of Dementia

by Jacqueline Marcell, author of "Elder Rage or, Take My Father… Please! How To Survive Caring For Aging Parents"

Caring for a "challenging" elder can be one of the hardest things you'll ever do. I know -- I went through a year of hell before I figured it out.

I had been the light of my father's life -- but with the onset of dementia he turned on me, doing and saying things that I would have never believed he could do. Having no experience with elder care, I just didn't get it. I thought it was just due to his bad temper of a lifetime and his need to control, which it was, but it was also the very beginning of dementia that intermittently made his actions even more illogical and irrational than ever before.

When he threw two little dilapidated hand towels at me, screaming and swearing at me for throwing them out, I was stunned and sobbed my heart out. With the knowledge I have now I'd say, "This seems illogical. This seems irrational. Big flag -- it is!” And I’d haul him off kicking and screaming to the Alzheimer's Association's best recommendation for a geriatric specialist to be evaluated right away. I'd know not to waste time with his regular doctor who didn't specialize in dementia.

Recognizing Dementia Symptoms Before It’s Too Late

The stereotype of a person with dementia (Alzheimer's is just one of many types) is that of someone who doesn't know what they are doing. That’s Stage Three, but there is a long road before one gets there.

Dementia starts very intermittently and is generally ignored by families who think that these strange behaviors are a normal part of aging: Stage One lasts two to four years; Stage Two lasts two to ten years; and Stage Three lasts one to three years. In the beginning, your loved one may have a raging temper tantrum and then suddenly be sweet as pie. Because there are usually long periods of normalcy, the tendency is to want to forget about the irrational incident instead of seeking treatment immediately.

Statistically families wait four years before they reach out for help -- usually after a crisis. By that time, however, the person has gone through Stage One and is starting into Stage Two already, which usually requires full-time care.

Getting medication for your loved one as soon as you recognize the early warning signs of dementia can slow its progress for two to four years doctors say, saving your family a lot of heartache and money. It will also save our society the burden of caring for so many elders who have progressed into Stage Two sooner than necessary.

The 10 warning signs of dementia are:

1. Recent memory loss -- your loved one may ask you the same question over and over, look at a beloved granddaughter and ask her name, or forget that they just told you that story and tell you again.
2. Difficulty performing familiar tasks -- such as tying a necktie or shoelaces, or being unable to do the knitting they have enjoyed for many years.
3. Problems with language -- using the wrong word or being unable to remember the right word to use.
4. Disorientation of time and place -- mistaking a time period of hours for days, or giving incorrect directions in the town they have lived in for many years.
5. Poor or decreased judgment -- for example, while babysitting they may completely forget about the child they are supposed to be watching.
6. Problems with abstract thinking -- inability to balance a checkbook, adding becomes difficult or they may insist that a one-dollar bill is a 20-dollar bill.
7. Inappropriate misplacing of things -- you might find the wristwatch in the sugar bowl, the iron in the microwave, or a hat in the freezer.
8. Rapid mood swings -- switching from tears to anger for no apparent reason.
9. Changes in personality -- you may notice a tendency toward fear and paranoia.
10. Loss of initiative -- your loved one may not want to get out of bed, withdraws socially or says they don’t want to live anymore.

Reprinted with permission from the Alzheimer’s Association of Orange County.

Medications that may slow the progression of dementia are: Exelon, Aricept and Reminyl. Consult a geriatric dementia specialist to decide on the best medical treatment.

Behavior Modification Techniques

Once the brain chemistry is properly balanced for the dementia, possible depression and perhaps even aggression, you will be able to start behavior modification techniques on a challenging elder if they are still in the early stage of dementia.

As amazing as it sounds, the use of tough love coupled with rewards and consequences worked to turn around the most obstinate man on the planet: my father, even with the onset of dementia. By being 100 percent consistent, never rewarding bad behavior and using praise to encourage good behavior, he finally changed his life-long behavior patterns and learned that he could (as Mom would say), "catch more flies with honey than vinegar."

Elder-Proof the House

There are things you can do to make navigation in the home easier for elders who may be losing their sight as well as their sense of mobility:

• Even out the ridge on the floor in front of a doorway to make it easier for a wheelchair to get over.
• Strategically place grab bars (even in the shower) to help reduce falls.
• Remove throw rugs as they are a hazard and easily tripped on.
• Put glow tape around the perimeter of doorways so they are visible at night.
• Place motion-sensing night-lights on the floor of their bedroom.
• Put colored tape on the edges of stairs so they can be clearly seen.

When You Can’t Do It Alone

When your loved one needs full-time care, it may be time to look into getting help with the caregiving. Adult Day Care turned out to be the answer to getting my parents out of bed 23 hours a day “waiting to die,” and giving them social, physical and intellectual stimulation during the day. When they come home there is a caregiver to help them who stays for all-night supervision.

Questions to ask when hiring a caregiver:

• Does the person live close by?
• Has he or she had elder care experience?
• Is the person willing to be fingerprinted so you can do a search on his or her background?
• If you’re hiring through an agency, is that agency a member of state and national organizations?
• What kind of background checks does the agency do? (If they refuse to give this to you in writing, they probably have not done any background checks.)

A Success Story

A year later, after turning around a seemingly impossible situation, I knew it was all worth the horror and heartache to hear my father say he loved me again.

I felt so compelled by what I had lived through, I wrote a book so that others won't have to struggle as I did to figure out how to manage their elderly loved ones. The result: Elder Rage or, Take My Father…Please! How To Survive Caring For Aging Parents.

I guarantee laughter out loud, as you learn everything you never wanted to know about eldercare but were afraid to ask. After the success story I include 70 pages of self-help, questions and answers, valuable resources and a doctor's chapter on medications. I'm honored to have 40+ prestigious endorsements including: Hugh Downs, Regis Philbin, the late Steve Allen, Dr. Dean Edell, Duke University Center for Aging, Johns Hopkins Memory Clinic, Dr. Eric Tangalos/Mayo Clinic, Dr. Rudy Tanzi/Harvard Medical School and Robert Stack, to name a few.

You can order online through Amazon.com - see it in our Book Recommendations

Informed Eldercare Decisions, Inc., provides the following services:

• Health, social & functional assessments to determine the services best suited for each individual.
• Care Planning and care management: arranging & monitoring home & community care, assisted living, nursing care facilities & other services.
• Support for family caregivers who live far from their parents or siblings.
• Advisory services to guardians and conservators.
• Counseling and assistance with methods of financing the high cost of long term care including: Long Term Care Insurance, Reverse Mortgages, Life Settlements and other long-term care financing strategies.

Informed Eldercare Decisions, Inc. is a private company dedicated to helping people make the best choices for long term elder care of their relatives. We are Experts in Long Term Care insurance and Elder Care planning.

450 Washington Street, Suite 108, Dedham, MA 02026-0428, USA
Phone 781-461-9637
Fax 781-461-9638