Depression and Alzheimer’s

“Depression is never normal.”  

Not even for someone with dementia.

In the most recent series of posts, we’ve been spotlighting some “what-ifs”: the sudden questions that can blindside caregivers as they contemplate what challenges the future might hold. Today, however, we’re taking a side trip to look at the issue of depression and the impact it can have on a loved one with Alzheimer’s.

According to the Alzheimer’s Association, it’s not uncommon for people with Alzheimer’s to be depressed, especially in the early and middle stages of the disease. In fact, the Association says, “Experts estimate that up to 40 percent of people with Alzheimer’s disease suffer from significant depression.”

And yet, “depression is never normal.” Shortly after I became Mom’s caregiver, I heard those words from well-known Dallas-area geriatric psychiatrist Dr. David Crumpacker. He was addressing a group gathered in a comfortable public room at an assisted living facility. The subject was Alzheimer’s.

Speaking for myself, the fact that 40 percent of people diagnosed with Alzheimer’s become depressed doesn’t surprise me. But Dr. Crumpacker’s words did surprise me. “Depression is never normal.” Not even for someone with Alzheimer’s? No, not even for someone with Alzheimer’s.

What does that mean? Why did the doctor make such a point of saying that, even when someone is diagnosed with such a cruel disease as Alzheimer’s, depression shouldn’t be considered a “normal” consequence?

Because, unlike Alzheimer’s, depression can be treated. And available treatments, the Alzheimer’s Association says, can lead to “significant difference in quality of life.”

And that’s information caregivers should act on. If you even suspect the person you’re caring for is depressed, pursue a diagnosis. As with virtually everything related to the changed behaviors that accompany Alzheimer’s, the first critical step for a caregiver is letting the doctor know.

You’re probably aware that Alzheimer’s can complicate the diagnosis and treatment of other illnesses. That includes depression. For one thing, the two illnesses share some symptoms, such as isolation, loss of interest in activities and hobbies, confusion and impaired thinking. And the cognitive impairment our loved ones experience may make it more difficult for them to describe their feelings and symptoms. Because of this, the Alzheimer’s Association says, “It may be helpful to consult a geriatric psychiatrist who specializes in recognizing and treating depression in older adults.” But caregivers can begin by talking to the primary care physician.

Don’t assume that, because he or she knows your loved one has Alzheimer’s, the doctor will automatically know the issues that most dramatically affect your loved one’s health and quality of life. Moods or behavior you observe that concern you should be brought to the doctor’s attention. I emphasize this because, as a new caregiver, I wrongly assumed the doctor would take the lead. I made the mistake of thinking, “The doctor knows this disease. He knows all the important topics to be discussed, all the important problems we’re encountering in caring for Mom.  If he doesn’t bring it up while we’re here in his office, it’s not really important.”

I was wrong. But I was fortunate. The results of my mistake could have been far more serious than they were.

In the next post, I’ll describe how I learned about the effects of depression on someone with Alzheimer’s. But for now, the facts are clear:

• Depression is never normal.
• Depression is not uncommon in Alzheimer’s patients.
• Depression can be treated.
• Treatment for depression may lead to significant improvement in quality of life for the one you care for.

I’ve experienced that shift from dark to brighter; I pray you can, too.

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Why are you cast down, O my soul? And why are you disquieted within me? Hope in God, for I shall yet praise Him….   (Ps. 42:5  NKJV)

Father, be with us as we care for our loved ones. Help us to see what we need to see, and then do what is necessary to protect them. Thank You that we are never alone.

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Christmas Remembered

A repeat of last year’s Christmas post. I hope it makes you smile. All caregivers need extra smiles at this time of year. Blessings to you, alleluia, and glory in the highest!

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The techno tree stood on a maple table in front of the windows in the den. An unlikely hero, it was less than two feet tall counting the motorized revolving base. Forest green branches stuck out from its black metal trunk, short and spikey at the top, longer toward the bottom, giving it the approximate shape of a fir tree. A Christmas tree, unadorned save for fiberoptic lights that, at the flip of a switch, glowed in changing colors from the tip of each branch.

My sister gave the tree to my parents in the hope it would brighten this holiday dimmed by Alzheimer’s. But my father had little faith anything could penetrate Mom’s darkness.  Thanksgiving had passed like any other day, and the weeks that followed carried no promises of Christmas cheer. As I made daily trips from my home to theirs to help him care for her, I saw no signs this year would be better than last.

A year ago Dad and I made cookies, wrapped gifts, lit lights and hung ornaments on a small, fragrant fir tree. I draped a white sheet over a side table and there, on 250 thread count snow, I arranged the old figures around the shaggy stable. Joseph, bound by human devotion to a task of divine magnitude, held a pottery lantern in his upraised hand. Mary, all fear erased from her scratched peach face, gazed upon her sleeping Son. Even the donkey and the sad-eyed cow looked to the manger where Jesus, Light of the world, dozed in the flickering rays of Joseph’s paint-chipped lantern.

But Mom had forgotten about the stable and the Baby, and though she ate most of the cookies, she professed to like “those regular ones” better. As for the gifts, they evoked so many questions, repeated hour after hour, day after day, eventually I put them out of sight.

So I understood Dad’s doubts. This year, until the gift of the funky little tree, we made no Christmas preparations. Twelve months had stolen so much more from Mom and filled the empty spaces with new fears, more confusion. The good days were rarer; the bad ones, worse.

Almost forgotten, the tree sat dark until late evening on one of the difficult days. As Mom sat at the kitchen table with Dad and me, her face still wore vestiges of the anger that had propelled her through the day. She perched crooked and stiff on the edge of the chair. Her feet shuffled like children who couldn’t be still. Our spirits were brittle with fatigue; the house, chill with despair.

Perhaps it was desperation that turned Dad’s gaze out of the kitchen, away from the heaviness that shrouded the table. Then his feet followed his eyes into the den.

“Where are you going?  What are you doing?” Mom’s voice was hoarse and hard.

I watched with her as Dad walked to the table where the metal tree with the bottle-brush boughs stood almost invisible against the heavy drapes behind it. He said nothing, only bent down and flipped the switch on the tree’s plastic base. From the fiberoptic branches tiny beams of color, delicate as starlight, shone on the curtains and ventured out across the room.

With a tiny hum, the tree turned ever so slowly. And ever so slowly, Mom relaxed. Her feet were still. Her shoulders sagged into the back of the chair.

“It’s a Christmas tree, honey.” Dad’s voice was low and soft, like the muted sound of church bells traveling over snow. “Do you like it?  It’s a Christmas tree.”

Just as softly, I began to sing.  “O Christmas tree, O Christmas tree, how lovely are thy branches….”

The old German carol. Mom’s favorite. In the time of my childhood when the first strains of Christmas music opened my heart like a jewelry box ready to receive all the bright treasures of the season, I waited each year with great anticipation for my mother to hear “her” carol playing on the radio. When she did, she would stop what she was doing and sing along. My sister and I watched her, smiling in wonder at the change in her face.  Every feature softened as she lifted her chin and raised her eyes to a long ago past. We could feel the room grow warmer as she sang. When the music ended, she always said the same words: “We learned that song in school.”

It was like a story to us, Mom’s singing and her words. Most of the story was told in the look on her face and the emotion in her voice, with the outcome always the same:  love for the fair fir tree.

Peace. Happiness. That was Christmas, she taught us, using only her memories and the words of her favorite carol.

Now, in the December of her life, all unaware, Mom reminded Dad and me what the season was about. Apparently not even Alzheimer’s could steal that remembrance from her. Somehow, evoked by the techno tree with its sweet hypnotic light, the melody of the old carol had survived in her memory, like a gift still wrapped in bright hope, the paper unwrinkled by age, the ribbons unfaded by the experiences of a lifetime.

“O fir tree dark, O fir tree fair…” I sang on to her. Then at the end, “You learned that song in school, right?”

And once again the gift unwrapped itself on Mom’s face. Anxious lines opened into softness and, subtle as candlelight, her eyes flickered in recognition of…what?

Peace, the heart of the Christmas story. A tree, a Gift. The sweetest story.  The oldest, the eternal carol.

“Glory in the highest!”

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And she brought forth her firstborn Son, and wrapped Him in swaddling cloths, and laid Him in a manger, because there was no room for them in the inn.…And suddenly there was with the angel a multitude of the heavenly host praising God and saying: “Glory to God in the highest, And on earth peace, goodwill toward men!”  (Luke 2:7,13-14 NKJV)

Welcome, LORD Jesus. You are our Glad Tidings. You know all our joys and our sorrows.  Prince of our peace, hold us while we sing a lullaby, to You and to our loved ones.

 

Exquisite

Caregivers recognize each other.

Yes, each caregiving path is unique. As different as each caregiver and the person he or she cares for, as different as their environment and lifestyle and family or lack of family—as different as each of our lives is different.

But unique as we are, caregivers recognize each other. With a pang of empathy and immediate respect, we recognize each other.

On Easter Sunday, my husband and I met one of my sons and his family at a restaurant for brunch. At a big round table in a beautiful dining room, our oldest son and his wife and our three senior grandchildren entertained us in the way only they can do—just by being themselves, unique individually and a unique unit in our larger family.

Though the room was full, the tables were arranged so everyone had plenty of elbow room. But when I felt a touch on my shoulder, I realized I was just a bit in the way of an older man guiding his wife’s (my assumption) wheelchair across the thick carpet.

“Oh, excuse me!” I said. I adjusted my chair, noting as I did so the gentleman’s well-polished wingtip shoes. (Wingtips always remind me of my father.)

Without making eye contact, the man nodded and moved on. As he walked away, I noted his carefully trimmed silver hair and handsome dark blue suit, and wished I had gotten a longer look at the lady in the chair. Then, just about the time I decided they must have been leaving the restaurant, I saw them coming back in our direction. Their table for two was just beyond us. I made certain they had a clear path this time and took the opportunity to see the lady who was dining with this debonair man.

My first thought when I saw her was Exquisite! Smooth, pale skin with little makeup, just a touch of blush, it appeared, and rose-red lipstick. Her dress draped her shoulders and lay across her knees with the unmistakable soft sheen of silk; her hands lay crossed on her lap; her feet rested in baby-pink, low-heeled pumps on the steps of the wheelchair.

My second thought was Alzheimer’s. Her husband wore shoes like my father’s; she wore the expression and air that had settled over my mother during the years of her decline into Alzheimer’s.

Our lovely celebration continued. My grandsons teased their big sister as they always have and she enjoyed it as she always does. On their parents’ faces I saw reflected the amazing light of their children. Harold and I basked in the light of the generation sitting with us and the later ones we expect to see. It was one of those exquisite occasions that marks and highlights the sweetness of life.

At the table just beyond, there was silence. Courtesy kept me from watching them openly, though I doubt they—he—would have noticed if I had. I did glance over occasionally and each look confirmed my second thought. I saw him reach across her plate and, with a smile, offer her a spoon. She looked at it, then at him; he laid it on her plate. At one point, her expression changed ever so slightly—was it a smile? He ate slowly, deliberately, watching her, always watching her. No talking. Just watching. I don’t think I imagined the look of exquisite pain I saw on his face.

We were sampling each other’s desserts when he wheeled her across the carpet again. This time they didn’t return.

Later, at home, I surrendered to thoughts I had pushed away as we celebrated.

This man had taken his wife to Easter brunch. Was it a tradition for them? Had he chosen her clothes? Put blush on her cheeks? Applied her lipstick? How long had it been since she got dressed up on her own? Stroked perfume across her wrists, straightened his tie, handed him his handkerchief? Had it been sudden, the silence? Or had it been that slow decline that let him deny reality, hope against hope? How did it feel—having someone leave who is more than half your life to you? Just leave? Leave you alone, to take care of them alone?

If I had asked my father that question—how does it feel, Daddy?—while my mother was still alive, he would have given me his standard answer to my concern for his well-being : “It’s ok, Baby. It’s fine. I’m fine. We’re fine.” It was true, I know. But I also know how far “fine” is from “exquisite.” Because yes, my parents had been exquisite together. Nothing less than exquisite. And when she died, he wanted her back. “However she is,” he told me, “I want her back.” I didn’t wish her back into the empty shell of Alzheimer’s, but to him, even that shell was always full of his love. Always exquisite.

If you know a caregiver, pray for him or her. If you are a caregiver, know that I pray for you.

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 For one will scarcely die for a righteous person—though perhaps for a good person one would dare even to die— ⁸ but God shows his love for us in that while we were still sinners, Christ died for us.          (Rom. 5:7-8  ESV)

LORD Jesus, You call us “friends.” You gave Your life for us. In Your infinite kindness, please bless those who are giving their lives as caregivers to loved ones and friends. In Your name, we ask that You give them wisdom and strength, and please, Jesus, remind them they are never alone. Show them Your presence. May they feel You smiling on them, their loved ones, and their work. Thank you.

 

Christmas Remembered

The techno tree stood on a maple table in front of the windows in the den. An unlikely hero, it was less than two feet tall counting the motorized revolving base. Forest green branches stuck out from its black metal trunk, short and spikey at the top, longer toward the bottom, giving it the approximate shape of a fir tree. A Christmas tree, unadorned save for fiberoptic lights that, at the flip of a switch, glowed in changing colors from the tip of each branch.

My sister gave the tree to my parents in the hope it would brighten this holiday dimmed by Alzheimer’s. But my father had little faith anything could penetrate Mom’s darkness.  Thanksgiving had passed like any other day, and the weeks that followed carried no promises of Christmas cheer. As I made daily trips from my home to theirs to help him care for her, I saw no signs this year would be better than last.

A year ago Dad and I made cookies, wrapped gifts, lit lights and hung ornaments on a small, fragrant fir tree. I draped a white sheet over a side table and there, on 250 thread count snow, I arranged the old figures around the shaggy stable. Joseph, bound by human devotion to a task of divine magnitude, held a pottery lantern in his upraised hand. Mary, all fear erased from her scratched peach face, gazed upon her sleeping Son. Even the donkey and the sad-eyed cow looked to the manger where Jesus, Light of the world, dozed in the flickering rays of Joseph’s paint-chipped lantern.

But Mom had forgotten about the stable and the Baby, and though she ate most of the cookies, she professed to like “those regular ones” better. As for the gifts, they evoked so many questions, repeated hour after hour, day after day, eventually I put them out of sight.

So I understood Dad’s doubts. This year, until the gift of the funky little tree, we made no Christmas preparations. Twelve months had stolen so much more from Mom and filled the empty spaces with new fears, more confusion. The good days were rarer; the bad ones, worse.

Almost forgotten, the tree sat dark until late evening on one of the difficult days. As Mom sat at the kitchen table with Dad and me, her face still wore vestiges of the anger that had propelled her through the day. She perched crooked and stiff on the edge of the chair. Her feet shuffled like children who couldn’t be still. Our spirits were brittle with fatigue; the house, chill with despair.

Perhaps it was desperation that turned Dad’s gaze out of the kitchen, away from the heaviness that shrouded the table. Then his feet followed his eyes into the den.

“Where are you going?  What are you doing?” Mom’s voice was hoarse and hard.

I watched with her as Dad walked to the table where the metal tree with the bottle-brush boughs stood almost invisible against the heavy drapes behind it. He said nothing, only bent down and flipped the switch on the tree’s plastic base. From the fiberoptic branches tiny beams of color, delicate as starlight, shone on the curtains and ventured out across the room.

With a tiny hum, the tree turned ever so slowly. And ever so slowly, Mom relaxed. Her feet were still. Her shoulders sagged into the back of the chair.

“It’s a Christmas tree, honey.” Dad’s voice was low and soft, like the muted sound of church bells traveling over snow. “Do you like it?  It’s a Christmas tree.”

Just as softly, I began to sing.  “O Christmas tree, O Christmas tree, how lovely are thy branches….”

The old German carol. Mom’s favorite. In the time of my childhood when the first strains of Christmas music opened my heart like a jewelry box ready to receive all the bright treasures of the season, I waited each year with great anticipation for my mother to hear “her” carol playing on the radio. When she did, she would stop what she was doing and sing along. My sister and I watched her, smiling in wonder at the change in her face.  Every feature softened as she lifted her chin and raised her eyes to a long ago past. We could feel the room grow warmer as she sang. When the music ended, she always said the same words: “We learned that song in school.”

It was like a story to us, Mom’s singing and her words. Most of the story was told in the look on her face and the emotion in her voice, with the outcome always the same:  love for the fair fir tree.

Peace. Happiness. That was Christmas, she taught us, using only her memories and the words of her favorite carol.

Now, in the December of her life, all unaware, Mom reminded Dad and me what the season was about. Apparently not even Alzheimer’s could steal that remembrance from her. Somehow, evoked by the techno tree with its sweet hypnotic light, the melody of the old carol had survived in her memory, like a gift still wrapped in bright hope, the paper unwrinkled by age, the ribbons unfaded by the experiences of a lifetime.

“O fir tree dark, O fir tree fair…” I sang on to her. Then at the end, “You learned that song in school, right?”

And once again the gift unwrapped itself on Mom’s face. Anxious lines opened into softness and, subtle as candlelight, her eyes flickered in recognition of…what?

Peace, the heart of the Christmas story. A tree, a Gift. The sweetest story.  The oldest, the eternal carol.

“Glory in the highest!”

And she brought forth her firstborn Son, and wrapped Him in swaddling cloths, and laid Him in a manger, because there was no room for them in the inn.…And suddenly there was with the angel a multitude of the heavenly host praising God and saying: “Glory to God in the highest, And on earth peace, goodwill toward men!”  (Luke 2:7,13-14 NKJV)

Dear Jesus, help us to care for our loved ones in this joyful season. Send us Your joy, Your love, Your peace.

A Big Mistake

My father was going blind when I began helping him care for Mom. There was a lot he couldn’t see: how dirty her hands were, the stains on the shirt she’d been wearing all week, the mold on the cheese he and Mom were still eating. Dad thought he’d been doing a bang-up job with taking care of Mom and the house and the shopping and laundry, and I couldn’t bear to burst his bubble.

So I made a big mistake: I didn’t mention the dirt. I just cleaned it up.

Some days I found it hard to climb the three steps to the porch, put my key in the lock, and sing out a cheery “Good morning!” to Mom and Dad. There was no way of predicting how Mom would feel and act—would this be the day I feared most, when I couldn’t find a way to calm Mom down and had to call for help? I knew Dad felt the same dread—I could read it on his face—but I wanted him to be able to relax while I was there.

So I made a big mistake: I smiled and acted calm all the time, happy and confident and never flustered.

When Dad and I took Mom to the clinic, the doctor directed most of his questions to me. I didn’t want Dad to feel insulted that the doctor turned to the patient’s daughter instead of her husband.

So I made a big mistake: I sat back and let Dad answer all the doctor’s questions. If I had anything to add or correct, I did it by telephone later.

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I didn’t recognize my actions as the mistakes they were until Mom was no longer in my care. As she lay in a hospital bed after surgery for a broken hip, the hospital social worker told us Mom would be released, but only to a care facility. She was unable to do the necessary rehab and wasn’t strong enough to go home. She had to go to place where skilled staff could meet her needs.

Dad shook his head. “No. She won‘t go to one of those homes.” When I didn’t immediately back him up, he turned to me with a look of shock. “We can do this, Katrinka. There’s no need to send her anywhere. We can do it at home, right?”

My father was a  reserved man, but virtually everyone who met him came to know one critical fact about him: he lived for my mother. He needed no one but her. Wanted no one but her. And from the very beginning of our journey through Alzheimer’s, I knew his one goal was to keep her at home. With him.

So my heart broke to hear his plea: “We can do this, Katrinka, right?”

He expected me to say yes. To smile with a can-do attitude, let him do all the talking, let him make the decisions.

That’s when I realized the mistakes I’d been making. Essentially, I had lied to Dad.

• I had let Dad think he’d done a great job caring for Mom before I stepped in to help, keeping from him the dangers posed to both of them due to his bad eyesight.
• I had purposely let him think that taking care of Mom (and him) was no problem for me at all.
• I had let him assume that he was alone responsible for directing the doctor, that all decisions about Mom’s care were based on his input alone.

I should been frank about the sometimes filthy conditions he and Mom had lived in. I should have told him how overwhelmed I felt, how exhausted I was handling the caregiving alone—especially since it might have prompted him to share his own feelings with me.  I should have spoken to the doctor in front of Dad, so he’d know that what he saw of Mom and her illness was limited by what he wanted to believe, and that the doctor needed to hear all the truth in order to keep Mom as healthy as possible.

I should have told Dad the truth.  Telling the truth back then might have eased the pain I was about to inflict by speaking to him now what he had to hear.

“Daddy, no,” I said. The social worker stepped back to give us some privacy.  “We can’t do it at home. This is different.”

His square hands hung at his sides in a way I’d never seen before. I was used to seeing them hold something—a wrench, a hammer, clothes for Mom or a glass of juice. Or if they weren’t working, they were thrust in his pockets, jangling his change and car keys. Now they just hung from his wrists with nothing to do.

In the face of his pain, I willed myself to continue. “Mom needs more care now than you and I know how to give, Daddy. It’s up to us to see that she gets what she needs. We have to let this happen.”

It did happen. More swiftly and smoothly than I could have imagined. In his relentlessly hopeful way, Dad spoke of it as a temporary situation, just while Mom rested and regained her strength. Then she’d be back home with him. Again, I didn’t contradict him. It was far too late for that now.

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My point for other caregivers is this: Be honest. Don’t pretend.  Do what you have to do; say what you have to say.

In my case, the truth might have resulted in better care for Mom. Being truthful with Dad would have shown him far more respect than trying to protect him from hard realities. And being honest in expressing my feelings and asking for help would have resulted in a better situation for all of us—Mom, Dad, me, and my family.

I thought I was being kind. I wasn’t. I thought I was being strong. I wasn’t. I thought I was protecting Dad. But I was trying to protect myself, too. It didn’t work. Trust me: facing the pain together—from the very beginning—would have been easier on both of us.

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He shall cover you with His feathers, And under His wings you shall take refuge;
His truth shall be your shield and buckler.  (Ps 91:4  NKJV)

Father, with You there is strength in the face of all difficulty and pain. Be with us, we pray, and help us serve and protect our loved ones with the shield of Your truth and mercy.

 

Surprise! Can Help You

You can often win cooperation from the one you are caring for by using the element of surprise.  What I mean by surprise is this:

You don’t have to announce everything that’s about to happen.

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Some days, Mom’s go-to answer was “No.”  “No” from breakfast to bedtime and everything in between. In spite of her refusals, life had to go on.

I remember well the times I felt extreme embarrassment when I went out in public with my mother. Her clothes were seldom fresh. Her shoes, white tennis shoes dotted with green shamrocks, were tan—brown in places—with spots of indistinguishable color. Worse than her clothes was her physical appearance. Her hair brought to mind a dirty door mat sitting crooked on her head. Her fingernails were long and tobacco-stained. The crust of untreated conjunctivitis lined the edges of her eyes.

As we walked into the grocery store or post office or bank, I usually felt a red-hot blush sweep up from my neck to my forehead. I thought I saw the greeter, the clerk, the customers staring at us, aghast at Mom’s appearance and wondering why I didn’t take better care of her. Of course, most of them had no way of knowing how difficult it was to get Mom dressed at all.

We know that Alzheimer’s wants it all. Not content to steal its victims’ memory, knowledge, judgment, and physical and emotional health, it will also take every shred of their dignity.

If we let it. We need a strategy. 

The subject of a caregiver’s embarrassment and imagined judgment from others is an important one which has been discussed on this blog and will be again. But the point I’m making here is this: I found a way to ease the struggle. Surprise!

Here’s an example. A typical morning might include a conversation like this:

I start with great enthusiasm and a big smile. “OK, Mama, let’s get your shoes on!’

“I don’t need any shoes.”

Uh-oh. “Well,” I say with a hopeful chuckle, “you don’t want to go outside barefoot, do you?”

“I don’t want to go outside.”

“But we’re going out to breakfast!” I say.

Mom smiles. I knew that would work. I smile back.

I put her shoes on the floor beside her feet, kneel down, and reach for her left foot.  Faster than she’s moved all morning, she pulls both feet back and hides them under her chair.

“I don’t need any shoes.”

So we’d wait a few minutes and repeat the whole process again. And again. Sometimes it was lunch time before we made it to breakfast. Sometimes we didn’t get to breakfast—or the bank or the store or wherever—at all.

Lack of cooperation is something most caregivers experience. It can move from the level of frustration—“I don’t need any shoes”—to danger—“I don’t need those pills.” Here’s my suggestion:

Don’t announce what you’re going to do. Let your loved one be surprised!!

As a new caregiver, I thought I could keep Mom calmer by telling her in advance everything that was about to happen. As the disease worsened, however, I could see that my explaining what was going on became another source of confusion for her. She began to fight any change I suggested.

So I stopped suggesting and started surprising. I learned that—to use our example—sometimes the easiest way to put Mom’s shoes on her was to put the shoes beside her chair, kneel in front of her, lift her left foot, and put the shoe on it. Without stopping or even looking up, I’d move to the other foot. When both shoes were on, I’d make eye contact, smile, and talk to her about something that had nothing to do with shoes.

What happened? Here’s how I explain the success of the method:  When our loved ones refuse to cooperate, I believe it’s because their power-word is—and always has been—“no.” I think some vestige of memory or instinct leads them to protect themselves from the unknown. Whether with their mouths or their actions, they just say no.

But in the case of our shoe-example, Mom had no chance to say no. I believe the surprise of me lifting her foot consumed all Mom’s attention.  My saying nothing about shoes, either before or after, let the event slide by too quickly for her to complain. And because her mind couldn’t take in or process the actions I took, she was as surprised the next day as she was the first.

[The surprise method can be effective in many situations. I was especially grateful I could use it to get Mom in the bathtub.  A later post will explain that process in detail.]

Maybe my reasoning is flawed as to why this simple method works, but I can tell you from my own experience and that of other caregivers I’ve shared it with — it does work. Not all the time, but blessedly often.

And it preserves dignity. Our loved ones with Alzheimer’s reach a point where they don’t know how they look or smell or act. They no longer understand the concept of dignity and wouldn’t know if they lost it. But we know. Caregivers know. If we let those living with Alzheimer’s descend below the level of their God-given human dignity, we have failed them. Once I understood that, my embarrassment at Mom’s appearance turned to new respect for her.

The last gifts we can give our loved ones live on after they themselves are gone: their dignity, our respect.

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In You, O Lord, I put my trust;
Let me never be put to shame.
Deliver me in Your righteousness, and cause me to escape;
Incline Your ear to me, and save me.
Be my strong refuge,
To which I may resort continually;
You have given the commandment to save me,
For You are my rock and my fortress.  (Ps. 71:1-3  NKJV)

Dear God our Father, You chose to create each one of us. You created each of us in your likeness. Please help us to care for our loved ones; may we look at them and see You.

The Bluebird of Happiness

Often it seems nothing we can do or say will bring happiness to our loved ones with Alzheimer’s. Since they gradually lose the power to choose their own pleasure, caregivers are left to use trial and error to guess what might bring a smile.

For me, when often became even more often, and even more often became ‘way too often, I re-discovered a happiness strategy from back before I was a daily caregiver…back when I was a daily mom. What I remembered is this:

Sometimes it’s what we don’t do that makes the difference between sullen and happy in those we care for.

I remembered the occasional evenings when I allowed my sons to skip a vegetable at dinner time…and decided maybe Mom didn’t need to wear fresh clothes every day. Some days I didn’t insist she drink a full glass of water at every meal; if she wanted juice at lunchtime, that was fine. No socks with her tennis shoes today? OK.

When I let some things slide, I found that, even if I couldn’t always get her to smile, I could at least erase her frown.

Why was it that skipping an action worked better doing something?

I believe the “never mind’s” worked better because the “please do’s” were beyond Mom’s grasp. She was able to let me know if something we were doing was UNpleasant, but she could no longer think of things she might enjoy. Or maybe she could think of some things some times, but she wasn’t able to put them into words.

The things we skipped depended, of course, on our activities for the day and, even more so, on Mom’s safety and hygiene. If we had a doctor’s appointment scheduled, I couldn’t let Mom go out without shoes. And we always had to keep her hands clean. Getting Mom to take her medications was a must; making sure she drank enough fluids was a must; and there had to be a limit to how many days she could wear her favorite outfit without washing it.

The “must’s” were seldom easy. But they were possible. How? By accommodating Mom’s wishes the same way I used to accommodate my children. I said yes as often as possible and insisted on no when it was necessary.

And I went a step further with Mom. When I had to insist she do something my way, I tried to include an enticement of some kind.For example:

If Mom scowled when I came toward her with shoes in my hand, sometimes—on days when I knew she could stay indoors—I was able to agree: “No shoes? OK.” But if we had to go out, I had to insist. “Well, you’re going to need shoes today. But here…why don’t you feed Charley-Dog some treats while I help you get your sandals on?” I knew feeding Charley was a fun–and dependable–distraction.

If Mom refused her lunch, I could say, “OK, but I’m afraid you’ll be hungry later. Tell me if you are, please.” If, however, she had already skipped breakfast, I had to insist she eat at least a few bites. And I usually had to feed her myself. Beginning with a potato chip got us off to a good start, and a couple more interspersed through the process helped me keep things moving.

When it came to clothes, I almost always let Mom wear her threadbare or hole-y favorites, which I put through the washer and dryer after she went to bed. As long as she was clean, dry, and modest, she was fine to go wherever we had to go. If her old clothes made her feel better, we were happy for her to wear them.

Please understand: when I say I used  some of the same strategies with Mom that I used with my children, I mean no disrespect to her. Alzheimer’s had robbed her of reason, judgement, and self-control. To expect things from her she could no longer give would have been cruel. Instead, I simply made it easier for Mom to go along with the necessities. And I had no fear of her expecting the same “privileges” every day–each day was all too new for her. I believe Mom remembered me and Dad when she awakened in the mornings; that much memory allowed her to trust us, at least most of the time.

Our loved ones with Alzheimer’s travel through life constantly on the edge: not remembering where they’ve been, unable to see where their next steps will take them. So it’s up to us to be flexible. We must make their paths as wide and comfortable as we can, by putting as few demands on them as possible.

Happiness for someone with Alzheimer’s? I think it’s like a little bird, a nervous little bird, to be sure, but willing to rest in a spot feathered with reassurance and safety. If we provide a house and fill it with all the comfort and security we can manage,

even if we don’t often see the little bird, we can trust that our loved ones are all right.

Blessed are those who have regard for the weak; the Lord delivers them in times of trouble. The Lord protects and preserves them—they are counted among the blessed in the land….  (Ps. 41:1-2  NIV)

Lord, you are the source of all our wisdom. When we turn to you and ask for help, you always answer. Thank You for helping us help our loved ones.

Making Assumptions

Making assumptions can be a good strategy for caregivers. Why? Because making an assumption will lead us to try something, take some kind of action that just might improve life for the ones we care for.

So many times in a day I was baffled by my mother’s actions. Or her words. Or the expression on her face. I could try to guess what she needed or wanted and come up with a lot of possibilities. But then I spent time trying to decide which possibility was the correct one. And as the clock ticked on, Mom either got upset because I wasn’t helping her, or she said—by word or action—“Never mind. Just forget it.”

My guessing game left us both unhappy.

But what if I had assumed? “Assume” carries the idea, not simply of guessing, but of acting on a guess. And where our loved ones who have Alzheimer’s are concerned, trying to do something for them is almost always better than standing around worrying about what they want.

A simple example:
Dad, Mom, and I walk into a large discount store. She’s pushing a shopping cart and I’m right beside her. Dad goes ahead of us with his own cart.

Usually Mom and I sit for a while in the coffee shop while Dad roams the store. So I gently steer the cart toward our regular table. Mom gives me an angry look. Asking her what’s wrong gets me no response. So I try again to turn the cart. This time Mom hisses, “No!” Before her temper is fully engaged, I stop to investigate. Her shoe isn’t untied. She’s not trying to sit down. Her hands aren’t in her pocket searching for a tissue. She’s just staring straight ahead. So I look that direction—and see a large display of poinsettias. They’ve arrived just in time for Thanksgiving.

And I assume that’s what Mom wants to see. Rather than ask her, I simply steer the cart in the direction of the flowers.

The closer we get, the bigger Mom’s smile grows. We walk around and around the large display, circling the blooms of red and pink and green and cream, some glitter-sprinkled, and all stretching their graceful necks above gold and silver foil collars.

After Mom’s admired and sniffed and pointed for a few minutes, I see her shoulders start to droop and assume she’s getting tired. So I start talking about our favorite table and the hot coffee we can enjoy there. And soon we’re there, sipping our coffee, Mom pointing toward the flowers again, me talking about each color, the three sizes of pots, and gold and silver ribbons.

I could have asked, of course. “Mama, do you want to see the flowers?” In the absence of a reply, I’d likely have gone on, “Or do you want to look at the popcorn tins? Or walk down the produce aisle? Or go find Daddy? Or….”

But on that day as on most days, Mom either couldn’t or wouldn’t have answered. The frown on her face would grow deeper with each question. So, knowing that almost any pleasant action is better than another question, I made an assumption and started moving. If I had found my assumption was false, I could have made a different one and moved in a different direction.

There are, of course, two other possibilities to consider:

Maybe Mom didn’t know what she wanted; maybe her reactions had more to do with a difficult mood than a specific desire. In that case, steering with my shoulder and my body, I’d have led her over to sit down or outside to wait in the car.

Or perhaps I had no idea what Mom wanted to do. What then? Well, I could still try all the likeliest possibilities, and sooner or later the activity would tire her and we’d just sit and wait for Dad.

The thing to remember is that making an assumption leads to some kind of action. For the caregiver, doing something feels better than standing around wondering. And for those with Alzheimer’s, our actions, even trial-and-error actions, are easier than questions. Even if what we end up doing isn’t what our loved ones had in mind, all our attention is focused on them. We’re touching them, talking to them, smiling at them. In Mom’s case, all of those gentle realities were less threatening to her than a question she couldn’t answer.

For me, doing something was progress. Finding out Mom would eat cranberries when nothing else pleased her, seeing that sometimes she wanted me to help with the left shoe first instead of the right—making discoveries like those helped me to see that I wasn’t just watching and waiting with her. I was helping her live a life, her life, in spite of Alzheimer’s.

He will feed His flock like a shepherd; He will gather the lambs with His arm, And carry them in His bosom…. Isaiah 40:11 (NKJV)

Lord, we ask you to guide our actions with our loved ones. Show us the possibilities, the opportunities we have to help them continue to live here on earth until You show them the infinite beauty of life with You.
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The Things We Do

The things we caregivers do…sometimes they don’t make a bit of sense!

Or do they?

The other day, looking through the closet where I stash new toys for my grandchildren, I came across some puzzles stacked in a corner on a high shelf. I didn’t remember them at first.

I opened one box and touched the odd shapes of cardboard; clearly the puzzle had never been worked. The edges of each piece were still crisp, not rounded or soft as they would be if my grandchildren had squeezed them into the right—or wrong—places. There were three boxes, each with the same “new” look.

Cool! I thought. Must have gotten these a while back and then forgotten them. Clearly they were for children: large pieces; cute pictures of animals; bright, primary colors. The turtle had 4 pieces; the teddy bear picnic, 15; the kitten on the fence, 30. Good! They must have been intended for three different age levels; that would mean years of entertainment.

That thought led to a discovery; the discovery triggered my memory. Looking for the age designations on the boxes, I found instead a neatly cut hole on the side of each lid. I frowned with irritation—who would so intentionally remove that information? Then I remembered: me. I removed it right after I purchased the puzzles.

Back when Alzheimer’s still allowed Mom some good days, I was always looking for activities that would keep her challenged and entertained. The activity had to balance on a thin line: too difficult and Mom would get exasperated and angry; too easy and she’d be insulted and angry.

Somehow I came up with the idea of children’s puzzles. I could get several, each for a different age level. That way I was sure to find one she could do and enjoy. It seemed like a great idea.

Until I envisioned putting the puzzles in front of Mom. What if she noticed the “Ages 4-7” label on the side of the teddy bear picnic box? Or “6-10” on the kitten or “2+” on the turtle box? Surely she’d be confused, even hurt. The thought of her looking at the numbers and seeing I had chosen children’s puzzles for her almost brought me to tears. So I carefully cut away the offending section of each box top.

As I recall, when I brought out the puzzles, Mom scarcely looked at them. I’m sure I called her attention to the animal pictures and started putting some of the pieces together. But Mom wasn’t interested. She ignored the bright boxes, and me. I guess I hadn’t chosen the right day to give them to her. And, apparently, the right day never came along.

At times like those, I had learned not to take Mom’s actions personally. A hard lesson, for every caregiver, but an extremely important one. Alzheimer’s and other types of dementia rob those we care for of the ability to consider a situation or a person or an event and decide how they should react. The disease can be as cruel to family and caregivers as it is to its victims. So gradually we must adjust, accepting that it’s the disease acting, not the person we’re caring for.

But what struck me last week when I found the puzzles wasn’t disappointment that Mom never got to enjoy them. Instead, I wondered what on earth I was thinking when I worried about words on the side of a puzzle box! Worried about them to the extent that I cut them off very carefully, hoping that straight lines and un-frayed edges would disguise the holes in the lids.What was I thinking??? So much worry over something so silly!

Looking back, seeing how desperate I was to protect Mom when she was already so far away, has left me with a hangover of sadness. Since then, I’ve struggled to enter that ache, and name it. I know if I can name my pain, I can take it apart, see it for what it truly is, and use it for something good.

So I’ve thought a lot about those neatly cut holes.

Why? Why? Why? If I really believed I was protecting Mom, it was protection she didn’t need. She didn’t read anymore, and even if she did, she was long past being able to understand the concept of age levels.

But…

I understood that concept. And it pained me to hand a teddy bear puzzle made for 5 year olds to my beautiful, talented mother. So I removed the evidence of her decline. For myself. For my father. And I did it carefully, with great precision. In contrast to the crooked and wandering trajectory of our days, I cut out the painful words with straight, controlled strokes. The edges were clean, not messy and frayed like our lives and our hearts.

No, I didn’t see back then that my motivation for removing the labels was anything other than shielding Mom from possible confusion or hurt. But I knew taking that action made me feel better.

And now I know why.

As a caregiver, are you ever tempted to call some of your words or actions “silly”? Look carefully first. Or better still, just give yourself the benefit of the doubt. If those seemingly pointless activities make you feel better or safer or happier, then they are important. They make sense.

Trust yourself. The same intuition and instincts that make you a good caregiver for someone else will help you take care of you.

How many are your works, LORD! In wisdom you made them all; the earth is full of your creatures….All creatures look to you….when you open your hand, they are satisfied with good things. (Ps. 104:24, 28 NIV)

We need You, Father, every day. In every circumstance, we need Your guidance. Show us what our loved ones need, and open our eyes to our own needs also. Thank You for Your care for all of us.

Holding On

The last on our list of “The Hardest Things” for caregivers to deal with is loss of our identity. We have been someone special to our loved one; now we could be anybody.

Or nobody.

People with Alzheimer’s, their own personalities long since stripped away by the disease, can eventually lose the ability to identify even those who are closest to them. Not just names are lost, but also faces and voices and the feeling of family or friendship. This effect of the disease arrives sooner for some patients, later for others. Those who escape it do so by virtue of dying before they experience it.

For the Alzheimer’s patient, all connections are dissolved. He or she is alone.

For the forgotten sons or daughters or spouse or friends, loss of identity in relation to their loved one is exquisitely painful. The caregiver has now become a stranger. In especially cruel cases, unknown loved ones and caregivers may provoke fear or anger in an Alzheimer’s patient. But even if caregivers are perceived to be kind and helpful, they’ve become kind, helpful strangers.

One reader told me he is an only child, caring for his mother who has Alzheimer’s. She asks him repeatedly if he knows her son. He tries to tell her he is her son, but she doesn’t believe him. She continues to ask.

Perhaps you’re the spouse of an Alzheimer’s patient. You and your wife are together virtually every minute of the day, yet she never says your name anymore. There’s no glimmer of recognition in her eyes when she looks at you. The years you’ve been married appear to count for nothing now.

Maybe a faithful friend who visits your loved one regularly is no longer greeted with a smile, but with a blank face instead. The friend is heartbroken. She believes she’s of no help anymore.

When we’re no longer known by those we love most, the lack of connection leads to a lack of words, an emptiness that’s hard to describe. The person with Alzheimer’s is beyond the point of recognizing the loss. But the caregiver, the son, daughter, spouse, friend—these people suddenly experience what may be the most devastating pain inflicted by the disease: where once we were needed, special, able to touch the heart if not the mind of our loved one, now we’re invisible.

It’s easy to understand the caregiver’s thought that maybe now is the time to give up.

Fatigue and despair tell us, The road is too hard. The non-stop work doesn’t improve anything; it only brings you closer to the end. You can’t hide the pain anymore. It’s too big to carry. Surely someone else can do the job now. Your name means nothing to your Mom anymore. Anyone else’s face could take the place of yours; anyone else’s hands could do what yours do. You’re lost to your mother now. She’s lost to you.

But have we truly lost our connection with the one we’re caring for? I don’t think so. We just have to carry it on our own now. It’s up to us to hang on to it through the hardest times of Alzheimer’s. The person we’re caring for has been robbed of the ability to live out her identity, but she is still the person she was before Alzheimer’s. The relationship we had still exists; it’s just that now, only one of us is able to make the connection visible. The curves and angles, the highs and lows, the deep and the wide—one of us must keep them now for both of us.

Since any time is a good time to bring in help with caregiving tasks, now is perfect. Since it’s always helpful to share thoughts and feelings with someone who will listen with mind and heart, now’s a great time for that, too. It’s a fine time for a break, to get away for a while, to rest mind, heart, and body. I pray you do those things.

Because if you do, or maybe even if you don’t, you’ll be in a better position to see the real nature of your caregiving. The bigger picture. Perhaps at this point, with no more rewards of a smile, a few words, a pat of recognition, you’ll finally understand that the caregiving has been a gift. To both of you. Every facet of it has defined or reinforced who you are in relation to the one you care for. And you affirm the identity of your loved one, also. As long as you relate to her as a daughter, she is still a mother. As long as you care for him as your spouse, he is still a husband.

Though our loved ones have been robbed of the ability to live out their own identity, they are still God’s unique creations. When we’re with them, holding the essence of our relationships in our hearts and in our caring hands, the people we care for are real. They maintain their person-hood.

They live bigger than Alzheimer’s. And that’s a victory.

 But now, this is what the Lord says–he who created you…he who formed you…:”Do not fear, for I have redeemed you; I have summoned you by name; you are mine.”

Is. 43:1  NIV)

Father of us all, You know who we are. You made each of us unique. Help us as we guide our loved ones on their journey back to their true identities, back home to You. Thank You for Your assurance that we are all loved, each one as if there were only one. Show us how to give You glory, Lord. Amen.