Treating People Like VIPs

We all liked to feel valued - important - knowledgeable - a part of something - a voice with family and friends. This value carries over to those with Alzheimer's disease or other dementias. I know it is easy to chat over and around someone who does not appear to understand or to be actively involved in the conversation, but I also recognize that this is absolutely wrong. Inclusion is vital to good physical and mental health.
A recommendation from the Bravo Zulu presentation I attended is treating others like VIPs:
V - valuing their personhood, our relationship and their extended relationships, and their cultural identity;
I - treating people as unique individuals;
P - looking at the world from the perspective of that person;
S - providing a positive and supportive social environment. (Brooker, 2007)
In reality, shouldn't these simple steps be the way that we interact with everyone. From infancy through adulthood, it is nice to have a sense of belonging.

Relationship-Centered Dementia Care

I am currently a participant in a course offered by Jennifer Carson, PhD, who is with the Sanford Center for Aging at UNR. Called "Bravo Zulu" as it was first intended for members of the military and their families, the topic and information are applicable to everyone serving as care giver or care recipient.
A first step in relationship-centered care is knowing and understanding the loved one with dementia and above all, making him/her an active member of the caregiving planning team. Few people like decisions foisted upon them without a shred of input, and that is true of those with dementia. Understanding of culture and cultural background is key to helping understand how needs can best be met and by offering solutions that match the values and wants of each individual.
Military families as a focus helps attendees better understand culture as the military entails strict rules and protocols especially focused on being tough and never asking for help. Breaking down, or at least chipping some holes in the "no-need-for-assistance" barrier, means that a loved one in need can receive care and advice that benefit good health and healthy living.
It is important in the military culture - just as in every culture - to begin by accepting that military is a general term and that Army, Air Force, Navy, Coast Guard, and Marines are specific. Each branch has a unique creed and mission. Not all military are infantrymen or sailors, just as every person is an individual. Relationship-centered care requires that caregivers fashion care around the concerns and desires of an individualized life history made up of experiences, events, and relationships.

The Holidays Approach

With some big holidays arriving soon it is important to be prepared to make each event wonderful, safe, and satisfying for everyone, especially a loved one with Alzheimer's disease or other dementia. Even though an individual may appear lost, befuddled, and anxious, s/he still can benefit greatly from  the love and camaraderie of family and friends. A few hints include:
1. Plan events for the late morning or early afternoon. This allows plenty of wake-up time plus lots of light to avoid confusion.
2. Determine a quiet spot in your home so that your loved one can be surrounded by those who care, but just a few at a time. Even noisy little ones add joy - but in small doses with rambunctiousness at a minimum.
3. Create a menu of your loved one's favorite dishes, taking under consideration items that come in small bites. A few specialties are perfect - too  many may add to angst as decision-making may be tough.
4. Decide where a nap can occur, if necessary. This should be in a quiet area with adequate lighting to avoid potential mix-up in where your loved one is should s/he suddenly awaken. Move a chair, pillows, or soft objects next to the bed or couch in case your loved one should decide to roll. Be sure to check periodically that a peaceful rest is unfolding.
5. Select photo albums or create a slide show to share past events and memories with all of the family, especially designed with your loved one with dementia in mind.
6. Encourage all attendees to be kind and gentle, to assist but not to overwhelm, to help but not demean. Some folks will not be able to deal with this cognitive decline. Help them understand that the same person resides within but it is hard for him/her to engage as in the past.
Love makes a difference!

Care and Trust...continued

Often, those with dementia become wanderers. A familiar stroll around the neighborhood can turn into a misadventure as steps become jumbled and surroundings become strange. This is even worse, of course, when it comes to driving. Those with dementia still want to be independent and driving is of supreme importance. After all, when a license is removed, the opportunity for freedom and social interaction diminishes creating isolation, dependence, and depression.  A good conversation includes these concerns and also potential remedies such as a walking partner or driving services. I also recommend that families contact law enforcement about concerns so that officers can learn walking routines of one who may become lost. A GPS device for shoes and/or an identification bracelet with an emergency number engraved on one side and the health concern on the other are vital.

            I recommend that beginning at age 50, people hold a yearly summit about worries, finances, health issues, purchases, and other transactions. By maintaining an open conversation, when problems do arise, much is already out in the open. No, you do not need to divulge deep secrets, precise monetary subjects, or other private material, but honest talk now alleviates some stress of burdensome conversations later. Perhaps spouses, children, and other significant relations may not agree, but at least they are fully aware of wishes and requests. In later family gatherings, if dementia has appeared, realize that your loved one may not be able to assess multi-step processes and questions. A little at a time, a few subjects on the table, will provide the most positive results. “To be continued” is recommended.

            This should probably have come at the beginning, however, I wanted to emphasize the worthiness of building trust and personal reliability. Hopefully your loved has recognized some cognitive decline – forgetting dates, losing valuables, feeling perplexed about decisions – and has already suggested a complete medical examination by a neurologist or gerontologist. Self-analysis is undoubtedly the best way to pursue the most beneficial health diagnoses. But sometimes, denial is far easier and so you, as the caring and devoted family member, may be the one to broach this somewhat uncomfortable conversation. Knowing that an abrupt refusal may greet you, plunge on accepting that your concern is of utmost significance.

Care and Trust

With holidays approaching and family and friends visiting, it is essential to maintain calm and safety for loved ones with Alzheimer’s disease. There is nothing like a ruckus to set off a fuse; being prepared can circumvent that. The more I have thought about appropriate behavior and reactions toward those with dementia, the more I understand that this is the way we should treat everyone – with dignity and respect.

Always approach a loved one from the front so that eye contact is made and safety is assured.  Speak calmly and evenly with no excess inflection or tones that sound accusatory or gruff. A soft, gentle voice is relaxing and is likely to encourage conversation. Although this conversation may be one way, primarily you speaking, you may find that your loved one engages. While this back and forth conversation may be confusing with responses off topic and strange, the sound resonating from this interaction is precious.

If somewhere during the visit your loved one becomes agitated, frustrated, or angry, again remain calm, nodding in agreement even when you are completely baffled with what is transpiring. Kindness goes a long way in helping comfort someone with dementia. Arguments and raised voices only exacerbate the situation transforming a slightly out-of-kilter moment into a disaster which is difficult or impossible to remedy. You will never “win” an argument with someone with Alzheimer’s disease so relent, throw in the towel, and return to being that serene, supportive friend. You may need to remind other family members to avoid confrontation as well. There may be pressing issue about long-term care and future health choices that need to be discussed, but yelling about these solve nothing.

When the family gathering includes the above-mentioned conversations, be sure to include your loved one. Even in the deepest throes of dementia, the individual still possesses minutes, seconds, even milli-seconds of lucidity. No one likes being talked about or being talked over, so deliver this same dignity to someone with cognitive decline. Those with dementia can be amazing as well as wily, explaining or responding to one idea with clarity and to the next with utter bafflement. Grab the lucid moments and hang on to the treasure that they are.

Tips for Getting and Staying Connected

          Here are a few tips for getting and staying connected to enrich your body and your soul plus these can provide a tremendous surge in brain stimulation. First, nurture existing relationships as you cultivate new ones. You have to be a friend to have a friend so schedule time and energy to share with others. Remember, too, that there are many lonely people - become a friend to someone who needs one. You might just offer the magic elixir for good health.

          Schedule time for friends as you schedule private time for yourself. Life is busy - we can get going about 300 MPH and lose track of something very important - our friends. Call, set a time and place, then follow through. And sometimes, after all of those friendly visits, you just need some down time, time to think, reflect, take a walk, write a letter, or curl up with a cozy blanket and a wonderful book.

          As you find more time and energy in your life because of the way you have scheduled time and improved your life with good friends you will find to have time to volunteer. Volunteer to help out to the degree you feel willing and capable. Volunteer where your heart speaks and your soul directs -  at a school, for respite, to assist a friend.

          This next one comes almost automatically if you have followed the guidance of the aforementioned suggestions. Become involved and socialize. Doing something important adds life value and personal spirituality. You can and do make a difference.

          Perhaps one of your new goals (yes, yes, yes) is taking up a bit more physical exercise. Remaining physically active means that the more you do the more capable you become. Perhaps your new friend loves to bike. Maybe your old buddy is into weightlifting. Or maybe you are feeling brave and are ready to launch out into something new and different all on your own. Just do it!

           Empower your brain by taking a class, learning to play an instrument, or immersing yourself in a second language. A little challenge to your mind is a wonderful thing. Although at the outset you may sense some frustration, that's OK. It just means that your brain is filling to capacity with a super new subject or activity. This is good for you and promotes brain growth and mental power.

          No matter what you choose, your brain and your body will love these activities just as you will love yourself more!

Get Your Brain Activated

The following are some tips to keep your brain operating at maximum capacity:

•      Mental flex – keep your hands busy as well as your mind – knit, crochet, paint,   color…
•      Call a friend or family member today and share a happy story with him or her.
•      Tell the world why brain health is important to you and your well-being. 
•      Encourage friends to become involved with keeping a healthy, active brain
•      Enjoy a home-cooked meal - too much eating out is not good for your health
•      Get your body in the game - get rolling in some action
•      Do not be sedentary but rather be up and moving - good for the body and the      soul
•      Complete 3 yoga poses morning and evening plus 3 focused breathing sessions – in through the nose and out through the mouth for 1 minute.

Fully knowing and understanding your family medical history now – to the best of your abilities – will impact not only your health, but the health of most of your family members. You might know your family tree, but now it’s time to learn your family medical history. Schedule time to sit down with your relatives to learn more about the health risks you might face. Write down what you learn and keep a file for your records.