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Dealing with Depression

Have you been feeling anxious or blue lately, and you can’t shake that feeling? If

so, you’re not alone. One in five seniors has mental health challenges. It’s a

Canadian health crisis, yet we’re often hesitant to discuss it because there’s still

stigma, or negative stereotypes, around mental illness. Seniors face unique risks

for developing depression. As we age, we may feel increasingly isolated or lack

community support. A change in mental health could also be related to medical

conditions, reduced mobility, physiological changes in the brain, or life events

such as financial strain, the loss of a spouse or moving out of the family home.

People with a family history of mental illness, or who have experienced

depression before, are especially vulnerable. Late-life depression is not a normal

part of aging. Anyone experiencing symptoms such as a persistent depressive

mood, sleeping problems, changes in appetite, difficulties with memory or

concentration, negative thoughts, or thoughts of death and suicide should seek

help immediately. The majority of older adults respond well to treatment.

Seniors can also support their mental health by staying active, such as

participating in activities at their retirement home, exercising regularly and

socializing with friends and family.

Contact White Wings Home Care Services for more information

info@whitewings.ca

www.whitewingshomecare.ca

519-615-7621




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Home care clients who require urgent care need an alternative to the Emergency Department

Between 2008 and 2013, the number of Canadians receiving some form of home care grew by 55 per cent, to 1.4 million. And as our population continues to age, more and more Canadians expect that care at home will be a viable option. Since the beginning of many coordinated home care programs in the late 1980s home care clients have changed. They are sicker, frailer, more acute, and more complex. The challenge is that in spite of the growth in numbers and increasing complexity and acuity, home care programs are having to do more with less. Demand for home care is increasing, but funding has not kept pace. Although home care programs are seeing more clients who are sicker, the volume of service per client is shrinking in order to keep up with this growing demand.  If home care is to be sustainable in this environment, we need new and innovative options to adequately address care needs in the community.

Home care programs offer sophisticated care and effectively manage complex conditions and multiple chronic conditions. However, there are times where a more acute event, a decrease in health status, or a need for more intensive observation or intervention is required. Interventions that are not required, nor are they best provided, in an acute care hospital or busy emergency department. Yet because we do not currently have an integrated health care system, if someone currently requires more urgent intervention for a condition that is not life threatening, there is little option other than going to an emergency department.

A promising alternative to the current situation is a transitional or halfway hospital. A transitional hospital could serve a population in a geographic area in an integrated manner when they are already a part of a home care program. A home care client may have fluctuating levels of health and need an urgent intervention, but not necessarily from an acute care hospital. For example, a frail elderly person who suffers from a short-term illness like a virus that creates a state of dehydration or electrolyte imbalance that cannot be fully managed at home and requires a short term intervention. There are a myriad of other health concerns that are urgent – but not emergencies -, that lead home care clients to seek hospital care because there are no intermediary options.

This kind of solution exists in many parts of Sweden. A transitional short stay (24-72 hours) unit designated just for home care clients—for clients known to their team and connected to their team – a truly integrated system. Such an option could be offered in Canada. There would of course be parameters around the type of concerns that could be seen and how many over-night stays could be accommodated. In a transitional, or half way hospital, the services provided would be much less intensive than the hospital would provide, but more intensive than home care can provide. Most often the individual might require frequent intervention for a few days such as IV antibiotics, comprehensive wound care, or monitoring of a frail elderly person for a few days. Home care provides regular but episodic care whereas in a transitional hospital care would be more regular and could support integrated care; at least for home care clients. Monitoring and decision making by a health care professional such as physicians or nurses or more frequent observation by a regulated professional would be possible. This level of care would be less expensive than occupying space in an emergency department or in an acute care hospital and being seen by member of the health care team would be expedited because the client is already known to the team. This would be the case in an integrated system.

In Canada, this level of care is only available in acute care hospitals. In many cases clients with complex chronic conditions recognize a problem they are experiencing that requires intervention. It is time for some creative problem solving and decision making if we hope to create a sustainable health care system into the future. . It is time to stop doing things the same old way in home care programs—after 30 odd years it is time for a change.

Kimberly D. Fraser is a professor in the Faculty of Nursing at the University of Alberta.

Dementia Care Do’s & Don’ts: Dealing with Dementia Behavior Problems

By Sarah Stevenson

Alzheimer’s behavior, Alzheimer’s disease, dementia, dementia care

Mid-to-late stage dementia and Alzheimer’s patients often present challenging behavior problems for their caregivers.  The anger, sadness, paranoia, confusion, and fear they’re experiencing can result in oppositional, aggressive and sometimes violent speech or actions.  Read about some things people with dementia say, understand why they’re saying it and learn which strategies are most effective in dementia behavior management.

Communication difficulties can be one of the most upsetting aspects of caring for someone with Alzheimer’s disease or some other type of dementia—and it’s frustrating for the patient as well as for loved ones. Although it can be hard to understand why people with dementia they act the way they do, the explanation is attributable to their disease and the changes it causes in the brain. One concrete step you can take to make communication easier is to familiarize yourself with some of the common situations that arise when someone has dementia, so that if your loved one says something shocking or puzzling, you’ll know how to respond calmly and effectively.

Common Situation #2: Aggressive Speech or Actions

Examples: Statements such as “I don’t want to take a shower!”, “I want to go home!”, “I don’t want to eat that!” may escalate into aggressive behavior.

Explanation: The most important thing to remember about verbal or physical aggression, says the Alzheimer’s Association, is that your loved one is not doing it on purpose. Aggression is usually triggered by something—often physical discomfort, environmental factors such as being in an unfamiliar situation, or even poor communication. “A lot of times aggression is coming from pure fear,” says Tresa Mariotto, Family Ambassador at Silverado Senior Living in Bellingham, WA. “People with dementia are more apt to hit, kick, or bite” in response to feeling helpless or afraid.

Ann Napoletan, who writes for  Caregivers.com, is all too familiar with this situation. “As my mom’s disease progressed, so did the mood swings. She could be perfectly fine one moment, and the next she was yelling and getting physical. Often, it remained a mystery as to what prompted the outburst. For her caregivers, it was often getting dressed or bathing that provoked aggression.”

DO:  The key to responding to aggression caused by dementia is to try to identify the cause—what is the person feeling to make them behave aggressively? Once you’ve made sure they aren’t putting themselves (or anyone else) in danger, you can try to shift the focus to something else, speaking in a calm, reassuring manner.

“This is where truly knowing your loved one is so important,” says Ann Napoletan. “In my mom’s case, she didn’t like to be fussed over. If she was upset, oftentimes trying to talk to her and calm her down only served to agitate her more. Likewise, touching her–even to try and hold her hand or gently rub her arm or leg–might result in her taking a swing. The best course of action in that case was to walk away and let her have the space she needed.”

DON’T: “The worst thing you can do is engage in an argument or force the issue that’s creating the aggression,” Ann says. “Don’t try to forcibly restrain the person unless there is absolutely no choice.” Tresa Mariotto agrees: “The biggest way to stop aggressive behavior is to remove the word ‘no’ from your vocabulary.”

Common Situation #2: Confusion about Time or Place

Examples: “I want to go home!”, “This isn’t my house.”, “When are we leaving? Why are we here?”

Explanation: Wanting to go home is one of the most common reactions for an Alzheimer’s or dementia patient living in a memory care facility. Remember that Alzheimer’s causes progressive damage to cognitive functioning, and this is what creates the confusion and memory loss. There’s also a psychological component, says Tresa: “Often people are trying to go back to a place where they had more control in their lives.”

DO: There are a few possible ways to respond to questions that indicate your loved one is confused about where he or she is. Simple explanations along with photos and other tangible reminders can help, suggests the Alzheimer’s Association. Sometimes, however, it can be better to redirect the person, particularly in cases where you’re in the process of moving your loved one to a facility or other location.

“The better solution is to say as little as possible about the fact that they have all of their belongings packed and instead try to redirect them–find another activity, go for a walk, get a snack, etc.,” says Ann Napoletan. “If they ask specific questions such as ‘When are we leaving?’ you might respond with, ‘We can’t leave until later because…’ the traffic is terrible / the forecast is calling for bad weather / it’s too late to leave tonight.”

“You have to figure out what’s going to make the person feel the safest,” says Tresa Mariotto, even if that ends up being “a therapeutic lie.”

DON’T: Lengthy explanations or reasons are not the way to go. “You can’t reason with someone who has Alzheimer’s or dementia,” says Ann. “It just can’t be done.” In fact, says Tresa, “A lot of times we’re triggering the response that we’re getting because of the questions we’re asking.”

This was another familiar situation for Ann and her mother. “I learned this one the hard way. We went through a particularly long spell where every time I came to see my mom, she would have everything packed up ready to go–EVERYTHING! …Too many times, I tried to reason with her and explain that she was home; this was her new home. Inevitably things would get progressively worse.”

 

Common Situation #3: Poor Judgment or Cognitive Problems

Examples: Unfounded accusations: “You stole my vacuum cleaner!”

Trouble with math or finances: “I’m having trouble with the tip on this restaurant bill.”

Other examples: unexplained hoarding/stockpiling, repetition of statements or tasks

Explanation: The deterioration of brain cells caused by Alzheimer’s is a particular culprit in behaviors showing poor judgment or errors in thinking. These can contribute to delusions, or untrue beliefs. Some of these problems are obvious, such as when someone is hoarding household items, or accuses a family member of stealing something. Some are more subtle, however, and the person may not realize that they are having trouble with things that they never used to think twice about.

According to Ann Napoletan, “There came a time when I began to suspect my mom was having problems keeping financial records in order. At the time, she was living independently and was very adamant about remaining in her house. Any discussion to the contrary, or really any comment that eluded to the fact that she may be slipping, was met with either rage or tears. It was when she asked me to help with her taxes that I noticed the checking account was a mess.”

DO: First you’ll want to assess the extent of the problem. “If you’re curious and don’t want to ask, take a look at a heating bill,” suggests Tresa Mariotto. “Sometimes payments are delinquent or bills aren’t being paid at all.” You can also flip through their checkbook and look at the math, or have them figure out the tip at a restaurant.

The Alzheimer’s Association says to be encouraging and reassuring if you’re seeing these changes happen. Also, you can often minimize frustration and embarrassment by offering help in small ways with staying organized. This is what Ann did for her mother: “As I sifted through records to complete her tax return, I gently mentioned noticing a couple of overdraft fees and asked if the bank had perhaps made a mistake. As we talked through it, she volunteered that she was having more and more difficulty keeping things straight, knew she had made some errors, and asked if I would mind helping with the checkbook going forward. I remember her being so relieved after we talked about it.” From there, over time, Ann was gradually able to gain more control over her mother’s finances.

DON’T: What you shouldn’t do in these circumstances is blatantly question the person’s ability to handle the situation at hand, or try to argue with them. “Any response that can be interpreted as accusatory or doubting the person’s ability to handle their own affairs only serves to anger and put them on the defensive,” says Ann.

Are you a caregiver or family member of someone with dementia? Do any of these situations sound familiar? We want to hear your stories, too—please feel free to share them in the comments.

Dementia Care Dos & Don’ts: Dealing with Dementia Behavior Problems by Sarah Stevenson

Sarah J. Stevenson

http://www.aplaceformom.com/blog/2013-02-08-dealing-with-dementia-behavior/