By Tammera J Karr, Ph.D., FAAIM, BCIH, BCHN ©2016
Many of you may have childhood stories like my husband and father of baldfaced hornet encounters. When these stories are being told, there is always someone who steps in the nest first who walked away relatively unscathed, while others are repeatedly stung and attacked.
Dealing with difficult family affairs, especially those involving the elderly can hold these moments as well. What is the old proverb – good intentions pave the way to hell. Those dealing with difficult, at best seniors, siblings, spouses, or even live-in care providers, will have moments they question their sanity for agreeing to be the “responsible one.” There are volumes of unknown laws, considerations, and medical pitfalls for the elder person to live with and for the designated family members to navigate – often under extream stress.
This is a perfect storm for migraines, high blood pressure, ulcers, IBS, insomnia, panic attacks, stroke, heart attacks and those are just the family members, not the elders. With seniors, it becomes easy for them to be over medicated, loss of appetite, outbursts of tears or anger, retreating into themselves, incontinence, or personal endangerment with erratic decision making.
The best-laid plans of mice and men, all of a sudden change, rapidly when you decide to bring mom or dad into your home. They actually go out the window if your elders are more than you can handle, and they must be placed in a memory care facility for medication and mental evaluation against their will. These are the times it is important for you to have documentation, be prepared for allegations of elder abuse, neglect or miss appropriations of resources; waged by other family members or even the elder in question.
Now, this certainly isn’t the case for everyone, but trust me there are those out there who have had their lives turned upside down by situations like these. Family caregivers begin reacting not responding to the crisis at hand, later regretting some of the decisions made in the heat of the moment. Relationships can be irreparably damaged. Some of this could be avoided with careful planning before saying yes to our loved one’s requests to care for them, or before asking someone to care for you.
Everyone reading this who has elder family members or spouses should begin with attending classes on planning for the senior years. Classes are often free and offered through churches, senior services, and the veterans administration. Learn how to set up medical information portals to review medical records including medication lists. Ask questions about credit scores and banking liabilities before agreeing to be involved with financial decisions. And if it is a married couple needing simultaneous care investigate conservatorships, powers of attorney, medical guardianship’s, and advanced directives; all carefully before a crisis happens.
Talking but not heard, may be the case for both the elder family member and for those caring for them. This was brought more fully to my attention by Therese Johnson, Gerontologist, and Senior Care Consultant. Therese stressed the importance of validation communication with older family members. She directed my attentions to the work of Naomi Feil and her book the Validation Breakthrough ; Validation is a way of communicating with older adults with Alzheimer’s-type dementia. This approach reduces stress, enhance dignity, and increase the happiness of the elder family member and those caring for them.
Since its inception in 1989, Validation has helped thousands improve their relationships with loved ones with dementia. Caregivers who use these techniques validate older adults’, rather than focusing on disorientation and confusion.
Research in the United States and Europe show trying to make older family members deal with the realities of what is happening, which can push them farther into disorientation and confusion, isn’t the best approach; it is better to talk to older folks in a different fashion, which allows them to come back to reality through validating their frustration, anger, fear and sense of loss. Many individuals in their seventies are then able to resume their lives with modest supervision.
Now I’m not known for my patience, which may mean my personality is not well suited as a caregiver. All the more reason to do homework before saying yes to that special older person.
When caregivers are under the hornets-nest-stress, they often look to foods to sooth, which in turn can create health problems for the care provider. Muddying ones ability to think clearly, support energy and healing ability of the body. Here is when others can be so invaluable to the struggling caregiver. Friends and family can provide nourishing food, and provide opportunities for caregivers to have safe conversations to detox from the problems of the day. Nothing can refuel the exhausted caregiver as efficiently as a nourishing meal with laughter .
Here is to transition without the sting.
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Part Three
We have had numerous road trips to central California since March 2016 to help elder family members. But in May, we brought the Aunt and Uncle home with us. During this time, our focus has been on their needs and helping them regain some of their mental and physical strength. The care of elder family members was not new to us, but, and that is a big but, everyone is different, and the experience was vastly different from our time with the Mother-in-Law.
I caught myself wondering if there was an owner’s manual to cover real life challenges for both parties of this story. Anne, a friend of ours in Texas said to me – “girl, you need to write a book on this.” Anne is now approaching her 50’s, and lives with her aging mother; she has lived through a multitude of life changes with family and clients. “No one has written about what it is like in the trenches,” she said to me…. “It is easy to see why family just dumps their older parents in care facilities, that way they don’t have to deal with the messy parts of aging.”
Some of the messy parts of aging involve adult diedies (diapers) as my Uncle calls them, then there is the other favorite “nose papers.” I learned the importance of providing my Uncle with a masculine carrier for his emergency needs – no man of his generation is comfortable carrying a flowery bag or shopping bag into a public restroom. It is hard for them to maintain their dignity when they are faced with incontinence, especially when they are slower moving and unstable. The length of time required for them to navigate to the bathroom, clean, change and straighten themselves is exhausting. The need to remain independent runs deep in many elder family members and the barging-in of an inpatient caregiver, to help them hurry up, in the bathroom is mortifying.
I selected a small easy to carry backpack in black for my uncle with a larger area for the diedies and flushable wipes. The outer smaller pocket was perfect for the medication or test kit he would also need, and the mesh side pockets kept water and smoothy bottles easy to access. Now he can walk into a public area prepared without embarrassment. Oh and I also stocked it with pocket-sized nose paper (kleenex) for the weepie dry eye or blueberry stain on his nose.
We learned the 
importance of having a trash can large enough to handle unmentionables with a lid in the home bathroom. This allowed for odor control, privacy, and convenience.
Change is never easy; it is especially hard for the elderly who have cognitive elasticity challenges (memory and anxiety), the change of purses, wallets, coats, shoes or suitcases may place your elder family members in a tailspin. The Aunt has used a black leather purse for decades, a well-meaning family member gave her and insisted she uses a bright flowery summer bag. For two weeks the Aunt searched each day for her purse where she knew all her valuable information and stuff was kept. Each day we would retrieve her new bag for her and remind her this was hers now. The anxiety was evident and potentially unnecessary. One day she couldn’t remember where her little Yorkies leash was (it was in her belly bag), it took until the next day for her to recover. For the first two weeks, the Aunt believed she didn’t have any clothes to change into because the suitcase in her room was green. Her suitcase was red, once we learned this, we quickly changed her clothes into a red suitcase we had on hand– she was fine after that.
Sundowners syndrome: making changes later in the day can be the hardest. For most of us, sunset isn’t a problem; it is a time to unwind and relax. For family members with Alzheimer’s or dementia, it can be a time of increased memory loss, confusion, agitation and even anger. Witnessing this increase in symptoms of disorientation at sunset can be troubling, painful, frightening and exhausting for family and caregivers.
Common Sundowning Triggers:
Too Much End-of-day Activity: Some researchers believe the flurry of activity toward the end of the day may lead to anxiety and confusion. We personally saw this to be true.
Fatigue: End-of-day exhaustion or suddenly the lack of activity was also a contributor.
Low Light: As the sun goes down, the quality of available light may diminish, and shadows may increase, making vision even more challenging.
Internal Imbalances: Hormone imbalances or possible disruptions in the internal biological clock that regulate cognition between waking and sleeping hours is also a principle cause.
Winter: The onset of shorter days exacerbates sundowning, we also saw the changes in weather from sunny to stormy increased symptoms. Depression is a major challenge for those with memory issues.
Suggested reading:
Grace and Grit: Insights to Real-Life Challenges of Aging for Adult Children and Their Parents By Fritzi Gros-Daillon
How Hard Could It Be?: A Caregiver’s Story By Margaret Sheehan
How To Fold Superman’s Cape: A Woman’s Guide To Elder Care by James Burns Jr.
The complete elder care planner: For caregivers of aging parents or other family members by Joy Loverde
To a grace-filled elder life transition.
Part Two
by Tammera J. Karr, PhD, BCHN, BCIH
Two years ago, we said yes to an elderly family member when they asked if we would help them when the time came. We knew from past experience that this could mean trying times for both our elder family members and us, some of you like us may say – “what was I thinking?” There may be days when you repeat yourself twenty times or days you hear the same stories over and over, deal with tears and anger. These are the days when Gods grace and peace will be your closest friend – that is once you can take a moment to recognize it’s presence.
These are the times sleep may be the most elusive for both you as a caregiver and for your elder family members. The change in environment can bring about increases in insomnia, pain, listlessness, confusion and short tempers. When sleep is in short supply it has an effect on cognitive functions; words may escape you, forgetfulness and spaciness may be your daily or weekly companions. Along with this may come an increase in headaches, blood pressure and cravings for sugar, salt and even alcohol. These are all ways of self-medicating in an effort to relax. The downside is food just like drugs never actually provides the relief hoped for.
There is research available today showing the benefits of L-theanine for the support of sleep architecture. L-theanine comes from green tea; Theanine is a constituent believed to counter-balance the stimulatory effects of the caffeine content in tea. Theanine comprises approximately 1% to 2% of the dry weight of tea leaves; theanine is also present in Xerocomus badius (a type of mushroom).
Theanine lowers blood pressure in hypertension patients, prevent ischemic stroke and minimize memory impairment after the occurrence of stroke. Theanine increases alertness, is used in the prevention and treatment Alzheimer’s and various subgroups of dementia; L-theanine has been found to be useful in the treatment of anxiety; due to its ability to generate (relaxing) alpha waves in the brain and increase attention span.
We can’t overlook the food component of elder care. Food doesn’t have to be bland, but it has to be something our seniors are willing and able to eat. I like spicy food, my Aunts and Uncle do not. For them, simple peasant foods that are flavorful but not spicy are the better choices along with healthy protein sources and vegetables. Most seniors do not require three full meals a day, but rather small snacks and two meals. For those who are diabetic or concerned about memory challenges, selecting low glycemic foods and following a paleo dietary plan reduces inflammation and erratic blood sugar spikes. Don’t overlook the need for healthy fat; the diet should contain 15% saturated fats from real butter, animal and plant sources. With the remaining 15% coming from avocados, olive, nuts, seeds, and fish. Fat is crucial to blood sugar regulation and in maintaining weight for an elder who are borderline sarcopenia. Both fat and protein play key roles in the utilization of neurotransmitters necessary for cognition and memory.
As daytime temperatures increase, pay close attention to water consumption and sodium, low sodium levels and dehydration are common causes of memory loss and confusion. The standard of care is to restrict water for those with low sodium. However, this may be counter-productive and should be discussed with healthcare providers to be sure it is the best option for your senior and their health.
Minimizing inflammation is a huge part of dietary concerns for elder family members. While meat and potatoes may be the foods they want most, they can also be what is causing increases in pain for them. Gout is caused by sugar, processed flour, red meat and some fish like salmon high in purines. Here is when tart cherries come to the rescue for many. Cherries are highly beneficial for those with inflammatory illnesses, in side by side studies with prescription anti-inflammatory medications the cherries outperformed the prescription drugs and had no side effects to cause additional challenges.
While some may have a passionate relationship with the divine, others may be agnostic, or atheist. Often religious beliefs are varied within a family and can be a source of conflict. For me it isn’t about what church you go to but whether you have faith. During my mother-in-law’s final days, we knew she was set in her agnostic beliefs, instead of brow beating her or asking her to change her thoughts we prayed in quiet for a peaceful passing, which she had. A relationship with our maker is a private one; his grace is there for the asking, and you as the caregiver may be in the greatest need.
To a grace-filled elder life transition.
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by Tammera J. Karr, PhD, BCHN, BCIH
Part One
Life is ever changing, and with it are unexpected surprises and challenges. This spring has reminded me of this, as an elderly Aunt and Uncle have moved back to the west coast and have been needing help getting settled. This event has reminded me of the changes and challenges we went through when my mother-in-law moved in with us. The trials are never one-sided; they affect everyone in the caregiver/elder relationship. No matter how much you may love your family, no one can push your buttons like that of a parent or sibling.
Not everyone is well suited to being a caregiver, and often times those who are caregiver’s burnout or collapse from the “stress” of always being alert or vigilant to the needs of their charge. New parents go through this, then as time passes a balance – new normal settles in. This process isn’t quite so easy when it comes to our elder loved ones.
Our parents or older charges have lived life, been independent, functioning, and in charge for years, unlike children. They have moved and shaken business’, communities and shaped the world we live in. For them, the loss of independence is heartbreaking, frustrating and depressing. The realization they are in the final portion of their journey through life makes for anger, fear and confusion. As their bodies fail to answer their commands, their minds rebel – you see they mentally do not feel like an “old man or woman.” I distinctly remember my mother-in-law saying to me; “ it makes me so damn mad, my brain isn’t any different than when I was in my forties, but my body has betrayed me.”
When older family members move in with you, they have given up a big chunk of themselves in order to have your help and safety. They balk at “your rules” just like any normal adult would do, and while some may thrive on being “cared for” like a child others begin to resist and respond with anger. This creates confrontation and stress for everyone. The older family members have to change their schedule to suit whomever it is they are living with, and this is not always easy – years or decades of habits may be in conflict with what you as the caregiver feels is correct.
Equally, the caregiver has their privacy, independence, work schedule and life altered. Often times the caregiver is a family member in their early fifties, they were planning for retirement and all the things they have always wanted to do; or they are at the peak of their career and soon feel overwhelmed by the addition of care responsibilities – these responsibilities often come hand-in-hand with those already involving college-age children. As modern adults, we have a lot going on, sometimes too much, and it is impossible for us to wish for the good ol’ days because we don’t really have the same history as a different generation like that of our parents. My Aunt Linda shared with us the following – “Your memories are not the memories of those you are caring for”. If they are not correct by your recollection, it is ok; you can still enjoy them”. Frustration is not just reserved for the caregiver. However, there are times you will want to pull your hair out or wring a neck.
No matter how much you may love those in need, there are times the situation or person may be “toxic” to you; not everyone can be a care provider, and it is important to know and be willing to ask for help. My Aunt and Uncle have always been very independent and in charge of their life journey. Today may be a good day, or it may be a bad day, but it is their day just the same. It isn’t one I have to fix; it is one I am willing to share with them and help them through. As appointed caregivers we help family members find a compromise – whether it is in regards to the amount of support they need or finding the right place for them as individuals to live were full-time care is available. They need to feel they can trust, just as much as you need to feel you are doing the best for them. Be willing to allow your elder family to settle be involved with making the decisions in regards to their care and personal routine; don’t assume you know best and forced them to your will.
Our own fears over our family members wellbeing and safety will cloud our thought process and as care providers if we are not careful; irreparable damage to our relationship with our family may occur. I tell my clients; Consider carefully how you want to be remembered and remember your loved ones. The choice is all in your hands.
To a peaceful life transition.