Caregiving

Lactose Intolerance Can Sneak Up on Elders

By Carol Bradley Bursack -
 

Dear Readers: Several years ago, I used this space to highlight lactose intolerance, an issue many older adults face. Due to some recent questions, I felt it was time, once again, to share some anecdotes regarding this sometimes hidden problem.

Many of our elders enjoy milk, ice cream and other dairy products. In general, dairy products can provide valuable nutrition and needed calories, but dairy products contain lactose, a milk sugar that requires the enzyme lactase for proper digestion. Even people who’ve enjoyed dairy products for decades can gradually lose their ability to produce enough lactase to digest milk or other dairy products. When this happens, abdominal discomfort and diarrhea can result.

My 80-year-old neighbor, for whom I was a primary caregiver years ago, provided me with some education in this area. During one of our daily chats he confided to me that he was experiencing severe diarrhea. I was concerned about the many serious health issues someone his age could have, so I scheduled an appointment for him to see his doctor. His primary physician then scheduled him for a number of tests, all of which proved negative.

Since my neighbor seemed to have no alarming medical issues, I thought that an experiment was worthwhile. Lactase drops had recently become available over the counter at the pharmacy. The only dairy product that my friend consumed regularly was milk for his cereal, so I purchased some lactase and added the appropriate number of drops to my friend’s weekly quart of milk. Problem solved. He was able to enjoy his morning cereal and milk with no adverse effects.

Unfortunately, the source of lactose isn’t always this obvious. A reader wrote to tell me that his wife had suffered lactose intolerance for years, but had successfully worked around the problem. However, after his wife was diagnosed with Alzheimer’s disease, she was given new medications. She then began suffering from severe diarrhea.

“After fighting the problem for many months,” he wrote, “we found out that some of the medications she is on contain lactose. Not only that, lactose is considered to be a non-active ingredient, so it is not usually listed in the ingredients.”

The reader suggested that people who suffer from lactose intolerance ask a pharmacist to check all of the ingredients in their medications, including the non-active ones. The solution for this woman was to continue to take her medications, but to take a lactase enzyme pill at the same time.

Digestive issues can be a symptom of many serious illnesses, so always check with the doctor if your elder develops diarrhea or other severe digestive problems. If no other cause for digestive discomfort is evident and the doctor doesn’t suggest lactose intolerance, bring up the possibility. This is one of those health issues that can begin with such vague disturbances that it continues undetected for quite some time. Lactose intolerance can be managed once it’s discovered, but it may take some detective work. Remember to read labels on food items, as well. Some prepared foods also contain lactose.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

Caregivers Strive For Balance in Life

 
By Dr. Marion Somers, Ph.D.  -
 

As a caregiver to an elder, it is common to feel out of sorts due to caregiving duties combined with work and family obligations. Working caregivers everywhere need to strive for balance in their lives. It is important to try and eat right, exercise regularly, maintain a social life, be productive at work, and set aside the right amount of time for your family, all while being a caregiver. I get dizzy just thinking about it, but you can do it. It’s not hard to spot when a working caregiver is out of balance. They might gain or lose weight, abuse alcohol or drugs, perform poorly on the job, and even neglect their own family. Being conscious of this will help you avoid the dangerous pitfalls.

Sit back and think about what you like to do. What makes you feel good? Then go do it.  Maybe buying a new suit, getting your haircut, or going hiking or fishing in the wilderness does the trick for you. Many people like to go for a bike ride, see a movie, or go out to a nice dinner with friends. Whatever it is, you have to set aside time for yourself or you risk becoming so rundown that you will not be able to be present for your elder loved one, your family, and/or your co-workers.

As a working caregiver, you have to focus on what keeps you physically, mentally, spiritually, and emotionally charged. If you neglect even one of these four areas, you can become out of balance and begin to break down. You cannot expect other people to take care of these needs for you. Most people are trying hard just to meet their own needs. So take a long, honest look at yourself and move forward. Set realistic new goals and try to meet them. Correct any problem areas starting today, and caregiving will soon become a much easier challenge.

Learn more about Dr. Marion on her bio page. Find more articles by Dr. Marion here or find other articles for caregivers in the Caregiving section of our Library.

A version of this blog appeared on Dr. Marion’s Web Site.

Resources for Long Distance Caregiving

Helping Aging Parents from a Distance is Challenging

By Carol Bradley Bursack - 
 

DEAR CAROL: I live 500 miles away from my aging parents. They are starting to need some help, but they don’t want to move to be near me. My husband and I can’t quit our jobs and move back to our home town, either. How do I go about looking for help for Mom and Dad from so far away? – Lori

DEAR LORI: One option is to look for a geriatric care manager in your parents’ community. Hiring a geriatric care manager can run into some serious money, but a care manager should be well acquainted with resources available locally for your parents. Some care managers will work directly with your parents, even managing medications. Others will provide research and oversight, but not be involved with any hands-on care.

Geriatric care management is a relatively new field. At this time there’s no control over credentials, but many people who become geriatric care managers have social work or nursing backgrounds. The website for The National Association of Professional Geriatric Care Managers is www.caremanager.org. If you’re interested in this option, the NAPGCM website is a good place to start.

Another excellent resource for you is the Administration on Aging website at www.aoa.gov. There is significant information on the AoA site as well as a link to the Eldercare Locator. The Eldercare Locator, also accessible at www.eldercare.gov, will help you find resources by typing in your parents’ Zip code. If you prefer to talk with someone on the phone, call (800) 677-1116.

Other resources can be found on your parents’ state website. Type the name of their state into your Internet browser along with “aging.” Your search should pull up many helpful links to direct you to resources. Every state has a version of the Nation Family Caregivers Support Program, which can also be found on the state website.

If either of your parents have a disease such as diabetes or arthritis, there are disease specific websites you can locate with just a little searching on the Web. An additional website for resource questions is the Community Resource Finder at www.communityresourcefinder.org.

It’s important that your parents appoint you or someone else they trust as Power Of Attorney for financial purposes as well as health care. If this legal work hasn’t been done, you may need to visit an attorney with them.

None of these resources take the place of family members and friends. It would be nice if you could contact some of your parent’s friends to check in on your parents regularly. Also, of course, do try to see them yourself as often as possible. You can’t control everything that happens to them, but you should visit often enough to keep tabs on their general welfare, and if possible, accompany them to some medical appointments to stay aware of their medical needs. This is time you’ll never get back, Lori. You can “manage” from afar, but it takes personal touch and eye to eye contact to really connect.

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Helping Mom Move on after Dad’s Death

By Carol Bradley Bursack - 

DEAR CAROL: Dad was sick for a long time before he died three months ago. Now, without Dad around, my sisters and I notice how much Mom has aged. We’d like Mom to move from her house into assisted living, because caring for the house is too much for her and she just stares at the TV all day. She says she’s not ready to move. How can we help her make the change? – Shawn

DEAR SHAWN: Long-term marriages often evolve into an efficient support system so it’s not unusual that your Mom’s aging was less apparent while your dad was alive. Likely, her grief over your dad’s death has taken a toll, as well. You may want to make an appointment with her doctor to rule out clinical depression or other issues just to be certain she’s okay.

I understand that you feel that your mom should sell the house and move, but try to be patient. This was her home with your dad. She may need several more months just to get enough of a grip on her life to think about moving. Unless her living alone is dangerous, don’t push too hard for a change.

Communicate with your sisters and see if there’s a way that you can split up time so someone can be with your mom often. Don’t force changes, but suggest one small step at a time. Maybe she will be able to slowly part with unneeded things around the house if one of you is there to help.

Do encourage her to have her legal papers updated as soon as possible. If your mother had your dad as her Power Of Attorney, she should now name one of you to take care of her financial and health interests if she cannot. If you bring this up gently, she may actually be relieved. If she says she can’t handle thinking about this now, set a date to discuss it again in a short while. Remind her that she wouldn’t have wanted strangers to make decisions about your dad’s health and she wouldn’t want that for herself. She needs to make sure someone who loves her can step in if needed.

Time is your friend. Pushing too hard for changes may emotionally paralyze her. Let her grieve. Occasionally test the waters with some suggestions. Perhaps, in a few months, you can take her to explore assisted living facilities so she sees people her age having a good time. If any of her friends live in a good retirement or assisted living center, recruit that friend to help with the transition.

Moving is a huge step for anyone. It’s even harder for someone who has suffered a life-changing event such as the death of a spouse. Compassion and patience will help you all get through this.

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Use Caution When Hiring an Independent Caregiver

By Carol Bradley Bursack - 

DEAR CAROL: My mom is 89 and lives alone. Considering her age, she gets along in her apartment quite well. She wears a personal alarm so she can get help if she falls, and I stop in twice a day. Still, I worry. I’d like to hire someone to stay with her, at least at night. Recently, I was introduced to a nice college woman who said she has a background in caring for the elderly. She’d be willing to move in with Mom and take care of her needs. Part of her salary would be room and board. She has references and the family likes her. Could this work? Mel

DEAR MEL: You’re talking about an arrangement that many people would consider ideal, and it could be, but please do your homework before making a decision. This woman may truly be an angel and you could develop a wonderful partnership, but your mother is vulnerable, so it’s vital for you to be sure the caregiver is capable and trustworthy.

Good care agencies run a professional background check, plus they check references thoroughly. You should do the same. For the background check, don’t just rely on your computer search engine. Check state court records and general public records, as well. If you have a professional company run a check, you will likely get more complete results. Definitely validate her references, both personal and those she has given you, for her work with elders.

Even if this woman checks out wonderfully, and she likely will, you still need to understand that by hiring her, the state may consider you her employer. When you are the employer, you may need to pay into Social Security and worker’s compensation for your employee. You can find more information on the IRS website about independent contractors versus employees at www.irs.gov. You should also check with the Federal Department of Labor and your State Department of Labor for assurance that you are in compliance with laws regarding domestic workers.

I am not trying to dissuade you from hiring this woman. The partnership could work out beautifully. If she can be considered an independent contractor, you may not need to worry about liability and Social Security taxes, but for your own protection you need to be certain about the procedure.

You can find additional information through the Private Duty Homecare Association at www.pdhca.org or the National Private Duty Association at www.privatedutyhomecare.org. The sites, of course, are biased toward their members, but you may find them helpful.

At the very least, I’d suggest that you do a background check, a reference check and call the state’s Department of Labor for information about state laws. A live-in caregiver where everyone benefits can be ideal. You just want to make sure you have a truly honest, caring person living with your mom. Carol

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Dr. Travis Stork interviewed about obesity and fitness

By Carol Bradley Bursack

Dear Readers: Do you or a loved one use age as an excuse to not bother with taking off weight? In a recent phone interview with Dr. Travis Stork of the television talk show “The Doctors,” I asked how we can encourage our aging loved ones to lose weight and exercise when they say it’s too late to do much good. Stork responded with an amused chuckle, saying that he hears that excuse “all the time.” He then went on to say “I don’t care if you’re 90… it’s a medical fact that it’s never too late to change behaviors.” He added that diet and lifestyle changes had “almost an immediate impact on quality of life and that saying it’s too late is medically inaccurate.”

During the month of May, “The Doctors” is focusing on obesity and lack of exercise as important causes of many serious health problems. They’ve dubbed the month “Get Moving May.” Educating overweight viewers to reduce their weight through a healthy diet and sensible exercise is the goal.

Stork is aware that many people hate exercise and most people hate diets. He doesn’t advise extreme workouts unless the person does this type of exercise for enjoyment, and he strongly opposes fad diets or diets that limit nutrients. What does he advise?

  1. Walking. Stork says that if people walk briskly for 10 minutes after every meal they are getting their 30 minutes of exercise without drastic change.
  2. Mindset. Stork says we should find a type of exercise we enjoy and can sustain. Our mindset is important so we need to set realistic goals and care about ourselves enough that we want to feel better and be healthier. Walking or bicycling (Stork’s exercise of choice) can include friends and family if the social aspect keeps people motivated.
  3. Standing. We need to stand more and sit less. Pace while we use the phone. Consider standing in line at the grocery store exercise. Stand to visit with your neighbor. Just being on our feet burns significantly more calories than sitting.
  4. Diet. Don’t try to change everything at once. Work with food preferences. Stork has mid-western roots and noted his preference for “meat and potatoes” rather than vegetables. He mentioned that he and his fiancé puree vegetables and then add them to marinara sauce for their pasta.
  5. Water. Stork suggests that we drink water before meals. He said that it’s been shown that people who drink a glass of water before eating will consume 20% fewer calories during the meal.

Summarizing Stork’s advice is simple. Take baby steps toward increasing exercise and diet and you’ll gain immediate health benefits. If you then build on your efforts you will enjoy long-term health benefits.

You are a wonderful daughter to care so much.

Learn more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Daughter Feels Guilty for Dreading Time Spent with Her Mother

By Carol Bradley Bursack

Dear Carol: My 92-year-old mother is being eaten up by dementia and I am struggling with guilt because I dread visiting her.

She lives in an assisted living center, which she likes, but there is no memory unit and not a lot of hands-on help. I try to give her the personal care she needs, but she hates having me assist her. She often insults me, which is unlike how she used to be. I know she acts this way because of her dementia, but I cannot help but dread my time with her.

I never thought I would feel this way about my beloved mother. At times her old self seems to shine through, though not for long. I know I should cherish this time with her, but I do not. Then guilt eats me up. What is wrong with me? – Renee

Dear Renee: You have no need to feel guilty for a very human reaction to your mother’s cognitive decline. I think it is safe to say that most people who have cared for someone with dementia, or even someone who continues to decline in other ways, would have times where we dread visiting them and seeing the painful changes.

There is often tremendous grief for adult children as they watch the parents they once depended on become physically and/or mentally frail.

When dementia enters the picture and our elders no longer seem to act as “themselves”, our distress can escalate. The child inside of each of us still wants to please our parents. When our loved one has dementia, we often do not get the feedback that we are seeking. Instead, we can be faced with complaints, and for some people, even verbally abusive outbreaks. It is as though we are being scolded for wanting to help and we cannot quite get it right.

We need to remind ourselves that our elders are in distress. Confused, frightened, in mental and/or physical pain, he or she acts out in a very human way. Complaints, frustration, anger and other negative emotions can take over our time spent with them. We take this acting out personally, which is understandable, but it is generally not meant that way.

It sounds from your letter that perhaps it is time for you to hire an in-home agency to go into your mother’s assisted living center to provide more care, or if she qualifies, a nursing home may be better. Making these changes will keep your mother safe and well-cared-for and leave you to do smaller things that may please her. You will be able to be her daughter again, and not just her caregiver.

You are also smart to recognize the precious moments when your mother shines like her “old self,” even if those moments are brief. You will treasure those instances long after she is gone.

You are a wonderful daughter to care so much.

Learn more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Daughter Cannot Trust Mom Caring for Dad

By Carol Bradley Bursack

Dear Carol: My mother and I do not get along. She is manipulative and often nasty to me, so I have had to distance myself from the chaos. I keep intending to walk away completely, but I cannot do that because I want to help take care of my dad, or at least spend time with him.

He has Alzheimer’s and does not even know who I am, but I do not entirely trust my mother with him. I am not sure he is being cared for properly. If I ask questions about his care, or just day-to-day issues, she thinks I am criticizing her and emotions escalate. If I try and turn away, I get the martyr routine. I remind myself that this is not about us, it is about my dad, but it remains hard. Any advice? – Monica

Dear Monica: This is a tough, emotional situation and, unfortunately, not uncommon. My first thoughts are about your dad. If you have serious concerns about abuse or neglect, you need to call Social Services and ask them to do a welfare check.

If your concerns are not that serious, you will have to make choices. Trying to detach from your mother’s manipulation does require setting some personal boundaries. You will need to learn not to fall for your mom’s martyr routine or any other manipulations if you want to stay close to your dad.

Your mom may feel threatened when you try to help with care. Try to give the way you approach your mother some thought. Past hurts involving your relationship are likely still interfering with your relationship today. Are there any instances you can think of where you could apologize to her? I realize that this may seem unfair, and that some people have personality disorders that make it nearly impossible to get along with them, but occasionally reaching out in a non-threatening way can help people unite over a common objective.

Is it possible for you to get some counseling to help you vent your feelings and learn how to handle your issues with your mother so you can help care for your dad? Do you belong to a spiritual organization? A leader there may be able to help you. If you belong to a church, they may have trained Stephen Ministers who can listen to you and give you encouragement.

You are trying to do the right thing. A trained third party may be able to help you learn how to detach compassionately from your mother’s manipulations. You may also learn more productive ways to approach your mother.

Acquiring these tools could help you tread this delicate area and make it easier for you to help your dad. Good luck.

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Dad’s Obsession over Wallet and Paying Bills Caused by Alzheimer’s

By Carol Bradley Bursack - 

Dear Carol: My dad has Alzheimer’s and lives in a very good nursing home. We visit often. What I’m wondering about is his habit of repeatedly taking his wallet out of his pocket and emptying out the contents. He then carefully puts everything back. He also tries to pay the nursing home staff when they help him. Telling him everything is paid for simply doesn’t work. Any insight? Julie

Dear Julie: I can say with confidence and sympathy that I know what you are going through, and so do many others. The situation isn’t uncommon, particularly with men. After my dad’s brain surgery, meant to correct some effects from a WWII brain injury, left him with severe dementia, Dad became obsessed about his wallet and with paying for everything.

Like many men, Dad’s wallet seemed to signal to him that he was still a provider. The other issue associated with his wallet may have been that his proof of identity is carried there. His driver’s license (lapsed), his credit cards, clubs he belonged to – all of these cards would have his name on them. That could have been reassuring to him. I believe that is what your dad is doing – looking to reassure his identity. Understanding what your dad’s billfold means to him can help you better understand his behavior.

Dad, too, couldn’t understand that he was already paying for everything at the nursing home. Generally, when a staff member helped him with something, he insisted on paying them on the spot. He did the same at meals. He’d get so upset when we’d tell him everything was paid for that I wondered, sometimes, if he felt that he was taking charity. Even telling him that they put everything on a “tab” to be paid at the end of the month didn’t alleviate his anxiety.

We tried leaving a few dollar bills in his wallet so he felt as if he had cash, but the low denomination of the bills made him feel “broke,” so that backfired. Next, I dug around until I found some expired credit cards with his name on them, and closed the accounts, but he didn’t use them.

My most successful solution was to make him “business cards.” When someone helped Dad, or he ate a meal, he offered his business card as payment. That way he felt responsible, and also had an ID, so I think it helped both wallet issues. The staff members were most gracious about accepting the cards. They even recycled them in an envelope hung in the kitchenette.
You’ll have to experiment and see if any of these suggestions work for your dad.
Try to remember that this too will pass. Carol

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

The Wonders of Senior Creativity

By Dr. Marion Somers, Ph.D.  -

Creativity works wonders for the elderly. Whether it’s singing, painting, playing an instrument, dancing, or writing poetry or a journal, creativity keeps aging people in the here and now. I had one client I cared for, a man who appeared to be very “tough,” who started writing poetry at the age of 89. He entered a contest for poets over 75, and darn it if he didn’t win. His poetry changed the way he looked at the world – and himself, and it did wonders for his mental outlook and energy level.  Getting in touch with their creative selves will allow your elders to stay connected to the wonders of life. They might even draw on creative impulses and abilities they never knew they had, or just never had the time to nurture.

Creativity will also help tap into your elders’ long-term memories. Ask them about their favorite music. I always try to find songs from the era when my clients were 15 to 30 years old.  I’ll sing their favorite songs and even pass around sheet music so other family members can sing along. You can also use music as a way to introduce dancing to help your elders get some exercise. My clients often dig their heels in about exercise, but they usually love to dance.  Also, the creative juices flow more freely when a person is moving their body.

If you care for an elder who is confined to the house, you can always bring creativity to him or her. If a senior citizen is unable to write anymore, have him or her tell stories into a tape recorder. If the elder you care for likes to draw, make sure that paint, pencils, markers, crayons, and pens are available. Also, be sure to accommodate the little things, such as having enough light or providing a left-handed person with left-handed scissors. Many of my aging clients enjoy making collages out of old photos. I’ve also found that some elders enjoy making a family tree. The key is to have fun with it. Creative pursuits will give your elders something to look forward to and talk about with their friends and family. They might even better understand themselves or discover a new talent after all these years. You may also find that they’ll be in better spirits, enjoy improved mental acuity, have a better appetite, and be more social.

Learn more about Dr. Marion on her bio page. Find more articles by Dr. Marion here or find other articles for caregivers in the Caregiving section of our Library.

A version of this blog appeared on Dr. Marion’s Web Site.