Chair Exercises for Older Adults or those with Mobility Limitations

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Photo credit: jill111 – pixabay.com

I was approached by Joseph Jones at California Mobility to provide my recommendation on how to help an older adult with dementia stick to an exercise routine. My comments are in the article 21 Chair Exercises for Seniors: A Comprehensive Visual Guide.

This extensive guide on chair exercises for older adults (or anyone with mobility issues) includes easy-to-follow videos, helpful images, and lots of great tips on chair exercises. These exercises can be adapted for anyone! Please check out the article for helpful tips on keeping active, at any age.

Age well my friends!

Angela G. Gentile, MSW, RSW

 

 

 

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The Mighty Ant: An Anthology of Short Stories for Seniors

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I am a contributor to a collection of short stories, called The Mighty Ant, edited by Jessica Bryan. This collection will delight anyone who enjoys reading or being read to.

My two stories include “You are Never Too Old” and “For the Love of Flowers.” These are my first attempts at short-story writing.

Here’s me reading my short story called “For the Love of Flowers.”

The book is in large print and is a fundraiser for the North Carolina Chatham County Council on Aging.

Get your own copy and enjoy reading and sharing with others! The stories are also great conversation starters!

Happy reading!

Angela G. Gentile

 

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Angela G. Gentile, B.S.W., M.S.W., is a registered social worker and is employed as a Geriatric Mental Health Clinician in Winnipeg, Manitoba. She is married to Agapito and has two adult children, Lorenzo and Simone. Angela enjoys writing, reading, and travelling and considers herself a realistic optimist. For more info: www.AngelaGGentile.com

“The Memory Keeper” Will Touch Your Heart and Tickle Your Funny Bone – Book Review

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Five Stars *****

JESSICA BRYAN’S SWEET AND HUMOROUS ACCOUNTS of life with her 99-year-old mother who has Alzheimer’s disease will touch your heart and tickle your funny bone. Jessica states there is never a dull moment in the Bryan household, and you will be entertained as she writes about her experiences in an easy-to-read, conversational tone. Jessica believes “When things get too heavy, you just have to lighten the mood.”

Although it is heart-wrenching when she writes about her mother “disappearing moment by moment, memory by memory,” her stories will encourage you—knowing that caring for a loved one who has Alzheimer’s has its rewards and there is humour to be found in any situation. The photos sprinkled throughout add a beautiful, personal touch. Anyone who values the importance of love and caring for one another in difficult times (especially caregivers and family members) will enjoy reading “The Memory Keeper” (2018).

Available in Kindle and paperback on Amazon.

Angela G. Gentile

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide,” “A Book About Burnout: One Social Worker’s Tale of Survival,” “How to Edit an Anthology: Write or Compile a Collection that Sells,” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and has two adult children. For more information, visit: www.AngelaGGentile.com

Call For Submissions for Upcoming Book on Anal Cancer

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Call for Summary/Ideas – Deadline for Submissions December 10, 2017

Re: Anal Cancer (AC) Book – A Collection Compiled by Angela Gentile (title to be determined)

 

Dear Potential Co-Author,

This is your chance to become a published author and to help you promote any other work you may have (books, blogs, etc.). Your contribution to this book on anal cancer will provide your invaluable insight, advice and support to others who may be going through something similar. It could help end the stigma of this disease and educate others on the importance of the HPV vaccine.

I am putting together a collection of works by many authors. I have written two other books and they are both on Amazon. This will be my first “anthology.” This book is intended to educate, inspire, strengthen and empower those affected. I am looking for chapters written by anal cancer patients/survivors/caregivers.

At this time, I am looking for 10-20 authors to provide a total of 10-20 chapters for this self-published book. I will put my time, money and energy into making this a meaningful book for those who are affected by anal cancer. It will also be of interest for those who want to learn more about the disease. If you are successful in being selected as one of the co-authors, I will help you write and refine your chapter(s) and I will also have it professionally edited.

There is no cost to you, and there is no compensation (other than knowing you will be helping others!). However, I will ensure you get two copies of the paperback book. Additionally, a portion of the proceeds will go to charity, and we will decide which one.

I have put together a listing of chapter ideas for you to review (see FILES in the closed members only Facebook group: AC Book or ask me for a listing). If you would like to do something else that is not on the list that is fine, too.

Please submit the following information via the form below, or ask me for my email address:

1. Your Name, Full Address, Phone Numbers (Home, work, cellular), Email.

2. Summary of your idea (up to 500 words). You can submit as many summaries as you’d like. Include the topic, what you want the main points to be, and whom you think will benefit most from your story or topic. The more personal and original the better! (Have a friend or family member review and proofread if you’d like a little more feedback before submitting.) Keep in mind, your completed chapter should be between 2,000 – 5,000 words.

3. Deadline for summary submission: Sunday December 10, 2017. Submit via email in form below. (.doc or .docx is acceptable. Google Docs is also accepted.)

If you already have a completed work (between 2,000-5,000 words), please feel free to submit that instead of a summary. Ideally, each chapter will be about 2,500 words but this is only a guideline.

I will review the submissions and get back to you, either way, on or before January 7, 2018.

Thank you for your interest and I look forward to your submission(s)!

Warm regards,

Angela Gentile

P.S. If you have a Facebook account and would like to be a part of the AC Book group, please request to join!

Contact me, here:

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and has two adult children. She is creator of the Facebook communities – “Aging Well for Women” as well as “God, Cancer and Me.” For more information, visit: www.AngelaGGentile.com

Ways to Improve Your Memory Skills Podcast Interview

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I had the pleasure of being interviewed by Kathe Kline in March 2017 for the Rock Your Retirement Show and it went live on 23 Oct 2017. Have a listen to my 30-minute audio only podcast (it’s like a radio show) to hear me talk about various topics including tips on how to improve memory skills. You can play it off your device, or download and listen to it later. There is a freebie on this as well, you just have to sign up to get a copy of it (see link below).

Link to the interview – Ways to Improve Memory Skills

Here are links to the show in popular smartphone apps:

iTunes

Stitcher

iHeartRadio

I have also provided a Freebie for the listeners – Five Strategies to Help Improve Memory Skills.

After you’ve had a listen, please feel free to comment on the Rock Your Retirement Show interview link page (see link above), or down below, here. Or just send me a personal note.

About Rock Your Retirement and Kathe Kline.

Rock on!

Angela G. Gentile

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Angela G. Gentile  MSW, RSW is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and has two adult children. She is creator of the Facebook communities – “Aging Well for Women” as well as “God, Cancer and Me.” For more information, visit: www.AngelaGGentile.com

 

 

 

Learn About Burnout at the Transform Conference

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From Burned Out to Fired Up!

Angela G. Gentile MSW, RSW

I am honoured to be one of six guest speakers at the Transform Conference to be held on February 21, 2017 in Winnipeg, Manitoba. I will be presenting on my knowledge and experience with job burnout and compassion fatigue. In addition to discussing the issues of the costs of caring too much, I will share my personal story of burnout. I will offer advice, tips and solutions to nurses, social workers, healthcare professionals, students and other helping professionals on how to recognize, cope and survive in the demanding yet rewarding field of healthcare.

What better way to learn. Be inspired. Some consider it a gift from a wounded healer.

You may also want to read my eBook, “A Book About Burnout: One Social Worker’s Tale of Survival“. Paper copies will be available at the conference.

For more information on Transform, the conference, please visit Sycamore Care.

www.AngelaGGentile.com

 

 

This Self-Help Book for Caregivers Educates, Supports and Comforts

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When I titled my book “Caring for a Husband with Dementia: The Ultimate Survival Guide” (2015) I did not expect to have people mistakenly assume that I am a wife caring for a husband with dementia. The warmth and sympathy I receive from people who don’t know me personally has been incredible. I gently explain that I am not a wife caregiver and that the book is inspired by the experience I had in counseling eight amazing caregiving women.

When I was deciding on a topic for my master’s degree final project, I decided to focus on older women. I explored what issues are affecting them, and the subject of caregiving came up quite often. I did some research on the subject and discovered that there was very little written about women who care for husbands with Alzheimer’s or a related dementia. My career as a geriatric clinician and social worker exposes me to many different mental health issues, and dementia is unfortunately a common one. I quickly became an expert in assessing and screening for dementia, and recognizing the symptoms of caregiver stress and burnout.

The short-term, individual counseling program I designed, implemented and evaluated with eight caregiving wives was very rewarding and successful. It inspired me to want to help others like the women I had learned so much from. What started out as a small booklet turned into a 16-chapter book. “Caring for a Husband with Dementia” was written specifically to help women who care for husbands who have been diagnosed with a dementing illness such as vascular dementia or Alzheimer’s disease. I dedicated this book to caregiving wives, everywhere.

Writing this book came surprisingly easy to me. I called it a “Divine Intervention.” I received help from colleagues and other experts in the field who generously donated their time reviewing, editing and offering feedback. It is a unique, informative and therapeutic self-help type of book. The book offers opportunity to make it personal for the reader. There is space for self-reflection on important questions. Don’t know what to “Google” to find your local resources? I’ll help with that, too. There is a listing of helpful and important resources, plus more.

All of the reviews and feedback I have received thus far has been very positive. Some of the more helpful feedback has been that this book is written not only for wives, but for all caregivers. I have been told this book is like a bible and it is kept at the bedside and is read every night. It’s a reference guide, a companion, and a source of education and support. It’s like a year’s worth of therapy all in one book.

I know this book has helped spouses and other caregivers. They have told me, “Everything I was thinking, feeling and wondering about was written in this book.” I am honoured to be able to help those who are struggling with the issues of diagnosis, getting help, difficult behaviours, grief and loss, legal issues and more. I have been at book signing events where even men say they want their wives to buy this book as they want them to be prepared – “…just in case.”

My hope is that this book reaches those who are in need of education, support and tips on how to survive the difficult task of caring for a loved one with dementia. It is also a great gift for someone in need.

Angela G. Gentile, MSW, RSW

Link to original article on #AlzAuthors, published 23 Nov 2016.

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

Twelve Areas to Consider When Thinking About a Retirement Community with Lifelong Services

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Image courtesy of powerbee-photo at FreeDigitalPhotos.net

(This article has been written with guest blogger, Alan Wolkenstein MSW, ACSW)

As family members age, there may come a time when an older person’s needs can no longer be met in his/her current home. It may be unsafe, there may be too many worries, or it may be stressful for all involved. For example, if Mom and Dad lived in their moderate-sized bungalow for the past 40 years, things may change dramatically when one of them passes away. Maybe Mom is now left in this house on her own, and she is overwhelmed with all there is to do. Even with family support, and the supports from other agencies and programs, Mom is still not being cared for the same way she was when dad lived with her. Although Mom does not want to move from the home she has known for so many years, sometimes a move to a more supportive environment is needed. Having this discussion can be difficult.

There are many issues that can arise with respect to an aging family member and housing needs. Illness, finances, mobility, socialization, recreation and access to services are some of the issues that may have to be considered. How does one make the right choice? Should the older family member stay in the house longer, or move to an appropriate “elderly persons housing”? Maybe he/she should move to a retirement community, or a place that also has lifelong service options. Should the person move to a 24-hour care facility like a nursing home? A good quality of life is usually the overall goal.

Conversations About Moving Can Be Difficult

Conversations about relocation may become uncomfortable and anxiety-provoking because they usually consist of making major changes in where one lives, relationships and even in family dynamics. The older person him/herself or other family members may be thinking about these issues, but the conversations may be avoided in order to prevent upset or problems in the relationship. We already know that everyone seems to have a slightly different opinion on the subject.

For those directly involved, the stakes are very high, and previous attempts to have such conversations may have not turned out very well. People can feel unsure of themselves and the older adult may experience that their own wishes may be disregarded by their children who push for changes to ensure a more safe and healthy environment. Relocation usually involves downsizing, a major disruption, adjustment issues, loss, and a change in daily routines. Ultimately, it should also come with benefits that outweigh the negatives.

This may be the first time adult children have seen their parent(s) unsure of themselves, possibly afraid of the future, and even angry or refusing to participate in these talks. It seems that no matter what is decided, many feelings may be hurt and someone will feel disregarded and not appreciated for their wishes.

Conversations About Moving Can Be Welcomed

However, in many situations, the family discussions around this topic go well. For example, an older adult may want to move on. In this case, the family can come together with a unified plan that seems positive and helpful to the whole family. Then the issues become where to look, how to assess, and when to choose a place.

Making Decisions Regarding Housing Needs Can Be Confusing and Complex

For others navigating the housing dilemma, the situation is confusing and complex, and there seems to be no way to satisfy all. In the end, no one feels or experiences satisfaction. If an older person moves into a retirement community following this scenario, the likelihood of a successful adjustment is deeply compromised.

Many situations regarding decision-making related to relocating an older family member require and benefit from professional intervention. Professional assistance could come in the form of:

  • helping the older person and his/her family members choose a suitable place
  • mentor and support the family so they can choose for themselves
  • help them sort through the levels of conflict

12 Areas to Consider When Choosing Seniors’ Housing

The following are a number of questions to be used as a working outline in maneuvering through these scenarios. Each requires input and shared conversation with a guide or mentor to monitor and direct the conversations and the powerful emotions they generate. In order to get answers to these question, you (the person seeking housing and/or the person’s advocate) will have to make arrangements for tours and meetings with key people. A trusted professional or seniors’ organization can help you get a list of possible options to choose from. Keep a log of the answers so when decision time comes, you will have some notes to look back on. The questions are not listed in any rank order of importance, but as they come to our mind as we have worked with older adults and families during these potentially troubling and stressful times. As always, take with you what seems most helpful to your unique situation. Note: These questions are written for the person who will be moving. Sometimes a trusted family member or advocate (someone who knows the older person very well) can assist through this process.

1. Costs and how they will be paid for. Remember that the highest cost establishments may not be the most rewarding one. Many have entrance fees that may or may not be refundable in some degree if you leave or pass on. All require fees for their services. Ask if there are any move-in incentives. What is included in the costs (i.e., meals, housekeeping, recreation, etc.). Do they have a free or low-cost “trial stay” option? In the United States, some may take Medicare. In Canada, some of the facilities may be government subsidized. Get the facts down right. Higher cost is not always an indicator of better service and dedication to you. You may also want facts about the establishment’s financial health to guarantee their viability.

2. Location, location, location. How far is it from your family and friends? How close or far are familiar places such as services, restaurants, theatre, clubs, church or synagogue? Are there plans to establish all these in the retirement community once there, or will your time be split? Remember that connection with important people in your life is a definite component of good quality of life.

3. Values and commitment. Ask the management or representative at the establishment about values and commitment to each person. Get this from the people you talk with, not the brochures they send out. While it is good to talk to folks who are available to talk and share their experiences there, they will probably have you speak with the most satisfied members.. Ask for a list of complaints they have received and dealt with. Seek a place that shares your values about what is important in your life and maintaining a high quality of life: continuity here is also important to your quality of life. Ask what procedures are in place to ensure they uphold their commitment to these core values. Ask how these core values are implemented and evaluated. Are they open to improvements? Is there a “Comment Card” system where the residents/tenants can forward their comments and concerns anonymously? Alternatively, what avenues are in place to motivate, celebrate and encourage outstanding service and achievements by staff?

4. Religious affiliation is only part of the equation. Try not to select by religion alone. You may find the system falls far short of meeting your overall needs. While many families share they receive much comfort if the community is of their religion, this does not guarantee a successful placement.

5. Processes in place to ensure a warm welcome and adjustment. What processes are in place to help you or your loved one transition into their system and become part of their “community”? Who is the “go-to” person if there are questions?

6. Supports to help with the adjustment. How will they assist you or your loved one in coping and adapting to their environment? You or your loved one may find it more complicated and anxiety-provoking to move through the process of adjusting there. Who are the staff and what are their qualifications to do this with you or your loved one?

7. Availability of care and counseling after a major life stressor. Many people and families seek out a place following a serious loss to them, such as death of a loved one; illness; financial problems; or diminished ability to provide activities of daily living (ADLs). Attempting to adjust now can strain an individual’s ability to cope and adapt. How will the community provide care and counseling? Does administration view the need for counseling as necessary for enhanced quality of life for some tenants/residents? Is this included in the overall fee? Is it an add-on expense? If counseling is an additional expense (versus an available built-in service), administration does not view this need as a normative cost to them.

8. Counseling and advocacy for relocation concerns. Most people have some degree of ambivalence and uncertainty about such an important move. Who is there to smooth the way and champion their concerns?

9. Counseling for family members. What family counseling services are available to your family? Not all of us have made our amends with our family, dealt with the issues that cause us strife and worry, and resolved any family guilt or anger between members.

10. Regular assessments to assist with adjustment. Are there regularly scheduled assessments of how you or your loved one is coping and adapting? Who are the people and what are their qualifications?

11. Health services. Your health is crucial. How do they incorporate physicians, nursing, and allied health services into their system?

12. Future care needs. What does the facility offer in terms of long-term care needs? Do they adhere to an “aging in place” concept? Meaning, if your health or condition declines, do they continue to support you in their facility, or do you have to move again? Ask them how long you could stay, and what are the reasons you may be asked to leave (“Exit-criteria” or reasons for “eviction”).

We have listed for you 12 areas of concern we feel are important. There are certainly more and some may be equally as important or more important that any on this list. Think for a moment what they might be for you or your loved one. You may be surprised how these questions and concerns bring other ones to the surface. For example, is there a pet involved? Is the pet welcomed?

Reconsidering a Move

What if you began to rethink about your loved one remaining in their home? What services would they need? What services would they accept? Where would the funds come from? Is this just a temporary measure, and if so, would it give everyone time to breathe easier and simply let the person remain in his/her home for a little while longer? Would this be reasonable for a family with many different opinions? Would it be reasonable for an older person who may perceive these service providers as strangers intruding their home further solidifying their sense and awareness of growing frailty and needs?

Seek Professional Consultation

Consider a consultation by a specialist during this challenging time. Seek out someone who has the experience and expertise to guide you and your family with and through this process. Meeting with this person can illuminate a path that you may not have thought of, and provide guidance to see you through.

Many older adults and their families find selecting appropriate seniors’ housing and the accompanying transition somewhat stress-free. Many do not. If your loved one or family is finding this transition difficult, there is help available. There are many fine people in the community to serve you. Start by discussing with your loved one’s mental health professional or doctor. Start by making an appointment.

We wish you and your family well.

Alan S. Wolkenstein, MSW, ACSW
Clinical Professor of Family Medicine (Ret.)
University of Wisconsin School of Medicine and Public Health
Wolkenstein and Associates, LLC
Mequon, Wisconsin, 53092
Alan.Wolkenstein@gmail.com

Angela G. Gentile MSW, RSW
Specialist in Aging

 

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Angela G. Gentile  MSW, RSW. is a clinical social worker and author of the book, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband and two adult children. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

When Confusion is Confusing: Older Adults and Delirium

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Delirium – Photo Credit: Angela G. Gentile

I have been a geriatric mental health clinician since 2010. One of the most complex and perplexing conditions that I have seen in those 65 and older is delirium. Of the troubling “3Ds” (Delirium, Depression and Dementia) often found in the geriatric population, it is easier for me to identify depression and dementia because of the psychological and behavioural features. To complicate matters, these 3Ds can also overlap.

Delirium (or “sudden-onset confusion”) has it’s own unique features, and it affects people in different ways. It is one of those conditions that doesn’t have a specific laboratory test, and takes at least 24-hours of observation to detect.

Watching a loved one in a delirious state can be very distressing. I have interviewed three women (Mary, Donna and Emma) and I will share their stories of delirium and their older family members. I hope it will help you if you or a loved one happens to be in a similar situation (I have changed all the names to protect privacy).

Delirium is often unrecognized and often misdiagnosed as depression or dementia.

Delirium is a common, serious and frightening brain disorder. It is also reversible in most situations. It can also be life threatening. I have seen how delirium affects people. I remember assessing a woman in a nursing home who was about 80 years old, “picking” at the air. It struck me how inattentive she was. Another man, about 90, was walking around in his apartment complex, oblivious to me as I was trying to get his attention.

Delirium is a medical emergency and requires immediate medical attention.

Delirium is a confused mental state that causes problems with thinking and speaking. A hallmark of the condition is “inattentiveness” with a fluctuating course. The cause of delirium can usually be determined (not always), and it is often medication side effects, infection or some other medical illness that causes a disruption in normal thinking patterns. It usually comes on quite suddenly. It often leaves suddenly as well. In some older people it is harder to detect, especially if the person already has an underlying cognitive impairment such as Alzheimer’s or another related dementia.

Delirium often comes on suddenly. Sudden changes in behaviour or mental functioning requires medical attention.

Some health care professionals also find it difficult to determine if the person is having a sudden-onset of mental problems because of dementia or a medical problem such as a stroke (like in Emma’s story, below). Sometimes it takes a bit of guesswork because there isn’t a “delirium blood test” that can be taken to determine if the person is experiencing delirium.

Health care professionals can be helpful, as in Mary’s story, or unhelpful as in Emma’s story. Delirium can come at the end of life, as you will learn in Donna’s story.

There are three subtypes of delirium: Hyperactive (restlessness, agitation, hallucinations), Hypoactive (drowsy, quiet, confused), and Mixed (both hyperactive and hypoactive).

“The Confusion Assessment Method (CAM) is a quick way to determine if the person in question may or may not be experiencing delirium:

Ask these questions, and answer to the best of your ability (scoring information below):

1. Acute (comes on quickly) change in mental status and fluctuating (tends to come and go) course:

a) Has there been a sudden change in the person’s thinking and usual behaviour?

b) Does the unusual behaviour fluctuate or change during the day? (i.e. tends to come and go, or increase and decrease in severity, periods of clarity mixed with confused episodes)

2. Inattention: Does the person have difficulty focusing attention or become easily distracted? (i.e. has difficulty keeping track of what is being said, can’t concentrate)

3. Disorganized thinking: Is the person’s thinking disorganized or incoherent (doesn’t make sense)? (i.e. rambling speech or irrelevant/unrelated conversation, unclear or illogical (nonsensical) flow of ideas, or unpredictable switching of subjects)

4. Altered level of consciousness: Is the person appearing as anything besides normal alertness? (i.e. vigilant/careful/watchful or hyper alert; lethargic/lazy/sluggish or drowsy but easily aroused, stuporous/lazy or difficult to arouse/awaken/excite, comatose/unconscious or unable to arouse).

Scoring: The diagnosis of delirium requires the presence of features 1 and 2 and either 3 or 4.

Mary’s Story – When Delirium is Diagnosed in Hospital

Mary’s mom and dad are up in years. Her mom is 87 and her dad is 97. Dad is a very healthy and active senior who still participates in many social activities, including driving. Mom has mild-to-moderate dementia. Dad is her primary support, while Mary and her sisters help with caregiving tasks.

One night, Mary stayed with her mom because her mom was experiencing pain due to compression fractures in her back (she also has osteoporosis). Her mom, who is a petite lady (112 lbs.), was taking one Tylenol #3 every four hours. In the night, her mom was unable to follow commands to walk with Mary’s assistance to the commode. She noticed her mom had a “blank look” on her face. Her mom was scared. Things didn’t seem right to Mary. She decided to call 911. The paramedics assessed her and Mom was transferred to the hospital via ambulance.

Delirium often occurs in people with other conditions such as dementia or depression. It is often difficult for health care providers to determine the reason for the changes in behaviour or mental functioning.

While in hospital, pain control was a main issue, so they gave her Percocet and Hydromorphone. These are strong painkillers, both in the opioid class of medications, also referred to as narcotics. Mary explained her mom’s behaviour:

  • Soon after, her mom was shrieking, her eyes looked “wild”, she was paranoid – but couldn’t really say what she was afraid of.
  • Her hearing was super-sensitive (hyper alert), although she had a hearing impairment.
  • She was hallucinating and saw a waterfall coming from the ceiling.
  • Her paranoia escalated and she asked her family members if they were afraid too.
  • Her hallucinations continued and she started picking at imaginary things in the air.
  • She took off her gown and her adult brief.
  • She had periods of lucidity (thinking clearly).

This went on for three weeks.

Mary says it is very hard, emotionally, for her and her sisters to see her mother, who is such a modest person, act in a way that is so out of character. She said she sees occasional glimpses of her mother, then she “disappears.” Her mom knows there is something wrong, but she can’t figure out what it is.

I asked Mary what the medical professionals told her about what was going on with her mom. Mary said it took a couple of days before she could convince them that this was not her mom’s typical behaviour. This was not how her mom usually acts, and it was different from her mom’s dementia-related behaviour. She says the hospital staff were very good, and explained that her mom was experiencing a delirium. They were also suspecting she may have had a small stroke.

Delirium can last days, weeks or months.

I asked Mary what advice she has to give others who are going through a similar experience. She told me she wishes she had advice. She is still trying to figure it out. She goes to see her mom, and they try to be there with her. Sometimes she’s mad at them. Sometimes she cries. Sometimes she fixates on things. She can be good in the morning, then confused in the afternoon. The hospital floor she is on has people that are calling out, screaming, walking the hallways and are agitated. This is not helping matters.

Mary says she advises family members to ask the health care team questions. How long will she be like this? What happens if mom doesn’t improve, then what? Unfortunately, they may not have all the answers either.

Sometimes the cause of delirium is never determined.

Mary said her dad has been very quiet throughout all of this. He visits as often as he can, and talks to her on the phone. He worries about her, but doesn’t talk about it to Mary and her sister.

Mary’s advice is, if your loved one has delirium, educate yourself on the subject. Read books, do some research and talk to the professionals. She says we “figure it out day-by-day, hour-by-hour.”

Both Mary and her sister Wendy say it’s so important to be an advocate for your loved one. She says it’s okay to ask the doctors and nurses what is being planned, or what medications will be given to your loved one. She says numerous people have told her such as her doctor, nurses and friends that she needs to look after herself, too. She says it’s hard. “It’s hard to find time for myself. Sometimes I wake up in the morning and I ‘hit the wall.’ There are some days where I just cry and sleep because I feel so overwhelmed.”

Both Mary and Wendy wonder why the emergency doctors don’t have more insight in terms of the best practices when working with the elderly, especially in terms of medications. They feel geriatric specialists should be consulted more and the emergency doctors may require more training in this area.

A few weeks later Mary is relieved as her mom’s condition is improving. She was transferred to a geriatric rehabilitation ward where she is receiving excellent care. She states her mom’s memory is perhaps a little worse than it was before her hospitalization. She is still a little delirious, and they think she may have had another stroke. But overall, “She is much more like our mom, and that is great.”

Emma’s Story – When Delirium is Not Diagnosed

Oftentimes even health care professionals don’t recognize delirium. Sometimes they don’t listen to family members as well as they should, either. In Emma’s case, her mother Nellie went to a long-term care facility due to complications from a stroke she experienced when she was 78. Her condition resulted in frequent trips to the hospital. Emma looked after her mom for over a year before she went into a long-term care facility.

Emma had negative experiences with both the long-term care facility and the hospital regarding how they handled her mom’s sudden-onset confusion while ignoring the concerns from family. Emma suspects many of the difficulties her mom was experiencing were related to delirium, although a doctor never diagnosed it.

“Hospital visits were painful, difficult, frustrating and sometimes harrowing experiences.”  – Emma

Emma accompanied her mom to the hospital on all occasions. Emma states her mom was “handled poorly once delirium began.” She explained the doctor or nurse would often assume her mom had “full-blown dementia” and they would “no longer consult” with either Emma or her mom regarding reasons for the visit. Doctors seemed to be indifferent for the cause of her mom’s sudden confusion and determined it was dementia-related behaviour. There was never a diagnosis of delirium given to Emma, her mom or other family members.

The delirium-related symptoms that Emma’s mom had while in hospital were:

  • Struggling to get out of the stretcher repeatedly/constantly
  • Seeming to have no idea where she was or why she was there
  • Attempting to get people to help her “escape”; i.e. she would say, “Let’s say we’re going to the washroom and we can leave.”
  • Crying and sobbing; high emotional distress
  • Indications of increased pain

Emma also mentioned what she believes to be misdiagnoses her mother was given. Her mom never had a psychiatric diagnosis in her 80 years. She was surprised to find out that her mother, now in her 80’s, had been diagnosed with schizophrenia and another time she was diagnosed with bipolar disorder by the doctor at the long-term care home.

“Be alert to sudden changes in behaviour triggered by new medication or change in environment or emotional distress and keep a diary to track patterns and common themes related to the changes.” – Emma

A social worker by training, Emma did her research and read up on drug interactions and the impact they could have on her mom’s mental health. She began looking at the causes of sudden-onset behaviour changes and discovered delirium as a possible explanation.

Emma suspects it was some of the psychotropic or mind-altering drugs that were the cause of her mother’s delirious episodes. Medications that were in the antidepressant, benzodiazepine/anxiolytic, antipsychotic and hypnotic categories were all used both effectively and ineffectively in her mom’s case. Her mom found one of the anxiolytic and hypnotics helpful, but not harmful, in the end. It’s also important to note that some pain medications such as morphine and oxycodone (also called narcotics) can also cause delirium (as in Mary’s story, above).

Emma states throughout these experiences it’s difficult for her to put her feelings into words, but the experiences stay with her. “I felt helpless, useless, ineffective, frustrated, maybe even a bit hopeless about our system of care.” The other family members felt overwhelmed and torn in terms of what the doctors were saying and how they directed care. The family members found it difficult to vocalize their legitimate concerns. Ultimately, the family did not want to “make a fuss” and felt confused, distressed and frustrated.

“If you ever find yourself in a similar situation, to seek out a professional who specializes in studying, treating and diagnosing delirium.” – Emma

Emma advises if you have a loved one in a facility, or are considering a move to one, it is “critically important to know the possible side effects and adverse events related to psychiatric drugs; and to know the rate and use of psychiatric medications” in long-term care centres or residential care facilities.

Professionals such as geriatricians (doctors who work with adults aged 65 and older) and geriatric psychiatrists are two types of specialists who can be consulted to help sort out behavioural and mental health problems in older adults. Geriatric Mental Health Clinicians, or those who specialize in psychogeriatrics are also helpful in these situations.

Donna’s Story – Delirium at the End of Life

Delirium is common at the end of life. Donna had experience with knowing three people who became delirious. She said the behaviours were consistent in all three of them: “Extreme agitation, taking sheets and clothes off, in and out of bed and expressing the need to go home.”

Donna lost her dad a few years ago. Near the end of his life, he experienced delirium. The symptoms he experienced were heightened restlessness and agitation, pulling at his sheets and clothing, and constantly trying to get out of bed to “go home.” Sometimes he spoke incoherently and often he believed he was in a different time in his life. He was a firefighter and also used to sell cars.

Donna explains, “One morning he asked me if that guy had come to pick up his keys for his new car. When I told him he had, he settled down. Another day he was fighting fires and that is how it went. Sometimes we could not understand what he wanted if his speech was not clear and had to do our best to figure it out.”

The following is Donna’s advice to others going through this experience:

“I would say to just go with what is happening depending on the circumstances and do not make the person feel bad for whatever they say. If they are in the past, you need to be in the past, this is not a time to create more anxiety for the person. Also, recognize that even though they are delirious, they are still often aware of what is happening around them.

One time we thought my dad was not really with it and an old song came on the radio. We were all trying to figure out who sang it and he suddenly blurted out ‘Patsy Cline.’ This type of thing happened often and showed me how aware a person experiencing this still is.

Even when he seemed to be in a deep sleep or delirious, if my mom would take her hand away, his hand would begin to move around looking for her. We saw many signs that dad was still there even when in and out of delirium or coma. It is so important to be there for them and continue to do the things that make them comfortable.

This is not a journey we wanted or that anyone wants, but none of us would have missed taking it with dad for anything. We experienced great sadness, moments of joy, tears and laughter. I would tell anyone to allow themselves to fully engage in the process and do not be afraid to laugh – it is not inappropriate and not an insult to your loved one.”

What I Have Learned About Delirium

Delirium can last for days, weeks or months. It can recur in people who have had delirium in the past. Medications, illnesses (such as a urinary tract infection), dehydration, or sleep deprivation are some of the risk factors. When delirium is superimposed onto a dementia, it can also be difficult to sort out what is causing the confusion.

Evenings can be more difficult for a person with delirium. They may be more afraid or agitated for example (also called Sundowning or late-day confusion). Being with familiar people and objects can help, but it won’t make the symptoms go away. This can be very hard on family members.

When a person has delirium, it is very important to try and determine and remove what caused the delirium in the first place. This is not always possible. The delirium can clear just as quickly as it came, without any notice. It is not contagious, but I see it like a “little intruder” that invades the brain for a bit, causing all kinds of problems. Once the intruder is eliminated, or “burns out,” then things get back to normal. Sometimes there is a bit of a step-wise decline and there is a bit of a change in the person’s new normal, or baseline functioning. The person plateaus in terms of his or her thinking and functioning, but at a slightly lower level. Sometimes s/he gets right back to where s/he was to begin with.

Recovering from Delirium

People who are delirious need to be taken off medications that could be causing the problem. They need to be kept comfortable, safe, hydrated with proper fluids and fed with proper nutrients. If they are dehydrated, intravenous fluid administration (and electrolytes) may be required until they can tolerate oral rehydration (drinking by mouth). Make sure they have their eyeglasses, hearing aids and someone to interpret if required. They need to get up and walk around and socialize. They need frequent reminders of their location, and orientation to the time. Involvement of friends and family is important. They need to sleep. Their sleep patterns may be disrupted, so they will need daylight and activity during the day to help keep them stimulated (as tolerated). They may benefit from relaxation techniques such as music, massage or breathing exercises. They will need lots of tender loving care and close supervision. Encourage them to safely walk and do self-care with assistance if required. Aim for a normal sleep-wake cycle, having them sleep in a quiet room with low-level lighting. Discourage daytime napping. Offer a non-caffeinated warm drink at bedtime. Treat pain. It can last days, weeks or months.

According to the 2012 Beers Criteria, the following list of medications should be avoided, especially for those older adults who are already delirious or at risk for delirium:

  • All Tricyclic Antidepressants
  • All Anticholinergic drugs
  • Benzodiazepines
  • Chlorpromazine
  • Corticosteroids
  • H2-receptor antagonist
  • Meperidine
  • Sedative Hypnotics
  • Thioridazine

A low-dose of an antipsychotic medication may be prescribed temporarily to decrease severity and duration of delirium. Antipsychotics should be reduced after the severe symptoms of delirium have resolved with discontinuation as the ultimate goal (Forsberg, 2017).  However, a study on antipsychotics and those who are palliative (dying) revealed they can increase the symptoms of delirium (Agar, Lawlor & Quinn, 2017).

Unfortunately, delirium can increase the risk for developing dementia. Therefore, it is important to diagnose and treat as soon as possible. Delirium can also increase the risk for death.

Delirium prevention in older adults includes keeping on top of risk factors that may trigger an episode. Medication side effects, withdrawal, surgery and illness are all factors that can lead to delirium. The symptoms of delirium can be lessened by removing the cause, supporting good sleep and nutrition habits, helping the person remain calm and orientated, and helping prevent medical problems or complications. For older people who need to go to the hospital, this brochure on Delirium that may help.

A special thank you to the three women who shared their stories here in hopes of helping others.

Angela G. Gentile

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker and author of the books, “Caring for a Husband with Dementia: The Ultimate Survival Guide”, “A Book About Burnout: One Social Worker’s Tale of Survival,” “How to Edit an Anthology: Write or Compile a Collectino that Sells,” and the “Dementia Caregiver Solutions” app for iPhone and iPad. She lives in Winnipeg, Manitoba with her husband, daughter and two lovable dogs. She is passionate about all things related to Aging Well. For more information, visit: www.AngelaGGentile.com

For further information:

Delirium – Mayo Clinic

For more information on delirium at the end-of-life, check out this article on Mental Confusion or Delirium from cancer.net.

For Health Care Professionals:

Canadian Coalition for Seniors’ Mental Health – Tools for Health Care Providers: The Assessment & Treatment of Delirium in Older Adults and the Delirium Tool Layout.

Clarifying the Confusion About Confusion: Current Practices in Managing Geriatric Delirium

Delirium Treatment and Management

Delirium Update for Post Acute Care and Long-Term Care Settings – A Narrative Review by Martin Forsberg (2017)

Delirium in Elderly Adults: Diagnosis, Prevention and Treatment

The “Confusion Assessment Method” is a fairly easy and commonly used tool that has been written in 14 different languages. It is often used by healthcare professionals.

Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care: A Randomized Clinical Trial by Agar, Lawlor and Quinn (2017).

Senior Moments: Should I Be Worried?

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Although I don’t particularly like the term “senior moment,” most older people know what that means. When someone who is at middle age or beyond has difficulty remembering something such as, “Where did I put my reading glasses?” or “I can’t remember her name” he/she may find someone else responding in a joking fashion, “Are you having a ‘senior moment?'” The other person is replying with a joke about having a poor memory. I have heard people themselves make jokes about their own “senior moments” in hopes of making light of the situation. It’s true that as people age there are normally changes in memory and thinking skills. On one end of the spectrum there is normal aging that affects everyone. At the other end is dementia which is common but not normal.  In between is a condition known as mild cognitive impairment. I will touch on all three.

We all have memory lapses on occasion

It’s true we all have occasional lapses in our memory. I even see my teenage children doing it. I even remember walking into a room years ago, forgetting what I went in there for, having to go back to what I was doing in order to jog my memory. Little lapses in memory is common for everyone. We get distracted or side-tracked especially when it is something that is not really that significant. Forgetting names is a common occurrence for example.

I have been working with older adults for over 25 years now and I see all different types of memory and thinking problems. I also know many older people (including caregivers) who do not show any signs of cognitive (brain function) decline.

I often note increased anxiety in people who are struggling with the loss of cognitive abilities. It must be a scary feeling to know that they are losing their faculties.

One of the common fears people have is developing dementia. Declining memory skills are often one of the first signs of dementia. The good news is that memory problems do not always lead to dementia.

Normal aging, mild cognitive impairment and dementia

Slowed thinking and minor problems with remembering things is quite common and almost expected in our later years. There are some things we can do to help reduce our risks of further problems with our cognition such as exercising (to get the blood pumping to our organs including the brain) and doing brain exercises (such as crosswords and learning a new musical instrument). Normal aging causes us to slow down in more ways than one.

Sometimes our memory problems become more problematic and they are noticed by other people. If you are continuously forgetting someone’s name or miss appointments, this may start to interfere with your relationships and daily functioning. You may have to learn new ways of coping with the normal changes in your brain such as keeping lists handy and using your calendar more regularly. Memory and thinking problems that can be noticed by others but don’t really affect your day-to-day functioning is called Mild Cognitive Impairment (MCI).

By the way, it’s a good sign if a person is aware of or concerned about their changing memory skills as one of the skills lost in dementia is the ability to know they have problems with their memory. If you ask someone with dementia if he/she has memory problems, he/she will most likely say “No.” It’s true that long term memory may still be intact.  It’s the ability to remember recent events and learn new information that is lost.

In some cases your memory skills, thinking and cognitive functioning may be impaired to the point where you can no longer do things on your own. For example, you may need someone to give you your medication on a daily basis or else you will forget. Or you can no longer drive because your sense of direction is off. Dementia is a syndrome and can be found in a variety of conditions  that affect cognition (such as Alzheimer’s disease). In early stages of dementia you can  live on your own as long as you can enlist the support you need to keep yourself safe. Dementia can create a variety of problems. For example, sometimes people with dementia forget to eat, or think they have already eaten. In this case it’s important to have someone provide a reminder or stop by to ensure he/she eats. In the later stages of dementia, it is not possible to live alone.

Seek a memory assessment if you are concerned

If you are concerned about your memory skills or other brain-related functions (such as language, problem-solving or judgment skills), please speak to your doctor for a memory assessment. Let your doctor know if you are concerned your problems are beyond the changes seen in normal aging (such as slowed thinking, and the occasional difficulty remembering things). Only a skilled practitioner can diagnose and determine the difference between normal aging, mild cognitive impairment and dementia, and provide treatment and management solutions.

For more information, check out Aging, Memory Loss and Dementia: What’s the Difference? from the Alzheimer’s Association.

You may also like to check out Senior Moments Explained by Terry Hollenbeck, M.D.

 

Angela G. Gentile, MSW RSW

www.AngelaGGentile.com