Drinking and Dementia Don’t Mix: How Families Can Help

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Angela G. Gentile, MSW, RSW

People with dementia who are also experiencing alcoholism or alcohol abuse is a very challenging situation for family members to manage. Alcoholism speeds the decline in the skills needed for independent living, worsens behavioural problems, and raises concerns of safety for the affected family member and those living with/caring for them. This is in addition to the known health risks of alcoholism (e.g., cirrhosis of the liver, alcohol withdrawal syndrome and death).

Statistics reveal that 40% of adults 65 and over drink alcohol. We also know that almost 15% of older adults have Alzheimer’s disease or another form of dementia. The issues surrounding dementia and alcohol are becoming more prevalent as our society ages. We need to work together to find solutions to manage this difficult situation.

For families who are caring for a loved one with dementia such as Alzheimer’s, alcohol use becomes extremely challenging. The person is already impaired cognitively (in thinking, memory and processing information) and adding alcohol to the situation makes it much worse. A person with memory impairment may not appreciate how much s/he is drinking and will often neglect nourishment and basic hydration. It is even harder for family members to keep on top of things when the loved one lives independently. I have seen this problem in many settings such as when the person lives alone, or with family members, or in long-term care.

Family members ask what can be done. There are a few things that can be tried; however, there is not a clear-cut answer. I would like to share with you some of the common problems and solutions related to drinking and dementia.

Problems:

• A person who consumes a lot of alcohol on a regular basis may start to neglect his or her own hygiene and health care. Self-neglect is often the first sign that alerts family members that something is not right.

• Certain medications and alcohol do not mix. For example, a sleeping pill taken with alcohol can cause increased confusion. Be aware of over-the-counter sleep aides that often contain diphenhydramine (e.g., Benadryl).

• The person with dementia is already impaired — becoming intoxicated makes matters worse. Increased confusion, risky behaviour and falls can cause complications. Falling can cause bruises, cuts, sprains and fractures and can lead to hospitalization.

• Against his or her better judgement, an intoxicated person may decide to go for a drive. Remove the keys or disable the car if this poses a potential risk.

• If the person lives in a rental suite, s/he may face risk of eviction. If the person neglects to care for the home environment and/or him or herself, co-tenants may complain of fruit flies, rodents or odours (like urine due to mismanaged incontinence). Other tenants may not like the fact there are risks associated with the person smoking (fire hazard). The person with alcohol dependence may not pay the utility bills, or fail to pay rent. These are all grounds for eviction if the situation is not rectified.

• Some people develop life-threatening illnesses related to drinking, such as cirrhosis of the liver. They are told they should stop drinking, but forget that they were told. They may need to be in a 24-hour secured facility to keep them healthy and alcohol-free. This is only when deemed incompetent or incapable of understanding the risks.

• People with dementia and/or alcoholism may confabulate. This is when a person unintentionally lies about the facts. They appear to be telling the truth, but in fact, it is all made up. This makes it difficult for family members to trust their loved one and get a true sense of what is going on.

• Nutritional deficiencies can occur in people who have alcoholism. They tend to drink a lot of alcohol, but usually don’t eat enough foods containing thiamine, or vitamin B1. Thiamine is naturally found in fruits and vegetables. This continues to cause damage to the brain and body (Wernicke-Korsakoff Syndrome) which may be irreversible.

Practical Tips for Helping a Loved One with Dementia Stay Safe:

• Remove all alcohol from the home. If necessary, replace it with non-alcoholic beverages such as low-alcohol or non-alcoholic beer or wine.

• Put the person’s address on the “Do Not Deliver” bottle delivery list. Some bottle delivery programs will accept a letter from a doctor or another person in authority, such as the person assigned Durable Power of Attorney. Call your local liquor commission to inquire about this option.

• Let all other family members and friends know that you would like them to refrain from bringing alcohol to the person.

• Keep the person busy with other activities.

• Find out what is motivating the person to drink. Could it be loneliness, stress, anxiety, depression or grieving? Find solutions to these underlying causes.

• If possible, limit access to funds they use to pay for the alcohol.

• Contact your local addictions organization for more support. Join an Al-Anon Peer or Family Group.

• Know your limits as a family member/caregiver. Look after yourself first. The overuse of alcohol likely predated the dementia and will likely be a difficult behaviour to change. A loved one with dementia is unable to appreciate (or remember appreciating) that there is a problem.

• Get your loved one assessed by a specialist. Geriatric Psychiatrists are experienced in this area. It is difficult to determine the level of cognitive impairment when someone is under the influence.

• Enlist the help and support from other family members and friends.

• Consider Family Counselling to work on the issues together.

• Pursue individual psychotherapy if you are feeling guilty, struggling with the change in roles, or grieving the loss of your loved one.

• Contact your local Alzheimer’s organization for more support and tips.

Solutions:

• Detoxification and rehabilitation are difficult and usually impossible for persons who have irreversible brain damage from chronic alcoholism. I have seen situations where the person is hospitalized, detoxed (removing toxins and abstaining from alcohol), then move to a secured facility for older adults which offers either no access to, or controlled access to alcohol. Voluntary recovery is almost impossible in persons with dementia. A person needs certain mental abilities to benefit from rehabilitation (restoring to optimal health and functioning). Most programs are based on cognitive-behavioural changes, which is not possible for someone with mid to late-stage dementia. A person with mild or early stages of dementia may be able to benefit.

• I have seen success in persons who have dementia and whose lives were derailed by alcoholism when they are detoxed in hospital, then moved to a supportive environment where there is no access to alcohol. They benefit from living in a secured environment where they have stimulation, supervision and activities. They thrive with regularly scheduled meals, medications, and personal care assistance. In my community, these facilities are called Supportive Housing or Personal Care Homes (also known as Nursing Homes.) One unfortunate (or fortunate?) side-effect of this is that the person thrives and does so well that he or she may get to the point where it appears that s/he will be safe and capable of living independently. We fear that once the person moves out and lives independently, they will start drinking again. With proper supports and increased diligence (although the person may not see a need for it) it is possible for them to move home.

Preventative Measures:

Families can encourage older adults to ensure that Power of Attorney, Wills and a Living Will/Advanced Health Care Directive is prepared well ahead of time. This will help prevent any major problems down the road — for example, when it comes time to sell property.

If you or someone you know has an addiction to alcohol, seek medical advice or call your local addictions organization. Education and support are key to aid in prevention and treatment of this challenging situation.

 

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Angela G. Gentile, M.S.W., R.S.W. is an author and specialist in aging with more than 25 years of experience working with older adults and their families in a variety of capacities. She has written a book called “Caring for a Husband with Dementia: The Ultimate Survival Guide” and a mobile app for iOS called “Dementia Caregivers Solutions.” When she’s not working, she enjoys writing, traveling, photography and exploring what it means to age well. She is a realistic optimist who lives in Winnipeg, Manitoba with her husband and two children. Find her online at angelaggentile.com.

Photo credit: “Dandelion Wine” by Sattva @ FreeDigitalPhotos.net

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Men Concerned About Developing Dementia Want Their Partners to Read This Book

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“Caring for a Husband With Dementia: The Ultimate Survival Guide” has been out for almost two months now. I have been to a few events since my book launch. On Saturday, May 9, 2015, Coles – Kildonan Place (Winnipeg) hosted a book signing event for me. This is my second time doing an event like this, and I couldn’t find any “How To” on the subject. I’ve been learning as I go.

BUY THE BOOK – Caring for a Husband with Dementia

I suited up; packed up my signing pen, rack cards, business cards and candy dish and headed over to Coles with a positive mindset. I was looking forward to the event, hoping to connect with lots of people. Since I only sold one book at my first event (and the author sharing a table with me that day sold two books) I hoped to sell one or two books at my second event.

What I find most memorable from the event are the people who stoped by to chat. I appreciate when people open up and tell me their stories. My sister-in-law even stopped by on her lunch break to see me and I got her to take a picture (see above).

A middle-aged man stopped by to say he wants to buy the book for his wife. I wasn’t sure if he was joking or not. But he went on to explain that he feels his chances of developing dementia are high because both of his parents had Alzheimer’s. He said his wife doesn’t want to talk about it. I encouraged him to take a rack card and wished him all the best.

People seemed to enjoy the candies I was offering. Many children stopped by to take a caramel or a Lifesaver. It was interesting to hear the parents direct them to, “Say thank you.” Some asked for permission to take, others just dove right in.

A younger couple told me about the man’s head injury from years ago and that he has been told he’ll most likely develop dementia when he gets older. He wanted his girlfriend to get the book so that when and if that time comes she’ll be well prepared. They were a sweet couple and she appears to be committed to the relationship and whatever may come down the road.

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A few people took my rack card. It’s a bigger version of a bookmark with information about me and my products including my mobile app for caregivers. One young woman said she couldn’t afford to buy the book ($19.95 CDN) but asked me to sign the rack card for her. I told her I am working on getting the book into the library but that it takes time.

I chuckled to myself when a man in his late 70’s flirted with me. He told me how good I looked as he gave me a little wink and whistle. About a half-hour later he came back my way and he said I had nice legs. Both times I smiled and said, “Thank you.”

At the end of my two-hour event, a woman came to me with a smile, and told me I looked lonely. She went on to tell me about her experience of looking after her husband who had dementia. He eventually became quite aggressive and had to be moved to a nursing home. He died about a year ago. Now her neighbour is going through the same thing. She bought a book and asked me to sign it in memory of her late husband. She planned on sharing it with her neighbour or anyone else who may benefit from it.

I ended up reaching my goal for sales. Selling two books in two hours doesn’t seem like a lot, but I was told that some authors don’t sell any books. It has been the bookstore’s experience sometimes the customers come back during the week to purchase the book. Some of them don’t buy when the author is there, but choose to come back at a different time. I have also read that sometimes a person needs to hear about, read about, or see a book seven times before they buy it. So, any exposure is good exposure.

Overall, I really enjoyed my book signing event and I would say it went well. I especially enjoyed talking to people about their experiences. I learned that men want their partners to read this book. I also learned that men in their late 70’s like to flirt with middle-aged authors. 😉

Have a great day!

Angela G. Gentile

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Angela G. Gentile, MSW, RSW is a clinical social worker who specializes in aging. She has helped hundreds of people who are struggling with the challenges aging can bring. Angela is passionate about challenging ageist myths and stereotypes and exploring what it means to age well. She considers herself a realistic optimist but she still can’t tell her left from her right. Find out more at http://www.angelaggentile.com.

Dementia Caregiver Solutions App on the Radio

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I had the awesome opportunity to be interviewed by Faisal Karmali of News Talk 770 regarding our new app, “Dementia Caregiver Solutions”, March 27, 2015, for a program called “More Than Money” for News Talk 770 in Calgary, Alberta. Check out the 10 minute YouTube video I made:

 DCS App Interview on News Talk 770 

The program is produced by Peter Watts. It’s a finance and lifestyle program, aimed primarily at a 50+ demographic which is transitioning to, or is already into retirement. It is co-hosted by Dave Popowich and Fasial Karmali, who run a financial advisory practice catering to this same demographic, under the CIBC Wood Gundy banner.

I was flying by the seat of my pants, and I also got a chance to promote my new book, “Caring for a Husband with Dementia: The Ultimate Survival Guide.” The segment will be aired on Sat. April 25, 2015 on News Talk 770 in Calgary.

Have a great day!

Angela G. Gentile

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Angela G. Gentile, M.S.W., R.S.W. is a clinical social worker who specializes in aging. She has helped hundreds of people who are struggling with the challenges aging can bring. Angela is passionate about challenging ageist myths and stereotypes and exploring what it means to age well. She considers herself a realistic optimist but she still can’t tell her left from her right.

Private Facebook caregiver support group launched

Image courtesy of Salvatore Vuono at FreeDigitalPhotos.net

Image courtesy of Salvatore Vuono at FreeDigitalPhotos.net

Caregivers often find themselves feeling isolated, and trying to do everything on their own. This can lead to burnout. Education and support can often alleviate some of the stress they feel. Having a good friend or two and supportive family members are always the first choice, however, sometimes it is not enough. A support group can be a great addition to the caregiver’s resources.

Connecting with someone who understands what you are dealing with can do wonders for your mental well-being. Support groups can offer so much. However, sometimes it is difficult for caregivers to leave their homes, therefore online support groups are a viable option for many.

Here is what  the Mayo Clinic (www.mayoclinic.org) has to say:

Benefits of support groups

Regardless of format, in a support group, you’ll find people with problems similar to yours. Members of a support group typically share their personal experiences and offer one another emotional comfort and moral support. They may also offer practical advice and tips to help you cope with your situation.

Benefits of participating in support groups may include:

  • Feeling less lonely, isolated or judged
  • Gaining a sense of empowerment and control
  • Improving your coping skills and sense of adjustment
  • Talking openly and honestly about your feelings
  • Reducing distress, depression or anxiety
  • Developing a clearer understanding of what to expect with your situation
  • Getting practical advice or information about treatment options
  • Comparing notes about resources, such as doctors and alternative options

Please join our private, closed group, Dementia Caregiver Solutions Support Group on Facebook. It is moderated by a clinical social worker, and a dementia consultant. All are welcome.

Sincerely,

Angela G. Gentile

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Angela G. Gentile, M.S.W., R.S.W. is a Specialist in Aging who has more than 25 years of experience working with older adults and their families in a variety of capacities. She has worked in private practice, long-term care, home care, health care and non-profit organizations. She is a realistic optimist who lives in Winnipeg, Manitoba with her husband and two children.

 

 

 

Don’t you remember me?

Image source: “Oma” from freeimages.com

Image source: “Oma” from freeimages.com

It can be upsetting and frustrating when a loved one with dementia forgets who his/her family members are. Sometimes it’s a case of not being able to recognize faces. Many times I have heard family members say, “He thinks I am his sister,” or “Mom thinks I am her brother.” It can cause distress because it is another reminder that the relationship they once had is eroding away. It is another sign they are losing the mother/father/spouse/grandparent they once knew.

→ For tips on how to manage the difficult behaviours of dementia, check out the Dementia Caregiver Solutions app.

Get into their world.

     One way to look at it is to try to get into the world of the person with dementia. What period of life is s/he in? Is he young and still working? Maybe she is still living in her own home with four young children. When she looks at you, she doesn’t see her 48-year-old daughter. She sees someone she recognizes, but you are “out of context.” It is like seeing into the future. From her perspective, her nine-year-old daughter is in the other room or at school, and this 48-year-old version of her is standing in front of her. She sees a familiar person, but is not sure who.

Put yourself into context.

     Consider this – How many times have you gone to the supermarket or to another public place and bumped into someone you recognize. You make eye contact, but you can’t figure out how you know this person. He is familiar to you. He smiles and says, “Hello!” and addresses you by name. He asks how you are doing. You still can’t figure out who this man is. You smile back, but stay silent because you don’t want to appear silly. Finally, he says, “I am Bill, we met at the last staff meeting. I am the new guy,” as he chuckles. You are relieved because now you can place him. He was out of context. You didn’t expect to see someone from work at the supermarket. When he explained how you knew each other, it helped place him into context.

Clarify if that’s what is needed.

     That is my take on how to understand and respond to someone with dementia and/or memory problems. S/he may need a little reminder of who you are and how you fit into her/his life. Putting everything into context can help relieve the person’s anxieties and insecurities. Even if she thinks you’re her sister, that’s okay, too. If she asks for clarification or she is not sure who you are, gently remind her and put yourself into “context.” S/he will most likely respond favourably.

Avoid using a disapproving tone.

     It’s a natural reaction to want to be angry or disappointed with the person. At times you may have responded in a disapproving tone and said something like, “I’m not your sister! I’m your wife.” This can result in making your husband feel more confused and ashamed.

Respond in a calm and reassuring manner.

     The next time your loved one with dementia mixes you up with another family member or is not sure who you are, consider responding with kindness, patience and understanding. Help put yourself into context. That may help her/him remember who you are.

NOTE: The medical term for the inability to process sensory information is called agnosia. There are different forms, including prosopagnosia, the inability to recognize faces. Check out Wikipedia if you want to learn more about agnosia, or watch this video on YouTube called Prosopagnosia.

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Angela G. Gentile, M.S.W., R.S.W. is a Specialist in Aging who has more than 25 years of experience working with older adults and their families in a variety of capacities. She has worked in private practice, long-term care, home care, health care and non-profit organizations. She is a realistic optimist who lives in Winnipeg, Manitoba with her husband and two children.