Okay, after this post I’ll go back to “fun” topics. Because of the well-deserved attention of Alzheimer’s, there is a tendency for we non-medical individuals to lump all dementia in older people into that category. That is not inherently a problem in the sense that other forms of dementia often have essentially the same impact on family and friends as Alzheimer’s. Treatment, however, can be different and in seeking the appropriate treatment, family and friends need to recognize that medical and non-medical treatments are extremely limited for many types of dementia. While there are standard treatments for Alzheimer’s, for those who have dealt with it, you are aware of the limitations, but they do have tests to be able to verify that the condition is Alzheimer’s. Sadly, once dementia in whatever form it takes or degree of it there is, in general grows progressively worse, sending the individual into a downward spiral.

That’s why I want to discuss “Partial Impairment” which is what many people experience and it is not necessarily a prelude to Alzheimer’s. Before I do, please be aware that I am not medically trained and you can seek information published through medical sources for more details. In a broad brush stroke, Partial Impairment is the situation where severe memory lapses interfere with day-to-day functioning and might cause a problem for an individual continuing to live independently. It can also result in increased “living in the past” where an individual only wants to talk about past experiences and people and is reluctant to deal with current day activities. This condition is intermittent and the individual can go for days or weeks with no problem, then have a day or series of days of “episodes”. The unpredictability can lead to the suspicion of “playing head-games”, and while that might be true, more often it is not. If you can emotionally do so, embrace the situation and allow it to co-exist within reality as much as possible. For example, if the individual persists in calling you by the name of a long-dead relative or friend, correct the person gently and don’t make an issue of it. If the individual wants to speak only of events that are long passed and of no interest to anyone else, try to patiently listen yet again.

Since partial impairment can interfere with health and safety functions, such as not remembering to take medications, not remembering to throw spoiled food away, maybe not remembering to take care of basic personal hygiene, assistance with living whether through at-home care or in a facility will probably be required. Again, this is a step beyond manageable memory lapses and you may need professional assistance in determining if the individual that you care about has taken that downward step. If so, it is usually not a physical danger and the individual can continue in this state for a  number of years. Finding a means to emotionally support yourself becomes just as important as arranging for care of the individual. There is nothing good about these situations and certainly nothing easy. It is, however, a reality of life that you may be faced with.

Disconcerting Content Alert! I don’t know many people who are not understandably worried about Alzheimer’s as it applies to a relative or friend. There are a lot of books, many more articles, and numerous foundations and groups to consult about specifics of this insidious disease. One of the sad realities that I learned while writing Your Room at the End: Thoughts About Aging We’d Rather Avoid is that while Alzheimer’s is the most recognized form of dementia, it is far from being the only one. There is, in fact, something referred to as Partial Dementia and this is what a lot of us encounter with older relatives and friends. Before getting to that though in Part II, I want to address unsettling memory loss that also often occurs.

This primarily manifests itself in ways such as not being able to recall names even of people that the individual knows well. For example, suddenly forgetting the name of a grandchild or calling a grandchild by the parent’s name without realizing it. Another example is not being able to recall having completed a task even if it is something routine. By the way, this isn’t the same thing as leaving the house and wondering if you set the alarm. This is more like not being sure if you took your required medication that day. This type of memory loss is disturbing for both the individual and those around her or him, but in general, it can be coped with. Being honest about it is very important, however. Let’s use the medication piece as an example. Labeled medicine boxes are a great solution for this, but someone may need to assist in filling the box and quite probably have a note somewhere that says, “Medicine Box filled for the week. If unsure, call _______”. That will be the name and telephone number of whomever filled the box.

Perhaps the most important thing when facing memory loss in another individual is sympathy and patience. It is incredibly common for an individual to tell the same story or repeat the same question multiple times (and I mean multiple) as her or his brain is trying to lock in that the information has been passed. It can be frustrating for the listener, but it is frightening for the individual who feels the inability to remember. Once this type of memory loss sets in, it won’t normally improve and finding the means to work around it will be highly individualized. The key is to find a method that works for the person with the memory loss. In one case I am familiar with, a lady used a calendar and left a note on her bedside lamp, one taped to her bathroom mirror, and another taped next to the telephone. “Check calendar every day”, was pretty simple to follow. For example, garbage pick up was Thursday. So on Wednesday, she would write, “Get garbage ready for pick-up tomorrow”. For every appointment she had, she would write a reminder one-to-two days prior that she had the appointment. A couple of close friends who often drove her places as she cut back on driving knew about this technique and would wait patiently as she carefully filled out the calendar.

I recently used the analogy of:  “Consider this type of memory loss to be like a dripping faucet. It’s annoying and you constantly lose water because of the drip. If you place a bowl under the faucet, it catches the water and you can at least recover that and use it to water plants or whatever. It’s isn’t an ideal solution, but it does work. Having memory aids that work (whatever those are) are the ‘bowl under the dripping faucet’.”

In Part II, I’ll discuss Partial Impairment, although that post won’t be until Wednesday.

Serious Content Alert! As I have written in previous posts, I feel strongly that almost every Baby Boomer needs a copy of Your Room at the End: Thoughts About Aging We’d Rather Avoid for three reasons – to face our parents or other loved one’s aging, to face our own aging, and to think of those things that we must discuss with our adult children or younger individuals who are likely to be a part of our aging when the time comes that we can no longer live as independently as we would like to. No matter how rationally we try to approach this subject, if we are being truly honest with ourselves, we just don’t see that we’re going to become that infirmed old person who can’t manage. Somehow, someway, that isn’t going to happen to us and we are almost as reluctant to realize it is happening to our parent/parents. It usually manifests in a medical emergency first, although it might be an unsettling memory lapse or bout of extreme confusion. That call from the neighbor, the emergency room, or perhaps the individual sets your heart to racing and your brain into high gear. Once the immediate crisis is passed, you may still be able to hope that “all will return to normal” until the doctor gives you the real news. “Not yet,” is what most of us think, “it isn’t time yet for this. I/we haven’t made the arrangements that we need to.”

Now, there are lots of people who have done some preparation – have someone lined up for when they can no longer drive, have looked into alternate living options, or in-home care that might be available and affordable; all actions that can then be set into motion fairly quickly. Those are good things to do. What you probably aren’t prepared for is the emotional assault and the extraordinary amount of your time that is about to be consumed for what could be months or years. Even if there is cheerful agreement of moving into an independent or assisted living facility or having in-home care, someone will have to serve as an advocate for an incredible number of things and there are likely to be many, many trips to emergency rooms. The reason for that is because once someone enters into as assisted living category, the body and perhaps mind are already experiencing difficulties and those problems will increase. Also, the individuals charged with caring will almost always err on the side of caution, not wanting to be accused of negligence if a borderline situation worsens. The other time-consuming reality is that it is a major life adjustment and that usually causes at least some degree of emotional turmoil for everyone. There may well be a need for constant reassurance or a repetitive longing for the independence that has been lost. Unless you are in a special set of circumstances, these new tasks will be layered on top of obligations that you already have and finding a way to juggle them is not easy. It is important to understand that among the arrangements to be made is to have a “venting outlet” of some sort for everyone who is coping with this new stage of life. Frustration will set in and having the means to deal with it is incredibly important.

Ah, the things that we can’t plan for. First, the flu bug has absolutely no sense of holidays and wings its nasty way about with exactly zero regard for what havoc it wreaks. However, it can be a mild case as opposed to severe and I suppose one can be grateful for that. I knew full well that my husband was coming down with whatever everyone else at the dive shop had and he chose to believe otherwise. By Sunday evening, it was difficult to deny how he really felt and by Monday when he was faced with a 10-hour drive to Georgia early the next morning, he admitted defeat. At that point, aside from the fact that he was dragging badly, we didn’t know if I would catch it and if I did, then I would be the contagious one in the midst of elderly mother, two infants, and a very pregnant second cousin. Not the sort of holiday cheer that one wishes to spread.

Okay, scratch the trip to Georgia and a neighbor who heard immediately offered for us to come to their house. A couple they had planned on wasn’t able to and she was already intending to cook for six. The expectation was that we would either go there or plates would be delivered to us. Fine, that’s a good back-up plan. Except, with a twelve-pound turkey on hand, her husband is not feeling well (not the flu) and there is no way for them to have a house full of company. Alright, this is manageable. The other couple going to her house actually lives closer to us and often dines with us. So, she will have a small meal with her husband, then bring turkey, a wonderful cranberry chutney that she prepared yesterday and perhaps potatoes to our place in the late afternoon. I dashed to the store to get green bean casserole, frozen apple pie, Stove Top stuffing, and a jar of gravy – no chastisement will be accepted at this point for taking shortcuts. I will make the lovely artichoke and cheese spread from scratch since I had offered to do that anyway. None of that even addresses the other set of good deeds that I will be doing for much of Friday, but that is most assuredly a different subject. Happy Thanksgiving to all!

Thoughtful content alert. Volunteering to do good is a wonderful thing – something that I do and have often encouraged others to engage in, especially Baby Boomers who may finally be at the stage where there is time to spend in volunteer activities. In truth, there are almost always more volunteer opportunities than volunteers and choosing where to put one’s time can be tricky. So, you pick something that you feel strongly about, whether it’s cultural in nature, philanthropic, community support, or whatever. And then, well, then you can occasionally run headlong into an unexpected situation that may cause you to re-think the whole thing. The reality is that people volunteer for lots of reasons, and in some cases, those reasons are firmly attached to personal agendas that may little, if anything, to do with the good of whatever organization/group/effort you’re volunteering with. It’s human nature and that, folks, ain’t likely to change.

It may be mild enough that you can shrug it off as an irritant, a roll-your-eyes sort of response that a glass of wine (or whatever) can sooth over. At other times though, the involved party or parties may dig into a position that begins to cause you genuine stress. There are a variety of things to try if faced with this – perhaps it is all a difference of perspectives that can be resolved with a heart-to-heart conversation. Perhaps there is some background that you are unaware of that can shed light on the subject to the degree that it can revert to being an irritant rather than a stressor. If not, then it could be time to walk away. Any relationship can become dysfunctional to the point of no longer being worth the emotional investment and that includes volunteering. There are always canned excuses one can use to depart – yes, I’m talking maybe taking a dip into the “white lie” barrel, but in these cases, candor isn’t likely to be productive. If you need to walk away, don’t do it abruptly if you can avoid it, though. Give some notice, and then take a few weeks off from volunteering as you decide on another worthy project. There are plenty and you’ll find a good fit.