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  • jsonyoung 5:23 am on July 8, 2009 Permalink | Reply  

    The Stigma Of Geriatric Psychiatric Inpatient Treatment 

    On 7/6/09, I was interviewed by Patricia Grace, founder and CEO of Aging With Grace, on Blog Talk Radio.  Please listen to the show:

     
  • jsonyoung 6:26 am on June 29, 2009 Permalink | Reply  

    Dignity and Respect are Important Factors for Personal Caregiving 

    Most of the older people we care for retain a normal sense of modesty.  We can make efforts to provide as much privacy as possible while helping our aging loved ones with personal care.

    Our loved ones may have cognitive problems, but they can still feel embarrassment. By adding some new knowledge to our toolboxes, we can greatly improve our skills with regard to personal care needs.

    Consider keeping the number of people present to a minimum when undressing and bathing.  This is to avoid embarrassment and keep distractions to a minimum.  Your family member may be having problems hearing, as well as understanding the words you are saying.  With two or more conversations going on at once, it makes following your directions very difficult.  When your voice is the only one they hear, it is easier to focus on what you want them to do.

    Keeping your loved one clothed for as long as possible before entering the bathtub is also very helpful.  This can be accomplished by leaving a robe on their shoulders until they are in the water.

    Try to be mindful of the room temperature.  Often our elders like their environment much warmer or than we do.  This is something you can take care of before ever entering the bathroom.

    If your family member starts to have trouble with something they have always been able to do on their own, don’t get discouraged.  Sometimes you may have to “show” them how to wash themselves if they don’t understand what you are asking them to do.  Move the washrag along your body and see if they can mimic you.  This can help them to remember what you want them to do and reduce their frustration greatly.

    When you stop and think about it, these are ways that we want others to treat us. We all want privacy, we don’t want a bunch of people in the bathroom with us, and we don’t want to be too hot or too cold!  By keeping these factors in mind, you will probably see a big difference in the cooperation you get from the person you care for.

     
    • robyn 7:03 am on June 29, 2009 Permalink | Reply

      great points. like the golden rule … do unto others as you would want done unto you. lets all just be nice to people. esp. people in our families.

    • caroldodell 4:13 pm on June 29, 2009 Permalink | Reply

      Thanks for this most thoughtful post.
      I was my mother’s 24/7 caregiver and I was as protective of her (especially when bathing, changing, etc.) as I was my children when they were young and vulnerable. We have to consider two important factors: that their level of modesty may be different than our own (and you’re so right, we should respect that) and we also have to consider that other people might not treat them with the respect they deserve, and may even take advantage of them in a number of ways that are scary and appaling.
      I know how challenging it is to bathe a person who is an elder or has a condition (my mom had Alzheimer’s and Parkinson’s) that might make bathing/changing uncomfortable or scary. It is exhausting and at times, can be frustrating–so my heart goes out to the many many caregivers who are doing all they can to care for those they love.
      I decided that it was wise for me to be present when my mother was being bathed or dyring other forms of intimate care. Wouldn’t I do that for my own children?
      ~Carol D. O’Dell
      Author of Mothering Mother: A Daughter’s Humorous and Heartbreaking Memoir
      http://www.mothering-mother.com

      • jasonyoung99 6:35 pm on June 30, 2009 Permalink | Reply

        Thank you so much for writing such a personal account of your experiences, you have no idea how this helps others in knowing they are not alone in going through the same types of situations. I am so glad to see that you “got it” with what I was talking about in reference to modesty. Your comments meant a lot to me. I will definitely be checking out your website.

    • Matt Johnson 3:11 pm on June 30, 2009 Permalink | Reply

      Jason, I really enjoyed this. I’m going to share it with our caregivers. How do you think routine factors into this? Does our own adaptability affect our perceptions of embarrassment, bashfulness, etc?

      • jasonyoung99 6:26 pm on June 30, 2009 Permalink | Reply

        Matt,

        I love hearing that your shared this blog with caregivers, thank you. In answering your question, we must remind ourselves that even as things become routine, our routine is of our own making. More often than not, we know what we are supposed to be doing, we are simply choosing not to do it. Time is most quoted as an excuse, though there is no increase in productivity that results from decreasing quality of service. The reality is quite the opposite.

        Most caregivers are extremely busy with many tasks to perform in a short amount of time. If the caregiver will consider that their efforts to minimize things like embarrassment, as discussed in this article, will ultimately SAVE them time not dealing with an agitated care recipient, they can see that such efforts are not only helpful, but essential if we are going to fulfill our obligation to provide the best care possible.

        I don’t subscribe to the belief that different people have differing capabilities in regard to adaptability. I do believe that some people gave an extremely difficult time in grasping the concept, though I think the person that states they absolutely cannot become adaptable should choose to stop caregiving immediately, due to their ensured failure at trying to be effective. Those that employ such people should terminate their employment immediately. The root of the problem with someone that has difficulty in being adaptable is in their ignorance of how to be so. One cannot fault someone for not automatically knowing what to do in caregiving for seniors. It can be extremely difficult and emotionally draining for even the most seasoned of professionals. We must recognize that people must have the education and tools needed to carry out the many tasks involved in caregiving. If someone needs extra help or advice in doing so, as long as they are willing to continue trying and don’t accept failure as an option, they will already find themselves to be much more adaptable.

        I don’t think our own adaptability affects our perceptions of embarrassment, as much as our trying to convince ourselves that the person receiving care “doesn’t mind” when we choose to make poor choices as caregivers. Just because a client / loved one does not punch us in the face when we embarrass them does not mean that they “didn’t mind”. The people we care for often have a difficult time communicating with us. And even when they are able to communicate, they many times choose not to because of the fact that they become accustomed to being ignored.

        Your questions were excellent and I greatly appreciate your posing them because they got me thinking. I think I need to write an article on adaptability! Again, thank you Matt.

    • Matt Johnson 8:55 pm on June 30, 2009 Permalink | Reply

      Jason, Thanks for the thoughtful reply. I appreciate your insight and I definitely think you should write an article on adaptability. We appreciate your blog…keep it up!

    • Kay Webster 1:47 am on October 24, 2009 Permalink | Reply

      Dear Jason

      Thank you for your outstanding reply to Matt. What an empathic and professional man you are.

      I will be referring this site to Catholic Care (my Mother’s In-Home Service Carers) in Sandgate NSW Australia.

      As a “seasoned” psychiatric nurse of many years duration I was moved to tears when reading your response to Matt.

      The world needs more people like you.

      Kay

      • jasonyoung99 4:35 pm on October 25, 2009 Permalink | Reply

        Kay,

        Thank you so much for your kind words. It makes me so happy that you were touched by what I wrote. When you chose to write me could not have come at any more perfect a time. My wife and I had been sitting on the couch after having an extremely emotionally draining day and I checked my messages from my cell phone and found your message. It made us both feel so much better and changed the whole mood of our evening. Thank YOU.

        Please stay in touch,

        Jason

  • jsonyoung 6:38 pm on June 15, 2009 Permalink | Reply  

    The Road Less Traveled; The Inpatient Psychiatric Option 

    Making the decision to admit a loved one to a geriatric psychiatric unit can be extremely difficult and emotionally devastating for families.  Unfortunately, those who never choose to make the difficult decision to do so can never feel the ecstatic relief and happiness from improvements that can come as a result of making such a commitment for change.

    Caregivers often recognize the need of such treatment, though avoid admitting to themselves just how bad things have gotten.  This avoidance often leads to worsening of problems that can be more easily resolved if the family follows their intuition as to what needs to occur.  By learning more about common treatment scenarios at psych units, one can be more prepared to make an informed decision if faced with needing such assistance.

    When a geriatric patient begins to experience a substantial decrease in appetite and sleep, this can quickly become a life threatening situation.  For example, someone diagnosed with Major Depression showing a sudden decrease in appetite may benefit greatly from an evaluation of their antidepressant medications.  Often, specialists are able to prescribe medications that have strong appetite stimulating properties in addition to their psychotropic effects.

    The person diagnosed with Alzheimer’s Disease doing fairly well for a few years may begin to become more agitated and uncooperative with care, sometimes refusing medications.  If the complete refusal of medications continues for long, numerous complications can occur.  Many times, adjustments can be made to memory enhancing meds and anti-psychotics that can be of great help.  Other times there is untreated depression and / or anxiety that can be addressed accordingly.

    The aforementioned examples certainly do not encompass the hundreds of differing treatment scenarios that occur.  Though by considering the positive results that can be reached in a short amount of time within an intensive psychiatric program, one can conceptualize how such an approach may be able to help their loved one.  Acute intensive psychiatric treatment should be thought of as the option to take when ones primary physician and / or psychiatrist has been unable to stabilize the patient on an outpatient basis.  The only reason to seek treatment at an inpatient unit is to allow a specialist the opportunity to evaluate the patient for needed changes to their medications.  This is certainly not the only advantage of entering such a facility, though it is the primary goal that should never be lost sight of.  Great things happen in these facilities.  All caregivers of elderly persons with cognitive problems should become more knowledgeable on where their loved one could obtain such help should it ever be needed.

     
    • Olga Brunner, MS CMC 5:38 pm on June 22, 2009 Permalink | Reply

      We have a female 80 y.o. Alzheimer’s client that we are closely monitoring at home with past history of suicidal ideations, depression, manipulative behavior. Currently the medications are working, but should the situation change, this will be the ultimate route. I enjoyed hearing about the signs to watch for. Thank you.

  • jsonyoung 8:12 pm on May 26, 2009 Permalink | Reply  

    Aphasia: Facts & Tips For Better Communication 

    Most people have not heard about aphasia, nor do they know the term until someone in their family or a friend acquires aphasia.  Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write.  Effective communication is crucial to comprehensive assessment of mental problems occurring in seniors.  Learning more about aphasia can be an excellent way to improve ones skills in providing care.

    Aphasia is always due to injury to the brain.  It occurs most commonly from a stroke and particularly in older individuals. But brain injuries resulting in aphasia may also arise from head trauma, from brain tumors, or from infections.

    The condition can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect mainly a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some channels remain accessible for a limited exchange of information. It is the job of the professional to determine the amount of function available in each of the channels for the comprehension of language, and to assess the possibility that treatment might enhance the use of the channels that are available.

    Important for caregivers to keep in mind is the wide range of severity that aphasia can encompass.  Some people are able to understand others with almost no problems while their speaking is most affected.  Others experience the reverse scenario of interpreting speech being difficult while verbalization comes very easily.

    First and foremost we must exercise patience in allowing the processing time needed by those affected with aphasia when communicating.  We are often compelled to “fill in the blank” for the person who is having trouble completing a thought.  Many times a greater amount of time must be dedicated to completing what would normally be a short discussion.  We must also not be quick to “reword” what we are saying when the aphasic person is having trouble understanding us.  Often times changing the wording only complicates things further.  Restating your questions / statements rather than rewording them will often produce better results in communication.

     
  • jsonyoung 6:25 pm on May 14, 2009 Permalink | Reply  

    Should My Loved One Be Placed On An Antidepressant As Has Been Recommended By Their Physician? 

    There are so many things that can be discussed in reference to psychotropic medications.  I am going to focus on questions that you, as family members, can ask yourself in deciding if antidepressant medication therapy is the right choice for your loved one.  Hopefully after reading this article, you will have the information available to assist that doctor and / or facility in making the best determination.

    First we must define what types of scenarios necessitate the consideration of antidepressants to be prescribed in the first place.  Essentially, the presence of a Major Depressive Episode needs to have occurred and / or be presently occurring to even consider the necessity of psychotropic medication use.  The following is a list of the types of symptoms that must be present in order to justify a Major Depressive Episode: (keep in mind that at least five must be present during the same two week period)

    1. depressed mood most of day, nearly every day
    2. marked diminished interest or pleasure in all, or almost all, activities most of day, nearly every day
    3. significant weight loss when not dieting or weight gain
    4. insomnia or hypersomnia nearly every day
    5. psychomotor agitation or retardation nearly every day
    6. fatigue or loss of energy nearly every day
    7. feelings of worthlessness or excessive or inappropriate guilt
    8. diminished ability to think or concentrate, or indecisiveness, nearly every day
    9. recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

    Now let’s take a look at many scenarios where antidepressants may not be appropriate.

    Could symptoms be happening as a result of a medical condition?  Considering the many medications being used to address medical conditions, the person may, for example, be losing or gaining weight in response to side effects of a medication already prescribed.  Many narcotic pain medications can cause sleep difficulties.  Physiological effects of medications cannot be underestimated as possible causes.

    Has your family member recently experienced the loss of a loved one?  Bereavement causes a depressive state that is natural and expected.  We should be more concerned if our family is NOT affected by such events!  I cannot tell you how many times I have been consulted within nursing homes where a staff member has approached me and said, “Mrs. Smith has been so depressed over the past few weeks after her son passed away.  She really needs an antidepressant.  Which one do you suggest?”  I have so many times had to explain that depression following a death of a loved one is not a scenario where medications are appropriate.  Love, support, understanding, and most importantly patience are the best prescriptions in this case.  We must wait at least two months to see if symptoms decrease to assess if medications may be helpful.  It is not as if we can tie a specific timeframe to how long it takes a person to “get over” a loss.  We can though wait 2 months to see if someone is still experiencing five or more depressive symptoms at once.  In most cases, the number of symptoms decreases and even though Mrs. Smith may never completely “get over” the loss of her son, she may very well get through the initial adjustment period where we must allow her to greave without bringing medications into the picture.

    While we are speaking of the adjustment periods, it is an excellent time to talk about the correlation between adjustment to nursing home placement and medications to address associated depressive symptoms.  Often people have a very difficult time adjusting to living in the nursing home.  Many times I have worked with people who lived in their homes for 40 or 50 years in the same house and now suddenly and unexpectedly find themselves living in a nursing facility.  I cannot even imagine that feeling.  So why so many times do people feel that an antidepressant is necessary in this case?  It is understandable that one be depressed.  As was applied in the aforementioned subject of grief, we should wait a couple of months to see how a person adjusts before exploring use of medications to address symptoms. Information about a person’s personality should be conveyed to social services staff at facilities upon admission as to avoid such confusion from occurring.

    Anxiety should always be considered as a cause of depression.  Depression can cause anxiety and anxiety can cause depression.  As a clinician I am always keeping a close eye on person’s symptoms because both conditions are so closely related.  The key thing to keep in mind is that if the primary problem is anxiety, than treat the anxiety and see if the depressive symptoms cease.  If the problem is depression, treat the depression and see if the anxiety ceases.  Too often medications are given for both conditions at the same time and all the medications were not needed.

    Now that we have listed the scenarios where antidepressants are often unnecessary, let’s take a look at when they can be a great alternative to improving quality of life for the ones we love.

    Anytime where a person is experiencing suicidal ideation, either with a specific plan or without, it is my feeling that antidepressants be strongly considered.  Close assessment of these situations should be completed just as in all cases though.  Suicidal statements can sometimes be made during attention seeking type behavior and other times may be expression of going through a time in life of dealing with feelings about death and dying.  The person that is 93 years old and states, “I just wish god would just go on and take me home” is not necessarily in need of antidepressant therapy.  But the person that states, “If I could get my hands on my shotgun that hangs over my bed at home, I would kill myself”, should be seriously considered for assistance through medications.

    When plenty of adjustment time has been given in either a scenario where someone is grieving a loss or is having trouble adjusting to placement, this is a time to consider if medications can help.  The underlined issue here is that if someone experiences five or more symptoms of a Major Depressive Episode for longer than two weeks and it continues for a long period, they will more likely become physically ill as a result.  If the depression can be treated successfully, then other problems may be less likely to arise.

    Many antidepressants have appetite stimulating properties to them.  If someone is depressed and this is thought to be the cause of their weight loss, then antidepressants have the capacity to be highly effective in activating appetite, both in alleviating depressive symptoms, and stimulating appetite through mechanisms within the medication.

    Those diagnosed with dementia are great candidates for antidepressants.  Especially those persons who have just been diagnosed with the disease are often appropriate.  People in the mild stages of dementia are often much more emotionally affected by the disease during the early stages rather than at the moderate or severe stages because of the fact that later in the disease progression they may not even recognize that they are affected by the disease at all.  In early stages one must deal with acceptance of the disease and they are aware of their many faculties deteriorating.  During this time in their lives they can benefit greatly from medications not only to help cope with the situation, but in the fact that depression actually causes dementia to progress faster.

    The dominating theme throughout consideration of the appropriateness of antidepressants is to assess the situation thoroughly.  We must consider all the factors that may be contributing to depression in order to best address the root of the problem.  The root of the problem is not always clinical depression, though when it is found to be, antidepressants can be a great way to improve the quality if life for your loved ones.

    –  Here are some thoughts from fellow Twitter users when asked, “Do you feel that antidepressant medications are under-prescribed or over-prescribed within the geriatric population?”…

    wayneguerra@wayneguerra –  ER MD working on iTriage, an iPhone App that gives users medical information, transparency around price and quality, and access to healthcare.

    “My subjective opinion is antidepressants are overprescribed.  Many of the elderly we see in the emergency departments come from living situations where they are disenfrachised and lonely.  Not surprisingly they are depressed, and it is easier to prescribe medication rather then work on the social issues behind their depression.  Many times it is more situational than true organic disease.” Wayne Guerra

    ElderCareRN

    @ElderCareRN – Registered Nurse, writer, caregiver for my father, offering Encouragement, Education, Empathy & Effective strategies to Enrich the lives of eldercare giver.

    “My official position is that anti-pressants are under prescribed & anti-psychotics are over-prescribed. This generation of elders come from the depression era and don’t often seek help for such things as ‘feeling down today’ “. – Shelley Webb

    MrMedSaver

    @MrMedSaverFounder and president of MrMedSaver.com, an online consulting company that helps people save money on their medications.

    “Way overprescribed…I think many doctors prescribe antidepressants at the drop of a hat.   The problem’s even worse with antipsychotics.”  – Jake Milbradt PharmD

    drkathyjohnson@drkathyjohnson – CEO and founder of Home Care Assistance. PhD and CMC.

    “The problem with all medication use in the elderly is that adverse effects of medication are often misinterpreted as a new medical condition.  It takes a Geriatric MD or Senior Care Pharmacist to identify and prevent medication-related problems.  In terms of anti-depressant medication, the potential for interactions with other drugs is of concern, and vertain antidepressants have been shown to worsen anxiety in some seniors.  So prior to starting any antidepressant medication, potential medical, medication and environmental precipitants must be thoroughly investigated.” – Dr. Kathy Johnson

    caregiving@caregiving – Certified ElderCare Coach, Author, Speaker.  Founder, Caregiving.com.  Interested in Social Media, Biking, Sports, Travel. Glad to connect!

    “Under-prescribed.  I think depression in the elderly is an over-looked problem.  I wish we did more to help w their depression.” – Denise M. Brown

    onerusty@onerusty – Be the change you wish to see in the world.  Fan of theseniorlist.com.  Empowering seniors and those who love them.  Let’s live, love & learn!

    “Antidepressant’s underprescribed in general population, over in nursing homes.” – Frank Clark

    daccarte@daccarteInterested in all things that enhance the quality of life in the elderly

    “As a daughter of an elderly mother and from what I’ve read, I think anti-depressants are probably under-prescribed.  Although I don’t think depression is inevitable in the aging process, I do think there are a number of factors that make the elderly more susceptible.  Health problems, disabilities, hospitalizations, isolation in their homes, major transitions.  I imagine many elderly are like my mother.  They try to cope in silence. While I don’t believe drugs are a quick fix, I do believe the drugs play a role in the treatment of depression, especially in the elderly.” – Dale Carter


     
    • Jill Gilbert 11:03 pm on May 14, 2009 Permalink | Reply

      While I can’t speak from a professional medical perspective, I personally know many elderly relatives that have benefited from the use of anti-depressants. Prior to their physicians taking notice of their depression, they were rather lethargic and lost their zest for life. It not only changed their day-to-day happenings, but also improved their relationships. While I’m sure they can be overly prescribed at times, in these particular instances, anti-depressants have changed their lives for the better!

    • Beth Parker-O'Brien, LCSW-C 11:09 pm on May 14, 2009 Permalink | Reply

      I am a clinical social worker in a psychiatric practice that focuses only on geriatrics and dementia. I think your article is well thought out and provides useful information. Depression in the aging population is often under-diagnosed and under-treated. Dr. Guerra is correct in stating that it is sometimes loneliness, but all too often it indicative of a other issues. We often see the older adult in our office when it becomes a crisis. Encourage pts to discuss their concerns with their PCP about their symptoms and possible referral to a therapist and/or a geriatric psychiatrist.

    • Sandra Chancellor 2:49 am on May 15, 2009 Permalink | Reply

      Very informative. My viewpoint is from providing caregivers for elders at home. Often depression can be lifted by the caregiver providing companionship, conversation, mild exercise, tasty food, and interesting activities. The resulting improvement in the general health and happiness of an elder can be dramatic.

      We do sometimes send caregivers into nursing homes to provide the extra attention needed. It can make a real difference for an elder in a facility.

      But there are elders, still living at home, whom the caregiver can’t cheer up. Nothing works, and the elder is not even willing to try anything that might be helpful. Those elders probably need to be evaluated for clinical depression.

    • Wayne White 2:14 pm on May 15, 2009 Permalink | Reply

      Enjoyed you article. Information like this can be very helpful to caregivers. My wife and I were caregivers for my father for over two years. Your information would have been helpful during that time. We placed my dad in a ficility for memory patients two months ago. While visiting him I have noticed some change related to your article. Thanks,

    • Anne M. Sadler 12:58 pm on May 25, 2009 Permalink | Reply

      Jason you are right on target as usual. As a former nursing home administrator I would say that antidepressants are under prescribed in the community and over prescribed in facilities. One of my biggest frustrations is that we often do not allow our elders to work through the feelings of grief and loss and adjustment to placement. Time is a factor in nursing homes and social workers have little of it for one on one counseling that would benefit. Many facilities lack proper supportive care programs from psychologists and psychiatrists despite the reimbursement from Medicare. They give a pill and come back monthly for drug review! We must look at the big picture with each case and treat wholistically. Wish I had you on my team when I was running my rehab center. Thanks for the thoughtful article.

  • jsonyoung 2:31 am on April 10, 2009 Permalink | Reply
    Tags:   

    What Can Make The Most Positive Impact Toward More Effective Communication With The Cognitively Impaired Senior? 

    The title of this post triggered immediate requests for me to be more specific.  Most often I was asked if I was referring to caregivers at home or long term care facility professionals.  I was focused on neither.

    Posing the question, “What can make the most positive impact toward more effective communication with the cognitively impaired senior?”, within the Twitter format was an excellent way to see what people think is most crucial.  It was my goal to induce a bit of “soul searching” as people tried to answer within 140 characters or less.

    The following are the answers I received…

    joemd1 @joemd Husband, Father, Physician, Educator, Writer, and Life Coach for Doctors, Guiding them to More Free Time, More Income, and More Fun.

    “A smile, eye contact and a hand to hold.”

    caregiving @caregiving – Certified ElderCare Coach, Author, Speaker. Founder, Caregiving.com. Interested in Social Media, Biking, Sports, Travel. Glad to connect!

    “Helping family caregivers better understand the perspective and abilities of someone w/ a cognitive impairment.”

    gerohelper1 @gerohelper – GeroHelper on LinkedIN, B.A. Gerontology, Geriatric Web 2.0 and Assisted Living Reform are my interests, enjoy geriatric freelance writing

    “Finding out where they are in time, who they think they are, & connecting in their reality – b/c their reality is all that exists anymore.”

    mreldercare @MrElderCare – Expert in elder care financia planning & bridging the communication gap between boomers and their parents.

    “Begins w/ understanding that the cognitively impaired communicate differently and the caregiver must adapt to the care recipients ability to duplicate. Approach with patience, simplicity and tenderness.”

    liononstage @Liononstage – Author, speaker, speech coach, trainer, and communication consultant, Dilip’s passion is to help you unleash your communication & performance potential.

    “Cognitively impaired seniors are like children w/ life experiences.  To communicate with them – stimulate memories, be kind, patient.”

    daccarte @daccarte – Interested in all things that enhance the quality of life in the elderly.  Creator of website assisting families with transition of aging parents.

    “Keep noise level down, stay calm and respectful, offer simple choices.”

    annesadler @AnneSadler – Owner of Smart Senior Services, a geriatric care management company. She has 23 years experience in nursing home administration.

    “Listening with your heart.  They have so much to tell us if we would only listen.”

    procarenurse @procarenurse – I am a Nurse Life Care Planner, Care Manager and Nurse Consultant.

    “Find out what motivates them and take advantage of that and get help from people they trust.”

    eldercarern @ElderCareRN – Registered Nurse,writer, caregiver 4 my father, offering Encouragement, Education, Empathy & Effective strategies to Enrich the lives of eldercare givers.

    “Touch is the most effective communication;  gentle, non-threatening, loving, accepting touch does wonders.”

    We all have different areas of expertise and experiences that lend toward our playing a part in caring for others.  Some of us do so in within our profession, and some through taking care of our families.  (and some do both!)  We need only pay attention to the many wonderful keywords used throughout these answers to reflect on what is truly important in continually making our best effort to communicate with the cognitively impaired, regardless of in what capacity.

    Understanding, Connection, Adaptability, Patience, Simplicity, Tenderness, Experience, Kindness, Quiet, Calm, Respect, Listening, Motivation, Trust, Gentleness…

    and Love.


     
    • Dale Carter 10:15 am on April 10, 2009 Permalink | Reply

      I like your approach with the open-ended question. It led to good, insightful answers. This was a wonderful post. Thank you!

    • Mark 1:07 pm on April 10, 2009 Permalink | Reply

      What a great post and so much valuable insight from the Twitter community. You can tell the truth of all this input lies underneath; in the residue of the personal experiences these people have had.

      My takeaway from this? Let compassion reign in your care giving.

      Thanks for this thought provoking post and for taking the time to engage others.

    • Anne M. Sadler 1:21 pm on April 10, 2009 Permalink | Reply

      Jason,
      great job! As a Nursing home Administrator now turned Geriatric Care Manager and caregiver for my Mother who has Alzheimer’s I can say that I agree with everyone. Thanks for putting it together.

    • Brenda Ellison 5:22 pm on April 10, 2009 Permalink | Reply

      Jason, This was an amazing thing to read. I truly think that all the respondents are correct in some way. In dealing with the elderly members of my husband’s family who have become cognitively impaired at one stage or another, as well as my niece, who is cognitively impaired through her brain’s inability to balance itself, I have learned that calm and simple are true key elements, but through it all, you have to have compassion or all else is worthless.

    • Emily 6:22 pm on April 10, 2009 Permalink | Reply

      Very nice, big brother. I always enjoy features such as this that focus on positivity and how it effects the people around us.

    • Denise 7:10 pm on April 10, 2009 Permalink | Reply

      I loved reading all suggestions! I also loved how you used Twitter to gather your responses. We can knowledge and find more great minds to follow.

    • Mary 9:30 pm on April 10, 2009 Permalink | Reply

      I also think it was a great idea to ask on Twitter and I really loved the responses. Janice at the Eldercareabcblog.com wrote a great post about a method called SAFE. I use it all the time now and I hope it is alright that I share it here.
      http://eldercareabcblog.com/communicating-through-dementia-with-safe/

    • Olga Brunner 12:40 am on April 11, 2009 Permalink | Reply

      In my experience it was a non confrontational behavior that I adopted early on with my mom who had cognitive impairment. I have adopted this in my professional life as well and it has served me well with my residents in long term care and now with my private clients. Great job! I love your approach to this.
      http://www.agooddaughter.com

    • Carole Larkin 1:53 am on April 11, 2009 Permalink | Reply

      Make eye contact first.Speak twice as slow as your normal speech pattern. Short direct sentences with only one thought per sentence. Take a breath between sentences. (All this gives them more time to process what you are saying, therefore giving them a better chance at understanding you) Ask who, what, when and where, but never why. The answer to why is too involved for them. It’s frustrating.

    • JHohn G. Self 6:06 pm on April 11, 2009 Permalink | Reply

      Jason, this is an important subject. I wish I had seen this a year ago when my mother was still alive.

    • Tim 6:29 pm on April 11, 2009 Permalink | Reply

      Jason, as the grandson of a cognitively impaired senior who recently passed, it is comforting to remember that, somewhere behind the surface, the soul remembers and knows.

    • Wayne Guerra 7:23 pm on April 11, 2009 Permalink | Reply

      Great post and good advice from a wealth of talented people.

    • Patricia Grace 7:30 pm on April 11, 2009 Permalink | Reply

      Jason, Thank you starting this dialogue on Twitter. Excellent insight accompanied by great input from other professionals working with the cognitively impaired and their families.

    • Natalie Tucker Miller 12:05 pm on April 13, 2009 Permalink | Reply

      Great discussion. Having spent the wknd at a nursing home with dear friends, the experiences are fresh in my mind. Learning about this developmental stage in crucial.

      Brain research shows us that elders view of life is unique, cognitive impairment or not. Spiritual development shifts as well, and unless we consciously observe and follow the wisdom of the elders, we cannot serve them appropriately.

      We are more apt to influence a positive experience when we learn to remove emotional attachment to the situation (not the person, the situation)and see how fear/concern/misinformation prevents a meaningful connection.

    • Alexandru Vasilcenco 5:09 pm on April 13, 2009 Permalink | Reply

      Hello Jason, thank you for such an insightful article. I am happy that you covered this actual and important topic. As a professional social worker with some experience in working with seniors, I would like to emphasize the importance of possitive and supportive communication with seniors. I also admire your innovative and creative approach to use Twitter to gather advice from others. I will use your ideas in my professional practice and pass your article to other colleagues.

    • Anthony Cirillo 7:16 pm on April 14, 2009 Permalink | Reply

      while I am late to the discussion many have hit upon wonderful solutions. When I visit nursing facilities the two things I strive to do is really listen and then connect with that person’s reality. It may not be yours or mine but it is theirs and it is often all they have.

    • robyn 3:32 am on April 15, 2009 Permalink | Reply

      Connecting with other carehelpers improves the quality of life for the successful ager and the one caring for them. find a community, like ours at http://www.caringsource.com. Also, knowing the tasks ahead before the crisis point allows you to know what they need… with Health, Emotional, Legal, Portfolio/money, and Social needs. being prepared is the best thing you can do to make things smooth in this crazy transition period from child to parenting your parent.

    • Laurence Harmon 1:47 am on April 16, 2009 Permalink | Reply

    • Sheila Lehner 3:28 pm on April 16, 2009 Permalink | Reply

      Jason, What wonderful responses to your question!…Understanding, Connection, Adaptability, Patience, Simplicity, Tenderness, Experience, Kindness, Quiet, Calm, Respect, Listening, Motivation, Trust, Gentleness… Yes all of these are valuable. The method I teach in my Benevolent Ballet-Fall Prevention seminars is connecting through empathic engagement. By understanding where the individual is coming from and where his strengths lay we can connect and even help him “see” more clearly.
      Sheila

    • LovingGrand 9:16 pm on April 24, 2009 Permalink | Reply

      Jason, the first thing I think of to share is they may have cognitive issues but their feelings are in tack and real. Cognition varies by degrees in my opinion; cognition is as individual as the person, one has to learn where they are and never underestimate! Caregivers should have patience, be sincere, stay positive, be knowledgeable, in short – tender – that’s what it takes towards LovingGrand♥♥♥

  • jsonyoung 3:04 am on February 24, 2009 Permalink | Reply
    Tags:   

    The Thankful V/S The Burdened: A View On Medical Power Of Attorney 

    If you have ever needed someone to step up and serve as the medical power of attorney for a mentally ill patient, you know how difficult it can be to get that commitment. And how that person responds emotionally to your request can make you feel proud to be a member of the human race or ashamed that you’re included in the group.

    I do clinical assessments of patients being admitting to an inpatient geriatric psychiatric program. My job is to ensure that my patients, who are often suffering from dementia and are actively psychotic, will have someone to act in their best interests while they are receiving treatment.

    Here’s why I’m writing this: We clinicians need to remind ourselves constantly that relationships in the greatest family histories and the deepest personal friendships can be ruined for an endless number of reasons. Even though we might be in dire need of assistance from a family member or a patient’s friend, it is irrational to expect that all of them will be willing to serve in that role.

    We can never fully know the interpersonal conflicts and histories that might have led family members to choose not to care for one another any longer. We can only do our best to convey how badly their help is needed and explain thoroughly why their assistance is so crucial to the patient’s treatment. And when clinicians have made every effort and nobody will step up, we can still be vigilant on behalf of patients who cannot help themselves, and not give up.

    I see people every day who not only embrace this responsibility, but are deeply thankful to have been chosen or nominated. On the other hand, I also see people who are so burdened by the mere request that they refuse it. The humanity that I witness in my job is often beautiful–seeing people care so deeply for older men and women. But often the humanity is equally ugly, when caring is actually nonexistent among family members and “friends.”

    There are choices available to clinicians. You can choose not to allow others to diminish your level of caring. You can choose to advocate for your patients even when it seems that nobody cares about the patient but you. You can be the difference in your patients’ lives when they cannot do so for themselves.

    –  This article also published at Great Places Inc. The following are comments that were made in reference to this article:

    “Jason, this post evokes strong emotions in me.  The elderly are so vulnerable and defenseless.  Each human life is so precious.  Thank you for being there (and advocating for that in other clinicians) when the patient’s family is not.  I just read a review of a book written by a brain scientist who had a stroke.  She writes about the different levels of care and respect she was shown by medical professionals, and how it impacted her and her recovery.  What a wake-up call! This book ought to be required reading.   http://drjilltaylor.com/book.html” – Comment made by Dale Carter of Transition Aging Parents

    “Jason, you have articulated very well the sentiments of many professionals that deal with these situations.  I recently had a meeting with a daughter who said to me “I just want you to take over.  I want nothing more to do with Dad and I am moving out of state.”  When I heard her story I was surprised that she had stepped up in the first place to care for Dad for the last 5 years.  The other side of this is the depression of the person receiving care and the sadness when they realize that they have been abandoned by family and friends and often due to their own behavior. Sometimes in the case of memory impaired clients we never find out the story behind the story.  We as clinicians can make a difference by valuing every individual regardless of frailties or past mistakes.  Our ability to advocate, protect and care for others is the gift we have been given.  My philosophy: God’s love is realized in our daily dealings with our fellowman.  Remember in all you do that you may be the answer to someones prayer. Every interaction holds opportunity. An encouraging word or smile or the smallest act of kindness may be the thing that rekindles the flame in another to keep on for another day.” – Comment made by Anne Sadler of Smart Senior Services.

    “I’m going to come at this from a different angle: the caretaker who just happens to be a registered nurse.  Nobody asked me to become guardian for my father – it just became evident that I needed to do so because of some decisions he was making in his life (i.e. selling his home for 100 k less than it was worth, buying a truck (he can’t drive) while I was away at work.  But the thought of having control over my father’s life was terrifying.  I had dreams that Eldercare Protective Services came out to see how much food I had in my refrigerator.  Social workers DO visit and I wondered: is my house clean enough, is my father’s room appropriate?  I’ve had bankers question my use of my father’s bank funds, as if I were sneaking off with it for some luxury cruise.  As a caregiver, I don’t get a lot of thanks for what I do, but I have always been treated kindly by my father. In the case of many family members, they have been treated unkindly themselves, often dealing with angry, irrational “patients” and extended family and have just “HAD IT!”  I can understand why family members and friends would shy away from the responsibility, especially in the litigious, disconnected society in which we live.  You’re right, Jason; all we can do as clinicians and caregivers is advocate in the best interests of our clients, or in my case, loved one.” – Comment made by Shelley Webb at Taking Care Of The Folks

    “The end of life brings out the very worst in families. It also reveals some of the worst aspects of our healthcare silos — we have no “system” in the U.S.   This will always be a time for dysfunction for some families but providers should not let the patient down. Those who work in this area of care should remember that you get once chance to do it right, to bring comfort and calm to the sick or dying.” – Comment made by John G. Self of HealthCare Voice

    “These stories show the variety of skill levels that people who are asked to be caregivers bring to the table.  Many of us haven’t done much work on our emotional lives and now all our beliefs are being tested from minute to minute.  I learned so much about myself from taking care of my husband for 8 years that I can almost say it was the strongest reason I am who I have became today.  Challenges can bring out the best or the worst in us and sometimes some outside help is needed to turn caregiving into a loving, intimate experience.” – Comment made by Christine Sotmary

    “You are so right.  We do make a choice how we are going to serve or not serve others.  I also, agree that people looking outside in do not always have a grasp of the family relationships.  It is crucial not to walk into a situation assuming things are as they seem.  I like the idea of engaging thefamily members and doing what you can to help them see ways to be involved with the care of their ager.  The family dynamics are always so deeply rooted that it is wise to keep in mind in regard to filters when dealing with families that are known.  If you are in the family, you will already know the history and particular strengths and weaknesses of the people involved… you have an advantage and can find the best ways to approach those who will be helping. Good blog Jason.  I like the discussion this brings up.” – Comment made by Robyn Blaikie Collins of CaringSource

    “Good post, Jason, you said it all.  We regularly provide home care for elderly who have no relatives alive or willing to help them.  Some have a public fiduciary and guardian provided by the county.  I have found the county case managers and our caregivers to care greatly about these vulnerable people.” – Comment made by Sarah Chancellor

     
    • Brandi 12:02 am on February 27, 2009 Permalink | Reply

      Hey, thanks for sharing your blog on Power of Attourney. My husband became PoA for his mother after she had several mini strokes in 2000. Her siblings have not quite forgiven him for the decisions he had to make on her behalf. It’s tough. He struggled for years to understand her Manic Depression. He took a 6 week leave of absence to care for her after the strokes, but had to return to work. He did the best he could for a 29 year old only child who lost his father to lymphoma in 1993. His mother was so upset with him for returning to work and hiring a nurse to come sit with her while he was gone that she ended up in the psychiatric ward and willed herself after a day there into a catatonic state. It was crazy. She went to a nursing home, they checked her brain function and found that there wasn’t any, wanted to put a feeding tube in her stomach, etc. and he declined. If he had agreed, she’d probably still be there. He didn’t want her to “live” like that. Unfortunately, her sisters didn’t understand. Since we’ve married and had kids, her sisters have warmed up a bit, wanting to see the kids. But it was nearly 3 years before they even spoke! Anyway, just wanted to say thanks. 🙂 Take care…

  • jsonyoung 2:38 am on February 20, 2009 Permalink | Reply  

    Surround Oneself With Excellent People And Achieve Excellent Results 

    The first word that should be noted in this blog is simply this…Wow.  I am a geriatric clinician currently working in an inpatient psychiatric setting in a hospital.  During my quest for knowledge and wisdom on cultivating a speaking career based on my clinical knowledge, I have run into some absolutely incredible people along the way.

    First, I would like to thank Tammy Redmon, who allowed me to ask her a billion questions on the phone a few months back.    Tammy is an Executive Coach & Business Growth Strategist.   I found her through the Twitter service, though you can find her website is at Redmon and Associates.  Tammy was invaluable in providing me with guidance that is helping me to this day.  Thank you Tammy.

    I have got to give BIG thanks to Bertalan Mesko, creator of ScienceRoll, whom provided me with my first virtual speaking opportunity within the Second Life platform.  I have provided an endless number of trainings and presentations in real life, but this was truly different, and SO EXCITING!  The setting was located inside the Ann Myers Medical Center in Second Life on February 7, 2009.  I spoke on “Improving Communication With Cognitively Impaired Patients”.  It is one of my favorite topics because of its relevancy to all fields of practice and study, and proved to be a great topic within this platform and setting.  Thank you so much Bertalan.  You probably don’t realize how much I appreciate what you’ve done for me.

    Just over the past few days, I have connected with so many people that have been simply great.  Gina Schreck with Synapse3Di gave me SO much good information.  I can’t wait to work with you more Gina!  Kimberly Winnington with Sand Castle Studios got me even more fired up about presenting more in Second Life, and if not for her, I definitely would not have stayed up tonight to create this blog.  Kimberly, thank you for offering me the writing opportunity of which I am greatly looking forward to.  There is no way to list all the remaining people that I have come in contact with.  It’s just amazing.

    In the process of carving out a niche for myself in the speaking world, I am finding it to be challenging and rewarding on a level I did not know was possible.  Though I definitely am feeling the positive energy,  I will now choose to turn off my computer and get some sleep.  For if I don’t function well in my current job, there will be no funds to continue enabling the internet access to flow.

     
    • Gianna Borgnine 6:44 am on February 20, 2009 Permalink | Reply

      Congratulations on staring your blog! I’m looking forward to seeing more from you and you begin a new chapter!

    • Tammy Redmon 4:43 pm on February 21, 2009 Permalink | Reply

      Excellent first showing on your new Blog Jason! I acknowledge your persistence and quest for modeling the title of your post. I look forward to the contribution you make to others quest for excellence as you publish your blog and share your passion.

      Thank you for the generosity of the acknowledgment in your post!

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