Thursday, November 5, 2015

Change Anyone?

Change can happen in an instant. It happens in attitudes, the changing seasons,  how we relate to our inner and outer environment, and to ourselves.  And for most of us, we can adapt to change rather quickly. We give ourselves cues of where we are, what we are doing, how we arrived at our destination, who we are traveling with, and what prompted our journey in the first place.

 The processes that relate to change in human beings, are all mediated by areas in the brain. Our cerebral cortex covers 2 cerebral hemispheres which transfer signals for immediate outcomes into bio chemical-electrical impulses eventually leading to active patterns of sensory motor control and behavior. The rate at which these signals are transferred, interpreted and engaged is directly proportional to the health of our neurons, or nerve cells themselves. As we age, the functional capacity of our neurons can diminish, due to many factors. Nutrition, lack of exercise, dehydration, lack of mental stimulation, physical, chemical and emotional traumas affecting nerve centers, etc.

According to cognitive psychologists Fergus Craik, PhD, and Timothy Salthouse, PhD, the neurons (nerve cells) themselves in human beings can shrink or atrophy, and there's a large reduction in the extensiveness of connections among neurons (dendritic loss). This can happen after 40 years of age, and can continue throughout the aging process. These researchers have concluded in their study, "Memory changes In Older Adults, " published by the American Psychological Association Monitor, that the aging brain has lower blood flow and gets less efficient at recruiting different areas into operations.

 All of the above has to due with normal aging. However, it is common knowledge that the elderly population throughout history has been less flexible to change, than the younger population,   which could possibly be caused by the physiological limitations of aging itself (blood vessels, musculoskeletal systems, and neurons) which literally become , "less flexible, " as we age. And also, there can be many life altering changes happening all at once around the same period of time. Changes caused by the death of a spouse, a serious illness, a change in residence, changes in hearing, vision, losing the ability to drive, physical strength and mobility, etc. So much change can not only be overwhelming, but can be heartbreaking to the person experiencing these sudden changes.

However, when a person has dementia, change is interpreted physiologically, neurologically and behaviorally much differently than from a person experiencing a normal aging brain. Short term memory retrieval is greatly diminished. And a slight change for a person with dementia, can have far reaching implications. Pathways of neurons suffer from a lack of connections, and lead to an incredible degree of confusion. The implications of one little change in routine, is illustrated by the example below.

Lori's mother had been napping for most of the morning. She had eaten well, had her medications and supplements, and wanted to go back to sleep. She woke up around 1 PM. Lori was in the living room on the computer. And then the pacing started. Lori's mother was shuffling her feet, pacing from one end of the room to another looking out both of the windows at either end of the room. Her walking was sped up, almost as if she was ready to walk out of the house. Then she started shaking her head. "I don't know where to begin, it's just terrible, just awful news, terrible. Oh Lori, this is bad, really bad!"  Lori looked up at her mother. "What's happening Mom?" "Your grandma died, and I have to plan the funeral. What am I going to tell everyone? And I wasn't even with her, she died alone, she died alone."  Lori observed her mother pacing and pacing, and then intuitively decided to offer her mother a new understanding of her mother's transition. "Mom, sometimes your heart doesn't bring enough oxygen to your brain and when that happens, you can become forgetful. Would you like me to help you remember what happened? Would that be okay with you?" Lori waited for a response. "I don't remember what happened, Lori." Lori's mother almost looked relieved to admit that she didn't remember. "Well Mom, your mother wasn't exactly alone. She made her transition while she was sleeping and I do believe that she knew you were with her helping her the entire time. You were a great daughter to her, the best ever!! " Lori's mother stopped pacing and looked at Lori. "I was?""Yes Mom, you really were!"

Lori's mother was calming down now, like a child after they cry from being overstimulated by too much input. "You gave grandma a beautiful eulogy. You stood up there at the podium where the preacher stands and told everyone how much you loved her, and I believe she was listening from heaven and that she heard every word of it, she really did!!! At least that's what I believe, mother!" Lori was not holding back. Then Lori's mother had a smile on her face and slowly walked back to her room.

 "What are you thinking right now, mother?" Lori's mother looked out the window. "It's a beautiful day, Lori."  Lori's mother went back to her room and started writing in her journal.  But what surprised Lori, was that her mother wasn't writing about her mother, but about her immediate circumstance, even referencing the month and where she was in the present time and place.

  What was the change that caused the pacing, and anxiety illustrated in the example in the above paragraph???  Lori and her husband were expecting some furniture to arrive by a moving truck and moved some things out of Lori's mother's room, and cleaned some linens. Again, a slight alteration in routine can cause an incredible amount of confusion for a person with dementia,  and can bring up memories from the past.

 Knowing that confusion, anxiety, agitation and pacing behaviors by people with dementia are all probable during times of change, proper planning can create comfort and security for both the carer and caregiver. 1) When leaving the house, allow plenty of time for confusion.If it takes 10 minutes to get to an appointment, allow 60 minutes or more to get ready. Never rush a person with dementia.  Give them time to get dressed,to put on their shoes, and to walk out the door. 2) When traveling long distances stop the car several times to allow for visits to the rest room. A person with dementia can get distracted riding in a car and can forget that they have to visit the bathroom. 3) Always carry Depends, bottles of drinking water, a change of clothes that you keep in the trunk, and healthy snacks when traveling even to church or the grocery store. Again ANY change can cause confusion, and blood sugar can be a physiological change people with dementia can experience, too. So, healthy snacks are good. Lori's mother loves trail mix with walnuts, sunflower seeds, etc.  4) Bring toys. YES TOYS. (Mini etch a sketchers, Word Searches, Sudoko.)

Having an awareness as a caregiver/care-partner of how change affects a person with dementia either in the home, or while traveling away from the home, and expecting the change that change can bring, can  avoid difficult, or confused behaviors altogether,  and lead to a happy, peaceful home. 

Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA, Naomi Feil, MSW,, and her books, all of them. And the life changing, ground breaking books, "Contented Dementia," by Dr. Oliver James, "The Mindful Caregiver," by Nancy L. Kriseman, and "Deeper Into The Soul," by Nader Robert Shabahangi, Ph.D, and Bogna Szymkiewicz, Ph.D

Copyright 2015 Caregivers Get Fit! Mama  Nicey

The information in this blog is information. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.

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