The most common form of dementia is Alzheimer’s disease. However, there are many other conditions that also bring on memory problems. It is important to accurately identify the cause, even if there’s no cure, because this will shape the best strategy for addressing difficult symptoms.

Lewy body dementia (LBD) is the second most common form of dementia. But it is not nearly as well known, even by doctors. It’s easy to misdiagnose because it shares symptoms with several other dementia conditions. It also varies a lot from one person to the next.

Signs of Lewy body dementia

• Swings in ability to remember or concentrate. This may be mistaken for Alzheimer’s disease. However, the swings can be greater from day to day. Plus, short-term and long-term memory can be affected.
• Changes in mood and/or behavior.
• Increased sleepiness and confusion.
• Physically acting out dreams while sleeping. This may be one of the earliest signs, occurring years before other symptoms develop.
• Difficulty with movement, much like Parkinson’s disease.
• Visual hallucinations. People with LBD see things that are not visible to others. Medicines usually given for hallucinations can be damaging for people with LBD. They worsen movement problems and can lead to kidney failure.

Three out of four individuals with LBD were first diagnosed with another condition. If your loved one is having odd symptoms that don’t match up to their diagnosis, ask about possible LBD. A thorough exam by a neurologist or neuropsychologist can tease out the distinctions. Two tests are available: One a skin biopsy, the other a spinal fluid test. 

If your relative’s symptoms seem all over the map, you aren’t going crazy. It could be one of these lesser known conditions. You don’t want your loved one getting medications designed for something else. Ask for a second opinion if you think there might be a mismatch.

Wondering if your loved one has Lewy body dementia?
As the San Francisco experts in family caregiving, we at Compassionate Community Care share your concern for an accurate diagnosis. Give us a call if you think a second opinion and some medical advocacy is in order (415) 921-5038.

It’s unpleasant to imagine that your loved one might become the victim of crime, but it’s worth considering. There are valuable preventive steps to take. Unless your relative lives in a high-crime neighborhood, their greatest risk is a property crime in or around their home. In fact, older adults experience thirteen times more property crime than violent crime. Home invasions and theft are the main concerns.

Secure the perimeter.

• Install motion detection lights and test them often. Light is an excellent deterrent to those who mean no good. Be sure the front and back doors are particularly well lit.
• Put gravel on walkways. It’s difficult to sneak up quietly while walking on gravel.
• Consider installing a video camera at the front door. One that allows those inside to view out before deciding to open the door.

Lock up the house. With the increasing boldness of home invasions, encourage your relative to keep windows and doors locked, even during the day.

• Exterior doors should have deadbolts, with a peephole or video camera for viewing anyone at the door.
• Inside, install a solid bar lock, much like they have at hotels, so your loved one has the option to open the door slightly without letting someone in. (Chain locks are too flimsy.)
• Have them bring their phone in hand when they answer the door so they don’t have to look for it to call for help. If your relative has a personal medical alert pendant, they can use that in an emergency.
• Train your relative to ask for ID before letting a stranger inside. Even if they say it’s an emergency, call the company to verify employment and the purpose of the visit.
• Add plexiglass or security film on windows if your loved one lives in an area where break-ins are common.
• Ensure curtains or blinds are closed at night and thick enough to block the view of activities indoors.
• Have your relative keep valuables in a safe and vehicle keys out of sight. Home invaders are looking for easily available, expensive items to grab quickly.

Are you worried about crime?
With all the bad news about crime these days, it’s hard not to be concerned. As the San Francisco experts in family caregiving, we at Compassionate Community Care share your worries and are happy to help you implement preventive activities to protect your loved one. Give us a call at (415) 921-5038.

If your loved one is discharged from the hospital to a skilled nursing facility (SNF), their care will be in the hands of a team of specialists. It’s a good idea to understand the players’ roles so you know whom to call upon for what.

• Director of nursing. This professional oversees residents’ medical issues. Also, the nursing staff. Their job includes tracking delivery of prescriptions and monitoring each resident’s physical health. They also work with the SNF’s doctor to carry out orders for therapy.
• Social workers. Trained to address social, emotional, and psychological issues, social workers help residents and families adjust to life in the facility. When the time comes for discharge, they also help ease the transition. If there’s something you want done differently with your loved one, you might start a conversation with the social worker.
• Certified nursing assistants (CNAs). The CNAs are the frontline staff. From answering a call button to helping with bathing and dressing, they are often the biggest part of your relative’s daily experience.
• Therapists. Depending on your loved one’s challenges, daily therapy may be required. A physical therapist helps improve walking, range of motion, stamina, and flexibility. A speech therapist helps residents recover language abilities. Or overcome swallowing problems. An occupational therapist uses exercises and assistive devices to regain daily life skills. They teach new strategies for self-care tasks such as feeding, dressing, and bathing.
• Dietitian. Every resident has a food plan. This is based on their personal preferences and any medical restrictions (e.g., low fat, low salt, low sugar).
• Activities director. This professional organizes activities for residents’ social and mental stimulation.
• Housekeeping. Is the bed rail not releasing? Is there a spill to be cleaned? These are responsibilities of the housekeeping staff.

Is your loved one in a skilled nursing facility?
It’s easy to feel overwhelmed by all the different staff members. As the San Francisco experts in family caregiving, we at Compassionate Community Care can help you understand the system and advocate for the care you want your relative to have. Give us a call at (415) 921-5038.

Depression is common in older adults.

It’s long been known that brisk exercise can help reduce depression. But it turns out that exercise doesn’t have to be vigorous to make a difference. Even mild exercise can be effective. This is great news, especially since depression zaps energy and initiative. Researchers have found that

• completing an exercise task yields a sense of achievement
• achievement boosts our sense of personal power
• increased self-confidence reduces feelings of depression and fatigue

In this case, the purpose of exercise isn’t to increase heart rate. It’s to accomplish an activity-related goal. Because when we’ve achieved something, we talk more kindly to ourselves about ourselves. As our self-talk gets more positive, that lifts our mood.

Help your relative create an activity program that suits their physical capacity. Ideally, something that can be done easily three to five times a week, eventually building up to a total of 30 minutes over the course of the day.

It doesn’t have to be strenuous: Simple stretches. Lifting light weights. An easy stroll around the block. If they are up for something more engaging—a class or walking with a buddy—all the better. They are more likely to stick with it if they have a pal. And the social contact will also help lift their depression.

Check in with the doctor first to be sure there are no foreseeable problems.

Is the person you care for depressed?
As the San Francisco experts in family caregiving, we at Compassionate Community Care know how hard it can be to keep your spirits up when you are caring for someone who is feeling down most of the time. You don’t have to do this alone. Give us a call at (415) 921-5038.

No one likes to dwell on the possibility of disaster. But we all need to prepare for one, just in case. Help your relatives gear up for safety. Whether you live across town or across the nation, the action items are the same.

Prepare to stay in contact. In case of a disaster, how will you know your relatives are safe?

• Because local phone service may be sketchy, choose an out-of-town contact. Also identify the address and phone number of a potential gathering place. This might be a friend’s house or a church, school, or store within walking distance. Ask family members to leave a note if they are evacuating. Have it include date, time, and plan. OR consider registering for the Red Cross Safe and Well program where family members can post messages for each other.
• Program “in case of emergency” (ICE) information into contacts on cell phones. This helps emergency personnel know who to phone.
• Teach family members to text message. Text messaging is often possible even when phone service is disrupted.

Assemble emergency supplies.

• Have a “go bag” suitcase packed with clothing, a pair of comfortable shoes, personal hygiene items, and prescription medicine in case there is little time before an evacuation.
  • Regularly replace medications so they don’t expire.
  • In a waterproof container (e.g., a “zip-lock” plastic bag), keep copies of health insurance cards and an up-to-date list of prescriptions, doctors, and any special needs. Also, family identification documents (things you might otherwise keep in a file at home: Passport, marriage certificates, vaccination records …).
  • Include a list of important phone numbers (neighbors and family) in case the phone runs out of power.
  • Pack an extra phone charger.
  • Include a supply of cash.
  • Consider packing an extra set of prescription eyeglasses, readers, or contact lens (and solution). Batteries for hearing aids.
  • Include a special pillow, blanket, or other comforting item if your loved one has dementia. This can help keep them calm in a stressful situation away from home.
• Prepare a “stay box” using a few easy-to-carry waterproof containers with at least a three-day supply of necessities in case services are down but evacuation is not necessary.
  • One gallon of water per person per day. Ideally, buy water containers and keep them sealed until needed. If you must prepare your own, use water storage safety precautions.
  • First aid kit, over-the-counter medicines (pain and fever relievers, antidiarrhea medicines, antacids, laxatives, antihistamines), extra masks in case of dust, smoke, or the eventual need to shelter indoors with large groups.
  • A whistle to call for help.
  • Flashlight and a battery-powered or hand-crank radio. Check or replace batteries once every six months. Use the time changes in fall and spring as a reminder.
  • Matches, candles, battery- or solar-powered lamp.
  • Food, can opener, mess kits, or plates and spoons. Paper towels. Rotate in new canned goods if their expiration date is near.
  • Bedding or sleeping bags.
  • Moist towelettes, toilet paper, garbage bags, and plastic ties (for personal sanitation).
  • Plastic sheeting and duct tape for makeshift shelter if needed. Or a pop-up tent. (This is handy for helping people with dementia stay calm if there is too much stimulation or chaos around them.)
  • Wrenches to shut off gas and water.
• For those who are medically challenged
  • Have your relative wear an identifying bracelet if they have a disability or significant medical condition.
  • If your loved one has trouble getting around, keep an extra cane or walker in the car or with the stay box.
  • If your loved one has assistive devices that require power (for example, an electric wheelchair), talk to the doctor or device provider about options when the power is out. Contact the local utility company to see if the person you care for can be put on a priority power restoration list.
  • Store instructions for assistive devices in the go bag with other important documents. Note the serial number of each device in case the provider needs to be contacted.
  • Create a list of the nearest medical facilities, hospitals, and transportation options. If your relative is on dialysis, locate alternate centers that are somewhat close but far enough away that they may not be affected by a local disaster.
  • Consider enrolling in the Medicare Blue Button program so your relative can share their last three years of medical history with doctors they haven’t seen before. (This is useful in case of a need to evacuate.) There’s also a Veteran’s Blue Button program.

Get tech-ready

• Sign up for alerts from local government or stay up to date via their social media channels.
• Consider downloading the FEMA app (Federal Emergency Management Agency) to stay informed.
• Get preparedness tips by texting PREPARE to 43362.
• Find open shelters by texting SHELTER and the zip code to 43362.
• Keep a portable phone charger in the car, and ideally a back-up energy supply.
• Store copies of important documents (insurance policies, medical records, identification documents) in the cloud or on a password-protected “thumb drive.”
• Sign up for direct deposit and online banking so funds can be accessed remotely in case of an evacuation.

Create a local support network

• Give at least one trusted neighbor a key to the house or apartment.
• Find a neighbor willing to be a “buddy” and show them where to find the emergency supply “stay box” you created.
• Show them how to operate any special equipment, such as oxygen or a wheelchair. Put written instructions in the stay box.
• Contact the city or county emergency department and find out if you can register your loved one to receive any special disaster check-ins offered to solo, disabled, or medically challenged seniors. If you aren’t sure which agency to call, start with the fire department or police department.

Are your loved ones prepared?
As the San Francisco experts in family caregiving, we at Compassionate Community Care recognize that in the event of a disaster, you will be pulled in many directions. Your relatives may need you while you also are needing to gather those in your immediate household. Take some time to develop a plan. Need help? Give us a call at (415) 921-5038.

If your loved one has balance problems, the culprit may be in the medicine. Many common medicines have side effects that can impair balance and lead to a fall. Over 40% of persons age 65 and older take five medications or more. This increases the chance that at least one of the drugs has side effects of dizziness, blurry vision, drowsiness, or muscle weakness. Or affects balance sensors in the inner ear. More medications also create the potential for a drug-to-drug interaction that leads to a fall.

Medicines known to increase the risk of falls include

• allergy drugs (antihistamines)
• antidepressants and antianxiety drugs
• blood pressure and heart drugs
• diabetes drugs
• pain drugs
• sleep drugs

If your loved one has fallen or seems unstable on their feet, ask the doctor or a pharmacist for a medication review. They may suggest some of the following strategies:

• Reduce the number of drugs. Sometimes a specialist orders a drug without knowing that another doctor has ordered a similar drug.
• Lower the dose. Ask the doctor or pharmacist for their recommendation.
• Change medication. There may be another drug that will accomplish the same treatment but does not have side effects that could cause a fall.
• Altering the schedule. By changing when drugs are taken, you may be able to reduce the side effects or risk.
• Nonpharmaceutical approaches. Relaxation techniques and good sleep hygiene habits might relieve the need for sleep medicine. More exercise and weight reduction could lower the need for insulin.

Do NOT make these decisions on your own. It is important to have the doctor or a pharmacist review all medications and over-the-counter drugs, because they will know which ones to target and the safest way to make changes.

Are you worried about a possible fall?
If you think your loved one is at risk, best to be proactive. As the San Francisco experts in family caregiving, we at Compassionate Community Care observe that a fall often results in the need for more care and a loss of independence. Let us help. Give us a call at (415) 921-5038.

Has your parent remarried? If so, you may be sharing the caregiving with a person you don’t know very well. Biological families often encounter tensions when it comes to eldercare. Add a stepparent and the challenges can grow exponentially.

At its best. A stepparent can be a wonderful partner in care. Their daily companionship and support may be very meaningful to your parent. Plus, it’s easier to accept assistance with intimate tasks from a partner than from a child. Ask them how you might be of help. It may be running errands, talking with the doctor, communicating with other siblings, paying for extra help, or giving your stepparent a break now and then. Celebrate victories with them: A successful surgery, a clear cancer report. And don’t forget to thank your stepparent regularly for all they do.

Sometimes it’s complicated. Many adult children believe that their stepparent is standing between them and their mom/dad. Or them and the doctor. Perhaps. Or it may be that the spouse is simply overwhelmed or distressed. They could be waiting until there’s a diagnosis and plan in place to tell you there’s a problem. Remember, a health crisis is a crisis in their marriage. They may not have discussed beforehand how they would handle medical emergencies or serious illness. Until you know otherwise, assume everyone is doing the best they can.

Respect roles. Become allies. If your parent named you as health care decision maker in their advance directive, plan ahead with your parent and stepparent about when you would like to be informed of a problem and how the three of you can work together. If at some point you have a “better” treatment path to suggest, consider: Will it require more work for one or both of them? Can you ease the burden? If not, you may need to bow to what your parent and stepparent feel they can handle. If your stepparent is the health care power of attorney, ask for permission before trying to speak with the doctor. Ideally, manage your concerns in a way that avoids creating strife in the marriage, as that truly doesn’t benefit your parent. Respect the decisions they have made and find common cause to cooperate with your stepparent to make your mutual loved one’s recovery or final days as positive and stress free as possible.

Are you close with your parent’s spouse?
In a health care emergency, whether you are close or not, you will need to work together. As the San Francisco experts in family caregiving, we at Compassionate Community Care have seen this become an opportunity for greater cooperation. But not always. Do you need help? Give us a call at (415) 921-5038.

Medicare pays for many screening exams, and even counseling sessions, to help nip common illnesses in the bud. Screening tests are designed to identify problems before symptoms emerge. They are usually for people who are considered to be “at risk” for getting a specific disease. Here are some of the most common noncancer preventive services that Medicare covers. Ask the doctor if your loved one should be tested.

• Bone density test every two years. A low-level x-ray can determine how brittle your loved one’s bones have become. Although women are at higher risk, men can also develop osteoporosis.
• Diabetes screening once or twice a year. This fasting blood test measures glucose to see how well the body is processing sugars. If your relative is at risk for diabetes, ask about Medicare’s 16-week Diabetes Prevention Program.
• Depression screening once a year. Typically, this involves a physical exam and a series of questions. Sometimes blood work is ordered to make sure the depression isn’t caused by something else, like a thyroid disorder. 
• Alcohol misuse screening once a year. The doctor may ask questions about alcohol use. If it appears there is a problem, Medicare may pay for some counseling.
• Glaucoma screening once a year. Glaucoma is a leading cause of blindness among older adults. An ophthalmologist (doctor who specializes in eyes) conducts glaucoma tests. One test involves dilating the eyes so they can be examined with special lights and magnifying equipment. Another test blows a puff of air into each eye to measure the pressure inside. It doesn’t hurt. It’s just a bit surprising.
• Cardiovascular screening once every five years. Fasting blood work tests for high levels of cholesterol and triglycerides. Yearly tests are available if the doctor makes a diagnosis of heart disease. This includes blood pressure checks and dietary counseling.

Is your loved one up to date on screenings?
Early detection is key to slowing the progress of many conditions. As the San Francisco experts in family caregiving, we at Compassionate Community Care know it often falls to you, the family caregiver, to track these tests. We hope this article makes that easier. Need help with eldercare? Give us a call (415) 921-5038.

Good communication requires both speaking and listening. Oddly enough, if you make a specific effort to listen, it can open doors. Once “heard,” the other person may be more willing to hear your point of view.

Deep listening is more difficult than it sounds. It’s not passive. It requires concentration. It also takes humility and empathy. Here are some tips:

Consider the setting

• Schedule your talk at an unhurried time.
• Turn off the TV, music, and cell phone.
• Make sure the seating and room temperature are comfortable.

Observe yourself. Are you

• distracted by physical needs or strong emotions? If you are hungry, upset, or tired, you won’t be able to concentrate on what the other person is saying. Consider talking after a meal or in the morning when you’ve had a chance to rest.
• bored? If you “already know what is going to be said,” it’s probably best to push your internal reset button. Be open to the possibility that things might not be completely as you expect them to be.
• unable to concentrate? If you find your mind wandering, try mentally repeating their words. It will help you focus and fully take in what the speaker means.
• preparing your replies? If you find you are concentrating on your response, try listening attentively and then waiting one full second after the speaker finishes before you begin talking. After completely hearing what was said, you can thoughtfully compose your reply.

Show empathy. Often the best way to get something is to give it yourself.

• Nod and encourage. “Yes,” “uh huh,” smiles, and open body language cue the speaker that you are interested and paying attention.
• Ask questions. “Could you tell me more?” or “An example would help me understand better.”
• Check in and repeat back. “I’m understanding that what you’d like most is . . .” or “So, you are feeling frustrated that . . .” Paraphrasing can ease defensiveness in the speaker, making him or her more open to hearing what you have to say.

Having difficulty with family members?
As the San Francisco experts in family caregiving, we at Compassionate Community Care are very familiar with this problem. It happens in many families. Old baggage and current stresses make for difficult communications. Let us help. Give us a call at (415) 921-5038.

For a teen, a relative’s dementia can turn a close relationship into one that’s now awkward, confusing, and embarrassing. And creates feelings of guilt.

Teens and tweens benefit from learning the basics of grandma or grandpa’s condition, such as “There are diseases of the brain that change memory and thinking. We should expect that [grandparent] will have repetitive questions, emotional outbursts, and may even forget our names.” Reassure your teen that these behaviors are a result of the disease. They are not intentional. Also let your teen know that dementia is not contagious.

Support the relationship with activities focused on what your loved one can still do. Explain to your teen that memories of the distant past are the strongest. This is a great opportunity to learn about family history. Engaging the present also works well, especially activities using all the senses (sight, taste, smell, touch, and hearing). Calm activities are more appropriate than fast-paced stimulation. Steer clear of games involving strategy.

• Music is almost always a hit. Try putting on music from your relative’s teen years. Consider dancing. (Remember the twist?)
• Try a walk in nature. Bring attention to the sights, sounds, and smells. Take time to pause and appreciate each sense. (In Japan it’s called “forest bathing.”)
• Visit with animals. Go to the dog park and watch the antics. Or have your teen bring over a favorite pet. Focusing on the animal together can alleviate awkward silences.
• Bring lotion and nail polish for a manicure. Your teen might really enjoy giving grandma a mani-pedi. Grandpa might like a hand massage.
• Watch old movies together. Is your teen a film aficionado? Perhaps you know some favorite classics from your loved one’s youth they could watch.
• Interview your relative. Consider making a scrapbook or memoir so your relative can pass along family stories. Plus, it’s a great gift to the family.

Share emotions. Acknowledge how sad you are to see your loved one slipping away. Also, that you are sometimes angry or frustrated by things they do. Describe what helps you cope with your feelings. Let your teen know they can be frank with you, including if they are embarrassed or uncomfortable and don’t want to visit. Let them have space if they need it. No judgments. Pushing them could backfire, and your loved one will feel it.

Is your teen confused by your loved one?
It can be heartbreaking to see what once was a close relationship become one that generates discomfort, embarrassment, or even rejection. As the San Francisco experts in family caregiving, we at Compassionate Community Care have noticed that teens have a particularly difficult time understanding dementia. It requires a maturity that is often beyond their abilities. That doesn’t make it easy for you, though, feeling caught in the middle. You don’t have to go through this alone. Give us a call at (415) 921-5038.