Monday, September 30, 2024

Personal Blog #37 … An AD Spouse Caregiver’s Emotions, Part 1 … Acceptance … 9/30/24

 I had 35 columns published in The Huffington Post (since renamed, HuffPost) in 2015-2016.  I discussed some of the emotions I was experiencing in 8 of those first 9 columns  while watching my wife, Clare, slowly dying due to her battle with Alzheimer’s disease (AD).  As Clare’s symptoms worsened, I went from being her loving husband to a distant memory in her mind.  Even when she no longer recognized our children, grandchildren, or friends, Clare still, somehow, recognized my face.  I honestly don’t know what she recalled about me, but she always smiled and looked happy whenever she saw me.

Clare spent most of her last 2 and a half years in an assisted living facility, except for 1 week in a hospital and 1 month in a psychiatric facility, and she lived her final 6 weeks in a nursing home.  Clare no longer knew my name, or that we were husband and wife. Clare referred to me simply as a “nice man” or ”nice lady,” often asking me to please help her find her husband.  Yet during that time and up until the last day of her life, during each visit Clare would smile and be so happy as soon as she saw my face.

I was feeling both married and widowed at the same time, and growing more depressed.  I knew that I had to do a better job of dealing with my emotions and feelings.  I did an internet search for words that described my feelings and I wrote some columns about a few of those emotions and feelings for The Huffington Post. 

Recently, while speaking with an AD caregiver having difficulties dealing with various emotions and feelings, I mentioned that I had experienced similar feelings.  My friend found our discussion helpful, and I thought that other caregivers might also find some comfort by reading about my own personal experiences dealing with difficult emotions and feelings as an AD spouse caregiver.

This is the first in a series of 10 Personal Blog columns I plan to write and post only on this site in the last week of each month through June, 2025.  This column expands upon my second column published in The Huffington Post in 2015 … the emotion/feeling of acceptance.  Future columns will discuss emotions and feelings I have never written about before in any forum.  For The Huffington Post, I wrote those 8 columns about some of my emotions in alphabetical order, and I plan to do the same for this series.  Hopefully, this series will be helpful to other AD caregivers who visit this site.

Acceptance … a month before turning 63, and more than 2 years after I first noticed symptoms of AD, comprehensive testing at an Alzheimer’s Disease Research Center in New York City led to my wife’s diagnosis of early onset AD.

Accepting that your wife has a fatal disease, one with no effective means of treatment or cure, is not easy.  But her diagnosis did not surprise me.  I accepted it.  In fact, I had expected that diagnosis months earlier, even though doctors were telling us that Clare’s symptoms were due to stress, anxiety, or depression.  Research I had been doing for 2 years made me feel certain that she was already in the early stages of AD

But my acceptance didn’t make it any easier to know that our lives would be changed forever.  Acceptance did not mean absence of pain.  Acceptance of her AD diagnosis hurt.  A lot.  And it kept on hurting.  Sadly, I had no way of knowing just how much more pain was to come after my acceptance of that AD diagnosis.

Pain came in waves, and just continued coming.  I had accepted that there is no way to effectively treat AD, and I had accepted that there is no cure.  I knew that after an AD diagnosis some people may only live for a year or two, some may live for 18-20 years, but the average time a person lived after an AD diagnosis was only 8 years.

Given Clare’s highly developed verbal skills, her fluency in several languages, and her young age, the geriatric psychiatrist who discussed the AD diagnosis with us said that we could reasonably hope for Clare to have 15 or more good years. I didn’t believe him.  I personally didn’t know of anyone who had even 10 good years after diagnosis.

This diagnosis became our new reality, and I had no other choice but to accept it.  But acceptance of my new reality did not mean that I had to like my new reality.  It did mean, however, that I had to learn to live with my new reality.  I had to learn how to get on with my own life, knowing that Clare would no longer be by my side during what we both had once hoped to be a lengthy retirement.

I knew that I had to accept that Clare and I would soon no longer be a “we” … those “we” days would soon be gone.  I knew that.  I knew that Clare would now have a future apart from me and I would soon have a future apart from Clare.  But knowing all of this didn’t make it any easier for me to move on.  Why was acceptance of my new reality so difficult to … accept?

A decade prior to Clare’s diagnosis, and shortly after her diagnosis, we had discussed what we wanted should severe health issues require either of us to ever need either 24/7 home health aides or placement in a facility.  In 2013, more than 6 years after I first observed Clare exhibiting AD symptoms, I placed Clare in an assisted living facility.

I was now living alone in “our” house, a house we had shared for 40 years. I still wanted to hold onto our past and wanted Clare to be part of a wonderful future … together … with me.  But that was no longer possible.  I knew that.  I had accepted that.  Painfully.

I wasn’t in denial.  I really wasn’t.  But I was finding it so very hard to accept our new lives.  I didn’t want to “let go” of Clare.  I was finding it so hard to accept my new life as an “I” instead of as part of a “we.”  There were lots of tears, lots of lying in bed at all hours of the day, lots of inertia.  And lots of pain.

Clare only lived for 7 years after her diagnosis.  She died in her sleep just one month before what would have been her 69th birthday … 2 months before what would have been our 49th anniversary.  Our “we” days were now gone forever. 

Acceptance … just the first of many emotions and feelings I was now experiencing and struggling with on a daily basis.

Monday, September 9, 2024

Top 5 Tips Physicians Can Share with Caregivers of People with Alzheimer Disease

 

THE NEUROLOGY HUB

 

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Alzheimer Disease & Dementia > Caregiver Essentials

Top 5 Tips Physicians Can Share with Caregivers of People with Alzheimer Disease

Allan S. Vann, EdD

 

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When a physician sees a patient with a diagnosis of Alzheimer disease (AD), they may also interact with the patient’s caregiver. Caregivers are an essential part of a person with AD’s treatment journey, and it is therefore critical to equip them with optimal care tools and strategies, and to help caregivers develop care plans early after diagnosis. In this article, I have drawn upon my own 10 years of experience as a spouse caregiver for my late wife, who was diagnosed with early onset AD, to provide physicians with my top 5 topics to bring up with caregivers of people with AD.

1. Make sure patients know where they are in their dementia journey and suggest they make plans accordingly.

When a physician makes a diagnosis of AD, it is essential that a patient and their caregiver understand exactly what that means for their daily life. You should clarify that, while AD progresses differently for each patient, one can never be sure how long it will take for significant impacts on normal activities to occur. Physicians do not need to “unduly frighten” their patients and caregivers, but they should be honest about the uncertainty regarding the timeline of transitions.

The unpredictability of cognitive decline became apparent when my wife and I were making travel plans. At my first AD spouse support group meeting, I mentioned that my late wife and I loved to travel and had already placed a deposit on an international trip we had planned to take in 12 months. A wise woman whose husband was in the moderate stage of AD whispered to me on the way out, “Allan, don’t wait 12 months to take that trip. Your wife may not be able to travel a year from now.” That night, I asked my wife where she would like to go if we could only take one more trip. She told me and then fell asleep, and then I booked that trip. We traveled 3 months later to another destination and that turned out to be our last major trip. My wife’s cognitive skills declined so quickly that the following year we were unable to take the international trip we had planned.

2. Broach the topic of long-term planning and long-term care options with your patients as early as possible.

There are numerous questions that you can ask caregivers of patients with AD:

What will you do if you can no longer care for your loved one by yourself? Can you rely on close family members or friends for support? Does your loved one prefer to stay at home with companions or health aides, or does your loved one prefer to be in a residential facility? Which do you prefer?

If not previously discussed, it is best to have these conversations as early as possible, ideally before the caregiver’s loved one has experienced significant cognitive decline. Caregivers need sufficient time to assess their options, visit potential care facilities, and to consider employing the help of home health aide providers. It can be especially helpful to include the person with AD in long-term planning conversations. The earlier that caregivers consider these options, the more prepared they will be at the different stages of transition that their loved one experiences. This is particularly important for the wide range of policies to which each care provider adheres, such as whether a facility uses a waitlist for admission, whether meals are provided, or whether a home health aide provider is available 24/7. You can refer caregivers to helpful information available on their state’s Department of Health website.

As each of these long-term care options carry different price tags, another aspect of long-term planning is finances. If possible, recommend that your patients and their caregivers meet with an eldercare attorney and financial advisor.

When my late wife and I retired, we discussed the possibility of long-term health care and decided that we did not want such care to take place in our home. Nine years later, my wife was in the early stages of AD, and we started visiting various facilities. It gave me some comfort to know that when I did eventually place my wife in an assisted living facility, it was the one where she had felt most comfortable during our site visits.

3. Discuss driving safety with patients and their caregivers.

As patients with AD experience cognitive and functional decline, they may also lose the ability to drive safely. Unfortunately, it is not possible for a physician to predict when exactly this may occur. A report from the American Academy of Neurology (AAN) notes the importance of physicians talking with patients and caregivers about the risk of driving once there is a diagnosis of AD or dementia.1 Friends and family members are often the first to notice any changes in behavior, including driving habits, so physicians should discuss this topic during every patient visit and document any changes.

At some point, caregivers may need to take the keys away from their loved one with AD. This is often an extremely difficult and emotionally straining decision, but it is a decision that must be made in most cases. My advice is to encourage caregivers to take their loved one’s car keys away early, before their cognitive ability declines to the point where they get into an accident and cause injury or property damage, or become lost while driving and forget how to return home and call for help. These are frightening scenarios, but very real possibilities.

4. Suggest that caregivers explore caregiver support groups.

Earlier, I mentioned how a fellow member of an AD spouse support group meeting helped me to realize the importance of scheduling an earlier trip with my late wife, rather than wait 12 months for the international trip we had previously planned. Like me, many caregivers can benefit from participating in this type of caregiver support group. These groups provide an environment where caregivers in similar situations can share helpful tips, recommendations, strategies, or stories about common experiences and challenges. Additionally, such groups can provide emotional support and tactics for time management, activities, and advanced care planning.

It is often beneficial for caregivers to identify a group that matches their specific experience. For example, the group I mentioned was for partners or spouses of people living with AD. Other groups might be catered to children caring for their parents or grandparents.

As with everything, it is helpful for physicians to encourage caregivers to join support groups early in their care journey, as soon as possible after their loved one is diagnosed with AD. Let caregivers know that participating in these groups requires a certain level of commitment, but that they can provide significant benefits including valuable social interaction that can help the overall physical and mental health of caregivers.

5. Consider recommending adult social day care and other resources.

Social day care programs can be a relatively low-cost, win-win option for loved ones in early-to-moderate stages of AD and their caregivers. These programs provide opportunities for those with AD to engage socially with others in similar circumstances and to participate in activities including art, singing, dancing, and games. Caring for a loved one 24/7 can be extremely stressful, so these social day care programs can provide several hours of respite for caregivers. Physicians can assist caregivers by making them aware that these types of programs exist. Consider becoming knowledgeable about day care options in your geographic area or referring caregivers to local AD organizations, municipal senior citizen services, adult homes for seniors, and assisted living facilities that provide social day care services.

Final Thoughts for Physicians

The caregivers of each of your patients have one thing in common: We are each paddling our boats as hard as we can trying to stay afloat to support our loved ones. We may be paddling different boats, in different waters, and at different speeds, but we are all dealing with a similar situation. We are all trying to keep our heads above water. Your patients and their caregivers are dealing with this situation for the first time, but as a physician, you are in a position to provide guidance and suggestions that can drastically improve the quality of life not only for your patients, but also for their caregivers. Any advice you can offer, however small, may make a big difference in the lives of your patients and their caregivers.

1.     Iverson DJ, Gronseth GS, Classen S, Dubinsky RM, Rizzo M. Practice parameter update: evaluation and management of driving risk in dementia. Neurology. 2010;74(16):1316-1324. doi: 10.1212/WNL.0b013e3181da3b0f

Published online only on July 23, 2024 on The Neurology Hub website. The Neurology Hub is a site “designed for health care professionals to learn, collaborate, and share content and ideas in the field of neurology” and is sponsored by the journal, Practical Neurology.

This article can be accessed at:  https://theneurologyhub.com/article/top-5-tips-physicians-can-share-with-caregivers-of-people-with-alzheimer-disease