• Is your loved one able to keep the house and yard as clean as before? Do you notice laundry piling up? Do the floors, furniture and bathrooms need to be cleaned?
• Is your loved one able to retain personal cleanliness? Can your Mom or Dad shower and bathe regularly without help? Has personal hygiene changed?
• Has your loved one fallen behind on bills? Is old mail piling up? Do you notice clutter that was never there before?
• Is your Mom or Dad able to manage their medical care, schedule and remember regular appointments? Can they explain and follow through with medical recommendations?
• Are medications in order? Do you know if your Mom or Dad is taking his or her medications as prescribed? Can they name their medications and their use?
• Has your loved one been repeating themselves?
• Does your loved one interact in a socially appropriate manner for light conversation, and yet if the conversation becomes more complex, they do not follow or respond appropriately?
• If you have one parent that you are worried about, does the other parent often answer for them?
• Does your loved one frequently misplace items? Do you ever find items in an unexpected place?
• Is your loved one still cooking proper nutritious meals every day? Is he or she maintaining a healthy weight and getting some form of exercise?
• Do you worry about your loved one’s safety when alone and cooking?
• What is the condition of the items in the refrigerator? Are food items adequate in supply and not expired by date or appearance?
• Has your Mom or Dad lost interest in day to day activities and social activities? Does your loved one make excuses why they don’t participate with friends or engage in social events or church activities?
• Do you think your loved one feels isolated or lonely?
• Does your loved one forget your recent visits or calls?
• Does your loved one seem to be withdrawn, fearful or depressed? Has his or her manner or character changed?
• Has your loved one’s driving ability diminished? Have you questioned if they should still be driving? Has your loved one become lost while driving a familiar route?
• Has your loved one experienced a crisis situation recently such as a hospitalization or an episode of wandering away from home and not remembering how to get back?
• Does your loved one deny any problems or refuse to discuss the situation, even though you may have answered “yes” to several of the above items?

It is estimated that over 65% of those with dementia will wander at some point, so it is critical for caregivers to monitor their loved ones and be alert for any signs of wandering (see below). However, it is often difficult to balance one’s need for a degree of personal freedom with the necessity of protecting him or her from the dangers of wandering. When a person with Alzheimer’s disease does begin to wander, it is important to recognize the confusion and help him or her refocus on real-life tasks.

According to the Alzheimer’s Association, a person may be at risk for wandering if he or she:

• Returns from a regular walk or drive later than usual
• Tries to fulfill former obligations, such as going to work
• Tries or wants to “go home” even when at home
• Is restless, paces or makes repetitive movements
• Has difficulty locating familiar places like the bathroom, bedroom or dining room
• Checks the whereabouts of familiar people
• Acts as if doing a hobby or chore, but nothing gets done
• Appears lost in a new or changed environment

The Alzheimer’s Association also provides a list of tips to aid those with Alzheimer’s who are susceptible to wandering and their caregivers:

• Encourage movement and exercise to reduce anxiety, agitation and restlessness
• Ensure all basic needs are met (toileting, nutrition, thirst)
• Involve the person in daily activities, such as folding laundry or preparing dinner
• Place color-matching cloth over doorknobs to camouflage
• Redirect pacing or restless behavior
• Place a mirror near doorways. The reflection of a person’s own face will often stop him or her from exiting the door.
• Reassure the person if he or she feels lost, abandoned or disoriented .
• Enroll the person in MedicAlert + Safe Return.
• Inform your neighbors and local emergency responders of the person’s condition and keep a list of their names and telephone numbers.
• Keep your home safe and secure by installing deadbolt or slide-bolt locks on exterior doors and limiting access to potentially dangerous areas.
• Never lock the person with dementia in a home without supervision.
• Be aware that the person may not only wander by foot but also by car or other modes of transportation.

MedicAlert and Safe Return:

Keep your loved one safe by knowing the risk factors for wandering and enrolling in MedicAlert® + Alzheimer’s Association Safe Return®, the Alzheimer’s Association’s 24-hour nationwide emergency response service for individuals with Alzheimer’s or related dementia that wander or who have a medical emergency.

More information

Wandering – Preparing For and Preventing It (2 pages)
Wandering: Who’s at Risk? (2 pages)

Those with memory loss live in a different reality from our fast paced, noisy lives. Theirs is slow, quiet, and based in the remote past which is a predictable place in its familiarity of people and routines. They cannot sustain staying in the present; it is too difficult and confusing. Retreat into the past with your loved one and you will have a better than good visit!

• Plan a time limit on your visit that you are comfortable with – as few as 15 to 20 minutes can make for a good visit.
• Slow down your pace and your mind before entering your loved one’s space.
• If possible, turn off background noises, such as the TV and music, when having a conversation.
• Identify yourself each time. If he or she doesn’t know who you are, introduce yourself by your first name, “Hi Mom. Brad, your son, is here to spend some time with you.” It may take a full minute for your loved one to orient to you being there and to recognize who you are.
• Address one topic at a time. Don’t jump from subject to subject, especially in mid-sentence. Processing information is slowed in the brain of a person with Alzheimer’s. Sometimes it takes a full minute or longer for the brain to accept a message, make some sense of it, and formulate a response.
• Plan a task to be accomplished while you’re there, such as a short walk with easy, slow talk (you’ll probably carry most of the conversation), reading a story, listening to music together, or giving your mom a manicure.
• Communicate positive feelings through quiet hand holding, a light back rub, or a hand resting on the back or forearm. Always approach your loved one from the front before touching so he or she isn’t startled.
• Talk slowly and simply. Avoid complex concepts and repeat information as necessary to be clear.
• Avoid arguing with your loved one’s perceptions of things and don’t correct your loved one when he or she is wrong. Sometimes saying nothing works best. You always lose an argument with a confused person!
• Avoid long explanations, e.g., why your loved one must do something.
• Enjoy being in his or her world. Do not reality-orient or correct his or her memories or perceptions of things.
• Avoid questioning and quizzing. Avoid questions asking what, who, when, and especially why. Questions that can be answered “yes” and “no” are best.
• When asking a person with dementia to make a decision, offer only two choices, either of which is acceptable. More than that is too much for the brain to deal with now. For example, “Do you want to walk with me now, or talk together first?”
• Know that your presence alone brings peace and comfort to your loved one!

Relating to those with memory loss can often be challenging. It’s helpful to keep in mind that their behavior is their way of staying in touch with what is going on to feel in control of their lives. We understand that. The personal caregivers and Social Program Directors in our Memory Support Neighborhoods are trained in the habilitation method of memory care with a focus on maximizing the independence of each resident, as well as creating positive emotional experiences using all of the techniques and tips outlined here.

TIPS COMPLIMENTS OF

Beverly Moore, RN CS, Alzheimer Coaching Services, 617-233-1145

Living in silent anxiety, these seniors are often mistakenly viewed as being able to maintain their daily needs at home alone. Additionally, many individuals with mild memory loss live in “traditional” assisted living and senior housing communities yet are not receiving specialized memory care. In Massachusetts, for example, almost 30% of seniors living in “traditional” assisted living apartments have a medical diagnosis of Alzheimer’s or related dementia.*

In reality, without specialized treatment for the symptoms of their memory loss, anxiety increases and cognitive function declines more rapidly. Often, individuals suffer from increased isolation and depression.

How do you recognize someone who might have MCI? Look for these early symptoms:

• Forgetting to take medications as prescribed by the physician
• Difficulty maintaining a proper nutritionally balanced diet
• Increased difficulty with executive functioning, which includes losing or forgetting to pay bills, not being able to balance the checkbook, missing appointments, difficulty with decision making, and poor judgment in emergency situations
• Forgetting names and places and getting names of relatives confused (such as mixing up mothers and daughters)
• Increased anxiety
• Losing short-term memory, which often is noticed by repetitious stories

Senior Living Residences’ communities provide a supportive nurturing environment for individuals experiencing a wide range of memory issues with programming that actually treats the symptoms of their memory loss. Our innovative and extensive treatment program includes a specialized brain-healthy diet, a curriculum-based learning program designed specifically for individuals with memory loss, extensive staff training and resident case review by a Boston University School of Medicine Alzheimer’s clinician, and more.

The latest research is suggesting that treatment interventions, such as ours, may actually slow the progression of Alzheimer’s disease, minimizing the cognitive decline of seniors.

*According to Massachusetts Executive Office of Elder Affairs 2008 data, almost 30% of seniors living in “traditional” assisted living apartments in our state have a medical diagnosis of Alzheimer’s or related dementia. EOEA, 2008 Annual Report, Assisted Living Resident Aggregate Information

More and more, I see this term used for the general public: to describe newsworthy findings of studies about memory and aging, in educational materials from leading organizations like the Alzheimer’s Association, and from neurologists caring for people experiencing memory loss.

MCI refers to the stage between the cognitive decline associated with normal aging and the more serious changes associated with Alzheimer’s disease, marked by progressive loss of memory and day to day functional abilities.

Researchers and scientist are particularly interested in studying people with MCI as they may be seeing Alzheimer’s disease (AD) at its earliest stage. People with MCI are an important part of research studies seeking information about biomarkers, risk factors, and prevention of AD.

Senior Living Residences, www.seniorlivingresidences, is currently implementing a number of cognitive health initiatives to help people living with the memory changes associated with MCI and the earliest stages of Alzheimer’s disease.

Visit this blog again for information on the diagnosis, treatment, and services available for people with Mild Cognitive Impairment.

Focusing on innovation, Senior Living Residences, www.seniorlivingresidences.com, has been implementing a cognitively protective diet and nutrition program for the past two years. The Memory Preservation Nutrition® program, developed by and implemented in conjunction with Nancy Emerson Lombardo, PhD, is a unique evidence-based program incorporating foods and spices, specifically selected for their nutrient-rich properties and linked in research to healthy cognition, into everyday diet to improve overall brain health. The program seeks to improve brain function, decrease the risk of developing Alzheimer’s disease, and slow down the progression of Alzheimer’s disease for an individual who has already been diagnosed.

The main foods that are indicated through the program include fresh fruits and vegetables, especially leafy green vegetables, specific spices, whole grains, and foods containing omega-three fatty acids. All of the healthy foods in the right combinations provide the body with important disease-fighting antioxidants, nutrients with anti-inflammatory properties and also help to regulate blood sugar. These changes are all important for brain health, yours and mine.

To read more about the Memory Preservation Nutrition® program, visit http://www.seniorlivingresidences.com/senior-living-residences-launches-innovative-nutrition-program.