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Wednesday, May 13, 2009

The Alzheimer's Project - Review of Grandpa, Do You Know Who I Am?

The Alzheimer’s Project
 
Grandpa do you know who I am?

 
Of all the segments in the Alzheimer’s Project, I found this one the most difficult to watch. In fact, I cried all the way through. As a mother, it hurt to see all of those vulnerable children who love their grandparents unconditionally, struggle to understand why does my grandparent act this way? Why is this happening to this person that I love? If they love me, why are they acting like this?
 
As adults, we pretend that we understand this disease and that we are not hurt by the behavior of our loved one with AD.   However, many times the adult children and adult grandchildren of my clients tell me they cannot understand why their loved one is being so mean to them. Why is this person so angry? Why does this person hate me so much? Why can’t she remember my name?
 
In one segment of this episode, a grandchild tells that her grandmother had slapped her one day while the grandmother was in the nursing home. Although the granddaughter seemed to intellectually understand that the behavior was a result of the disease, it was apparent that that slap really hurt and that the memory of that slap would remain with the granddaughter for a very long time. Another segment shows a grandmother growling at her grandchild and telling the child to go home. The child’s older sister comforts her and reminds her that the grandmother is ill and does not really know what she is doing.
 
Throughout this segment, we see grandchildren taking care of their grandparents – combing their hair, walking with them, helping them to eat. Although it is painful for them to watch their grandparents deteriorate, I believe that each one of these children will be better for having learned compassion and service.
 
Maria Shriver’s narrative is compelling and true. Here is the daughter of one of the most accomplished, intelligent people in the U.S., and she tells us that she must introduce herself to her father every time she sees him. “Hello, Daddy, I’m your daughter, Maria.”

In the end, though, Maria says she is just happy that he is still here. And I believe that in the end, children and grandchildren of those who suffer with AD are just glad their loved one is still here.


Tuesday, February 10, 2009

Book Review: Memory Lessons: A Doctor's Story by Jerald Winakur

 

Book Review:
 
Memory Lessons: A Doctor’s Story by Jerald Winakur
 
I’m an admitted insomniac and a voracious reader. Thankfully, I can combine the two habits so that I can at least be productive during my periods of insomnia. I picked up Dr. Winakur’s book last night, and finished it by morning. Oh, I did get a few hours of sleep in between chapters.
 
 
Dr. Jerald Winakur, a seasoned geriatrician, writes a series of essays reflecting on his medical career and on the physical and mental decline of his father from Alzheimer’s disease. Dr. Winakur is a medical professional who treats the old-old, defined as those over the age of 85, but he is also a son facing the uncertainty of dealing with his old-old father’s declining mental and physical capacities. A son who, although not legally his father’s physician, is his father’s surrogate decision-maker.   Dr. Winakur exposes the human side of a physician - the side where the scientist and trained professional meets the man with doubts about the efficacy of the treatments prescribed for patients and the man with concerns about the ethics of those treatments. Dr. Winakur struggles with the lessons he learned early in his career – to keep the patient alive – with his life lessons. Those life lessons teach that sometimes it is better to let the patient go.
 
Those caring for loved ones with dementia will likely recognize the feelings of guilt and uncertainty that come with the day to day care of someone who no longer recognizes the caregiver. They will empathize with the family’s agony over deciding where the loved one should live, what treatments should be authorized, how to react to the repeated questions and how to deal with the endless wanderings in the night. 
 
Dr. Winakur also exposes some of the flaws in the medical profession, and ties many of those flaws to the system by which physicians are compensated. He raises concerns about the rising number of specialists who are well compensated for procedures, and the stingy compensation afforded family practice physicians, internal medicine specialists and geriatricians who are responsible for using their reasoning skills to diagnose and treat most of the nation’s patients. Specifically, he lays the blame on the Medicare system of reimbursement, the rates determined by a board of physicians heavily weighted with specialists earning their living by doing procedures on patients.
 
I recommend this book to those caregivers beginning their journey with the loved one with Alzheimer’s disease, for they can learn what may come. I also recommend this book for those who are at the end of the journey, for they can find a kindred soul.
 

Saturday, December 13, 2008

Veterans of World War II Remembered on Pearl Harbor Day

Sunday was the 67th anniversary of the attack on Pearl Harbor and I found a few articles on survivors of the attack in the Atlanta Journal Constitution and online. According to the Department of Veterans Affairs, there are less than 5,000 current members of the Pearl Harbor Survivors Association. At its peak, there were 20,000 members of the Association. As of Sept. 30, 2008, there were 2.6 million World War II veterans. Those veterans are dying at the average rate of 851 each day, with 310,777 expected to die by September 30, 2009. 

 
Therefore, it is important to capture the stories of those WWII veterans still living. The Library of Congress is conducting the Veterans History Project and seeks interviews, photographs, correspondence and other objects related to veterans. The website can be found at: http://www.loc.gov/vets/about.html and contains tips on conducting interviews of veterans to collect their first-hand account of their service. Here is a link to the Biographical Data form required by the Project: http://www.loc.gov/vets/pdf/biodata-fieldkit-2007.pdf. Here is a link to suggested questions to ask the veteran: http://www.loc.gov/vets/vetquestions.html
 
You may also learn about how to conduct an oral interview with your loved one at StoryCorps. http://www.nationaldayoflistening.org/
 
If you want to do some research on enlistment records or the Pearl Harbor Muster Rolls, check out the National Archives at: http://www.archives.gov/research/arc/topics/ww2/
 
For information about Veterans Pension and Aid & Attendance Benefits, please check out our brochure at: http://www.elrod-hillfirm.com/global_pictures/EHLF_Veterans%20handout.pdf or give us a call at 770-416-0776.

Saturday, December 13, 2008

DWE or Driving While Elderly

As the parent of a 16-year-old soon to be licensed driver, I think a lot about whether she will be safe on the roads -  and whether others who have to share the road with her will be safe!  At the same time, I worry about whether my aging clients are safe on the roads – and whether others are safe on the same roads with those aging drivers. In my practice I am regularly told stories –some funny and some frightening – about aging or impaired drivers. 

 

For my 16-year-old, the ability to get in the car and drive wherever she might like to go signals the ultimate freedom.  For my aging clients, the thought that they will no longer be able to drive wherever they want signals the end of that same freedom.  That is why the issues involved with the elderly drivers are so difficult and why we need to consider the options carefully before taking any action.

 

The families of the elderly often ask how they can get Mom or Dad to stop driving.  The story is usually that Dad or Mom runs stop signs, gets lost, or drives 25 miles an hour while other drivers zip by them at 75 miles an hour.  How do we know when its time to take away the keys?  And how do we take those keys away without a fight?

 

Clearly, there is no magic age at which driving skills decline, so what are some of the signs that Mom or Dad should either curtail some of their driving or stop altogether?

 

The website Aging Parents and Elder Care has a list of signs that a driver’s skills may be declining.  Among those signs are the following:

  

* Driving at inappropriate speeds, either too fast or too slow

 

* Having one or more near accidents or near misses

 

* Getting lost repeatedly, even in familiar areas

 

http://www.aging-parents-and-elder-care.com/Pages/Checklists/Elderly_Drivers.html

 

 

If Mom or Dad is showing some of the signs of declining skills, try to determine whether there is a medical reason for the decline that may be corrected with proper medical care.  Similarly, determine whether the elder may be able to modify their driving to accommodate the decline. 

 

Once you have determined that the problem is severe and the elder must completely stop driving, how can you get them off the road?

 

Here are a few suggestions:

 

* Confront Mom or Dad and let them know that you are afraid that they will injure themselves or others if they continue to drive.  Help them find alternative transportation options.  For help with this conversation, check out The Hartford’s Family Conversations with the Older Driver at:

 

http://www.thehartford.com/talkwitholderdrivers/having/main.htm

 

 

* Contact the Department of Motor Vehicles or have your loved ones doctor contact the Department of Motor Vehicles to report that the driver is no longer safe.

 

* Finally, you may have to either disable or take away the car. 

 

To help older drivers continue to drive as long as possible, consider driving classes offered through AARP.  You can find classes near you by checking out the AARP website at:  http://www.aarp.org/family/housing/driver_safety_program/


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