Alzheimer’s Disease – Associated Behaviors

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Guest:  Fran Emerson – Alzheimer’s Association

Host:  Sally Smith – Author/Resource literature on age-related disease and healthy aging


Sally Smith:  Welcome to Age to Age.  I’m Sally Smith.  Let’s talk.  We have Fran Emerson with us today, who is a virtual fountain of information on caregiving.  She has gained experience over many years in this field, with dementia and Alzheimer’s.  She is the program director for the Charleston area Alzheimer’s Association.  What I love, in learning more about Fran, is her attitude and way of looking at this disease in many practical ways.  Instead of judging certain things, she looks at them through the eyes of the patient, and she has given us some invaluable information. 


One of things we just talked about with Fran is common behaviors for patients with Alzheimer’s, loved ones with Alzheimer’s or dementia.  Some of these, of course, come with the disease, which we have heard much about.  But, actually, some of the causes may be not from the disease.  They may be cloaked, in our eyes, as part of the disease.  But, actually, we might find respite from these problems by looking at issues outside of the actual disease.  What are some of these factors that might lead to behaviors that might be giving us a problem, but not actually caused by the changes in the brain?


Fran Emerson:  There are a number of issues that we don’t see sometimes.  One of the fundamental things, of course, is, as we grow older, we collect a lot of medication treatments along the way.  And people with a diagnosis of Alzheimer’s disease often have other diagnoses that are being treated by other medications.  So you may have a cocktail of medications that isn’t conducive to that person’s well being and state of mind.  So, if there are behaviors, particularly those that occur out of the blue, take a look at any recent medication changes and see if adjustments are needed there. 


The environment in which we live is crucial.  And when there is a change of environment, you know, that can really trigger some reactions or behaviors that you haven’t seen before.  We talked a lot about this, particularly over vacation and holiday times.  Let me give you an example.  There’s going to be a family reunion, oh, we’ve got to take Mom to the family reunion.  She’s been functioning nicely in her home for the last five years of her diagnosis, and then suddenly she’s going to be transported into another house with thirty family members, all very excited, all very noisy, and overstimulation may well trigger some sort of anxious behavior.  It’s usually anxiety. 


I mean, I’m not in the first flush of youth and, now, when I get into a very crowded party situation, I don’t want to stay there for long.  You know, we like to become a little quieter as we get older anyway.  So, think of someone with a diagnosis.  They’re anxious.  They’ve got to make sense of what’s happening around them.  So, if you put them in a different environment, too much noise, too much light, a lot of conversation they can’t make sense of, there’s going to be a reaction. 


Sally Smith:  You know, that makes me think, too, about, just, issues, medical issues on the outside, like hearing and vision.

Fran Emerson:  Yes.


Sally Smith:  I realized my mother, some of the things I thought, actually, were her dementia, I think she actually wasn’t hearing well.


Fran Emerson:  Right.


Sally Smith:  And so, she was out of it.  She couldn’t follow the conversation, and yet, you know, we thought it was all part of this package, or at least that was our first, early assumption.  But there are probably so many things like that.  We got a hearing aid for mother, but she always said the thing never worked.  You know, she didn’t like it and didn’t want to use, and rejected it.  But there are these other pieces of the puzzle that would take you out of your comfort zone, that would make you feel like you’re not playing with a full deck of cards, while everybody else is expecting you to make sense.


Fran Emerson:  Exactly.


Sally Smith:  That’s interesting.  And, probably, fatigue and just the exhaustion of being in a big group, I know that’s a real factor, sometimes, with older people.


Fran Emerson:  Absolutely.  Tiredness is a big one.  If you’re going to do something with your loved one that you think might bring pleasure, like go for a walk, car ride, or whatever, do it early in the day.  You know, don’t leave it until late afternoon, early evening, because that’s the time when we’re all kind of winding down.  So, when you think of someone with Alzheimer’s disease, also think about what their life was like before the diagnosis.  You know, things are going to change dramatically, and some things are a given; at the end of the day, we’re tired. 


Sally Smith:  Mm hmm.  Well, you know, I think, one thing I remember when I had small children and my husband and I never had enough time together, he was in medical training, we’d say we’ll take the children and go away for a week, to the mountains, or whatever, and my mother would say, no, no, you go away to the mountains with your husband, and I’ll keep the children.  We thought it would be fun, you know, the car trip, the new adventures, taking a hike.  These were tiny children that were going to be in a backpack, and she said that would just be overstimulation.  What the child wants is your undivided attention; that’s fun for the child.  A car trip, over a week, with a lot of restaurants and different stops is not fun.  And, as one reaches older age, it’s probably the same thing.  You’re quiet undivided attention is probably the bigger gift than the fun shopping trip to the mall.


Fran Emerson:  Yes.


Sally Smith:  Or something that’s really out of their comfort zone.  I think some what works for a small child, structure, steadiness, quiet, works, also, at the other end of our life.


Fran Emerson:  It does, indeed.  And we know, we know there’s a lot of research that goes on to show that structure is very important for someone with dementia.


Sally Smith:  Let me ask you one other thing.  I’ve often heard of the contributing factors that mask as something like dementia, or Alzheimer’s.  I’ve heard that depression, not so much from the Alzheimer’s, can make someone seem as though they have dementia or Alzheimer’s.  Is that something where you notice there’s a depression and you have someone worked up for depression to eliminate that as a cause?


Fran Emerson:  We always recommend to family members that if they see someone changing that they look at those changes and see if there is a possible link with depression, particularly with someone who has lost a spouse.  Now, often a traumatic incident in life, a fall, a broken hip, or bereavement, can suddenly expose an undiagnosed dementia.  You know, people can function a long time and hide this if they’re in their comfort zone, they’ve got a routine, they’re in their own home.  But, particularly with a bereavement, if you see one becoming depressed, it’s very important that you encourage that person to see a physician, because that depression could be a dementia.  Or, what you perceive as someone losing it a bit, could be depression.  But depression is a huge issue that has a relationship with a dementia.  You can become depressed very quickly if you live on your own, you’re not motivated to do anything, and the medical profession, those who work in the field, do understand that relationship.  If you see anyone depressed, you know, try to encourage them to get help.


Sally Smith:  Well, you know, a spin off of that, I know a particular lady who has some depression, and she doesn’t care about eating.  She’s dehydrated.  She has just lost interest.  And I see, one of your factors that leads to behaviors, is dehydration.  Is that common, they just lose interest in drinking enough water or eating enough food?  Is that just part of what, sometimes, happens?


Fran Emerson:  Well, you have to remember, as we grow older, we are more susceptible to dehydration.  We really have to watch our fluid intake and drink that liter of water, at least everyday, and avoid the possibility of urinary tract infections.  Dehydration equals urinary tract infections.


Sally Smith:  Oh, okay. 


Fran Emerson:  There is a link there.  We’ve got to be very careful with that.  And it’s more prevalent in older age.  So, that’s a given, apart from the dementia.


Sally Smith:  I see.


Fran Emerson:  So, you’ve got someone with a dementia who becomes dehydrated because they don’t remember or they’re not able to work out that water is really essential in staying alive, even, it’s an actual reasoning process, then you have to actually offer water.  In facilities, you can see this.  They have a hydration process where they have regular offerings of liquid.  If you’re dehydrated, yes, your behavior is going to change.


Sally Smith:  Wow.  Well, there are many factors, and it’s complicated, but you’re making progress in helping us map our own journeys, as we see how our loved ones are acting, and ways to solve problems.  Thank you so much, Fran, for sharing that with us, the factors that can lead to behaviors that are even outside of Alzheimer’s, but seem to be part of it.  And thanks to all of listeners for joining us today.  We welcome your suggestions and comments on our website.  This is Sally Smith, Age to Age, saying good-bye, wishing you courage and joy on your journey.  We are all connected.

If you enjoy listening to Sally Smith, you can buy her book, The Circle.  It’s the story of how she personally responded to her mother’s journey with Alzheimer’s disease.  It’s a wonderful gift of hope for anyone with a parent with dementia.  Just click on Sally Smith’s name under the Health Professionals tab on the Podcast home page.  All profits support research at the Center on Aging.  Thanks.

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