“Should auld acquaintance be forgot and never brought to mind? Should auld acquaintance be forgot and auld lang syne?”

Most of us started out the year with those words, and many of us without thinking about their meaning — or perhaps knowing it, thanks to the Scots used by the original lyricist, poet Robert Burns. Loosely translated, ‘auld lang syne’ means ‘and old times since/past’ — something that, if you have an elderly loved one with dementia in your household or family, is often on your mind. Should old acquaintances and times long gone be forgotten? Of course not!

Throughout our lives, music serves as a source of both comfort and energy, calm and stimulation. Even before we’re born, we can hear and respond to music, and exposing the developing brain to it has been proven to improve brain function in children.

Dr. Oliver Sacks, a well-known and well-regarded neurologist and psychologist who has published extensively on both the brain and music, has been quoted as saying, “I regard music therapy as a tool of great power in many neurological disorders — Parkinson’s and Alzheimer’s — because of its unique capacity to organize or reorganize cerebral function when it has been damaged.” Even those of us who aren’t at the mercy of dysfunctional brains and overwhelming emotions–like many dementia patients are–recognize that music has a genuine power and ability to affect the way we feel.

While it cannot slow or stop damage wrought on the brain by dementia or Alzheimer’s, music can also improve the quality of life for those living with the diseases–as well as their family, friends, and caregivers. Music has the ability to lift moods and ease stress, and thus can have a palliative effect not only on a dementia patient, but also their emotionally-strained loved ones. Not only can it provide some emotional relief, but CNN reports that at least one study has shown that Alzheimer’s patients “consumed 20 percent more calories when music was played during lunchtime,” which is nothing to scoff at when put in the context of Alzheimer’s usual effect of decreasing appetite and leading to drastic (and unhealthy) weight loss.

Music can also be an easy way to “time-travel.” A general rule of thumb, when it comes to dementia patients, is that the first memories in are also the last ones out. It’s a lot easier to find music from the 1920s, ’30s, and ’40s than it is to recreate scenes from those decades, so playing old music can help stimulate a dementia patient’s fading memory.

The bottom line is, there’s definite potential for music to do good when it comes to Alzheimer’s, dementia, Parkinson’s, and similar diseases. Though it may not be able to reverse, slow, or cure brain disorders, the benefits far outweigh the only real negative–the threat of getting a song stuck in one’s head for longer than necessary!

Remember to tailor your response to your loved one’s dementia based on their specific symptoms and how advanced the disease is; not all of the tips below will apply to everyone!

Dealing with Dementia

A senior citizen with Alzheimer’s disease or dementia has very different needs than many other family members; try to keep them comfortable. Remember to keep a favorite sweater or a warm blanket handy in case they get cold; as we all know, the elderly often feel the winter nip in the air more keenly than those who are younger!

Many times, a loved one with early or moderate-stage dementia may feel the need to help with holiday preparations; after all, they’ve been doing it their entire lives! Rejecting their offers of help, even out of the best of intentions, can foster wounded feelings. Instead, ask them to help with simple, repetitive tasks, like stringing popcorn and berries for garlands, or signing cards from the whole family. Not only will it cut down on your own load, but repetitive tasks can be soothing for those suffering from dementia.

Remember that disruptions of routine can be upsetting to dementia patients; try your best to keep their regular schedule! If you have morning or evening routines with your loved ones, don’t let the holidays preempt them; starting and ending the day on the right note can lead to a reduction of stress for everyone involved.

If traveling is difficult with your elderly loved one, don’t be afraid to ask family and friends to come to you. The holidays are a time to be with the people you care about–and right now, one of those people has some very special requirements. There’s nothing wrong with adjusting family traditions to better facilitate your parents’ or grandparents’ enjoyment of them! Start some new traditions!

On the other hand, there’s a common saying among memory loss experts that goes, “last in, first out; first in, last out.” What this means is that long-standing memories–memories from decades ago–can be the memories that remain longest. Try to keep long-standing traditions; it can help your loved one remain oriented to their present time and season, and help them to better enjoy the holidays without becoming totally confused.

Preparing Family for the Differences

Before they arrive for the holidays, have a detailed, honest, and open discussion with your family members about your elderly loved one’s condition. If siblings, cousins, or nieces and nephews haven’t seen Grandma and Grandpa in a while, it’s best to prepare them, and let them know about any memory loss. Be sure to emphasize that memory loss is not a personal insult. Many times, people can become hurt when their grandparents or parents don’t recognize them, or mistake them for another family member or friend; remind them that this doesn’t mean they aren’t loved, just that your loved one is sick.

Let them know how to gently remind your loved one who they’re with and where they are, without getting upset; although dementia patients can be intellectually confused, they can pick up on emotional cues from those around them. If the people in their vicinity are upset or emotional, chances are your loved one will be too.

Explaining dementia or Alzheimer’s disease to children can be difficult and heartbreaking, but it can be for the best. Try to explain to any children present why they need to watch their behavior, even though they’re around family, and be sure to emphasize the first point–that if Grandpa and Grandma don’t recognize them, it’s just because they’ve changed so much!

Celebrating the holidays with a family member suffering from dementia or Alzheimer’s disease can be difficult, but keeping your eyes open and your expectations realistic can help to curtail any hurt feelings or family disasters. Remember–your loved one hasn’t morphed into a disease. The parent, spouse, grandparent, or sibling you love is still there; they just need a little extra TLC!

From all of us here at CarePlus, we wish you and your family members the best of holidays, and a happy, hopeful start to the new year.

It may not be easy, but it’s a good idea to try not to overindulge during the holiday season–and there’s no shortage of tips on how you can succeed at that. One of the best ways? Make substitutions while cooking! We’ve listed some of our favorite substitutions, many of which we’d never even thought of before.

1. Applesauce for oil or butter. Switching out the fatty oils for applesauce isn’t a new idea, but it’s one a lot of people might not be willing to try. The texture’s just right, though, and thanks to the natural sugars in fruit, even unsweetened applesauce can lend some sweetness to your baking!
2. Graham crackers for cookies in pie crusts! Pies are one of the holiday standards, and while everyone loves a good Oreo or cookie crust, swapping that out for reduced-fat graham crackers can cut out up to half the calories while still tasting great!
3. Stevia for sugar. This natural sweetener, which has recently been gaining in popularity is now more readily available, is lower in calories than sugar and up to 300 times sweeter. You read that right–300 times. Popular brand names are Sweetleaf and Truvia.
4. Prosciutto for bacon. While bacon is an American standard year-round, it’s also well-known to be a major (if majorly delicious) health hazard. Prosciutto can lend a similar taste while having half the calories and two-thirds as much fat!
5. Nuts for croutons. Serving up salad as a healthy option with your holiday meals? Croutons add a desirable crunch, but they can also pack quite a lot of fat and sodium. Instead, try lightly toasted almonds, pecans, or walnuts! Not only will you be eliminating those extra carbs, but nuts sneak in some extra omega-3 fatty oils.
6. Pureed fruit for syrup. Looking to warm up on cold mornings with some waffles or pancakes? Instead of slathering them with syrup, try pureeing fruit with a bit of honey; it packs in a lot less sugar, and when it’s warmed on the stove beforehand, tastes even better.
7. Frozen bananas for ice cream. You read that right! Freeze a couple of bananas overnight, then puree them in the blender; drizzle in a little bit of honey and some cinnamon. The texture’s almost identical, and the taste is to die for!
8. Ground turkey for ground beef. Since turkey is a leaner meat, it makes a great (and seasonal!) substitution for ground beef. A few spoonfuls of chicken stock can keep it from drying out!
9. Dry beans for canned beans. Sure, canned beans may be more convenient, but they’re so high in sodium and preservatives! Stock up on some dry beans; all it takes is a little extra soaking and boiling.
10. Marshmallow Fluff for the butter and sugar in frosting. Believe it or not, this childhood favorite is actually healthier than most frosting; 2 tablespoons is not only fat-free, it only has 40 calories and 6 grams of sugar, while conventional frosting can pack in up to 100 calories and 14 grams of sugar (not to mention all that fat)!

Of course, indulging in some of the ‘bad’ stuff around the holidays isn’t a mortal sin–feel free to treat yourself, but remember that, like with all things, moderation is key!

Do you have any favorite substitutions? Let us know!

• Stock up on bottled water. If the power goes out or the water supply is affected by the storm, you’ll need it!
• Dig out your battery-powered radio and some flashlights. Even if we lose power, you’ll want to stay aware of what’s going on – and don’t forget to stock up on batteries to run them!
• Charge your cell phones in advance. Also, if it becomes difficult or impossible to make phone calls in the wake of a disaster, try sending a text instead–they use less data than actual calls, and are more likely to get through.
• Make sure you have plenty of non-perishable foods, especially things that don’t require refrigeration or heating. Keep your refrigerator closed as much as possible if the power goes out–conserve food!
• Gas up your car. A full tank of gas is always a good thing to have, especially in emergency situations.
• Keep a first-aid kit at hand. We all hope you won’t have to use them – but if worse comes to worst, make sure you have the supplies you need ready!
• DON’T leave shelter during severe weather unless it’s absolutely unavoidable.
• DON’T drive into standing water - flash floods are dangerous!
• If you’re caught outside during severe weather, DON’T take shelter under a tree.
• Move to a central part of your house in the event of a weather emergency such as a tornado or strong winds; stay away from windows and secure them as much as possible.
• Check up on your neighbors, especially if they’re elderly, have young children, or are ill.

By now, we’ve all seen the dangers of skin cancer expounded on Oprah and the morning news, but skin cancer—usually carcinomas or melanomas—isn’t the only danger associated with overexposure to the sun.

Sunglasses aren’t just useful for protecting your eyes from glare; they can help prevent migraines and headaches, which are often triggered by exposure to bright light (such as sunlight), and they can also lessen the risk of developing cataracts. Cataracts appear as a cloudy or milky film over the iris and pupil—in fact, that’s almost exactly what they are. A cataract, which if left untreated can lead to blindness, is just the clouding over of the lens of the eye, and UV radiation—like that released from the sun—increases the risk.

Too much sun exposure can also lead to premature aging of the skin—which, in this case, is referred to as photoaging, the “photo” coming from the Greek word photos, meaning light. Photoaging, because it happens over such a long period of time, can be viewed as an unavoidable part of growing older, but in fact the careful and correct application of sunscreen and limitation to UV radiation can limit how leathery and discolored one’s skin becomes in later years.

Overexposure to direct sunlight can also lead to heatstroke, a potentially fatal condition, and let’s not totally discount sunburns—aside from the fact that they drastically increase an individual’s chances of later developing skin cancer, they’re just painful!

Skin cancer, of course, is the risk that we always hear about, and it’s not one to be taken lightly. Because the word ‘cancer’ isn’t preceded by the name of an organ we think of as vital—the heart, brain, or lungs, for example—people may brush melanomas and carcinomas off, but think about it this way: the skin is the largest organ of the body!  It’s also the most common cancer in the United States, with more than one in every five Americans developing skin cancer at some point in their life. The good news is that survival rates for melanoma—the malignant form of skin cancer—is pretty high; but think about it. Wouldn’t you rather just avoid the risk in the first place?

Though there may already be irreversible damage done, that doesn’t mean that adults and seniors shouldn’t slather on the sunscreen before heading outside, and parents and grandparents should be sure to extol the virtues of SPF-15 and higher to the kids in their lives; infants and children are much more susceptible to sun damage than adults.

So the next time you’re heading out to have fun in the sun, keep these facts in mind:

-          Throw on a shirt; if it’s white, it’ll also help to reflect some of that heat and light away!

-          Slather on sunscreen every two hours, and after you dry off upon getting out of the pool. That towel wipes more than chlorinated water off!

-          Don’t use sunscreen that’s more than two or three years old; it’s likely to have expired.

-          Wear a hat, preferably with a broad brim, to protect your scalp, face, and ears.

-          Don’t forget your sunglasses! They’re not just stylish; they also help to protect your sight.

First, let’s take a look at the benefits. One of the obvious upsides to having a pet is simply that they’re there—pets provide companionship, which can be more than just a comfort to seniors who may be isolated and lonely. Not only do pets fill up the time, but as human friends pass away and adult children and grandchildren get busy and increasingly self-sufficient, pets provide a sense of purpose—they may not be the best conversationalists, but being responsible for any other life can renew a senior’s sense of meaning.

Of course, one of the significant drawbacks to having a pet is upkeep—dogs need to be walked and groomed, and even cats, which tend to be lower maintenance, require attention; additionally, they can get underfoot and be moving, breathing tripping hazards, and can knock over other objects and create messes. Even smaller rodents can trigger allergies. So what’s to be done?

Amazingly, it’s been shown in several studies that fish can have a notably beneficial effect on Alzheimer’s disease patients. Not only does easy access and exposure to an aquarium soothe aggression and depression in dementia patients, but it also has shown a marked improvement in appetite and food consumption at mealtimes, even leading to an overall, quantifiable increase in weight!

According to a study done by a nursing professor at Purdue University, participants in an Alzheimer’s study increased their food intake by an average of 17.2%. The same study “showed a decrease in the number of instances and the duration of behaviors such as wandering, pacing, yelling and physical aggression.”

Aquariums also provide a colorful and constantly moving source of entertainment and stimulation; because of its active nature, it is well-suited to the naturally short attention span of an Alzheimer’s patient. Even better—Alzheimer’s patients will get a boost of confidence from helping to feed the fish and seeing them respond to the arrival of food, and the huge number of aquarium accessories—from the ubiquitous deep-sea divers and castles to laughing Buddhas and popular cartoon characters like Spongebob Squarepants—means there’s no end to the possibilities when it comes to setting up a creative and colorful background for your fish.

The downside to fish, of course, is that they’re nowhere near as cute and cuddly as, say, a cat or a dog, but as the Purdue professor who headed up the aquarium study says, “[Alzheimer’s patients] might step on the cat’s tail or pull the dog’s hair,” whereas fish are “basically indestructible.”

While tanks require upkeep and regular maintenance, there’s no risk of “accidents” on the floor, and the last we heard there was no record of a fish chewing on expensive shoes. There’s no grooming, shedding, or walks on rainy days required. With such considerable benefits and fewer downsides, when it comes to your seniors, man may have a new best friend!

Everyone knows that the keys to staying healthy during extreme heat are finding some place to chill (literally) and staying hydrated, but other health conditions that plague the elderly can complicate matters.

Should your elderly loved one live somewhere without air conditioning, a trip to the mall, a movie theatre, or a public library may not be an option the way it would with someone younger; there may be accessibility problems, and often seniors with Alzheimer’s or dementia—or even without—do not respond well to crowded and often noisy or chaotic public places.

Even hydration can be a challenge, as seniors with dementia may forget to drink or be resistant to loved ones who urge them to do so, and some medical conditions lead doctors to limit liquids or even prescribe diuretics, or “water pills.” If either of these latter two apply to your senior, please consult their doctor as soon as possible to find out how to deal with heat and hydration appropriately. If at all possible, do so at the beginning of the summer—don’t wait for the next heat wave!

Remember that because of health conditions and the side effects of some commonly used medications, seniors are one of the most vulnerable populations when it comes to extreme heat. Keep an eye out for signs of heat stress or heat stroke; heat stroke is a potentially deadly circumstance in which the body cannot regulate its own temperature, which can skyrocket as high as 106 degrees Fahrenheit in less than half an hour, leading to organ failure, brain damage or death.

Someone suffering from heat stroke can exhibit any or all of the following symptoms:

-          An extremely high body temperature

-          Red, hot and dry skin

-          Lack of sweat

-          Throbbing headache

-          Dizziness

-          Nausea

-          Confusion

-          Unconsciousness

If someone is suffering from heat stroke, it is imperative that you get them to a shady or cool area as soon as possible, provide them with non-alcoholic liquids, and call 911. As mentioned above, heat stroke can be deadly and it progresses astonishingly quickly. Fast action on your part can save lives.

Some caregivers, especially family and friends, feel selfish thinking about their own mental wellbeing while their wife, brother, son or mother is in such dire shape, but the fact of the matter is—whether you’re a primary caregiver part of the time or simply assist while a full-time nursing aide cares for your loved one, if you’re not in good psychological shape, your ability to help is critically diminished.

Now, this isn’t to say that you should rearrange doctor’s appointments so that you can take a spa day, but an ongoing effort to attend to your mental health—think of it as maintenance work, like you’d do for your car or a garden—can not only benefit you, but also the loved one you’re caring for.

The question is—how do you do it?

Relax in Minutes

Sometimes, as a caregiver, you may feel like you don’t have the time to spare to help yourself relax; we understand. Caregiving is a full-time job, whether or not you have a nursing aide helping you. Here are a few techniques you can use when you’re stressed but only have a couple of minutes to yourself.

1. Deep breathing. This isn’t quite as simple as it sounds. Often we breathe from our chest, rather than our abdomen, which means we’re actually getting less oxygen than we should. To ensure that you’re breathing from your abdomen, lay a hand on your chest and another on your stomach. When you breathe deeply, your stomach should expand—moving the hand there drastically—while the hand on your chest only moves a little bit.
2. Visualization. There’s more to visualization than simply remembering a pretty vista you saw once. In order to get the full benefit of visualization’s stress relief, focus on each sense in turn. For example, if your chosen visualization is a tropical beach, you should not only try to see the palm trees in the sun, you should feel the sand beneath your toes, smell the salt water on the sea breeze, hear the crashing waves and the sounds of sea birds, and taste that piña colada!
3. Stretching. Yoga is a great relaxation technique, but if you’re short on time it might not be the best option. So instead of doing a full series of poses, you can, instead, focus on just a few simple stretches. A good move for stretching your spine is the cat-cow, in which you get down on your hands and knees, and then slowly and rhythmically arch your back (like a startled cat) and then inverse it, letting your stomach arch toward the floor (like a cow’s belly). Any kind of stretching can refresh you and help reinvigorate you, though, and the best part is it requires no equipment—only a few minutes and a little bit of space!
4. Treat yourself. While self-medicating for stress is never a good thing, treating yourself to something you like every once in a while can have a positive effect on your overall mental health. Love chocolate? Keep a stash of Hershey’s kisses somewhere and, when you’ve had a rough day, allow yourself a few. There are other ways to treat yourself, too—YouTube your favorite scene from your favorite movie, listen to an embarrassingly bad band you happen to love, or take a bubble bath instead of a shower! A little treat can do wonders.
5. Scalp massage. Massage of any kind feels great, but scalp massage is easy and has multiple benefits—it boosts blood flow, relieves stress, and can reduce headaches and migraines (which is especially useful if you’re prone to tension headaches, often brought on by stress). Place your thumbs in the hollow behind each ear and spread your fingertips over your head, as far as is comfortable; massage in circles for a minute or two for instant relief.

No matter its cause, though, anger can be incredibly damaging to the caretaking process, taking its toll not only on the elder, but also on his or her caregiver and loved ones, and the relationship between them. It’s not always easy to be tender and understanding with someone prone to fits of rage over what seems like nothing.

The key to dealing with elder anger is in understanding where it comes from, and why it exists. Why are our elderly loved ones angry? Where does the stereotype of the crotchety, grumbling senior citizen come from?

A Walk in Another’s Shoes

Let’s say you’re older; you’re 85. You may have been one of those enterprising Americans who works even after retirement age, but force of will can’t keep someone in the workforce forever; you finally retired 12 years ago, at 73. You volunteered for a few years until you no longer had the strength to, and now you’re finding that your self-definition has drastically altered—even disappeared. Before, you were a lawyer, or a teacher, or a florist. Then you were a volunteer. Now what are you?

To compound that, your health is steadily failing. You may insist your hearing isn’t going, but you have to ask people to repeat things more often than in the past. You may have a hip replacement, or a pacemaker; perhaps you’re lucky and have escaped Alzheimer’s disease or congestive heart failure or chronic obstructive pulmonary disease, or any of the other more serious conditions that have robbed you of some old friends. Even in that case, you find that you tire much more easily, you’re often cold though you know you shouldn’t be, and even simple daily tasks you used to do without a second thought can leave joints aching. You find you have to get up multiple times during the night to relieve yourself, and you’re not as steady on your feet when you do so, prompting worries about falling (and potentially injuring your other hip). Additionally, things are starting to slip your mind more often. Is that an indicator of oncoming dementia?

Your doctor has prescribed pills to regulate your cholesterol, to alleviate your arthritis, to ward off countless diseases. You eat right and take vitamins to try to keep your body in top shape but it seems to keep failing. You finally gave in to your kids’ requests after a close call while driving at night, and gave up your license and your car.

Of course, that accession to safety has left you even more isolated than you were before. You have to wait for one of the kids or maybe a neighbor to take you to the grocery store, or have your groceries and prescriptions delivered. Perhaps, again, you’re lucky; like you, your spouse is in good health. But your parents and aunts and uncles are long gone, your siblings and cousins are falling victim to the conditions you avoided, and even your children are starting to suffer more in their middle age. You recognize more names in the obituaries than in the wedding announcements.

A Natural Reaction

As we discussed in the article about elderly depression in the last newsletter, such negative feelings aren’t unusual—and as we can see from the above example, they’re also not unreasonable. While it’s possible to live a full and happy life even after retirement and aging kick in, there are plenty of reasons for our elderly loved ones to feel blue.

To most people, depression simply means ‘sadness,’ but in reality, depression stems from a feeling of helplessness, of being stuck. When we feel like we’re in a rut or unable to change the things that are upsetting us, some people become what sad or apathetic—what most people mean when they say ‘depressed.’ Some people, however, react with an increased irritability or develop an unusually short temper.

How can you deal with this anger? Remember that your elderly loved one is going through major life changes, and many of them are unpleasant; try to react calmly, and never strike or yell at a senior (or anyone, really) when they show irritation or anger. Helping your senior find something they can invest their time and energy in can help assuage their irritability; help them see rediscover their self-definition, or create a new one!

Of course, when anger comes concomitant with another health issue, such as dementia—for instance, “sundowning” is aggression and confusion that often occurs in the late afternoon and evening among Alzheimer’s patients—simply offering them alternatives and understanding isn’t always enough. Remember to consult a doctor whenever you have concerns about your elderly loved one’s wellbeing.

Some people assume that being depressed is just a fact of life when you get older, but it’s not; in fact, though depression is common enough that it can be mistaken as dementia, it’s very possible to live a happy and fruitful life long after retirement.

While there are biological and mental causes of depression, a person’s environment contributes to its development as well. And, let’s face it, growing old is no picnic. At any given time, a senior may have to deal with one or all of the following possible causes of depression:

-          Health problems, which can not only exacerbate that feeling of being stuck, but can also affect self-worth and sometimes even count depression among their symptoms;

-          Loneliness and isolation created by the loss of mobility, a driver’s license, and the dispersion—or death—of one’s family;

-          Reduced sense of worth, thanks to leaving the workforce, having children ‘leave the nest,’ or physical limitations on beloved activities;

-          The many fears that accompany aging, such as a fear of illness, death, loss of mental faculties or independence, and anxieties over finances and the wellbeing of loved ones;

-          And bereavement and grief following the losses of friends, spouses, siblings, and other loved ones an individual has known for a long time.

To even further increase the risks, many of the medications that seniors frequently take—including beta-blockers, sleeping pills, and drugs used to treat arthritis and various heart diseases—can worsen existing depression or even have depression listed as a possible side-effect.

So how can you tell whether or not it’s depression? It can be tricky, especially since the physical symptoms that accompany depression—lethargy, lack of concentration, and a disinterest in previously enjoyed activities—can mimic various types of depression.

-          They notice their problems. If your senior is having mental symptoms and is both aware of them and possibly worried about them, there’s a good chance it’s depression, and not dementia; seniors with dementia are generally more unaware.

-          Mental decline is rapid. If the mental decline progresses at a slower, more staid pace, it may be dementia; decline due to depression occurs much more quickly.

-          Concentration vs. memory. Is the issue also with their short-term memory? It may be dementia. If they’re just having trouble concentrating, chances are that it’s depression.

What symptoms should you be worried about?

-          Sadness

-          Fatigue

-          Abandoning or losing interest in hobbies or previously-enjoyed activities

-          Social withdrawal and self-isolation

-          Weight loss or loss of appetite

-          Self-medication via alcohol or other drugs

-          Sleep disturbances (insomnia or hypersomnia)

-          Loss of self-worth

-          Fixation on death or suicidality

As always, if you have any concerns about your loved one—or yourself—consult a physician.