Q: HI Miss Regina, I have been taking care of my dad with Alzheimer’s for two years whilst my siblings live in Canada. One sister is so rude in that she thinks my dad can take care of himself. She thinks I made up his Alzheimer’s and it is not difficult to watch over him. Miss Regina, I do more than just watch over him. My siblings do not know how difficult this is. They do not understand the care my dad needs. How can I get them to understand he needs more than just watching over?
A: There is an old saying… “It takes a village to care for a child.” The same is true for an adult with dementia. Being the primary caregiver doesn’t mean you have to do this all alone. It means you have a better understanding of the whole situation and know what task need to be done.
It seems you have a sibling who may be in denial of your dad’s condition. Although it is frustrating and a list of emotions arise from this frustration it is best to always be the bigger person. A person in denial is experiencing their world as being threatened when you ask them to change their view on their parent. It is safe for them to pretend everything is fine and nothing is changing. The denial is either from a subconscious way to ignore the fact their parent is declining and for others it could be a way to avoid taking caregiving responsibilities. Whichever it is, it is a coping mechanism that gives them time to adjust to distressing situations.
Sometimes families in denial simply do not have enough information so be ready with educational information that explains their condition, symptoms and the type of care they’ll most likely need. Try not to argue with your sister, instead show her doctors report. Remain calm as possible. If she does not believe you have her meet with you on skype or phone with an expert on the condition. I know it is not fair to always be the voice of reason on top of doing everything else. If you try a few of these tips to break through her denial, you can at least know you have tried and make decisions without her input and know you did your best to help her understand.
Q: Good Day Ms. Posvar, I am worried about my mum with dementia. I am not sure which one she has but she has had it for some time. We have hired help for her during the day and a family member stays with her at night. We all take turns with her weekly. The concern is that she is not walking much anymore and she is starting to have falls. Our hired help says she doesn’t want to walk. I think it is making her weak and that is why all the falls. What can we do to help lessen her falls?
A: To you, who are concerned about walking and falls with dementia. Many reasons may cause falls with a dementia diagnose. To assist in reducing falls it is important to understand the type of dementia or the symptoms they may be experiencing. It is reported that Allan et al.5 found gait and balance disturbances in 93% of people with Parkinson’s dementia (43% with Parkinson’s disease alone), 79% of those with vascular dementia, 75% of people with Lewy Body dementia, 25% of those with Alzheimer’s disease.
A person’s perception, special awareness, poor judgement, medication changes, changes in the environment can all contribute to potential falls. For example, if memory is impaired, people forget to avoid hazards in their environment;
Perceptual difficulties often mean that the person is unaware of changes in levels, making them more likely to miss a step or lose their balance on a slope.
There is evidence that people with dementia walk too fast for their situation, perhaps because of a loss of control of gait velocity.If people become less active, either from reduced socialization or because concerned caregivers limit their walking, they become physically weaker. There is ‘loss of condition’ as the dementia progresses and the person becomes frailer with poor balance and posture.
To reduce fall risk: Make sure the environment is safe; side rails, ramps (but if depth perception is impaired this will be challenging); Assess medication; make sure they have their hearing checked, glasses cleaned and walking aid; encouraging activity may help reduce damage from falling, at the same time maintaining quality of life. You can also have a nurse with dementia care background come in and do a fall risk assessment.
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