Chapter 4
Nurturing Your Loved One’s Mind, Body, and Spirit
One of the challenges faced when a loved one is declining is recognizing that simply meeting his or her physical needs may not be enough. There is a definite connection between the mind, body, and spirit, and if all three aren’t being nurtured, then the care provided at one level may not be sufficient to create the highest quality of life possible. Not only does an individual’s physical care need to be managed, but consideration must be given to that person’s mental and emotional needs, as well as offering nourishment for the spirit. All three areas must be cared for as a whole in order to enhance an individual’s life—creating as much well-being and zest for life as possible, depending on the circumstances.
Yes, it’s a lot to consider, but it doesn’t have to be overwhelming. Breaking these needs into three components, understanding what is happening in each, and then deciding on approaches to address specific issues will help keep all the requirements in perspective.
The Mind: Understanding Changes in Your Loved One’s Brain
As we age, there are normal changes to the brain that take place. In our early twenties and thirties, the changes can be subtle—perhaps a slight forgetfulness after a particularly hectic workweek or an inability to sleep due to the presence of a newborn baby. By age forty and into our fifties, the changes increase and we may experience more instances of forgetfulness—like forgetting people’s names, or why we walked into a room, or what item we wanted to find when we got there. Sadly, some perfectly healthy minds will develop a nagging fear that this could be an early warning sign for Alzheimer’s disease and become unnecessarily worried. It can be equally distressing when observing these moments in an aging loved one. The best way to handle these changes is to understand what is normal, explore what the underlying causes of the problem may be, and then determine what, if anything, can be done about it.
What can lead to forgetfulness? Some of the factors might include the following:
• normal brain shrinkage during the aging process
• stress
• anxiety
• depression
• side effects from medication
• medical conditions, including thyroid imbalance, and infections like HIV, tuberculosis, and syphilis
• chronic low-level inflammation of the brain
• declining hormone levels
• dehydration
• poor nutrition
• excessive use of alcohol or tobacco and drug abuse
There can be many reasons for the changes aside from a serious medical condition. The best way to handle a loved one’s fears is to learn how to determine if it’s something to be worried about, if anything can be done to improve the mind, and when to seek professional help.
Reducing Those Awkward Senior Moments
Senior moments—those embarrassing seconds when saying hello to someone but being unable to recall a familiar person’s name, the dreadful moment when that PIN number at the ATM just won’t come, or the frustration over standing in the aisle at the store and having no idea why—can happen to anyone. Most of us laugh about these experiences after the fact, but there are times where they cause genuine concern, especially when they happen to our aging loved ones.
Memory lapses can be frustrating and irritating. The good news is that managing the environment or situation may help reduce the number of times or the degree of forgetfulness the elderly experience. Here are some strategies for reducing senior moments.
• Reduce the number of environmental distractions. If your loved one appears to struggle with confusion and forgetfulness during conversations, find ways to reduce the surrounding distractions—turn the television or radio off, choose a more quiet and intimate setting rather than an active restaurant, or provide a private sitting area at a family gathering for visiting.
• Do one thing at a time. Encourage your loved ones to focus on one thing at a time and complete each task before moving on to another. For instance, don’t hand them their medications while asking if they let the dog out. Multitasking can be confusing for many seniors, and this will help cement the thought or action in their memory.
• Create everyday routines. Everyday routines give your loved ones a sense of stability and reduce stress. Set up a schedule for normal daily activities such as taking medications, feeding the pets, checking in with family members, and eating meals. This will also assist you in understanding if something may be wrong, such as when they don’t pick up the phone and you know they are awake and should have had breakfast by now.
• Use reminders and calendars. The practice of writing down thoughts or information provides security and relief for forgetful minds. Place notepads and pens throughout your loved one’s home so he can record important ideas before they slip his mind. Record appointments or special dates on a calendar so he can anticipate and prepare for outings and meaningful events. Or, using large print, write down important names and phone numbers he can call in case of emergencies.
• Take on fewer activities or commitments. Seniors can experience forgetfulness, confusion, frustration, and exhaustion if they are overscheduled or overstimulated. Don’t schedule everything in one day—a trip to the doctor’s office, lunch out, and then getting a haircut may be too much. Choose one or two errands to run, or select just one event at a time so that your loved one can absorb the experience and remember it.
• Follow the guidelines for a healthy lifestyle. Encourage your loved ones to eat a healthy diet. If they always reach for processed or fast foods, consider a food delivery service such as Meals on Wheels or preparing dishes ahead of time and freezing them. Make sure there is always plenty of water and other liquids on hand so they can stay hydrated. Buy them a large cup (32 oz.) with a lid and straw and tell them to drink two a day. Monitor how much they are sleeping and, if need be, ask the doctor for medication to help them sleep through the night. Finally, encourage your loved one to move as much as they are capable of, whether it’s gardening, walking, or anything else that keeps them from becoming sedentary. These suggestions will help keep the brain healthy and boost memory.
Knowing When Memory Lapses Are Normal And When You Should Worry
Although many memory lapses are often just minor annoyances, concerns such as regular confusion or changes in personality or behavior can signify a deeper problem. As we grow older, it is normal to forget where we put things or to recall someone’s name, but when does memory loss indicate something more serious like dementia?
When observing your loved one, there are key symptoms that indicate cognitive impairment or the early stages of dementia.
• Repeatedly forgetting names, dates, or incidents. Anyone can forget a person or an event from time to time, but someone with early dementia might repeatedly forget names and incidents.
• Prompting or time doesn’t help. With normal forgetfulness, your loved ones may forget information, but when given a prompt they might quickly recover or, over time, remember the information on their own. However, with serious memory loss, prompting and time have a minor or no effect on the memory.
• Forgetting how to use everyday objects or words. With dementia, it is common for the elderly to forget simple words or to use word substitutes that make communication difficult. They may also misuse or misplace objects. For instance, trying to eat body lotion or leaving the phone in the refrigerator are strong indicators of dementia.
• Loss of orientation. If your loved ones become lost in familiar places, don’t know what day or time it is, or forget who they are or who family and friends are, they are no longer considered oriented, which is also a strong sign of cognitive decline.
• Asking the same questions over and over again. A person with mild forgetfulness should retain information for a reasonable period of time. However, someone with dementia will not be able to make a new memory and will keep repeating the question. The memory simply doesn’t stick.
• Unable to follow directions. If your loved one has dementia, he might lose the ability to understand basic directions like “Pick up your glass and drink your water.” He will also need prompting and assistance with normal activities such as eating, dressing, and grooming.
• Unusual changes in personality or behavior. Changes in personality, like becoming uncharacteristically angry, aggressive, or clingy, can indicate a more serious condition. Behavior and habits may also change. Someone who normally was an early bird and very social or active might start sleeping or watching television all day while ignoring family, friends, and normal interests.
The symptoms of serious memory loss can be broad and subjective. A thorough examination by a health care professional is called for if there’s concern that a loved one may be experiencing more than a normal level of forgetfulness. It is possible that symptoms need to be monitored over a period of time to make a diagnosis and to determine the level of severity.
Defending the Brain from the Damages of Aging
There is good news, though! Just as physical activity will keep our bodies strong, mental activity can keep our minds in shape. Research shows that pursuits that challenge the brain can offer protection against cognitive decline. A variety of activities may defend the brain from the damages of aging, such as the following:
• engaging in a favorite hobby, like painting or knitting
• reading
• playing games that stimulate the thinking process, such as cards or Scrabble, or completing crossword puzzles
• watching the news or talking about current events
• learning to play an instrument
• taking online courses
This is just a small sample of what might help stave off dementia in the elderly. The rewards from learning something new or accomplishing a challenging experience can reap great benefits. Various studies indicate that it is possible that brain cells can grow and learning can improve throughout life if the mind is kept stimulated. Not only will your loved one feel good about staying active and alert, but he or she may also delay any mental decline that might happen otherwise.
The Body: Understanding What’s Happening Physically to Your Loved One
As with the brain, there will be changes to an aging body. Those changes are largely affected by genetics and lifestyle, but overall, most of us will experience a similar process. Much like the mind, the physical decline can sneak up on us, but it’s visually apparent, leaving little doubt. And it can be especially shocking to see how much the symptoms worsen over time when you aren’t involved in your loved one’s care regularly.
While wrinkles and gray hair are the most obvious, there are a number of other changes that occur in most aging adults. Fortunately, an alert caregiver is aware of them and will seek treatment, help, or lifestyle alterations that can assist a loved one in learning ways to deal with the changes and enjoy a happier, healthier life. We will discuss some of the most common physical changes and offer suggestions as to how to deal with them in the sections that follow.
Hearing Impairment
Loss of hearing is widespread in the elderly. The changes in the ear make certain frequencies, tones, and speech less clear. This can then lead to an elderly person feeling confused, embarrassed, or left out. Hearing loss may be lessened in a variety of ways.
• Reduce any background noise and face the person directly when speaking to him. Speak clearly and slowly.
• Allow the person to see your face. Facial and hand gestures can aide in communication. Do not eat, drink, or chew gum while speaking.
• Repeat yourself, if necessary, and be patient. It may be difficult for an elderly person to hear or understand the total of what was being said immediately. If he appears confused, say it again, and as many times as necessary. Ask him to repeat what was heard to determine if he understood correctly.
• Visit the doctor. Most tests are easy and painless. There are many adaptive devices that can assist the elderly in hearing or communicating more effectively such as hearing aids, telephone amplifying devices, assistive listening devices for televisions and radios, and alarms that will vibrate or flash lights to alert a person that someone is at the door or is calling.
Vision Impairment
For the elderly, the loss of eyesight can cause a number of problems as well as safety issues. Those who can’t see clearly might be at risk of falling or injuring themselves and can become insecure or afraid. If they can no longer enjoy reading, watching television, or seeing the faces of friends or family, they may feel lonely and isolated. Loss of vision can affect a person in more ways than simply being able to see.
With age, it’s normal for night vision and visual sharpness to decline, and glare becomes a larger problem. This can severely impact a person’s ability to drive and maintain independence. The chances of developing cataracts, macular degeneration, or glaucoma significantly increase with age, and routine eye exams become more important. Dry eyes are also common in the elderly and can develop into a chronic condition.
Some of the challenges an individual with poor eyesight might encounter include problems with reading smaller print, seeing clearly in dim light or at night, and being able to locate objects. Regular eye exams, early detection, and proactive measures can help deter further decline or assist in a person’s ability to see longer. Here are some suggestions for coping with vision loss.
• Visit the doctor. A visit to an eye specialist can determine if your aging loved one has any of the serious conditions discussed previously. If she does, there are many solutions that can assist with her eyesight. With a proper diagnosis, specific recommendations can be made like surgery to correct cataracts, injections to slow the progression of macular degeneration, or drops to control eye pressure from glaucoma. Something as simple as glasses or magnifiers and telescopes could also greatly improve your loved one’s vision.
• Ask for large print. Large print can make all the difference for your aging loved ones to be able to read everyday items. Larger fonts can enable them to continue enjoying their personal freedom by interacting with others through games, managing their own medications, or staying current with world events by reading newspapers or articles. It’s surprising how many items can be adapted to large print. Prescription labels, playing cards, books, and online magazines are just a few examples of what can be printed in a larger font.
• Use brighter lighting in the house and utilize nightlights. Insufficient lighting can be dangerous for the elderly, often resulting in injuries from falling, getting sick because they failed to see that food is rotten, or even letting the wrong person through the door. To help your loved one navigate and manage more safely at home, replace light bulbs with a higher wattage. Seventy-five- to one-hundred-watt bulbs can make a big difference. Make sure entries, stairs, hallways, and other darker areas of the home are well lit and use night lights along the path to the bathroom to eliminate the risk of your loved one falling while using the restroom in the middle of the night.
• Outline steps or ramps with colored tape. Stairs and changes in elevation can be difficult for an elderly person to see. Using brightly colored tape on the edge of the stairs or at the beginning of a ramp draws attention and alerts the individual that she needs to move cautiously.
• Use contrasting colors. It is easier for an elderly person to see what she is looking for if there is a contrast in color. Buy a phone that has highly contrasting numbers, hang bright towels over the white counter or wall, choose colored soaps and lotions, and throw contrasting blankets and pillows on the bed or couch. Anything that will stand out against the background will be easier to find and use.
• Make sure medications or supplements aren’t causing vision problems. Check with your pharmacist or doctor to ensure that medications and supplements your loved one is using aren’t producing side effects that can cause dry eyes or interfere with vision.
Changes in Bones, Muscles, and Joints
Picture an older gentleman shuffling across the street or a woman who has fallen and is crying out for help. These are common images when thinking of the elderly. As we age, there can be significant changes to the structure of the body. Bodies lose bone mass, joints become less flexible and stiffer, and muscles lose their tone or sometimes become rigid. As this happens, we may experience an increase in pain, start falling, and possibly engage in a more sedentary lifestyle because of their effects. These changes are important for a number of reasons.
• Bones provide shape and support to the body. As bones become more brittle, they break more easily. A younger person might recover quickly after a minor fall, but for an older person, it might end with a stay in the hospital and result in permanent damage. Also, osteoporosis becomes more of a problem, especially for women. It can result in a loss of height as the spine and the trunk shorten, and a person can become painfully stooped over.
• Joints allow the body to move. Without joints, the body would be unable to bend and move. As the joints break down, the elderly can suffer from inflammation and pain, sometimes resulting in minor stiffness or severe arthritis. There may even be deformity as fluid in the joints decreases and cartilage erodes from rubbing together, or the bones may also start to thicken—think of an arthritic hand with swollen knuckles and bent fingers.
• Muscles provide strength, endurance, and control for the movement of the body. Both bones and joints need the help of muscles to operate. Without muscles pulling on the joints, the body cannot move on its own. With the loss of muscle mass, strength and endurance will change. Muscles can also become less toned and can sometimes become rigid. Walking may slow down as movement grows more limited and unsteady. Not only do muscles help us move about, but they also enable our heart to beat, our lungs to breathe, and our blood to flow, along with other numerous involuntary bodily functions.
Muscles, bones, and joints support each other and work together to allow the body to move and function. Even if just one element is declining or changing, it can cause stress and complications for the entire body. Here are some steps that can be taken to help prevent these changes or maintain the body once it starts to decline.
• Make sure your loved one eats a well-balanced diet and stays hydrated. Eating a healthy diet is important for anyone, but it takes on a particular importance for seniors. Having a well-balanced diet can help maintain bone strength, boost the immune system, and increase energy levels. Adequate hydration, at least 64 ounces of water a day, will help ensure that all parts of the body—like the brain, kidneys, and other organs—are healthy, functioning properly, and supporting the body as a whole.
• Use supplements to compliment your loved one’s diet. Changes in appetite, as well as the side effects from medications or illness, are just a couple reasons why a healthy diet might not be enough to ensure overall support of the body’s bones, joints, and muscles. Supplements can fill in the voids when the proper amount of nutrients cannot be obtained through diet alone.
• Encourage regular exercise. Moderate exercise is the best way to build bone mass, relieve joint pain, and strengthen muscles. An exercise program doesn’t have to be intense. It simply requires daily movement. Stretching for 10 minutes in the morning, walking as much as possible, performing chair exercises, or practicing yoga or tai chi are perfect examples of exercises appropriate for seniors.
The Spirit: Keeping Your Loved One’s Inner Light Shining
Most of us understand how critical it is to care for a senior’s mind and body, but not everyone understands that the spirit—that vital essence, inner quality, or nature of a person—needs nurturing as well. True, anyone can exist if the physical body functions at a level sufficient to support life. But what quality exists if that person’s disposition or frame of mind is in a low or dark place? Sadly, many seniors begin to lose that vital essence as their physical and mental capabilities decline.
Attitudes toward aging can greatly affect the spirit. Those who view aging as a depressing, useless stage preceding death tend to report a lower quality of life than those who view aging as an opportunity to continue learning and understanding more about themselves and others. The latter attitude tends to promote a sense of joy and purpose.
A variety of changes can cause an elderly person’s reason for living to diminish.
• Death of loved ones and friends. As loved ones and friends begin to pass on, seniors may start to focus on their own mortality. This can cause feelings of sadness and regret over things they wish they had or hadn’t done or said, and they now feel it’s too late.
• Failing health. When a person is feeling ill or realizing that his or her body is no longer responding and performing as it used to, negative feelings can set in. Anger, sadness, or depression can greatly reduce the overall happiness and quality of life.
• Altered family roles. As time passes, family roles become altered. The elders who once guided, provided for, and protected the family are now in need of assistance and care themselves. Children begin to take over the positions once held by their parents, and family dynamics shift. Navigating these changes may be confusing or difficult for all concerned.
• Reduced income. Many elderly find themselves forced to live with less money when they retire. They may struggle to afford prescriptions, food, rent, or care. This can create great levels of stress, affecting them physically and emotionally.
• Loss of independence. Perhaps even greater than dealing with the changes in their bodies or minds, the loss of independence hits seniors the hardest. Not being able to do the activities that most take for granted, like driving, managing finances, or even showering and dressing by themselves, can create a sense of no longer being in control.
• Shrinking world. Many find that their world becomes smaller and smaller as they age. Being unable to drive and get out on their own, family members being too busy to visit, friends or spouses passing away, or health issues such as losing their sight or hearing, can severely limit an elderly person’s environment. Loneliness and isolation can easily set in.
Spiritual nourishment can be delivered in many ways. Steven R. Covey, the author of 7 Habits of Highly Effective People, wrote, “The need to leave a legacy is our spiritual need to have a sense of meaning, purpose, personal congruence, and contribution.” A sense of meaning and purpose are two important concepts that can make a person feel like her life is worth living—creating a sense of self-worth, happiness, appreciation, and a higher quality of life overall.
Fortunately, it doesn’t have to take drastic measures to turn around a senior’s state of mind and help her enjoy life more. Here are some tips that might get her focused on what she still has to live for and not on what she has lost.
• Celebrate the small stuff. An attitude of gratitude can greatly improve a senior’s zest for life. Rather than focusing on all she has lost or what’s gone wrong, encourage your senior to take time each day to think about and give thanks for all that’s good. Create a gratitude journal and list five things each day that she appreciates. Or, if writing is difficult, recite it verbally. The point is to develop a habit of acknowledging and giving thanks each and every day.
You’re doing all you can to provide care and help to your elderly loved ones, but it’s not easy. There are days that nothing works and frustration sets in. You can get through these moments by doing the following things.
Choose your battles wisely. Consciously decide whether it’s worth it to argue details and correct every error. So what if they are getting the specifics of a story wrong or you’re frustrated because they think the checkout boy at the grocery store is your old neighbor’s son who is now in his fifties? Save your energy for the important challenges, such as when they insist on climbing a ladder to change their own light bulbs, or when you’ve noticed they are eating food that has mold on it because they can no longer see or smell it. Determine whether something affects their health and safety before making an issue out of it.
Remember that the situation will not last forever. Unless you have a crystal ball, there’s no completely accurate way to predict exactly how long a caregiving situation may last. There will be times when it seems as if this is what it will be like for the rest of your life. Please remember that there is always an end, and for most, when that time comes, you will be glad you gave everything you could to help take care of a vulnerable individual.
Forgive yourself. You’re only human. You will lose your patience. Take a time out, regroup, and ask for help if you need to step away for a while. Remember—you are doing the best you are capable of doing.
• Stay connected. Seeing people face-to-face, talking on the phone, or using e-mail to stay in contact with others can have a significant impact on one’s state of mind. Feeling connected to others eases anxiety, loneliness, and depression. Take advantage of local agencies that offer companionship services, senior centers providing meals and activities, or make regular dates with friends and family that don’t revolve around going to appointments or running errands.
• Volunteer. Giving back is a wonderful way to feel a sense of purpose and give more meaning to a senior’s life. It can be a wonderful way to meet new friends while helping those in need. More and more organizations are realizing that the elderly are a great resource for their volunteer needs. Even if mobility is an issue, volunteers might be able to help over the phone or by working from the home.
• Pursue a hobby or a class. Suggest that your loved one consider learning a new language or taking up painting—anything that she has always expressed an interest in but never pursued. Engaging the brain and seeking out new challenges will stimulate the mind and create a feeling of accomplishment.
• Practice faith. If religion or spiritual practices were always of importance, find ways to allow your loved one to practice her faith. Arrange for transportation to her place of worship, purchase tapes or books for inspiration and guidance, find television programming that fits her belief system, or locate volunteers who will come to the home and practice with your loved one.
Each of these three areas—mind, body, and spirit—are important. But when providing care for the elderly, it is important to embrace the concept of recognizing and caring for all three together to create a well-balanced existence.