Validation Therapy and Two (Mercifully) Short Poems

By C.A. Bryson

This post begins with a follow-up on last week’s Therapeutic Reasoning and Validation Therapy post.

I tried out Validation Therapy with my dad following a delusion he had about having to go to a conference. He had insight—he realized that he wasn’t thinking straight, but the fact that he did have delusion bothered and upset him. You may recall the scenario from last week (Scenario # 1: Milking the Cows), when I discussed the method for Therapeutic Reasoning. Dad was doing something similar: to him, attending a conference was something he did as part of his academic career, just like ‘milking the cows’.

And so, I did what Naomi Feil (Gerontologist, and expert in Validation Therapy), advised. I said ‘Dad, I hear you. I hear that you’re upset. Tell me more.’ And I listened. And within half an hour, the matter was forgotten.

Something else I use with dad that works—poetry. Recall that Ms. Feil advised caregivers to use music to soothe and calm their loved ones. Well with dad, poetry is like music to his ears. (There’ll be more on music therapy in a subsequent post, stay tuned.) And so, I bought him his favourite Lewis Carroll book ‘Through the Looking Glass’, in which the famous poem ‘The Walrus and the Carpenter’ goes something like this:

‘The time has come’, the Walrus said,

‘To talk of many things,:

Of shoes—and ships—and sealing wax—

Of cabbages—and kings—

And why the sea is boiling hot—

And whether pigs have wings.’

(p.168)

And while dad often can’t remember what day it is, he can recite the above poem by heart, as well as Hamlet’s famous ‘To be or not to be’ speech from William Shakespeare. It is in the moments when we share his childhood memories of summers up at Lake Simcoe that I savour the most and forget about his medication and doctor visit worries.  At night I think: ‘Good God, what will I do after he’s gone?’ and all that anticipatory grief washes over me in the silence, and then I feel grateful for the swooshing sound of the dishwasher and the drone of ceaseless traffic outside.

And now the poem. I composed this based on an Oprah ad I saw:

What You Need is Now

‘Create the life you want’, Oprah said

All well and good

As long as you realize

Getting what you want—

May not necessarily be

What you need.

And where you are at

Right now

Is probably just fine.

It’s like looking at a rose:

It’s beautiful but…

Watch out for those pesky thorns!!

The life I want?

Let me see…

Venice

Lobster

Cheesecake without calories.

The life I have?

A 90-year-old

His ‘Depends’ duty

A life nourished by screens

And mac and cheese

Doesn’t sound half bad to me.

Next week’s post is on Nostalgia: what is it and what does it mean to the caregiver and his/her loved one? How can we nurture it? What are the benefits?

Stay tuned… Thanks for coming along on my journey.

CAB 2022

Person-Centred Care: Dementia 101

By C.A. Bryson

May 24, 2022 was the Annual Alzheimer’s Walk for Memories, the world’s largest fundraiser for Alzheimer care, support and research. The walk was held in 600 communities nation-wide.

Some stats:

  • 1 in 5 Canadians have experienced caring for someone living with dementia
  • The annual cost of dementia to the Canadian economy and healthcare system is over 10.4$ Billion
  • Over 500,000 Canadians currently live with dementia
  • (Alzheimer Society of Canada website)

See the following website for free, educational videos on dementia:

https://alzheimer.ca/bc/en/help-support/programs-services/webinars/recorded-videos

What is Person-Centred Care?

According to Jill Gafner Livingston (Certified Dementia Practioner and Caregiver), it is:

  • Responding with dignity
  • Putting the person first, not the characteristic
  • Knowing your loved one: their life story, routines, and entering into their logic
  • Begin with basic needs: toileting, temperature, hunger and thirst
  • Taking time to figure out what your loved one wants.

Just what is Therapeutic Reasoning?

(Dementia Solutions is a private dementia consulting service. I learned about Therapeutic Reasoning on the Dementia Solutions website above)

Therapeutic Reasoning is when you…

  • Just agree with your loved one—apologize to them, say something nice to them, show them you care about their concern, tell them you will look into it
  • Employ an effective strategy used in dementia care that provides “reasoning” that is logical to the person and helps to reason and calm
  • Reasoning that is logical to the person with dementia (but not necessarily logical in reality), which creates a calm, reassuring feeling. As a result, it is beneficial both to the person with dementia and to the caregiver.

Examples of Therapeutic Reasoning in Action

Example 1: ‘Milking the Cows’

  • A person in mid-stage Alzheimer’s may firmly believe they need to ‘go home and milk the cows.’ The caregiver may state facts such as: “You don’t have the farm anymore, you sold it 15 years ago”, which can upset the person with dementia, or even lead to additional challenging behaviors. Instead, using Therapeutic Reasoning, you can say: “Milk the cows…well…lucky us! They’ve already been milked today! Isn’t that great news. How about a cup of coffee to celebrate? Treat’s on me.”
  • Use approach wisely. Ongoing practice will help you.

Example 2: A New Clock (My story as caregiver)

My father was upset because his favourite clock had stopped working. I tried putting in a new battery, but it still wouldn’t work. My father asked me to put in a different, fresh battery. Nothing doing. He asked me over and over to try a new battery. Finally, I took a new tack. I said: “Dad, I know of a watch repair store that also repairs clocks nearby. Would you like me to take your clock there tomorrow?” Carefully, I put the clock away out of sight. The matter was forgotten. I then bought a new clock and dad hardly even noticed!

Validation Therapy with Naomi Feil

What is ‘Validation Therapy’?

  • If your loved one is somehow unhappy, re-phrase what they have said as a question. Listen to them. Try music. Say: “I hear what you’re saying… Please tell me about it.” Then listen
  • You enjoy just ‘being’ with them. You step into their world

Naomi Feil is a Gerontologist that has a website at:

I highly recommend that you visit Ms. Feil’s website and spend just 5 minutes watching her introductory video, to watch her model the skills.

I hope you enjoyed this post, and that it will encourage you in your caregiving journey. Next week is poetry (which curiously, works really well with my dad). Stay tuned for upcoming posts on Wills and Advance Directives.

Thanks for joining me on my journey.

Stay well.

CAB 2022

Summary of Webinar: 6 Key Elements to Understanding Dementia

By C.A. Bryson

Photo by Kindel Media on Pexels.com

Note: This lecture was originally aimed at professional caregivers but is just as helpful for the family caregiver.

Instructor: Jill Gafner Livingston

Certified Dementia Practioner-Caregiver to her husband for 26 years. Her husband was diagnosed with lung cancer and had early onset dementia.

Webinar presented by American Society of Aging and sponsored by Right At Home, June 9, 2022.

Livingston shares, 70% of US caregivers have full-time jobs. Also, often one (professional) caregiver looks after many patients, there is only a limited number of caregivers.

Alzheimer’s is just one kind of dementia.

Other forms of dementia are:

  • Parkinson’s
  • Frontotemporal
  • Vascular dementia
  • Mixed dementia
  • Dementia with Lewy Bodies

Caregivers work with all behaviors. They don’t diagnose or prescribe medications.

Alzheimer’s is a non-reversible dementia.

5% of cases of Alzheimer’s start before age 65.

This is normal aging:

  • Slower recall
  • Difficulty concentrating
  • The capacity to learn is intact
  • New information takes longer to absorb

By age 65, you lose 10-15% of your recall.

If you lose your car keys OK, but if you don’t know what to do with your car keys, get checked.

Pseudo-dementia is a reversible condition. Ex. Drug interactions, or emotional disorders.

30% of people diagnosed with dementia also have depression. Both look alike.

Other Forms of Pseudo-Dementia:

  • Thyroid-mood fluctuations, confusion
  • Sensory loss (ie: hearing loss)
  • UTI (Urinary Tract Infection), looks like onset of dementia
  • Anesthesia-influences cognition

First Presentation of Dementia:

  • Memory loss
  • Personality changes
  • Verbal apraxia: Difficulty coordinating mouth and speech
  • Anomia: word-finding difficulties
  • Decline in grooming
  • Poor judgement (changes in logic)

Some examples: Elder is watching the show ‘Bonanza’. There is a scene of a barn on fire. The elder grabs the bucket, fills it with water and throws it at the TV. Caregiver says: “Why did you do that?” Elder says: “Because the barn was on fire.” Here is another example: Elderly mother in bathroom. Caregivers come to deliver food, ask: “Where are you, mother?” Mother says: “I’m in the bathroom.” Mother spends all day in bathroom, caregivers drop food off on table. Finally, daughter arrives, asks where is mother. Mother says: “I’m in the bathroom” Daughter asks: “Are you OK?” Mother answers: “I’m in the bathtub” Daughter asks: “Can I come in?” Mother has spent all day in bathtub. The mother fell in the bathtub that morning.

Second Presentation:

  • Poor short-term memory
  • Mood swings
  • Time confusion
  • Sleep disturbances
  • Change in eating habits
  • Socially dependent on family. Patient becomes very connected to caregiver-‘Shadowing’
  • Restlessness
  • Exhausting for caregiver, need support system in order. Caregiver can’t have a shower or even go to the bathroom, leads to caregiver burnout.

Third and Final Presentation:

  • Bowel/bladder incontinence
  • Very few words left in vocabulary
  • Constant supervision required
  • Short and long-term memory severely impaired

I hope you have found this webinar summary helpful. Next week, I will be posting about Person-Centred care, Therapeutic Reasoning and Validation Therapy. Stay tuned!

CAB 2022

Sleep Demystified

by C.A. Bryson

The following material is translated (by me) from:

‘Troubles de Sommeil : Sous le Radar’ by Martin LaSalle

Les Diplomés Number 441 (Spring 2022)

50% of Canadians suffer from sleep disorders

25-30% from occasional insomnia

10-15% from chronic insomnia

30% from sleep apnea

Researchers hypothesize that such lifestyle factors as atypical work schedules (experienced by 35% of Canadians) such as night work for example, coupled with anxiety and stress, might exacerbate sleep disorders. One must also bear in mind socio-economic factors and the social determinants of health, which means that certain groups are more at risk of sleep disorders and lack of sleep. Other factors such as light pollution, noise pollution, lack of proper ventilation, as well as excessive heat or cold can also contribute.

10 Myths About Sleep Revealed:

  1. One hour’s less sleep at night is insignificant.

False.

Even one hour less sleep can have deleterious effects on the body and cognition.

  • Alcohol helps you sleep.

False.

While alcohol may help initiate sleep, it can interfere with sleep rhythms.

  • A good night’s sleep enhances performance on tests.

True!

A good night’s sleep will enhance your performance on tests while pulling an ‘all-nighter’ does not. It appears that lack of sleep effects memory, specifically the area of the brain known as the hippocampus (the seat of memory).

  • Melatonin helps you sleep.

True and False.

Melatonin is not a sleeping pill. It helps the organism realize that it is dark, and usually only effects sleep if it is accompanied by proper sleep hygiene: regular bedtimes and wake-up hours, an effective sleep environment and relaxation before bed.

  • Sleep before midnight is better.

False.

Sleep quality is determined by phases of sleep and does not depend on the time at which you fall asleep.

  • You can make up for lack of sleep on the weekend.

False.

While extra sleep on the weekend may make up for lack of sleep the two nights prior, it will not make up for lack of sleep earlier in the week (Monday to Wednesday).

  • Screens detract from a good night’s sleep.

True!

Blue light emitted from screens inhibits the natural secretion of Melatonin.

  • One shouldn’t eat before bed.

True and False.

While a heavy meal or greasy or spicy food may inhibit sleep, a small snack before bed will do no harm.

  • A catnap is good for your health.

True!

Provided naps are no longer than 20 minutes long the overall effect will be beneficial, whilst longer naps will have negative repercussions on your sleep.

  1. Physical activity enhances sleep.

True!

Physical activity promotes relaxation which in turn enhances sleep.

More on sleep:

While lack of sleep has been correlated with the onset of Alzheimer’s disease, those with sleep apnea who use CPAP (Continuous positive airway pressure) machines gain at least 10 more Alzheimer’s free years on those who don’t use them.

Individuals who experience frequent nightmares may benefit from Imagery Rehearsal Therapy, a visualization technique in which people imagine their transformation day after day.

Free Resource:

Sleep on It! Canada

Canadian public health campaign on sleep (COVID-19, Sleep Disorders, Podcasts-in ‘Tools and Resources’)

I hope you have found this post helpful in your nightly quest for sleep. Stay tuned for resources to help you manage a loved one with dementia.

CAB

Planes, Trains and Automobiles: A Look At Seniors and Transportation

By C.A. Bryson

Recently, I wrote a letter to my local MP concerning the provision of bus stop shelters in the City of North Vancouver. I have observed, in my travels around the city, senior transit riders standing for upwards of half an hour at bus stops unable to sit down and rest. Furthermore, lack of bus shelters at some stops means no shelter from inclement weather.

This is simply not acceptable. About a year ago I found myself perusing online and read the following articles on seniors and transportation. These were truly fascinating and cutting-edge visions for enhanced transportation options for seniors.

The WHO (World Health Organization), created a Global Network of Age-Friendly Cities and Communities for older residents. They covered such issues as:

  • Health
  • Communication
  • Housing
  • Employment
  • Outdoor Spaces
  • Public Buildings and Transportation

Did you know that by 2030, seniors aged 65 and over will number 9.5 million and will make up 23% of Canadians?

Safe, affordable and accessible transportation for seniors must be prioritized. While the existence of ride-hailing services (taxis, Uber, Lyft) has been around for several years in Vancouver, we still have a long way to go. Uppermost in the minds of adult children of seniors is the issue of senior driving.

1st Article:

‘How Self-Driving Cars can Empower a Growing Population of Older Adults’ by Robert Moser,

American Society of Aging, 2021

https://generations.asaging.org/how-self-driving-cars-can-empower-older-adults

Of self-driving cars, experts say:

“For those who may lose the ability or confidence to drive, self-driving vehicles can help them to maintain a vibrant social life, allowing them to pick up grandkids from school or head out to dinner with friends without having to drive.”

On Senior Drivers:

  • For the medically at-risk driver (a person, regardless of age, who has a medical condition that may affect driving performance), driving cessation has serious consequences, such as isolation. What is needed is an action plan for maintaining community mobility.
  • Driving is a complex skill
  • Driving IADL (Instrumental Activities for Daily Living), therefore driving is a basic skill
  • Driving performance may show the first evidence for dementia
  • We will all outlive our driving ability by 6-10 years. Individuals with mild cognitive impairment may continue to drive, but an expert must make that determination. It is helpful to seek out a driver rehabilitation specialist who is also an OT (Occupational Therapist)
  • IADL may be determined by the OT

2nd Article: ‘Plugging Transportation Gaps: Microtransit Can Fill In Where Public Transit and Ride-Hailing Fail’ by Aparna Paladugu and Gabriel McCaig, American Society on Aging (2021)

https://generations.asaging.org/microtransit-can-fill-transportation-gaps

To report an individual who may be unfit to drive:

Contact Driver Fitness Unit: 250-952-6888

Or write to Road Safety BC

https://www2.gov.bc.ca/content/transportation/driving-and-cycling/roadsafetybc/medical-fitness/report

On-Demand Public Transit: What is It?

  • On-Demand Public Transit is a mix of fixed route bus service and Uber or Lyft Ride-Hailing
  • On-Demand Public Transit also known as Microtransit
  • Users request shared shuttle bus via an app that picks them up in minutes
  • Vehicles are routed to final destination, picking up other travellers along the way who are heading in the same direction
  • This kind of transit can be a lifeline
  • Freedom for the price of a bus ticket

Already Launched:

Newton, Mass (USA) and West Sacramento, California

  • Newton has a phone line with operators trained in older-adult sensitivity
  • They are wheelchair accessible
  • In Wilson, North Carolina qualifying older adults have special discounted pricing
  • An example of para-transit is HandiDart
  • On-Demand Public Transit is more sustainable than para-transit
  • These measures help older adults age in place and remain independent

How To Ride a Lime Bike (based on YouTube video):

  • Easy to follow 1-minute video on YouTube (Google ‘How to Ride a Lime Bike’)
  • To use Lime, you must download the app
  • Open the app, find your nearest ride
  • On your Smart Phone, unlock your bike by scanning the QR code or entering the 6-digit ID
  • Unlock cable
  • Put your foot on the ground and kick off to start ride
  • At end, lock cable and take photo of bike

Please note that NSCR’s Better At Home program offers transportation to seniors free of charge, for things like doctor’s appointments (also picking up prescriptions)

Call Nicola Harris at: 604-982-3313

Next week I talk about this year’s Alzheimer’s Walk and some resources for those caring for individuals with dementia.

Pictured Above: My grandfather’s car.

CAB 2022