Caregiving

Lactose Intolerance Can Sneak Up on Elders

By Carol Bradley Bursack -
 

Dear Readers: Several years ago, I used this space to highlight lactose intolerance, an issue many older adults face. Due to some recent questions, I felt it was time, once again, to share some anecdotes regarding this sometimes hidden problem.

Many of our elders enjoy milk, ice cream and other dairy products. In general, dairy products can provide valuable nutrition and needed calories, but dairy products contain lactose, a milk sugar that requires the enzyme lactase for proper digestion. Even people who’ve enjoyed dairy products for decades can gradually lose their ability to produce enough lactase to digest milk or other dairy products. When this happens, abdominal discomfort and diarrhea can result.

My 80-year-old neighbor, for whom I was a primary caregiver years ago, provided me with some education in this area. During one of our daily chats he confided to me that he was experiencing severe diarrhea. I was concerned about the many serious health issues someone his age could have, so I scheduled an appointment for him to see his doctor. His primary physician then scheduled him for a number of tests, all of which proved negative.

Since my neighbor seemed to have no alarming medical issues, I thought that an experiment was worthwhile. Lactase drops had recently become available over the counter at the pharmacy. The only dairy product that my friend consumed regularly was milk for his cereal, so I purchased some lactase and added the appropriate number of drops to my friend’s weekly quart of milk. Problem solved. He was able to enjoy his morning cereal and milk with no adverse effects.

Unfortunately, the source of lactose isn’t always this obvious. A reader wrote to tell me that his wife had suffered lactose intolerance for years, but had successfully worked around the problem. However, after his wife was diagnosed with Alzheimer’s disease, she was given new medications. She then began suffering from severe diarrhea.

“After fighting the problem for many months,” he wrote, “we found out that some of the medications she is on contain lactose. Not only that, lactose is considered to be a non-active ingredient, so it is not usually listed in the ingredients.”

The reader suggested that people who suffer from lactose intolerance ask a pharmacist to check all of the ingredients in their medications, including the non-active ones. The solution for this woman was to continue to take her medications, but to take a lactase enzyme pill at the same time.

Digestive issues can be a symptom of many serious illnesses, so always check with the doctor if your elder develops diarrhea or other severe digestive problems. If no other cause for digestive discomfort is evident and the doctor doesn’t suggest lactose intolerance, bring up the possibility. This is one of those health issues that can begin with such vague disturbances that it continues undetected for quite some time. Lactose intolerance can be managed once it’s discovered, but it may take some detective work. Remember to read labels on food items, as well. Some prepared foods also contain lactose.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

Resources for Long Distance Caregiving

Helping Aging Parents from a Distance is Challenging

By Carol Bradley Bursack - 
 

DEAR CAROL: I live 500 miles away from my aging parents. They are starting to need some help, but they don’t want to move to be near me. My husband and I can’t quit our jobs and move back to our home town, either. How do I go about looking for help for Mom and Dad from so far away? – Lori

DEAR LORI: One option is to look for a geriatric care manager in your parents’ community. Hiring a geriatric care manager can run into some serious money, but a care manager should be well acquainted with resources available locally for your parents. Some care managers will work directly with your parents, even managing medications. Others will provide research and oversight, but not be involved with any hands-on care.

Geriatric care management is a relatively new field. At this time there’s no control over credentials, but many people who become geriatric care managers have social work or nursing backgrounds. The website for The National Association of Professional Geriatric Care Managers is www.caremanager.org. If you’re interested in this option, the NAPGCM website is a good place to start.

Another excellent resource for you is the Administration on Aging website at www.aoa.gov. There is significant information on the AoA site as well as a link to the Eldercare Locator. The Eldercare Locator, also accessible at www.eldercare.gov, will help you find resources by typing in your parents’ Zip code. If you prefer to talk with someone on the phone, call (800) 677-1116.

Other resources can be found on your parents’ state website. Type the name of their state into your Internet browser along with “aging.” Your search should pull up many helpful links to direct you to resources. Every state has a version of the Nation Family Caregivers Support Program, which can also be found on the state website.

If either of your parents have a disease such as diabetes or arthritis, there are disease specific websites you can locate with just a little searching on the Web. An additional website for resource questions is the Community Resource Finder at www.communityresourcefinder.org.

It’s important that your parents appoint you or someone else they trust as Power Of Attorney for financial purposes as well as health care. If this legal work hasn’t been done, you may need to visit an attorney with them.

None of these resources take the place of family members and friends. It would be nice if you could contact some of your parent’s friends to check in on your parents regularly. Also, of course, do try to see them yourself as often as possible. You can’t control everything that happens to them, but you should visit often enough to keep tabs on their general welfare, and if possible, accompany them to some medical appointments to stay aware of their medical needs. This is time you’ll never get back, Lori. You can “manage” from afar, but it takes personal touch and eye to eye contact to really connect.

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Use Caution When Hiring an Independent Caregiver

By Carol Bradley Bursack - 

DEAR CAROL: My mom is 89 and lives alone. Considering her age, she gets along in her apartment quite well. She wears a personal alarm so she can get help if she falls, and I stop in twice a day. Still, I worry. I’d like to hire someone to stay with her, at least at night. Recently, I was introduced to a nice college woman who said she has a background in caring for the elderly. She’d be willing to move in with Mom and take care of her needs. Part of her salary would be room and board. She has references and the family likes her. Could this work? Mel

DEAR MEL: You’re talking about an arrangement that many people would consider ideal, and it could be, but please do your homework before making a decision. This woman may truly be an angel and you could develop a wonderful partnership, but your mother is vulnerable, so it’s vital for you to be sure the caregiver is capable and trustworthy.

Good care agencies run a professional background check, plus they check references thoroughly. You should do the same. For the background check, don’t just rely on your computer search engine. Check state court records and general public records, as well. If you have a professional company run a check, you will likely get more complete results. Definitely validate her references, both personal and those she has given you, for her work with elders.

Even if this woman checks out wonderfully, and she likely will, you still need to understand that by hiring her, the state may consider you her employer. When you are the employer, you may need to pay into Social Security and worker’s compensation for your employee. You can find more information on the IRS website about independent contractors versus employees at www.irs.gov. You should also check with the Federal Department of Labor and your State Department of Labor for assurance that you are in compliance with laws regarding domestic workers.

I am not trying to dissuade you from hiring this woman. The partnership could work out beautifully. If she can be considered an independent contractor, you may not need to worry about liability and Social Security taxes, but for your own protection you need to be certain about the procedure.

You can find additional information through the Private Duty Homecare Association at www.pdhca.org or the National Private Duty Association at www.privatedutyhomecare.org. The sites, of course, are biased toward their members, but you may find them helpful.

At the very least, I’d suggest that you do a background check, a reference check and call the state’s Department of Labor for information about state laws. A live-in caregiver where everyone benefits can be ideal. You just want to make sure you have a truly honest, caring person living with your mom. Carol

Find other articles by Carol in our Caregiving library.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders and a blog at www.mindingoureldersblogs.com.

Daughter Cannot Trust Mom Caring for Dad

By Carol Bradley Bursack

Dear Carol: My mother and I do not get along. She is manipulative and often nasty to me, so I have had to distance myself from the chaos. I keep intending to walk away completely, but I cannot do that because I want to help take care of my dad, or at least spend time with him.

He has Alzheimer’s and does not even know who I am, but I do not entirely trust my mother with him. I am not sure he is being cared for properly. If I ask questions about his care, or just day-to-day issues, she thinks I am criticizing her and emotions escalate. If I try and turn away, I get the martyr routine. I remind myself that this is not about us, it is about my dad, but it remains hard. Any advice? – Monica

Dear Monica: This is a tough, emotional situation and, unfortunately, not uncommon. My first thoughts are about your dad. If you have serious concerns about abuse or neglect, you need to call Social Services and ask them to do a welfare check.

If your concerns are not that serious, you will have to make choices. Trying to detach from your mother’s manipulation does require setting some personal boundaries. You will need to learn not to fall for your mom’s martyr routine or any other manipulations if you want to stay close to your dad.

Your mom may feel threatened when you try to help with care. Try to give the way you approach your mother some thought. Past hurts involving your relationship are likely still interfering with your relationship today. Are there any instances you can think of where you could apologize to her? I realize that this may seem unfair, and that some people have personality disorders that make it nearly impossible to get along with them, but occasionally reaching out in a non-threatening way can help people unite over a common objective.

Is it possible for you to get some counseling to help you vent your feelings and learn how to handle your issues with your mother so you can help care for your dad? Do you belong to a spiritual organization? A leader there may be able to help you. If you belong to a church, they may have trained Stephen Ministers who can listen to you and give you encouragement.

You are trying to do the right thing. A trained third party may be able to help you learn how to detach compassionately from your mother’s manipulations. You may also learn more productive ways to approach your mother.

Acquiring these tools could help you tread this delicate area and make it easier for you to help your dad. Good luck.

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at Minding Our Elders. She can be reached at carol@mindingourelders.com.

Dad’s Obsession over Wallet and Paying Bills Caused by Alzheimer’s

By Carol Bradley Bursack - 

Dear Carol: My dad has Alzheimer’s and lives in a very good nursing home. We visit often. What I’m wondering about is his habit of repeatedly taking his wallet out of his pocket and emptying out the contents. He then carefully puts everything back. He also tries to pay the nursing home staff when they help him. Telling him everything is paid for simply doesn’t work. Any insight? Julie

Dear Julie: I can say with confidence and sympathy that I know what you are going through, and so do many others. The situation isn’t uncommon, particularly with men. After my dad’s brain surgery, meant to correct some effects from a WWII brain injury, left him with severe dementia, Dad became obsessed about his wallet and with paying for everything.

Like many men, Dad’s wallet seemed to signal to him that he was still a provider. The other issue associated with his wallet may have been that his proof of identity is carried there. His driver’s license (lapsed), his credit cards, clubs he belonged to – all of these cards would have his name on them. That could have been reassuring to him. I believe that is what your dad is doing – looking to reassure his identity. Understanding what your dad’s billfold means to him can help you better understand his behavior.

Dad, too, couldn’t understand that he was already paying for everything at the nursing home. Generally, when a staff member helped him with something, he insisted on paying them on the spot. He did the same at meals. He’d get so upset when we’d tell him everything was paid for that I wondered, sometimes, if he felt that he was taking charity. Even telling him that they put everything on a “tab” to be paid at the end of the month didn’t alleviate his anxiety.

We tried leaving a few dollar bills in his wallet so he felt as if he had cash, but the low denomination of the bills made him feel “broke,” so that backfired. Next, I dug around until I found some expired credit cards with his name on them, and closed the accounts, but he didn’t use them.

My most successful solution was to make him “business cards.” When someone helped Dad, or he ate a meal, he offered his business card as payment. That way he felt responsible, and also had an ID, so I think it helped both wallet issues. The staff members were most gracious about accepting the cards. They even recycled them in an envelope hung in the kitchenette.
You’ll have to experiment and see if any of these suggestions work for your dad.
Try to remember that this too will pass. Carol

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

The Wonders of Senior Creativity

By Dr. Marion Somers, Ph.D.  -

Creativity works wonders for the elderly. Whether it’s singing, painting, playing an instrument, dancing, or writing poetry or a journal, creativity keeps aging people in the here and now. I had one client I cared for, a man who appeared to be very “tough,” who started writing poetry at the age of 89. He entered a contest for poets over 75, and darn it if he didn’t win. His poetry changed the way he looked at the world – and himself, and it did wonders for his mental outlook and energy level.  Getting in touch with their creative selves will allow your elders to stay connected to the wonders of life. They might even draw on creative impulses and abilities they never knew they had, or just never had the time to nurture.

Creativity will also help tap into your elders’ long-term memories. Ask them about their favorite music. I always try to find songs from the era when my clients were 15 to 30 years old.  I’ll sing their favorite songs and even pass around sheet music so other family members can sing along. You can also use music as a way to introduce dancing to help your elders get some exercise. My clients often dig their heels in about exercise, but they usually love to dance.  Also, the creative juices flow more freely when a person is moving their body.

If you care for an elder who is confined to the house, you can always bring creativity to him or her. If a senior citizen is unable to write anymore, have him or her tell stories into a tape recorder. If the elder you care for likes to draw, make sure that paint, pencils, markers, crayons, and pens are available. Also, be sure to accommodate the little things, such as having enough light or providing a left-handed person with left-handed scissors. Many of my aging clients enjoy making collages out of old photos. I’ve also found that some elders enjoy making a family tree. The key is to have fun with it. Creative pursuits will give your elders something to look forward to and talk about with their friends and family. They might even better understand themselves or discover a new talent after all these years. You may also find that they’ll be in better spirits, enjoy improved mental acuity, have a better appetite, and be more social.

Learn more about Dr. Marion on her bio page. Find more articles by Dr. Marion here or find other articles for caregivers in the Caregiving section of our Library.

A version of this blog appeared on Dr. Marion’s Web Site.

What is Best for Parents? Siblings Often Disagree

by Carol Bradley Bursack -

Dear Carol: My sister and I have co-power of attorney responsibilities for our parents. I live near my folks and have been the hands-on caregiver for several years. My sister lives 300 miles away but comes home every few weeks. For the most part, I have taken care of anything related to healthcare and my sister dealt with the financial issues.

Our parents are doing quite well with this arrangement, though they need increased assistance if they are to stay in their home, which they say they want to do. My sister doesn’t think this is safe and has been pushing for an assisted living facility.

She and I have always gotten along, but this is causing stress and some dissension. She is concerned that increased in-home care will cost more than assisted living. I hate taking sides. I agree with my parents but my sister makes some good points. –Cindy

Dear Cindy: While a few hours of in-home care will cost less than assisted living, the cost of in-home care 24/7 will likely exceed assisted living costs. Also, assisted living would give your parents social options which remaining in their home may not. It all depends on how much care they need and how they spend their time.

If they have a social life and can manage well with your help and some in-home care, which may be a good temporary option. If they rarely do anything with their peers and basically vegetate, they may do better getting involved with the activities in a good assisted living center. Another thing to consider is their home’s floor plan. Can they stay there if there is an emergency and they can’t climb stairs? Can they safely use the bathroom? Bathe?

Maybe you and your family can compromise for awhile. You can hire in-home care for more hours while you all tour assisted living facilities together. See if any of your parents’ friends live in assisted living nearby. If so, that can be a huge draw for your parents.

Your parents will likely complain if the decision is to move, but many people love the safety and the activity of assisted living once they get over the mindset that their home is the only acceptable option.

Others prefer to hire more in-home care and have alterations made to their home so they can continue to live there. Communication and flexible, non-competitive attitudes will take you a long way. It’s never easy, but since you don’t have an emergency you have time to take small steps. By doing that, you should come up with a workable solution.

Read more about Carol Bradley Bursack on her bio page.

Carol Bradley Bursack is the author of a support book on caregiving and runs a website supporting caregivers at www.mindingourelders.com. She can be reached at carol@mindingourelders.com.

Citrus Season: the Superhero Fruit Season for Seniors and Us All

by Laura MacDougall - 

Now is the time to enjoy the benefits of this winter fruit. We all know citrus has lots of Vitamin C, a great antioxidant. But did you know that you need vitamin C for the growth and repair of tissues in all parts of your body? It helps the body make collagen, an important protein used to make skin, cartilage, tendons, ligaments, and blood vessels. Vitamin C is needed for healing wounds, and for repairing and maintaining bones and teeth.

Vitamin C can help fend off heart disease, high blood pressure, the common cold and cancer. It is also good for osteoarthritis and age related macular degeneration. (Read more at the University of Maryland Medical Center Vitamin C information page)

So how can you add more citrus into your diet after the OJ in the morning? Easy.

Here are some suggestions to get you thinking.

Breakfast:

  • Make smoothies using orange juice
  • Mimosas for brunch – use grapefruit, blood orange or Meyer lemons for a twist
  • Use citrus juices and zests mixed with a little honey over fruit salad – combine citrus for depth of flavor
  • Add orange zest to your favorite waffle, pancake or muffin recipe then top with segments of fruit
  • Halve grapefruit and top with a little brown sugar – broil 1-2 minutes to melt

Lunch:

  • Add grapefruit, orange, or tangerine segments to your salad
  • Substitute citrus juice for vinegar in your favorite dressing
  • Mix lime juice, chopped peppers and celery into your tuna salad for a little kick
  • Snack on a Clementine, tangelo or blood orange – a little less tart than other varieties
  • Top your ham and cheese with a low sugar marmalade
  • Place cranberries and orange chunks in the food processor, pulse until finely chopped and add to frozen or fresh yogurt, or mix into your chicken salad for a little tang

Dinner:

  • Use orange slices (any variety) fresh basil and garlic on your fish -drizzle with EVOO, wrap in foil and bake
  • Like Picatta? Try the same recipe swapping citrus – orange pairs nicely with basil, ginger, chilies, rosemary, black olives and red onion. Lemon pairs with lavender, capers, thyme and sage. Lime goes great with cilantro, cumin, chili powder, and garlic.
  • Use blood orange juice in your next cocktail for a deep red color
  • Beef stew is wonderful cooked with orange juice, beef broth and cumin
  • Pork goes great with lemon and prunes or kumquats
  • Make a citrus curd and layer with Greek yogurt for a healthful dessert.

Cooking Tips – when zesting citrus, avoid the pith (white part), as this can be very bitter. Always wash your citrus when using whole fruit or zest in a recipe…. ever see the grocery store floor? Euwwww

Pick heavy fruit for the size…they’ll have more juice. Try new varieties of citrus too as the sweetness will vary.  From kumquats to pumellos, Key limes to Meyer lemons – ‘tis the season to taste these little powerhouses for yourself.

Get peeling and be healthy! Bon Appétit!

Read Laura’s bio or find more articles by Laura MacDougall

New Year Resolutions That Will Stick: “Go Fish” Twice a Week

by Elaine Magee, MPH, RD -

The American Heart Association isn’t the only one suggesting healthy people should eat fish two to three times a week. More and more research is showing that omega-3 fatty acids (among many other health benefits) seem to improve arterial health in general and they help make blood less likely to form clots that cause heart attacks. According to the American Heart Association, in a statement dated November 18, 2002, the effects of omega-3 fatty acids on heart disease risk is seen in relatively short periods of time. So, if you make eating fish your New Year’s Resolution, you can potentially start reaping the benefits fairly quickly.

Unless fish is a part of your culinary culture, this can be a hard food habit to follow through on. I try to make sure I have a lower fat tuna sandwich for lunch each week. Then I’m halfway there! I try to cook a fish dish for dinner at least once a week too—which gets me to the “eating fish two times a week” goal.

I have three tips to help you with the fish for dinner option.

  1. When you eat out in restaurants, see if there is a fish entrée on the menu that interests you.
  2. Start collecting fish recipes (hopefully lower in fat and not deep fried) that you want to try. This might help motivate you to make fish for dinner more often.
  3. Add cooked fish and shellfish to your green salads or stir fry dishes. You can buy cooked shrimp frozen (deveined and without tails) or frozen grilled fish filets and then all you need to do is thaw slightly before adding them to your dishes.

You can read Elaine Magee’s bio to learn more about her. You find more articles by Elaine in the Health Nutrition section of our library.

I am Overwhelmed Caring for My Parents; Can I Tell People At Work?

by Dr. Marion -

It is often overwhelming to be a caregiver while working a full-time job. However, people struggle with the idea of bringing up the topic with their boss or co-workers. Before talking to anyone, consider the following questions so you can individualize your situation. Thinking about these answers will help you move forward.

  • What is your problem or concern or special situation?
  • Does this issue relate to you alone, or is another person involved?
  • Are you dealing with an emergency or a certain sense of immediacy?
  • Is it specifically job related, or is it a private/personal matter?
  • How much time will it take to discuss the issue?
  • Is it better to approach the issue over lunch or coffee or in a more relaxed environment?
  • Do you know your supervisor well enough to stop by his/her office, or is a request for an appointment required?
  • Is your supervisor the right person to discuss this with, or is the Human Resource Department better (or another department entirely)?

Sometimes when we are unsure of how to present or discuss something, a little practice helps. This practice can be done in front of a mirror or with a friend or family member. The clearer your thinking and emotions are regarding your concerns, the more likely you are to get good results.

And keep in mind that any problem that’s negatively affecting you will eventually impact your job performance. Wise businesses know that a happy employee is a productive employee, so gather your facts and go forward.

Learn more about Dr. Marion on her Authors page.

A version of this blog appeared on Dr. Marion’s Web Site.

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