Navigating the Journey of Memory Care

Chandler Hall- Your Partner in Health

If you’re worried about whether you or someone you love may need memory care, now or in the future, this guide will help you understand more about the changes that can happen when we age, and how to know when it’s time to get additional assistance.

When Should You Be Concerned?

When someone is struggling with cognitive or memory problems, it can be subtle at first. We all joke about misplacing car keys as “Being a sign” or say things like “I must be losing it- where did I put the [bill/phone/remote control] ??!?” But those problems are frequently caused because our attention is divided and too many things are happening at once, not signs of serious cognitive problems.

What Does a Real Problem Look Like?

The first thing to understand is that cognitive declines can involve different cognitive domains or skills, not just memory. These include:

• Attention • Concentration • Executive functions (which

includes judgement and decision making)

• Memory • Language • Visual-constructional skills, • Conceptual thinking • Calculations • Orientation

That seems like a long list, and we all have those occasional issues with making sure you calculated a tip right or have a day where your concentration is off. Lack of sleep, stress, medications and other factors, including hydration, can certainly make you feel like you’re having an off day. However, if you notice sustained problems in yourself or a loved one in these areas, it’s easy to consult a doctor and get a simple assessment that will indicate whether or not additional testing is warranted.

Learn About Assessments and TestingA much used diagnostic tool, the Montreal Cognitive Assessment, sometimes referred to as the “MoCA”, is the gold standard for early cognitive assessments. The MoCA is a rapid screening tool, given frequently to test for early signs of dementia or cognitive processing issues. This test is one of many screening tools There are many more in depth assessments that can be done to determine whether or not someone has developed cognitive functioning issues which are impairing their judgement and decision-making.

When Should You Have an Assessment Done?

The easy answer is “as early as possible.” Early diagnosis and intervention can slow the progress of decline, but it is much easier said than done in practice. Why is it hard to catch memory and cognitive problems early?

Something’s Not 100%…

Sometimes changes are subtle, and if the person you suspect may be experiencing cognitive decline lives with you, it’s likely you have been working around some of these “quirks” for some time. We all compensate for the strengths and weaknesses of each other, filling in a word someone’s searching for, or getting up to help them if they’re

struggling with something. Sometimes, until problems get quite pronounced, or someone from outside the family mentions something, no one really seems to notice. Because the changes have been subtle and slow, the person and their family just work around the issues until they become undeniable.

Recognizing Issues For People Living Alone

If someone is living on their own, maybe they are asking for help managing more around the house, including bills and transportation to places, rather than going themselves. Maybe things seem vaguely out of place when you visit them. Maybe they seem to be more easily taken advantage of by telemarketing scams.

Maybe they stop doing favorite activities and the reasons for the change seems a bit odd, like “I think it’s someone’s else’s turn to do that”- but the

underlying reason for any of these things may also be that it is just becoming more and more difficult for them to manage.

A Mixed Picture and Many FactorsUnderstanding the sources of changes in behavior, memory or activities can be challenging as well. Are the changes due to medications or medication interactions? Is the person getting proper nutrition and sleep? Are they just normal age-related changes? Add in to your thinking that no one wants to admit that there’s a problem, and you can see how getting a loved one to take a step to getting evaluated for mild cognitive impairment is difficult.

This means getting an early diagnosis is often challenging. No one wants to even consider the thought that they may be moving toward the day when they need to give up their independence.

These changes can cause a lot of anxiety. However, if you can diagnose true cognitive decline early on, there are many new classes of treatment that can help slow the decline, and may be worth investigating.

Early Signs and Symptoms of Dementia

• Memory impairment, such as difficulty remembering events

• Difficulty concentrating, planning or problem-solving

• Problems finishing daily tasks at home or at work

• Confusion with location or passage of time

• Having visual or spatial difficulties, such as not understanding distance in driving, getting lost or misplacing items

• Language problems, such as word-finding problems or reduced vocabulary in speech or writing

• Using poor judgment in decisions

• Withdrawal from work events or social engagements

• Changes in mood, such as depression or other behavior and personality changes

Other flags that a neurological exam may be in order…

Some symptoms of neurological decline or dementia are unusual and should be noted and observed over time. They can include but are not limited to the following:

• Inappropriate social behavior, e.g. they may say inappropriate things or come across as rude or tactless

• Distractibility

• Loss of insight into the behaviors of oneself and others (making it seem as if they don’t care)

• Changes in food preferences

• Blunted emotions

• Decreased energy and motivation

• Changes in personality, e.g. more outgoing people may become quieter and quiet people may become more extroverted.

Where Do I Go to Get an Assessment?

Your doctor can be a good resource. In addition, there are many fine programs in the Lower Bucks area, including Saint Mary’s, Penn Medicine, Jefferson Health, and Doylestown Health, that can help you get an evaluation and perhaps a diagnosis of a suspected cause. These providers and others can be helpful when discussing treatment options and expected disease progression.

What kinds of dementia are there?

There are many different kinds of dementia. Some types are organic and caused by a disease process, or they can be genetic. Some can be due to traumatic injury. Some forms of dementia are caused by adverse interactions from medications, drug or alcohol abuse or even certain metabolic disorders and depression. That is why it’s especially important to get a thorough medical examination from a qualified neurologist or other neuro-specialist or gerontologist.

Please see your doctor or encourage your loved one to consult their physician if you notice any of these changes or symptoms of memory loss.

Options for Getting Extra Help When Needed

There are lots of options for people with cognitive and/or memory issues. At Chandler Hall, we provide support for our residents in our Residential Living and Personal Care apartments, allowing independence while providing support as needed, Over time, as needs change, we also have our secure Hicks Memory Care residences, adjacent to Friends Nursing Home. This welcoming area provides a stimulating environment with programs geared towards life enrichment for everyone.

Suggestions for Family Members and Caregivers

Learning about the experiences of other people living with dementia or Alzheimer's disease can be helpful to those who support them. Chandler Hall’s many support groups offer a care-giver centered sounding board to help people in our community deal with the challenges and strong emotions that can come with caring for people suffering from dementia. Be sure to look on our website for upcoming events, read the articles on our blog for more information about specific conditions, and even read family stories to hear how other families are addressing concerns with their loved ones.

Understanding How The Person Feels

People struggling with cognitive decline and dementia do understand something is wrong, and it can cause them significant fear and anxiety. Learning how to “meet them where they are” is important, and the suggestions below were put together in a handout called Memory Problems?3, written by the Early Stage Support Groups in the North/Central Okanagan Region of the Alzheimer Society of British Columbia, by people struggling with cognitive and memory challenges:

• Please don't correct me. I know better—the information just isn't available to me at that moment.

• Remember, my feelings are intact and get hurt easily. • I usually know when the wrong word comes out and I'm as surprised

as you are. • I need people to speak a little slower on the telephone. • Try to ignore off-hand remarks that I wouldn't have made in the past.

If you focus on it, it won't prevent it from happening again. It just makes me feel worse.

• I may say something that is real to me but may not be factual. I am not lying, even if the information is not correct. Don't argue; it won't solve anything.

• If I put my clothes on the chair or the floor, it may be because I can't find them in the closet.

• If you can tell that I am having trouble, please don't draw attention to it. Try to carefully help me through it so nobody else will be aware of the problem.

• At a large gathering, please keep an eye on me because I can get lost easily! But please don't shadow my every move. Use gentle respect to guide me.

• Sometimes I sense that you think I am faking these problems. What you don't see is my terrible confusion and my hurt knowing how you feel.

• I don't mean to frustrate you. I know you get impatient and tired of telling me things three times in a row. Please be patient.

• Ask me what I think or want. Don't assume that you know. • Believe I still love you, even if I am having trouble showing it.

More Suggestions for the Family—Taking Care of the Caregiver

A diagnosis of dementia can be difficult for everyone involved. Family members will need to take care of themselves throughout the disease process. The following are some tips for self-care and planning for the future.

• Avoid isolation and loneliness by keeping up with social activities and contacts with others as much as possible.

• Take care of your own health.

• Learn about the disease.

• Join a caregiver support group to connect with others.

• Keep a journal of what you are doing and how you are feeling.

• Try to keep physically active.

• Watch for signs of stress and how it can affect your health and ability to support the person with the disease.

• Seek professional help if feelings of depression or anxiety are overwhelming.

• Be flexible about routines and expectations.

• Try to be positive and find some joy in everyday things.

• Start planning for the future with the person you support.

Above all - seek help!

When it’s time to find professional help, We’re here for you

There comes a time with most dementia patients when more professional care is necessary. It is not giving up on you or your loved one, but rather seeking out and securing the help of professionals whose sole job is to care for patients with dementia.

The professionals, like our excellent staff here at Chandler Hall, are trained to provide a caring, respectful living and medical services specially designed for the Memory Care patient. Good providers offer specialized services designed to form bonds, stimulate and reinforce the patients’ cognitive capacities as well as provide skilled nursing services and medical care.

In the lower Bucks County area, Chandler Hall has an unparalleled reputation in their Hicks Memory Care Pavilion as a source of kind,

compassionate and professional care based on the Quaker tradition of finding the light in every person. Chandler Hall works with the patient, the care team and the family to continue to recognize and nourish the person within.

Like any intensive care plan, it is a team effort. No matter which program or facility you chose for your loved one, we can all make a difference in the lives of people suffering from dementia.

We also offer respite care on our campus for short stays, to help families when needed.

Families need support, too.

At Chandler Hall, we help support families with the ongoing journey of dementia. We help them make connections and maintain healthy relationships with their loved ones, even when challenges arise. By helping to educate and care for families as well as the person needing memory support, Chandler Hall delivers the care every family needs when navigating this journey.

If you want to explore options to help your family through the residential and service offerings here at Chandler Hall, Please call Ashley Floyd at (267) 291-2303 to take the next step. Along with our care team, Ashley can help you decide whether Chandler Hall’s options are right for you, and what level of support will help meet your needs.