Wednesday, December 4, 2013

My Cognitive Impairment Doesn’t Need a Name to Be Real




I notice that I'm allowing the uncertainty of my diagnosis to inhibit my blogging.

As I said in my last post, the uncertainty is not that difficult for me personally; my symptoms are no less real to me than before. I do realize, however, that, for many other people, the lack of objective evidence of cognitive impairment renders the value of this entire endeavor questionable.

Whatever my subjective experience, if there's no medical evidence of Alzheimer's (or, worse, no evidence of cognitive impairment at all), then, for many others, this blog might be an interesting study in psychosomatic illness but of little interest to those who are concerned about the inner experience of Alzheimer's. For those particular people, my writing about my symptoms may seem an almost pathetic, last-ditch attempt to convince myself and my readers of the reality of these symptoms.

All of which makes me a bit defensive while writing this blog. Nevertheless, this blog is about my experience of whatever-I-have, so that's what you'll get. Of course, the doubt of others and my defensive reaction to it are all part of the process, anyway. I just wanted you to know what's going on internally as I try to sort out this new phase.

Anyone with early Alzheimer's, I suspect, has such doubts. As I've worked with my uncertainty during the past few months, it's been helpful to categorize my symptoms into two rough and overlapping groups.

First, there are the "Well-that-could-happen-to-anyone" complaints, such as loss of memory, difficulty in word finding, deterioration of my ability to type, and so on. Everyone has experiences like these and they increase as one ages. They're poor evidence of disease.

Then there are the "Now-that's-real-impairment" symptoms: getting lost in a place I knew fairly well, the severe loss of ability to work with spreadsheets, the episode with the keys and others. These are not easily dismissible.

Over the course of the last three years, I've had a number of the latter "Now-that's-real-impairment" symptoms. They occur only infrequently—the last was at the beginning of August—but they've been important in helping me and others to accept my diagnosis.

There are also two things about the "Well, that-could-happen-to-anyone" symptoms that remove my doubt. First, their frequency has been staggering:
  • I now search around the house multiple times a day every day to find things I've just put down. Not only have lost my beltpack three times over the past couple of years, but I would also have lost it several more times if someone else hadn't noticed and pointed it out to me.
  • Anyone can have trouble word-finding, but I am daily having to use less-than-satisfactory substitutes for the word I want.
Second, these symptoms may be normal for some people, but they are decidedly not normal for me:
  • It wasn't until yesterday when I reread last week's post on the difference between Alzheimer's and normal aging that I recognized I'd written about the same thing at least twice before.
  • I've been forgetting some of the "shortcut keys" that I've used in my word processing program almost every day for over ten years. Only later do they come back to me. (My wife Marja is unimpressed: "I can't remember any of those shortcuts at all," she says.)
Maybe some other people have trouble with such things, but I never did before.
Because I've been aware, however, of how my normal tests this might seem to some others, I've become almost embarrassed to be writing these posts.

But then I remember the purpose of this blog: to describe my own experience of cognitive impairment, whether or not it's convincing to others. I'm to write down the truth of my experience, and it's up to others to decide whether it's helpful for them or not. My truth at this point includes my defensiveness and my reluctance to write about my symptoms.

If this turns out to be a chronicle of a "worried well," so be it.

Stepfamily Can Increase Caregiver Stress, Here's How to Handle It

Nearly half-a-million Americans over 65 remarry each year, according to the U.S. Census Bureau.
That number is projected to keep increasing, meaning more and more family caregivers will find themselves in situations where they are either looking after an aging stepparent or having to discuss and manage a loved one's care with stepfamily members.

Caregiving often causes varying degrees of conflict, even among the most close-knot family units. This potential for discord can be enhanced in blended family situations, because step relatives haven't had decades to bond with one another, says Carey Sherman, Ph.D., investigator at the Institute for Social Research at the University of Michigan.

Sherman led a recent study on spousal caregiving, stepchildren and stress, published in the Journal of Marriage and Family. Her team of researchers discovered that women who remarried and were caring for a husband with dementia often experienced increased strain from uncooperative or unhelpful stepchildren. "The majority of the women felt ‘let down' or ‘alone' in their caregiving role, and expressed surprise, disappointment and hurt, due to the lack of support from their stepchildren," she says.

Indeed, the stress of interfamily discord was so great that many of the women surveyed said that dealing with disagreeable stepchildren topped their list of caregiving-related stressors.

Personal connections beat blood bonds


Previous research suggests that the quality of family relationships typically trumps blood ties in caregiving scenarios. People are more likely to take care of (and want to take care of) individuals who've supported them in the past, regardless of whether they share the same genetic makeup.

A University of Missouri investigation found that, while genetics are an important factor for most would-be caregivers, shared DNA patterns weren't enough to oblige an individual to care for a family member he or she didn't share a positive connection with.

"How close family members are to each other, how much they have been helped by them in the past, and what hardships caregiving might place on family members are important factors when people consider caring for older kin," remarks Lawrence Ganong, a professor in Missouri's Human Development and Family Studies department.

The problem facing adults who remarry at an older age is that their combined family hasn't had the benefit of decades to forge these tight bonds and find their unique niche within the family unit. Also, as Sherman points out, older couples who've been divorced or widowed may focus more on their relationship, rather than trying to make sure their far-flung adult children play nicely with each other.
With fewer chances to cement strong relationships, these offspring may run into trouble if an unexpected event forces the issue of who will take care of mom or dad.

Strategies for avoiding interfamily arguments


Whether step relatives are involved or not, the same rules for interfamily interactions apply:
Hold a family meeting as soon as possible: When an elderly loved one falls ill, chaos can reign if there's no plan in place to take care of them. Getting the family together (whether in person, or via telephone conference call) is an essential initial step.

Let everyone have their say: During the family get together it's important to make sure that everyone has the opportunity to share their thoughts and opinions. The best way to avoid conflict and come up with an effective care plan for your loved one is to avoid passing judgment and respect other family members' decisions. Seeing a loved one suffer and hearing that other family members can't or won't help can be infuriating, especially if you're the one providing the majority of the care, but it's important to keep in mind that not everyone is cut out to be a caregiver.

Divide and conquer: Everyone who wants to participate in the care of an elderly loved one should be included in the family care plan. Even if someone lives thousands of miles away, they can still play a role—perhaps managing finances, or providing periodic respite care for the primary caregiver.
Bring in a third-party: Especially if interfamily relations are contentious, it may be helpful to recruit an objective outsider—social worker, clergyman, family friend, etc.—to help facilitate a discussion between family members. A third-party with some connection to the family can approach the issues with a more pragmatic, yet caring approach.

Keep your expectations realistic: Even the most harmonious families will disagree on some issues—caregiving is so emotionally-charged. Don't anticipate a solution to every problem. Accept that everyone may not be on board with every decision regarding a loved one's care and know that some compromises will be necessary.

Perhaps the best way to stave off clashes over care and responsibilities is to develop an action plan before a loved one needs help, says Sherman.

Having conversations with the elderly about end-of-life issues can be daunting, especially for adult children, but such discussions can save your family a lot of future strife and heartache.

Can a Veteran Get a Pension to Pay for Long-term Care?

Caregivers and their elderly parents are often frustrated by the vague information they receive from the VA explaining how to apply for pensions to help pay for long-term care.
The following is an excerpt from "Checks for Vets" by Joseph Scott McCarthy. This guidebook helps vets apply for pensions to help pay for long-term care.

"Imagine that you have just made the agonizing decision to move your elderly father into an assisted living facility because he can no longer care for himself. He is an honorably discharged veteran with no dependents. The assisted living costs about $3,000 per month. Your father has a total income of $1,400 per month from social security and interest. His net worth is $60,000. How will you be able to afford the cost of the assisted living facility?

The answer could be an Aid and Attendance pension for veterans. Because your father was honorably discharged, has caregiver needs due to his disability and has a net worth of less than $80,000, and meets the income requirements, he is eligible to receive a pension check for $1,644 per month from the Department of Veteran Affairs Aid and Attendance pension program. In addition, after your elderly father starts to receive the Aid and Attendance pension, he will also be able to receive free medications from a VA mail-order pharmacy.

Surviving spouses of wartime service veterans are also eligible for this pension; however they are not eligible for free medications.

While submitting an error-free claim can shorten your claim process, there will still be a waiting period before your claim can be approved. The waiting period for pension approval id different in each state and is dependent on a number of factor, including the retirement of significant numbers of VA regions office employees; the number of responsibilities place on the regional office, such as processing foreign country claims; and whether the regional office sends its claims to other offices for processing.

The waiting period also varies according to the backlog of claims the VA is processing. However, once the VA determines that you are eligible to receive a pension, the check you receive will contain a lump sum amount retroactive to the first of the month after your application date.

In addition to a wealth of information about veteran pensions, McCarthy's book "Checks for Vets" contains samples of the forms you need and tips for successfully filing a claim for an Aid and Attendance or Housebound pension.

There also is a special pension for care that many people don't even know about, and it is worth looking into to see if your veteran or surviving spouse qualify.