Archives for October 2015

Ten Great Tips for Communicating with a Dementia Person

(Family Caregiver Alliance) Caring for a loved one with dementia poses many challenges for families and caregivers. People with dementia from conditions such as Alzheimer’s and related diseases have a progressive brain disorder that makes it more and more difficult for them to remember things, think clearly, communicate with others, or take care of themselves. In addition, dementia can cause mood swings and even change a person’s personality and behavior. This Fact Sheet provides some practical strategies for dealing with the troubling behavior problems and communication difficulties often encountered when caring for a person with dementia.

We aren’t born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make caregiving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

1.      Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2.      Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.

3.      State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or question. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

4.      Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clarify your question and can guide her response.

5.      Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.

6.      Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

7.      When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

8.      Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.

9.      Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.

10.  Maintain your sense of humor. Use humor whenever possible, though not at the person’s expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Handling Troubling Behavior

Some of the greatest challenges of caring for a loved one with dementia are the personality and behavior changes that often occur. You can best meet these challenges by using creativity, flexibility, patience and compassion. It also helps to not take things personally and maintain your sense of humor.

To start, consider these ground rules:

We cannot change the person. The person you are caring for has a brain disorder that shapes who he has become. When you try to control or change his behavior, you’ll most likely be unsuccessful or be met with resistance. It’s important to:

  • Try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make him more comfortable.
  • Remember that we can change our behavior or the physical environment. Changing our own behavior will often result in a change in our loved one’s behavior.

Check with the doctor first. Behavioral problems may have an underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem.

Behavior has a purpose. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet on a daily basis, and we wonder why. It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate them.

Behavior is triggered. It is important to understand that all behavior is triggered—it doesn’t occur out of the blue. It might be something a person did or said that triggered a behavior or it could be a change in the physical environment. The root to changing behavior is disrupting the patterns that we create. Try a different approach, or try a different consequence.

What works today, may not tomorrow. The multiple factors that influence troubling behaviors and the natural progression of the disease process means that solutions that are effective today may need to be modified tomorrow—or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.

Get support from others. You are not alone—there are many others caring for someone with dementia. Call your local Area Agency on Aging, the local chapter of the Alzheimer’s Association, a Caregiver Resource Center or one of the groups listed below in Resources to find support groups, organizations and services that can help you. Expect that, like the loved one you are caring for, you will have good days and bad days. Develop strategies for coping with the bad days (see the FCA Fact Sheet, Dementia, Caregiving and Controlling Frustration).

The following is an overview of the most common dementia-associated behaviors with suggestions that may be useful in handling them. You’ll find additional resources listed at the end of this Fact Sheet.

Wandering

People with dementia walk, seemingly aimlessly, for a variety of reasons, such as boredom, medication side effects or to look for “something” or someone. They also may be trying to fulfill a physical need—thirst, hunger, a need to use the toilet or exercise. Discovering the triggers for wandering are not always easy, but they can provide insights to dealing with the behavior.

  • Make time for regular exercise to minimize restlessness.
  • Consider installing new locks that require a key. Position locks high or low on the door; many people with dementia will not think to look beyond eye level. Keep in mind fire and safety concerns for all family members; the lock(s) must be accessible to others and not take more than a few seconds to open.
  • Try a barrier like a curtain or colored streamer to mask the door. A “stop” sign or “do not enter” sign also may help.
  • Place a black mat or paint a black space on your front porch; this may appear to be an impassable hole to the person with dementia.
  • Add “child-safe” plastic covers to doorknobs.
  • Consider installing a home security system or monitoring system designed to keep watch over someone with dementia. Also available are new digital devices that can be worn like a watch or clipped on a belt that use global positioning systems (GPS) or other technology to track a person’s whereabouts or locate him if he wanders off..
  • Put away essential items such as the confused person’s coat, purse or glasses. Some individuals will not go out without certain articles.
  • Have your relative wear an ID bracelet and sew ID labels in their clothes. Always have a current photo available should you need to report your loved one missing. Consider leaving a copy on file at the police department or registering the person with the Alzheimer’s Association Safe Return program (see Resources).
  • Tell neighbors about your relative’s wandering behavior and make sure they have your phone number.

Incontinence

The loss of bladder or bowel control often occurs as dementia progresses. Sometimes accidents result from environmental factors; for example, someone can’t remember where the bathroom is located or can’t get to it in time. If an accident occurs, your understanding and reassurance will help the person maintain dignity and minimize embarrassment.

  • Establish a routine for using the toilet. Try reminding the person or assisting her to the bathroom every two hours.
  •  Schedule fluid intake to ensure the confused person does not become dehydrated. However, avoid drinks with a diuretic effect like coffee, tea, cola, or beer. Limit fluid intake in the evening before bedtime.
  • Use signs (with illustrations) to indicate which door leads to the bathroom.
  • A commode, obtained at any medical supply store, can be left in the bedroom at night for easy access.
  • Incontinence pads and products can be purchased at the pharmacy or supermarket. A urologist may be able to prescribe a special product or treatment.
  • Use easy-to-remove clothing with elastic waistbands or VelcroÒ closures, and provide clothes that are easily washable.

Agitation

Agitation refers to a range of behaviors associated with dementia, including irritability, sleeplessness, and verbal or physical aggression. Often these types of behavior problems progress with the stages of dementia, from mild to more severe. Agitation may be triggered by a variety of things, including environmental factors, fear and fatigue. Most often, agitation is triggered when the person experiences “control” being taken from him.

  • Reduce caffeine intake, sugar and junk food.
  • Reduce noise, clutter or the number of persons in the room.
  • Maintain structure by keeping the same routines. Keep household objects and furniture in the same places. Familiar objects and photographs offer a sense of security and can suggest pleasant memories.
  • Try gentle touch, soothing music, reading or walks to quell agitation. Speak in a reassuring voice. Do not try to restrain the person during a period of agitation.
  • Keep dangerous objects out of reach.
  • Allow the person to do as much for himself as possible—support his independence and ability to care for himself.
  • Acknowledge the confused person’s anger over the loss of control in his life. Tell him you understand his frustration.
  • Distract the person with a snack or an activity. Allow him to forget the troubling incident. Confronting a confused person may increase anxiety.

Repetitive speech or actions (perseveration)

People with dementia will often repeat a word, statement, question or activity over and over. While this type of behavior is usually harmless for the person with dementia, it can be annoying and stressful to caregivers. Sometimes the behavior is triggered by anxiety, boredom, fear or environmental factors.

  • Provide plenty of reassurance and comfort, both in words and in touch.
  • Try distracting with a snack or activity.
  • Avoid reminding them that they just asked the same question. Try ignoring the behavior or question and distract the person into an activity.
  • Don’t discuss plans with a confused person until immediately prior to an event.
  • You may want to try placing a sign on the kitchen table, such as, “Dinner is at 6:30” or “Lois comes home at 5:00” to remove anxiety and uncertainty about anticipated events.
  • Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.

Paranoia

Seeing a loved one suddenly become suspicious, jealous or accusatory is unsettling. Remember, what the person is experiencing is very real to them. It is best not to argue or disagree. This, too, is part of the dementia—try not to take it personally.

  • If the confused person suspects money is “missing,” allow her to keep small amounts of money in a pocket or handbag for easy inspection.
  • Help them look for the object and then distract them into another activity. Try to learn where the confused person’s favorite hiding places are for storing objects, which are frequently assumed to be “lost.” Avoid arguing.
  • Take time to explain to other family members and home-helpers that suspicious accusations are a part of the dementing illness.
  • Try nonverbal reassurances like a gentle touch or hug. Respond to the feeling behind the accusation and then reassure the person. You might try saying, “I see this frightens you; stay with me, I won’t let anything happen to you.”

Sleeplessness/Sundowning

Restlessness, agitation, disorientation and other troubling behavior in people with dementia often get worse at the end of the day and sometimes continue throughout the night. Experts believe this behavior, commonly called sundowning, is caused by a combination of factors, such as exhaustion from the day’s events and changes in the person’s biological clock that confuse day and night.

  • Increase daytime activities, particularly physical exercise. Discourage inactivity and napping during the day.
  • Watch out for dietary culprits, such as sugar, caffeine and some types of junk food. Eliminate or restrict these types of foods and beverages to early in the day. Plan smaller meals throughout the day, including a light meal, such as half a sandwich, before bedtime.
  • Plan for the afternoon and evening hours to be quiet and calm; however, structured, quiet activity is important. Perhaps take a stroll outdoors, play a simple card game or listen to soothing music together.
  • Turning on lights well before sunset and closing the curtains at dusk will minimize shadows and may help diminish confusion. At minimum, keep a nightlight in the person’s room, hallway and bathroom.
  • Make sure the house is safe: block off stairs with gates, lock the kitchen door and/or put away dangerous items.
  • As a last resort, consider talking to the doctor about medication to help the agitated person relax and sleep. Be aware that sleeping pills and tranquilizers may solve one problem and create another, such as sleeping at night but being more confused the next day.
  • It’s essential that you, the caregiver, get enough sleep. If your loved one’s nighttime activity keeps you awake, consider asking a friend or relative, or hiring someone, to take a turn so that you can get a good night’s sleep. Catnaps during the day also might help.

Eating/Nutrition

Ensuring that your loved one is eating enough nutritious foods and drinking enough fluids is a challenge. People with dementia literally begin to forget that they need to eat and drink. Complicating the issue may be dental problems or medications that decrease appetite or make food taste “funny.” The consequences of poor nutrition are many, including weight loss, irritability, sleeplessness, bladder or bowel problems and disorientation.

  • Make meal and snack times part of the daily routine and schedule them around the same time every day. Instead of three big meals, try five or six smaller ones.
  • Make mealtimes a special time. Try flowers or soft music. Turn off loud radio programs and the TV.
  • Eating independently should take precedence over eating neatly or with “proper” table manners. Finger foods support independence. Pre-cut and season the food. Try using a straw or a child’s “sippy cup” if holding a glass has become difficult. Provide assistance only when necessary and allow plenty of time for meals.
  • Sit down and eat with your loved one. Often they will mimic your actions and it makes the meal more pleasant to share it with someone.
  • Prepare foods with your loved one in mind. If they have dentures or trouble chewing or swallowing, use soft foods or cut food into bite-size pieces.
  • If chewing and swallowing are an issue, try gently moving the person’s chin in a chewing motion or lightly stroking their throat to encourage them to swallow.
  • If loss of weight is a problem, offer nutritious high-calorie snacks between meals. Breakfast foods high in carbohydrates are often preferred. On the other hand, if the problem is weight gain, keep high-calorie foods out of sight. Instead, keep handy fresh fruits, veggie trays and other healthy low-calorie snacks.

Bathing

People with dementia often have difficulty remembering “good” hygiene, such as brushing teeth, toileting, bathing and regularly changing their clothes. From childhood we are taught these are highly private and personal activities; to be undressed and cleaned by another can feel frightening, humiliating and embarrassing. As a result, bathing often causes distress for both caregivers and their loved ones.

  • Think historically of your loved one’s hygiene routine – did she prefer baths or showers? Mornings or nights? Did she have her hair washed at the salon or do it herself? Was there a favorite scent, lotion or talcum powder she always used? Adopting—as much as possible—her past bathing routine may provide some comfort. Remember that it may not be necessary to bathe every day—sometimes twice a week is sufficient.
  • If your loved one has always been modest, enhance that feeling by making sure doors and curtains are closed. Whether in the shower or the bath, keep a towel over her front, lifting to wash as needed. Have towels and a robe or her clothes ready when she gets out.
  • Be mindful of the environment, such as the temperature of the room and water (older adults are more sensitive to heat and cold) and the adequacy of lighting. It’s a good idea to use safety features such as non-slip floor bath mats, grab bars, and bath or shower seats. A hand-held shower might also be a good feature to install. Remember—people are often afraid of falling. Help them feel secure in the shower or tub.
  • Never leave a person with dementia unattended in the bath or shower. Have all the bath things you need laid out beforehand. If giving a bath, draw the bath water first. Reassure the person that the water is warm—perhaps pour a cup of water over her hands before she steps in.
  • If hair washing is a struggle, make it a separate activity. Or, use a dry shampoo.
  • If bathing in the tub or shower is consistently traumatic, a towel bath provides a soothing alternative. A bed bath has traditionally been done with only the most frail and bed-ridden patients, soaping up a bit at a time in their beds, rinsing off with a basin of water and drying with towels. A growing number of nurses in and out of facilities, however, are beginning to recognize its value and a variation—the “towel bath”—for others as well, including people with dementia who find bathing in the tub or shower uncomfortable or unpleasant. The towel bath uses a large bath towel and washcloths dampened in a plastic bag of warm water and no-rinse soap. Large bath blankets are used to keep the patient covered, dry and warm while the dampened towel and washcloths are massaged over the body. For more information, see the book Bathing Without a Battle, (details in the Recommended Reading section below), or visit www.bathingwithoutabattle.unc.edu/.

Additional Problem Areas

  • Dressing is difficult for most dementia patients. Choose loose-fitting, comfortable clothes with easy zippers or snaps and minimal buttons. Reduce the person’s choices by removing seldom-worn clothes from the closet. To facilitate dressing and support independence, lay out one article of clothing at a time, in the order it is to be worn. Remove soiled clothes from the room. Don’t argue if the person insists on wearing the same thing again.
  • Hallucinations (seeing or hearing things that others don’t) and delusions (false beliefs, such as someone is trying to hurt or kill another) may occur as the dementia progresses. State simply and calmly your perception of the situation, but avoid arguing or trying to convince the person their perceptions are wrong. Keep rooms well-lit to decrease shadows, and offer reassurance and a simple explanation if the curtains move from circulating air or a loud noise such as a plane or siren is heard. Distractions may help. Depending on the severity of symptoms, you might consider medication.
  • Sexually inappropriate behavior, such as masturbating or undressing in public, lewd remarks, unreasonable sexual demands, even sexually aggressive or violent behavior, may occur during the course of the illness. Remember, this behavior is caused by the disease. Talk to the doctor about possible treatment plans. Develop an action plan to follow before the behavior occurs, i.e., what you will say and do if the behavior happens at home, around other adults or children. If you can, identify what triggers the behavior.
  • Verbal outbursts such as cursing, arguing and threatening often are expressions of anger or stress. React by staying calm and reassuring. Validate your loved one’s feelings and then try to distract or redirect his attention to something else.
  • “Shadowing” is when a person with dementia imitates and follows the caregiver, or constantly talks, asks questions and interrupts. Like sundowning, this behavior often occurs late in the day and can be irritating for caregivers. Comfort the person with verbal and physical reassurance. Distraction or redirection might also help. Giving your loved one a job such as folding laundry might help to make her feel needed and useful.
  • People with dementia may become uncooperative and resistant to daily activities such as bathing, dressing and eating. Often this is a response to feeling out of control, rushed, afraid or confused by what you are asking of them. Break each task into steps and, in a reassuring voice, explain each step before you do it. Allow plenty of time. Find ways to have them assist to their ability in the process, or follow with an activity that they can perform.

Credits and Recommended Reading

Bathing Without a Battle , by Ann Louise Barrick, Joanne Rader, Beverly Hoeffer and Philip Sloane, (2002), Springer Publishing, (877) 687-7476.

Caring for a Person with Memory Loss and Confusion: An Easy Guide for Caregivers, (2002), Journeyworks Publishing, Santa Cruz, CA, (800) 775-1998.

Communicating Effectively with a Person Who Has Alzheimer’s , (2002), Mayo Clinic Staff, www.mayoclinic.com/invoke.cfm?id=AZ00004

Steps to enhancing communications: Interacting with persons with Alzheimer’s disease. Chicago, IL: Alzheimer’s Association, 1997. (Brochure) Order no. ED310Z Cost: Single copy free, call 800/272-3900

Steps to Understanding Challenging Behaviors: Responding to Persons with Alzheimer’s Disease, (1996), Alzheimer’s Association, Chicago, IL. (800) 272-3900.

The Validation Breakthrough: Simple Techniques for Communicating with People with “Alzheimer’s-Type Dementia,” Naomi Feil , 2nd Edition 2002, Health Professions Press, Baltimore, MD, (410) 337-8539.

Understanding Difficult Behaviors:Some practical suggestions for coping with Alzheimer’s disease and related illnesses , A. Robinson, B. Spencer, and L.White, (2001), Eastern Michigan University, Ypsilanti, MI, (734) 487-2335.

Resources

Family Caregiver Alliance
785 Market Street, Suite 750
San Francisco, CA 94103
(415) 434-3388
(800) 445-8106
www.caregiver.org
info@caregiver.org

Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research and advocacy.

Through itsNationalCenteron Caregiving, FCA offers information on current social, public policy, and caregiving issues and provides assistance in the development of public and private programs for caregivers.

For residents of the greater San Francisco Bay Area, FCA provides direct support services for caregivers of those with Alzheimer’s disease, stroke, traumatic brain injury, Parkinson’s and other debilitating health conditions that strike adults.

FCA Publications

Practical Skills Training for Family Caregivers, Mary A. Corcoran, 2003, Family Caregiver Alliance, 785 Market Street, Suite 750, San Francisco, CA 94103
(800) 445-8106.

FCA Fact Sheets. All Family Caregiver Alliance Fact Sheets are available free online. Printed versions are $1.00 for each title—send your requests to FCA Publications, 785 Market Street, Suite 750, San Francisco, CA 94103. For the full list, see: www.caregiver.org/caregiver/jsp/publications.jsp?nodeid=345

FCA Fact Sheet: Dementia, Caregiving and Controlling Frustration

FCA Fact Sheet: Taking Care of YOU: Self-Care for Family Caregivers

FCA Fact Sheet: Hiring In-Home Help

FCA Fact Sheet: Community Care Options

Other Web Sites

Alzheimer’s Disease Education and Referral (ADEAR) Center
(800) 438-4380
www.alzheimers.org

This service of the National Institute on Aging offers information and publications on diagnosis, treatment, patient care, caregiver needs, long-term care, education and research related to Alzheimer’s disease.

Eldercare Locator
(800) 677-1116
www.eldercare.gov

This service of the Administration on Aging offers information about and referrals to respite care and other home and community services offered by state and Area Agencies on Aging.

Alzheimer’s Association Safe Return Program
(800) 272-3900
www.alz.org/SafeReturn

A nationwide program that identifies people with dementia who wander away and returns them to their homes. For a $40 registration fee, families can register their loved one in a national confidential computer database. They also receive an identification bracelet or necklace and other identification and educational materials.

Citation

This fact sheet was prepared by Family Caregiver Alliance in cooperation with California’s statewide system of Caregiver Resource Centers. Reviewed by Beth Logan, M.S.W., Education and Training Consultant and Specialist in Dementia Care.

https://caregiver.org/caregivers-guide-understanding-dementia-behaviors

© 2015 Family Caregiver Alliance. All rights reserved.

 

Health Care Costs for Dementia Found Greater than for Any Other Disease

(NIH) In the last five years of life, total health care spending for people with dementia was more than a quarter-million dollars per person, some 57 percent greater than costs associated with death from other diseases, including cancer and heart disease.

The new analysis, appearing in the Oct. 27, 2015, online issue of the Annals of Internal Medicine, estimates that total health care spending was $287,000 for those with probable dementia and $183,000 for other Medicare beneficiaries in the study.

The analysis was funded primarily by the National Institute on Aging (NIA), part of the National Institutes of Health. Additional support was provided by the American Federation for Aging Research.

Amy S. Kelley, M.D., of the Icahn School of Medicine at Mount Sinai, and colleagues analyzed data from the Health and Retirement Study, a nationally representative longitudinal study supported by the NIA and the Social Security Administration, as well as linked Medicare and Medicaid records and other data.

They calculated the “social” costs of all types of care for 1,702 Medicare fee-for-service beneficiaries age 70 and older who died between 2005–2007. Patients were divided into four groups: those with a high probability of dementia; those with either cancer or heart disease; or those with another cause of death.

The researchers calculated costs from Medicare, Medicaid, private insurance, out-of-pocket, and informal care over the last five years of life. Specific categories of spending included insurance, hospital, physician, medication, nursing home, hired helpers, in-home medical care and other expenses. The investigators also measured out-of-pocket spending as a proportion of household wealth.

“This complex analysis lays out the significant health care costs to society and individuals in the last five years of life,” said NIA Director Richard J. Hodes, M.D.

“It provides an important picture of the risks that families face, particularly those with dementia and those who may be least able to bear major financial risk. Such insights are critically important as we examine how best to support the aging of the U.S. population.”

While average Medicare expenditures across all four disease categories were similar, almost all other costs were consistently higher for people with dementia. Medicaid—the federal/state program that supports medical and long-term care for people with limited funds—expenditures for people who died with dementia averaged $35,346 vs. $4,552 for those without dementia.

The dementia group had significantly higher enrollment in Medicaid at the start of the five-year study period (21 percent) than those who died from cancer (8 percent), heart disease (8 percent), or other causes (13 percent). Enrollment in Medicaid during the last five years of life also increased for those with dementia (27 percent) compared to those with cancer, heart disease and other causes (12 percent, 15 percent and 15 percent, respectively).

For families, out-of-pocket spending for those with dementia was $61,522 compared to $34,068 for those without dementia. Informal care costs were estimated to be $83,022 for people with dementia vs. $38,272 for those without dementia.

In addition, out-of-pocket spending as a proportion of total household wealth five years before death was significantly higher—median of 32 percent for dementia and 11 percent for other diseases. For African-American households the median out-of-pocket expenditure was 84 percent of household wealth for those with probable dementia.

The gap in the financial burden between those with and without dementia was larger among those who were unmarried, African American, and had less than a high school education. Single women with dementia also incurred more out-of-pocket costs than married women with dementia.

About the National Institute on Aging: The NIA leads the federal government effort conducting and supporting research on aging and the health and well-being of older people. The NIA provides information on age-related cognitive change and neurodegenerative disease specifically at its Alzheimer’s Disease Education and Referral (ADEAR) Center at www.nia.nih.gov/Alzheimers For more on health and on aging generally, go to www.nia.nih.gov. To sign up for e-mail alerts about new findings or publications, please visit either website.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Citation

Barbara Cire

https://www.nia.nih.gov/newsroom/2015/10/health-care-costs-dementia-found-greater-any-other-disease?utm_source=20151027_costs&utm_medium=email&utm_campaign=ealert

National Institutes of Health

 

Study Finds Jet Lag-like Sleep Disruptions Spur Alzheimer’s Memory, Learning Loss

(University of California, Irvine) Results suggest greater emphasis on managing slumber habits of people with AD risk.

Chemical changes in brain cells caused by disturbances in the body’s day-night cycle may be a key underlying cause of the learning and memory loss associated with Alzheimer’s disease, according to a University of California, Irvine study.

The research on mice, led by UCI biomedical engineering professor Gregory Brewer, provides the first evidence that circadian rhythm-altering sleep disruptions similar to jet lag promote memory problems and chemical alterations in the brain.

Clinical application of this finding may lead to more emphasis on managing the sleep habits of people at risk for Alzheimer’s disease and those with mild cognitive impairment. Study results appear online in the Journal of Alzheimer’s Disease.

People with Alzheimer’s often have problems with sleeping or may experience changes in their slumber schedule. Scientists do not completely understand why these disturbances occur.

“The issue is whether poor sleep accelerates the development of Alzheimer’s disease or vice versa,” said Brewer, who’s affiliated with UCI’s Institute for Memory Impairments and Neurological Disorders.

“It’s a chicken-or-egg dilemma, but our research points to disruption of sleep as the accelerator of memory loss.”

In order to examine the link between learning and memory and circadian disturbances, his team altered normal light-dark patterns with an eight-hour shortening of the dark period every three days for young mouse models of Alzheimer’s disease and normal mice.

The resulting jet lag greatly reduced activity in both sets of mice, and the researchers found that in water maze tests, the AD mouse models had significant learning impairments absent in the AD mouse models not exposed to light-dark variations and in normal mice with jet lag.

In follow-up tissue studies, they saw that jet lag caused a decrease in glutathione levels in the brain cells of all the mice. But these levels were much lower in the AD mouse models and corresponded to poor performance in the water maze tests. Glutathione is a major antioxidant that helps prevent damage to essential cellular components.

Glutathione deficiencies produce redox changes in brain cells. Redox reactions involve the transfer of electrons, which leads to alterations in the oxidation state of atoms and may affect brain metabolism and inflammation.

Brewer pointed to the accelerated oxidative stress as a vital component in Alzheimer’s-related learning and memory loss and noted that potential drug treatments could target these changes in redox reactions.

“This study suggests that clinicians and caregivers should add good sleep habits to regular exercise and a healthy diet to maximize good memory,” he said.

Kelsey LeVault and Shelley Tischkau of the Southern Illinois University School of Medicine contributed to the research, which received support from the National Institutes of Health (grant R01 AG032431).

Citation

http://news.uci.edu/faculty/uci-study-finds-jet-lag-like-sleep-disruptions-spur-alzheimers-memory-learning-loss/

© 2015 UC Regents

 

Memory Complaints and Risk of Cognitive Impairment

Neurology. 2015 Oct 28. pii: 10.1212/WNL.0000000000002153. [Epub ahead of print]

Memory complaints and risk of cognitive impairment after nearly 2 decades among older women.

Kaup AR1, Nettiksimmons J2, LeBlanc ES2, Yaffe K2.

Abstract

Objectives

To investigate the association between subjective memory complaints (SMCs) and long-term risk of cognitive impairment in aging because most previous studies have followed individuals for only a few years.

Methods

Participants were 1,107 cognitively normal, community-dwelling older women (aged 65 years and older at baseline) in a prospective study of aging. SMCs were assessed shortly after baseline and repeatedly over time with the yes/no question, “Do you feel you have more problems with memory than most?” Cognitive status 18 years later (normal or impaired with mild cognitive impairment or dementia) was determined by an expert panel. Using logistic regression, we investigated the association between SMCs over time and risk of cognitive impairment, adjusting for demographics, baseline cognition, and characteristics that differed between those with and without SMCs.

Results

At baseline, 8.0% of participants (n = 89) endorsed SMCs. Baseline SMCs were associated with increased risk of cognitive impairment 18 years later (adjusted odds ratio [OR] = 1.7, 95% confidence interval 1.1-2.8). Results were unchanged after excluding participants with depression. The association between SMCs and cognitive impairment was greatest at the last SMC assessment time point (18 years before diagnosis: adjusted OR = 1.7 [1.1-2.9]; 14 years before diagnosis: adjusted OR = 1.6 [0.9-2.7]; 10 years before diagnosis: adjusted OR = 1.9 [1.1-3.1]; 4 years before diagnosis: adjusted OR = 3.0 [1.8-5.0]).

Conclusions

SMCs are associated with cognitive impairment nearly 2 decades later among older women. SMCs may be a very early symptom of an insidious neurodegenerative disease process, such as Alzheimer disease.

Citation

http://www.neurology.org/content/early/2015/10/28/WNL.0000000000002153.short?sid=c14d7425-96e1-4cb3-b9b1-271ae4b5abbf

© 2015 American Academy of Neurology.

 

Caregivers: Here are 8 Ways to Make the Most Out of Doctor Visits

(AARP.org) What caregivers can do to make sure you’re getting the best care.

A medical appointment is too important — and often too quick — to enter unprepared. Whether you are seeing a doctor yourself or accompanying someone you care for, it’s smart to take time beforehand to make your visit as productive as possible.

Think ahead of questions you have for the doctor and be ready with your medical information. Consider your health care professional as your partner. Both of you have the same goal of keeping your family as healthy as possible.

Here are some tips to make the most of your visit.

1. Make a list of all prescriptions

Show your doctor a list of everything you or your loved one is taking — not just what that individual doctor has prescribed. Sometimes one doctor is unaware of what another doctor has prescribed. If you’ve gotten different medications at different pharmacies, the pharmacists can miss active interactions between drugs. And remember that over-the-counter meds and vitamin supplements can also interact with your prescribed drugs. By creating a complete list, and filling them with one pharmacy, you can help to ensure all your medications are working safely together.

2. Check your refill needs

Look through your medicine cabinet and make a note of any refills that will be needed soon. Remember not to let yourself get down to a few tablets before asking for a refill. Last-minute requests make up the largest volume of calls in many doctors’ offices, so having this information going into an appointment can save you and your doctor’s office time on the telephone.

3. If a wheelchair is needed, ask ahead

Many doctors’ offices have a wheelchair to help patients get from their cars to their office. If you are caring for somebody who uses a wheelchair, call ahead to find out if your doctor has one. This can save you the trouble and hassle of bringing your own.

4. Make a list of any questions

Think ahead about any questions you’d like to discuss with your doctor — and don’t just wait until right before your visit. Keep a list on your refrigerator or near your phone, and jot down questions as they pop into your head.

5. Don’t be shy

Don’t be embarrassed to discuss anything with your doctor. Whether it’s a question about sexual function or the price of a drug, you should not be afraid to bring it up. In the interest of your health, you need to be candid. Chances are the doctor has heard the concern before and will make you feel comfortable talking about it.

6. Don’t overlook nurses as a resource

Not all your questions need to be answered by the doctor. Often, a nurse can address your concerns and may have more time to explain. Usually, a nurse will come in to take your “vitals” — your blood pressure and pulse rate — before the physician examines you. Start asking those questions on your list. If the nurse doesn’t have an answer, you can follow-up with the doctor.

7. Make sure you go to all appointments

If you are a caregiver, it is very helpful to accompany your loved one to all medical appointments. It is time consuming, but hearing what the doctor has to say first-hand helps avoid confusion or misinterpretation of treatment. Some caregivers find it’s easiest to schedule all doctor appointments on the same weekday. Or ask to be scheduled early morning or late in the day around your work schedule. Your doctor may be more flexible than you think.

8. Ask for a home health care visit

If you are caring for somebody on Medicare, find out if he or she qualifies for home health care and, if so, ask the doctor to prescribe a home health care visit (PDF). There is no cost for Medicare home health services if the patient meets the conditions — for example, being homebound and needing skilled nursing care or physical therapy. Your doctor’s office may also help you set up a visit with somebody who will evaluate your home for dangers and will offer suggestions as to how you can improve the safety of the environment. Common household hazards, such as a loose rugs or slippery showers, can cause falls and serious injuries. A home safety review can make you aware of simple fixes to enhance the quality of life and comfort for your loved one.

Citation

http://www.aarp.org/home-family/caregiving/info-2014/caregivers-doctor-visit-tips.html
Copyright 2015 American Association of Retired Persons

 

Alzheimer’s Support Groups: Make Connections, Get Help

(Mayo Clinic) If you’re facing a major illness or stressful life change, you don’t have to go it alone. A support group can help. Find out how to choose the right one.

Support groups bring together people facing similar issues, whether that’s illness, relationship problems or major life changes. Members of support groups often share experiences and advice. It can be helpful just getting to talk with other people who are in the same situation.

While not everyone wants or needs support beyond that offered by family and friends, you may find it helpful to turn to others outside your immediate circle. A support group can help you cope better and feel less isolated as you make connections with others facing similar challenges. A support group shouldn’t replace your standard medical care, but it can be a valuable resource to help you cope.

Understanding Support Groups

A support group is a gathering of people who share a common health concern or interest. A support group usually focuses on a specific situation or condition, such as breast cancer, diabetes, heart disease, addiction or long-term caregiving, for example.

Support groups are not the same as group therapy sessions. Group therapy is a formal type of mental health treatment that brings together several people with similar conditions under the guidance of a trained mental health provider.

Support groups may be formed by a lay person with the condition or by someone interested in it, such as a family member. In some cases, support groups may be formed by nonprofit organizations, advocacy organizations, mental health clinics or other organizations.

Support groups also come in a variety of formats, including in person, on the Internet or by telephone. They may be led by professional facilitators — such as a nurse, social worker or psychologist — or by group members.

Some groups are educational and structured. For example, the group leader may invite a doctor, psychologist, nurse or social worker to talk about a topic related to the group’s needs. Other support groups emphasize emotional support and shared experiences.

Benefits of Support Groups

Regardless of format, in a support group, you’ll find people with problems similar to yours. Members of a support group usually share their personal experiences and offer one another emotional comfort and moral support. They may also offer practical advice and tips to help you cope with your situation.

Benefits of participating in support groups may include:

  • Feeling less lonely, isolated or judged
  • Gaining a sense of empowerment and control
  • Improving your coping skills and sense of adjustment
  • Talking openly and honestly about your feelings
  • Reducing distress, depression, anxiety or fatigue
  • Developing a clearer understanding of what to expect with your situation
  • Getting practical advice or information about treatment options
  • Comparing notes about resources, such as doctors and alternative options

How to Find a Support Group

To find a support group:

  • Ask your doctor or other health care provider for assistance. Your doctor, nurse, social worker, chaplain or psychologist may be able to recommend a support group for you.
  • Search the Internet. Online support groups are available as email lists, newsgroups, chat rooms, blogs and social networking sites, such as Facebook.
  • Contact local centers. Contact community centers, libraries, churches, mosques, synagogues or temples in your area and ask about support groups.
  • Check your local listings. Look in your local telephone book or check your newspaper for a listing of support resources.
  • Ask people you know with the condition. Ask others you know with the same illness or life situation for support group suggestions.
  • Contact organizations. Contact a state or national organization devoted to your disease, condition or situation.

What support group, if any, you ultimately choose may depend largely on what’s available in your community, whether you have access to a computer or whether you’re able to travel.

Questions to Ask Before Joining a Support Group

Each type of support group has its own advantages and disadvantages. You may find that you prefer a structured, moderated group. Or you may feel more at ease meeting less formally with a small group of people. Some people may prefer online support groups.

Ask these questions before joining a new support group:

  • Is it geared toward a specific condition?
  • Is the location convenient for regular attendance?
  • What is the meeting schedule?
  • Is there a facilitator or moderator?
  • Is a mental health expert involved with the group?
  • Is it confidential?
  • Does it have established ground rules?
  • What is a usual meeting like?
  • Is it free, and if not what are the fees?
  • Does it meet your cultural or ethnic needs?

Plan to attend a few support group meetings to see how you fit in. If the support group makes you uncomfortable or you don’t find it useful, try another one. Remember that even a support group you like can change over time as participants come and go. Periodically evaluate the support group to make sure it continues to meet your needs.

Also be aware that you may be at a different stage of coping or acceptance than are others in the support group. Or they may have a different attitude about their situation. While such a mix can provide rich experiences, it may also be unhelpful or even harmful. For instance, some in the group may be pessimistic about their future, while you’re looking for hope and optimism. Don’t feel obligated to keep attending the group if a conflict or group dynamic is upsetting — find another group or just sit out for a while.

Support Group Red Flags

Not all support groups are a good match for you. Some may be driven by the interests of one or two members. Look for these red flags that may signal a problem with a support group:

  • Promises of a sure cure for your disease or condition
  • Meetings that are predominantly gripe sessions
  • A group leader or member who urges you to stop medical treatment
  • High fees to attend the group
  • Pressure to purchase products or services
  • Disruptive members
  • Judgment of your decisions or actions

Be especially careful when you’re involved in Internet support groups:

  • Keep in mind that online support groups are sometimes used to prey on vulnerable people.
  • Be aware of the possibility that people may not be who they say they are, or may be trying to market a product or treatment.
  • Be careful about revealing personal information, such as your full name, address or phone number.
  • Understand the terms of use for a particular site and how your private information may be shared.
  • Don’t let Internet use lead to isolation from your in-person social network.

Getting the Most Out of a Support Group

When you join a new support group, you may be nervous about sharing personal issues with people you don’t know. So at first, you may benefit from simply listening. Over time, though, contributing your own ideas and experiences can help you get more out of a support group.

But remember that support groups aren’t a substitute for regular medical care. Let your doctor know that you’re participating in a support group. If you don’t think a support group is appropriate for you, but you need help coping with your condition or situation, talk to your doctor about counseling or other types of therapy.

Citation

Mayo Clinic Staff

http://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/support-groups/art-20044655/?utm_source=newsletter&utm_medium=email&utm_campaign=alzheimers-caregiving

© 1998-2015 Mayo Foundation for Medical Education and Research. All rights reserved.

 

How Alzheimer’s Disease Can Impair the Senses

(NIA) Alzheimer’s disease can cause changes in a person’s ability to interpret what he or she can see, hear, taste, feel, or smell. The person with Alzheimer’s should be evaluated periodically by a physician for any such changes that may be correctable with glasses, dentures, hearing aids, or other devices.

Vision

People with Alzheimer’s may experience a number of changes in visual abilities. For example, they may lose their ability to comprehend visual images. Although there is nothing physically wrong with their eyes, people with Alzheimer’s may no longer be able to interpret accurately what they see because of brain changes. Also, their sense of perception and depth may be altered. These changes can cause safety concerns.

  • Create color contrast between floors and walls to help the person see depth. Floor coverings are less visually confusing if they are a solid color.
  • Use dishes and placemats in contrasting colors for easier identification.
  • Mark the edges of steps with brightly colored strips of tape to outline changes in height.
  • Place brightly colored signs or simple pictures on important rooms (the bathroom, for example) for easier identification.
  • Be aware that a small pet that blends in with the floor or lies in walkways may be a hazard. The person with Alzheimer’s disease may trip over the pet.

Smell

A loss of or decrease in smell often accompanies Alzheimer’s disease.

  • Install smoke detectors and check them frequently. The person with Alzheimer’s disease may not smell smoke or may not associate it with danger.
  • Keep refrigerators clear of spoiled foods.
  • Touch
  • People with Alzheimer’s may experience loss of sensation or may no longer be able to interpret feelings of heat, cold, or discomfort.
  • Adjust water heaters to 120 degrees Fahrenheit to avoid scalding tap water. Most hot water heaters are set at 150 degrees, which can cause burns.
  • Color code separate water faucet handles, with red for hot and blue for cold.
  • Place a sign on the oven, coffee maker, toaster, crock-pot, iron, and other potentially hot appliances that says DO NOT TOUCH or STOP! VERY HOT. The person with Alzheimer’s should not use appliances without supervision. Unplug appliances when not in use.
  • Use a thermometer to tell you if bath water is too hot or too cold.
  • Remove furniture or other objects with sharp corners or pad the corners to reduce potential for injury.

Taste

People with Alzheimer’s may lose taste sensitivity. As their judgment declines, they also may place dangerous or inappropriate things in their mouths.

  • Keep all condiments such as salt, sugar, or spices hidden if you see the person with Alzheimer’s using excess amounts. Too much salt, sugar, or spice can be irritating to the stomach or cause other health problems.
  • Remove or lock up medicine cabinet items such as toothpaste, perfume, lotions, shampoos, rubbing alcohol, and soap, which may look and smell like food to the person with Alzheimer’s.
  • Consider a childproof latch on the refrigerator, if necessary.
  • Keep the toll-free poison control number (1-800-222-1222) by the telephone. Keep a bottle of ipecac (vomit-inducing agent) available, but use only with instructions from poison control or 911.
  • Keep pet litter boxes inaccessible to the person with Alzheimer’s disease. Do not store pet food in the refrigerator.
  • Learn the Heimlich maneuver or other techniques to use in case of choking. Check with your local Red Cross chapter for more information and instruction.
  • If possible, keep a spare set of dentures. If the person keeps removing dentures, check for correct fit.

Hearing

People with Alzheimer’s disease may have normal hearing, but they may lose their ability to interpret what they hear accurately. This loss may result in confusion or overstimulation.

  • Avoid excessive noise in the home such as having the stereo and the TV on at the same time.
  • Be sensitive to the amount of noise outside the home, and close windows or doors, if necessary.
  • Avoid large gatherings of people in the home if the person with Alzheimer’s shows signs of agitation or distress in crowds.
  • If the person wears a hearing aid, check the batteries and functioning frequently.
Citation

https://www.nia.nih.gov/alzheimers/publication/home-safety-people-alzheimers-disease/impairment-senses

National Institute on Aging

 

How to Sleep Well Over 50: Tips for Overcoming Insomnia and Sleeping Better

(HelpGuide.org) As we age we often experience normal changes in our sleeping patterns. We may become sleepy earlier, wake up earlier, or enjoy less deep sleep. Although these changes are a normal part of aging, disturbed sleep, waking up tired every day, and other symptoms of insomnia are not a normal part of aging. Sleep is just as important to our physical and emotional health over the age of 50 as it was when we were younger. These tips can help you overcome age-related sleep problems and get a good night’s rest.

The importance of sleep for older adults

No matter what your age, sleeping well is essential to your physical health and emotional well-being. For older adults, a good night’s sleep is especially important because it helps improve concentration and memory formation, allows your body to repair any cell damage that occurred during the day, and refreshes your immune system, which in turn helps to prevent disease.

Many physicians consider sleep to be a barometer of a person’s health, like taking his or her temperature. Older adults who don’t sleep well are more likely to suffer from depression, attention and memory problems, and excessive daytime sleepiness. They are likely to suffer more nighttime falls, have increased sensitivity to pain, and use more prescription or over-the-counter sleep aids. Insufficient sleep can also lead to many serious health problems in older adults, including an increased risk of cardiovascular disease, diabetes, weight problems, and breast cancer in women.

How many hours of sleep do older adults need?

While sleep requirements vary from person to person, most healthy adults tend to require between seven and a half to nine hours of sleep per night to function at his or her best. A recent study by the National Institutes of Health suggests that healthy older people may require about one and a half hours less sleep than younger adults, or an average of seven and a half hours per night. The study indicates that older adults sleep less even when given the opportunity for more sleep because of age-related changes in the ability to fall asleep or remain asleep.

While the results of the study may not be conclusive, it’s important to focus more on how you feel following a night’s sleep rather than the specific number of hours you spend asleep. Quality is as important as quantity. Some older adults mistakenly believe they have a sleeping problem because they go to bed expecting to be asleep for eight or nine hours of sleep a night, and may even needlessly start using medications to help them sleep more. Frequently waking up not feeling rested or feeling tired during the day are better indications that you’re not getting enough sleep at night and may have a sleep problem that needs to be addressed.

Insomnia and Aging tip 1: Understand how sleep changes as you age

As you age your body produces lower levels of growth hormone, so you’ll likely experience a decrease in slow wave or deep sleep. When this happens you produce less melatonin, meaning you’ll often experience more fragmented sleep (more rapid sleep cycles) and more awakenings between sleep cycles. As your circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, you may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning. If you don’t adjust your bedtimes to these changes, you may find that you have difficulty falling and staying asleep.

It should be noted that older adults tend to wake up more often during the night. Consequently, you may have to spend longer in bed at night to get the hours of sleep you need, or you may have to make up the shortfall by taking a nap during the day. In most cases, such sleep changes are normal and don’t indicate a sleep problem.

Sleep problems not related to age

At any age, it’s common to experience occasional sleep problems. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:

  • Have trouble falling asleep even though you feel tired
  • Have trouble getting back to sleep when awakened
  • Don’t feel refreshed after a night’s sleep
  • Feel irritable or sleepy during the day
  • Have difficulty staying awake when sitting still, watching television, or driving
  • Have difficulty concentrating during the day
  • Rely on sleeping pills or alcohol to fall asleep
  • Have trouble controlling your emotions

Insomnia and Aging tip 2: Identify underlying problems

Many cases of insomnia are caused by underlying but very treatable causes. While emotional issues such as stress, anxiety, and depression can cause insomnia, the most common causes in adults over 50 are a poor sleep environment and poor sleep and daytime habits. Try to identify all possible causes of your insomnia; once you figure out the root cause, you can tailor treatment accordingly.

  • Are you under a lot of stress?
  • Are you depressed? Do you feel emotionally flat or hopeless?
  • Do you struggle with chronic feelings of anxiety or worry?
  • Have you recently gone through a traumatic experience?
  • Are you taking any medications that might be affecting your sleep?
  • Do you have any health problems that may be interfering with sleep?

Common causes of insomnia and sleep problems in older adults

The most common causes of insomnia and sleep problems in older adults include:

  • Poor sleep habits and sleep environment. Examples of poor sleep habits are irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on.
  • Pain or medical illness. Pain can keep you from sleeping well. In addition, many health conditions such as a frequent need to urinate, arthritis, asthma, diabetes mellitus, osteoporosis, nighttime heartburn, menopause, and Alzheimer’s can interfere with sleep.
  • Medications. Older adults tend to take more medications than younger people and the combinations of drugs, as well as the side-effects of individual drugs, can impair sleep or even stimulate wakefulness.
  • Lack of exercise. If you are too sedentary, you may not feel sleepy or feel sleepy all of the time. Regular aerobic exercise during the day, at least three hours before bedtime, can promote good sleep.
  • Psychological stress or psychological disorders. Significant life changes like the death of a loved one or moving from a family home can cause stress. Anxiety or sadness can also keep you awake, which can, in turn, cause more anxiety or depression.
  • Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing—such as snoring and sleep apnea—occur more frequently in older adults.
  • Learned response. People with a legitimate cause for having trouble sleeping—after suffering a loss, for example—may lie in bed and try to force themselves to sleep. Eventually their bodies learn not to sleep. Even after your original reason for sleep disruption has passed, the learned response of not sleeping can remain.

Insomnia and Aging tip 3: Improve sleep habits

Poor sleep habits, including a poor sleep environment and poor daytime habits, can be the main causes of sleep problems and low-quality sleep. In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they age. Fortunately, these habits are easy to improve.

Improve daytime habits for better sleep

  • Be engaged. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep. If you’re retired, try volunteering, joining a seniors’ group, or taking an adult education class.
  • Improve your mood. A more positive mood and outlook can reduce sleep problems. Find someone you can talk to, preferably face-to-face, about your problems and worries.
  • Exercise regularly. Exercise releases endorphins that can boost your mood and reduce stress, depression, and anxiety.
  • Expose yourself to sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles. Try to get at least two hours of sunlight a day. Keep curtains and shades open during the day, move your favorite chair to a sunny spot, or consider using a light therapy box to simulate daylight.
  • Limit caffeine, alcohol, and nicotine. All are stimulants and interfere with the quality of your sleep.

Encourage better sleep at night

  • Naturally boost your melatonin levels. Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy. Use low-wattage bulbs where safe to do so, and turn off the TV and computer at least one hour before bed.
  • Don’t read from a backlit device at night (such as an iPad). If you use a portable electronic device to read, use an eReader that is not backlit, i.e. one that requires an additional light source such as a soft bedside lamp.
  • Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable. Noise, light, and heat can cause sleep problems. Try using a sleep mask to help block out light.
  • Use your bedroom only for sleep and sex. By not working, watching TV, or using your computer in bed, you’ll come to associate the bedroom with sleep and sex, so when you get into bed your brain and body get a strong signal that it’s time to nod off or be romantic.
  • Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep is a surefire recipe for insomnia. Light emitted from a clock, telephone or other device can also disrupt your sleep.

Keep a regular bedtime routine for better sleep

  • Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.
  • Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.
  • Go to bed earlier. Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.
  • Develop bedtime rituals. A soothing ritual, like taking a bath or playing music will help you wind down. Relaxation and stress management techniques, such as deep breathing and progressive muscle relaxation, take some practice but their benefits can be substantial.
  • Limit your use of sleeping aids and sleeping pills. Many sleep aids have side effects and are not meant for long-term use. Although it may be tempting to continue using them, they are crutches that only address the symptoms and not the causes of insomnia. In fact, sleeping pills can often make insomnia worse in the long run. Therefore, it’s best to limit sleeping pills to situations where a person’s health or safety is threatened.
  • Combine sex and sleep. Sex and physical intimacy, such as hugging and massage, can lead to restful sleep.

Can napping help with sleep problems?

People are biologically programmed to sleep not only for a long period in the middle of the night but also for a short period in the middle of the day. Naps can enhance visual, motor, and spatial skills, and have even been shown to decrease the risk of coronary heart disease. So, if you don’t feel fully alert during the day, a nap may be just what you need. For many people, taking a brief nap can provide the needed energy to perform fully for the rest of the day. Experiment with napping to see if it helps you.

Some tips for good napping:

  • Short – Naps as short as five minutes can improve alertness and certain memory processes. Most people benefit from limiting naps to 15-45 minutes. You may feel groggy and unable to concentrate after a longer nap.
  • Early – Nap early in the afternoon. Napping too late in the day may disrupt your nighttime sleep.
  • Comfortable – Try to nap in a comfortable environment preferably with limited light and noise.

Insomnia and Aging tip 4: Use diet and exercise to improve sleep

To promote good sleep, pay particular attention to your pre-bedtime diet.

Bedtime Diet Tips to Improve Sleep

Limit caffeine late in the day Avoid caffeine (from coffee, tea, soft drinks and chocolate) late in the day.
Avoid alcohol before bedtime Don’t use alcohol as a sleeping aid. It might seem to make you sleepy, but will actually disrupt your sleep.
Satisfy your hunger prior to bed Have a light snack such as crackers, cereal and milk, yogurt, or warm milk.
Avoid big meals or spicy foods just before bedtime Large or spicy meals may lead to indigestion or discomfort. Try to eat a modest-size dinner at least three hours before bedtime.
Minimize liquid intake before sleep Limit what you drink within the hour and a half before bedtime.

 

The importance of regular exercise in overcoming sleep problems

Exercise releases chemicals in your body that promote more restful sleep. There are four main types of exercise:

  • Aerobic activities, such as walking, swimming, or riding a bike, increase your heart rate and breathing to improve the health of your heart and circulatory system
  • Strength exercises build muscle tissue and reduce age-related muscle loss
  • Stretching exercises keep your body limber and flexible, allowing a greater range of motion as you age
  • Balance exercises build leg muscles to reduce the chances of a fall

While adults need some of each type of exercise, studies have shown that participating in moderate aerobic activity can have the greatest impact on improving sleep.

Aerobic exercise helps older adults sleep better

A recent study by Feinberg School of Medicine at Northwestern University found that aerobic exercise resulted in the most dramatic improvement in patients’ reported quality of sleep, including sleep duration, on middle-aged and older adults with a diagnosis of insomnia.

The participants, aged 55 and up, exercised for two 20-minute sessions four times per week or one 30-to-40-minute session four times per week. Participants worked at 75 percent of their maximum heart rate on at least two activities including walking or using a stationary bicycle or treadmill. The regular aerobic exercise improved the participants’ sleep quality from a diagnosis of poor sleeper to good sleeper. They also reported fewer depressive symptoms, more vitality, and less daytime sleepiness.

Source: National Sleep Foundation

Adding exercise to your life does not necessarily mean signing up for a gym membership. There are countless activities you can do to increase strength, improve aerobic capacity, burn calories, and prepare yourself for a good night’s sleep at the end of the day. Always consult your doctor before embarking on any new fitness program.

  • Swim/Water exercises – Swimming laps is a gentle way to build up fitness and is great for sore joints or weak muscles. Many community and YMCA pools have swim programs just for older adults, as well as water-based exercise classes such as water aerobics.
  • Dance – If you love to move to music, go dancing or take a dance class. Dance classes are also a great way to extend your social network.
  • Take up lawn bowling, bocce, or pétanque – Variations on throwing a ball on an earthen or grassy court are gentle ways to exercise. The more you walk, and the brisker the pace, the more aerobic benefit you’ll experience.
  • Golf – Golf is a form of exercise that requires precise, strong movement of particular parts of your body, but which doesn’t require vigorous movement. Walking can be an added aerobic bonus to your game.
  • Cycle or run – If you are in good shape, you can run and bicycle until late in life. Both can be done outdoors or on a stationary bike or treadmill.

If you have mobility issues, you can exercise from one position, either standing, sitting, or lying down.

Insomnia and Aging tip 5: Reduce mental stress

Stress and anxiety can easily get in the way of a good night’s sleep. Everyone has worries and lists of things to do, but it is important to teach yourself to let go of these thoughts when it’s time to sleep.

  • Keep a journal to record worries and concerns before you retire
  • On your to-do list, check off tasks accomplished for the day, list your goals for tomorrow, and then let go
  • Listen to calming music
  • Read a book that makes you feel relaxed
  • Get a massage from a friend or partner
  • Use a relaxation technique to prepare your body for sleep
  • Seek opportunities to talk with a friend or therapist about what is troubling you

Getting back to sleep at night

It’s normal to wake briefly during the night but if you’re having trouble falling back asleep, the following tips may help:

  • Don’t stress. Try not to stress over the fact that you can’t get back to sleep, because that very stress encourages your body to stay awake. Focus on the feelings and sensations in your body instead.
  • Make relaxation your goal, not sleep. Try a relaxation technique such as deep breathing or meditation, which can be done without getting out of bed. Remind yourself that although they’re not a replacement for sleep, rest and relaxation still help rejuvenate your body.
  • Do a quiet, non-stimulating activity. If you’ve been awake for more than 15 minutes, try getting out of bed and doing a non-stimulating activity, such as reading a book. Keep the lights dim so as not to cue your body clock that it’s time to wake up, and avoid TV and computer screens.
  • Postpone worrying. If you wake during the night feeling anxious about something, make a brief note of it on paper and postpone worrying about it until the next day when you are fresh and it will be easier to resolve.

Insomnia and Aging tip 6: Talk to your doctor about sleep problems

If your own attempts to solve your sleep problems are unsuccessful, your doctor may be able to help with sleep problems due to:

  • A sleep disorder
  • Medication side effects or interactions
  • Medical conditions or illnesses
  • Pain

Bring a sleep diary with you. Write down when you use alcohol, caffeine, and nicotine, and keep track of your medications, exercise, lifestyle changes, and recent stresses. Above all, don’t expect to sleep poorly due to your increasing age. Just as younger adults can solve their sleep problems, so can you.

Citation

Authors: Lawrence Robinson, and Robert Segal, M.A. Last updated: June 2013.

http://www.helpguide.org/life/sleep_aging.htm

©2015 Helpguide.org