What's So Important About a Diagnosis?

When I meet with an elder to conduct an assessment, I often learn that he or she has a memory problem. Unfortunately, many elders and their families do not have good information about memory loss, including what the term "dementia" means and the significance of a dementia diagnosis.

Dementia is an "umbrella" term that refers to an array of symptoms. A person with dementia exhibits problems with his or her memory as well as his or her ability to plan or think abstractly; to produce or understand language; to recognize or identify objects; or to perform motor activities such as walking or grooming. Having a memory problem by itself does not mean that the individual has dementia.

It is critically important for elders and their families to know whether the elder has Alzheimer's disease which accounts for approximately 2/3 of dementia cases, or one of the many other types of dementia such as those caused by head trauma, alcohol use or metabolic disorders.

Why is having a clear diagnosis so important?

• Some memory-impairing conditions are not considered to be dementia and should be handled differently. For example, a delirium is a change in cognition due to a medical cause such as a urinary tract infection which can be reversed when the condition is treated.


• The type of dementia determines the treatment options available. Someone with dementia related to Parkinson's disease will have different options available to them versus someone with a Alzheimer's diagnosis.


• If the elder has a clear dementia diagnosis, his or her physician may recommend psychotropic medications that may slow the progression of memory loss.


• The family has the opportunity to plan for the course of the illness as different types of dementia can have different symptoms and prognoses. It is important for families to be able to plan emotionally, we as make financial and legal arrangements.


• The elder may choose to enter into a clinical trial and possibly benefit from investigational medicines or treatments.

I encourage older adults and their families to talk with their physicians if the elder is experiencing memory problems, or symptoms such as paranoia or problems with language. Neurologists and psychiatrists are physicians with specialized training in diagnosing dementia and managing symptoms; in addition, there are diagnostic programs with teams of professionals who help to make the diagnosis and establish the plan of care.

While it is daunting for most people to consider the fact that they may have dementia, an early diagnosis can empower elders and their families to make informed choices about their care.

The Culture of Caregiving

The caregiving profession is one that attracts individuals from all types of cultures. One quality they all have in common, however, is their desire to help the elderly in a way only a few can.


One needs to dig deep in the screening process to find out about experience, and the quality of that experience, in order to determine if the candidate would make a good caregiver for your company. Sometimes, the best caregivers won't articulate their experience in a way that portrays their desire and/or ability to do the job. Upon initial judgment, many candidates might be turned away. Once their personal history and background are considered, however, their experience can be more than sufficient to be an outstanding caregiver.


A perfect example of this was when I didn't schedule an interview with a potential caregiver because she told me she didn't have any experience. However, since she was referred by a current, long standing employee, I reconsidered later and invited her for an interview. Upon asking her again, "Do you have any experience caring for an elderly individual?" Her response was, "Well not really. Just my husband who was over 70, had Alzheimer's, and was bed bound for the last 4 years of his life." BINGO! She is now one of our highly respected, dependable caregivers.


Caregiving comes from the heart. If an individual's culture and experience come from the same caring, positive attitude, you can rarely go wrong.

Elder Abuse - A Personal Story (part 2)

Continuing story from Elder Abuse - A Personal Story (part 1):

As already described, while visiting with my mother in the nursing home, I discovered that she was being abused by someone in the facility. Although her cognitive abilities were intact, she did have aphasia caused by her stroke and the only word she could verbalize was "waiter" which really held no specific meaning.

Since my mother couldn't identify her abuser by naming her, I had to come up with another way for mom to let me know who this person was. I wanted to inform the facility Administrator immediately but my mother, in her way, begged for me to hold off. She had such a look of fear, I realized she was afraid of retribution so I devised a new plan.

The plan was to push my mom in her wheelchair throughout the facility coming at various times of the day so I could cover all the different shifts. When we came upon the individual, my mom was to put her foot down, stopping the wheelchair, grab my hand and acknowledge the person.With this plan understood and agreed to, we entered the building and proceeded towards her wing.

It was a busy time and many of the staff were in the area. All at once, a caregiver (I'll call Mary- not real name) stepped out from a room. My mother put her foot down and grabbed my hand. Mary came directly over to mom, putting her arms around her in a hug and giving her a big kiss. The look on my mother's face said everything, there was fear, disgust and revulsion.

Mary had worked with my mother for a few years and was a very friendly type. Because of this, I had to ask my mom if she was sure that Mary was the abuser. She nodded yes, but I still hesitated because this all happened so quickly. I looked mom directly in the eyes and asked again, she grabbed my hand squeezed it, nodded and started to cry.

We immediately went to the Administrator, explained the situation and resulting discovery. He asked mom a few questions and agreed to take Mary off her care. Because of mom's aphasia she could not identify Mary verbally so they couldn't fire her but two years later, after my mother had passed away, I met some people who had had their relative at the same nursing facility and at the same time. They told me they had personally caught Mary abusing their relative. She was fired on the spot.

This experience ignited my resolve to help advocate for those who have no one to speak on their behalf and it is why I became an Ombudsman and ultimately a geriatric care manager. Sadly, my mother's story is not unusual but with more awareness of elder abuse and involvement in the programs helping prevent it, we will make a change.

Novel Highlights the Transformative Power of Support Groups

Still Alice is a 2009 novel by Lisa Genova, a fictional account of a professor of cognitive psychology who is diagnosed with early-onset Alzheimer's disease at the age of fifty, while at the height of her career. At the opening of the novel, Alice Howland, who has a loving and supportive husband and three young adult children, has noticed some minor changes - difficulty concentrating and frequently misplacing items around the house. When she becomes lost in a familiar square a mile from her home, she begins to suspect that there are more significant physical changes taking place. Her first suspicion is menopause, and when she seeks the advice of her physician, she begins the journey toward a terrifying diagnosis of Alzheimer's disease.

The writing is clean and simple, and I found it a very enjoyable read. Although many of the "uglier" aspects of dementia are not confronted in this novel, I appreciated the author's descriptions of some of the complex family issues that arise -- the initial denial of the diagnosis, a husband who jumps into high-gear to "take action" and "fix the problem," and children who disagree about the nature of the disease and quarrel over how best to care for their mother.

As her career comes to an early end and she becomes dependent upon others for the tasks of everyday life as the disease progresses, Alice battles depression and struggles to maintain her identity. She turns to her health care system for support services and is surprised to learn that there are no local support groups for individuals living with memory impairment. So she starts one herself in her home:

"They shared stories of their earliest symptoms, their struggles to get a correct diagnosis, their strategies for coping and living with dementia. They nodded and laughed and cried over stories of lost keys, lost thoughts, and lost life dreams. Alice felt unedited and truly heard. She felt normal."

Having facilitated a support group for individuals with early-stage memory loss for the past six years, I can testify to the healing power of social support for a person feeling isolated and frightened by a diagnosis of Alzheimer's disease. I thank author Lisa Genova for bringing this resource to light, and encourage families everywhere to reach out to their local chapter of the Alzheimer's Association to identify a support group in their area.

Caregiver Appreciation

The most important customers any company has are its employees. If your employees are given the highest quality customer service (employee relations), benefits and guidance, your company will flourish. This is certainly true in the elder care industry, when the employees are caregivers.

Caregiving is an extremely demanding position, both physically and emotionally. There are many ways in which a company can express appreciation to their caregivers. The most obvious choice is offering benefits, which come in many forms including medical and dental insurance, holiday pay, tuition assistance, educational offerings, and regular performance reviews. Additional appreciation avenues can include soliciting feedback via quality assurance surveys, caregiver appreciation parties, holiday gifts, and sending birthday cards.

An important way Elder Care Guides is showing Caregiver appreciation is through our quarterly newsletter, dedicated solely to our caregivers. Included within the newsletter is an announcement and spotlight on a chosen "Caregiver of the Quarter," one who has gone above and beyond in their work with their client, or employment in general.

A little goes a long way in Caregiver appreciation, and the dividends can come back tenfold. A happy caregiver is not only likely to refer quality prospective Caregivers, but future clients as well. Caregivers who feel valued produce high quality service, which translates directly to your clients and subsequently, their families.