Caring for someone with Alzheimer’s Disease

Your loved one has been diagnosed with Alzheimer’s Disease. You decide to be the primary caregiver so they can remain at home and benefit from a familiar environment and continued independence. As the disease progresses, you may be faced with more challenges which take a significant toll on your physical and mental well-being.

Caregiver stress is serious, and if ignored can lead to illness and, in some cases, hospitalization.

“The most important thing a caregiver can do is take care of him or herself,” says Dr. Tanya Pinto, Geriatric Psychiatrist with the GAIN Clinic at The Scarborough Hospital. “This means identifying supports and asking for help, taking personal time and managing their own health.”

The Geriatric Assessment and Intervention Network (GAIN) Clinic at TSH provides a holistic approach to care, including comprehensive assessments,providing education for caregivers and connecting them with appropriate community resources.

“Information is power,” says Debbie Driver, Nurse Practitioner with the GAIN Clinic at TSH. “Knowing what resources are available within your community and understanding the disease can reduce the stress in caring for your loved one.”

Debbie adds that several agencies will provide services such as home assessments to identify safety modifications, bathing and grooming care and education and resources to help a caregiver understand the disease and prepare for the future.

Dr. Pinto and Debbie also identify some strategies to help caregivers remain at an optimal level of well-being.

Learn about Alzheimer’s Disease. A person with Alzheimer’s Disease can present challenging behaviour as they experience memory loss. The behaviours can be frustrating, but understanding them will enable you to better cope with the situation. Speak to staff at the GAIN Clinic, consult your family doctor, read books and online information, and contact specialized agencies such as your local Alzheimer Society chapter.

Take a break. Sometimes a short walk around the block is enough to help you maintain your mental and physical health. If you need a longer break, such as a vacation, consider respite care. Ontarians who receive CCAC service are eligible for up to 90 days respite care annually. This could also serve as an initial introduction to a long-term care facility.

Ensure you get enough sleep. People with Alzheimer’s Disease often wake during the night, and their activity can disrupt your sleep. Ensure you both practice good sleep hygiene such as limiting daytime naps, joining a day program, and engaging in quiet activities before bedtime. Continued restlessness throughout the night, could indicate a physical issue such as sleep apnea, restless leg syndrome or a bladder infection. Visit your family doctor to rule out or address any physical conditions.

Have the challenging conversations early on. Once you have received the diagnosis, think about and discuss future plans before the disease progresses. For example, would your loved one want CPR or a feeding tube if needed? How do they feel about a long-term care facility? What does quality of life mean to them? These conversations are difficult, but discussing wishes ahead of time will reduce future stress.

Don’t take things personally. Emotional outbursts may arise from time to time, which may be directed at you since you are a familiar person. These outbursts are the result of frustration, and are not necessarily meant to hurt you. As difficult as it may be, try to remain objective during these outbursts.

Don’t be afraid to ask for help. You are not alone. Identify your support system, and don’t be afraid to ask for help. Family, friends, neighbours, a support group and healthcare professionals are available to help you through this difficult time and ensure you maintain your physical and mental health.

Remember that Alzheimer’s Disease is an evolving process, and every situation is unique. As a caregiver, you will be faced with constant change, so try your best to remain flexible. Experiment with different strategies and techniques to determine what works within your lifestyle.

Incontinence myths and facts

Although millions of Canadians experience some form of incontinence on a daily basis, it’s still a condition that is often misunderstood.

“There continues to be an enormous amount of stigma associated with incontinence and it can take a serious emotional toll on those living with the condition,” said Dr. Nick Logarakis, Chief of Urology at The Scarborough Hospital.

Much of this stigma stems from the myths that surround incontinence. Dr. Logarakis offers some of the most common misconceptions about incontinence and the truth behind them.

Myth: Incontinence is a disease.
Fact: Incontinence is a symptom of something else going on in the body. It’s important to talk to your doctor, who can help to discover what’s causing the incontinence.

Myth: It’s mainly seniors who experience incontinence.
Fact: Incontinence affects men and women of all ages. For instance, it’s estimated that 10 per cent of six-year-olds have bladder control problems and at least one in three women over 40 experiences incontinence.

Myth: Incontinence is just part of aging.
Fact: Although changes that occur naturally in the aging body may contribute to incontinence, aging itself does not cause incontinence and it should not be accepted as a part of getting older.

Myth: You just have to live with it if you have incontinence.
Fact: In most instances, incontinence can be cured, treated or successfully managed. There are a variety of options for managing incontinence, but their success depends on receiving the right diagnosis and underscores the importance of speaking to your doctor.

Memory screening can help with early diagnosis of dementia

Early detection of Alzheimer’s Disease and other dementias can lead to appropriate interventions, such as medical treatments, social services, and advanced care planning. The key to an early diagnosis is the use of memory screening.

“Memory screening is about the storage and retrieval of information,” explains Jacqui Robinson, Occupational Therapist, GAIN (Geriatric Assessment and Intervention Network) Clinic at The Scarborough Hospital. “We start with three or five words, and ask the patient to remember those words while doing other tasks. As an OT, I cannot diagnose dementia, but I can probe to determine specific memory problems. Once I have identified thinking changes, I collaborate with the rest of the team so that we can provide diagnoses and recommendations.

“We also look for patients who are repeating the same story or question over and over again, which can be a sign of dementia.”

June 14 is National Memory Screening Day, and the interprofessional team of healthcare providers at TSH’s GAIN Clinic offer the following early signs of changes in thinking:

• Changes in memory – forgetting how to do something you’ve done all of your life, like following a recipe or a simple repair job around the house.
• Changes in language – increasing word-finding problems or difficulty reading the newspaper or books.
• Changes in judgement, such as wearing clothing that’s not appropriate for the weather (i.e., going out in a snow storm with only a sweater).
• Misplacing things in strange places (car keys in the fridge, for example).
• Changes in personality, such as acting out of character, withdrawing from people or social situations.
• Changes in driving proficiency – increases in “close calls” and/or fender benders, stopping at a green light, etc.

Five signs you may be having a stroke

Think about what you were doing in the last ten minutes. In those past ten minutes, someone in Canada had a stroke.

A stroke is a medical emergency, where a blood clot or ruptured artery stops the flow of blood to the brain. With 50,000 occurring each year, strokes are the third leading cause of death in Canada.

“A lifestyle that includes a healthy diet and regular exercise can help to reduce your risk of stroke,” says Dr. Garry Moddel, a neurologist at The Scarborough Hospital. “Unfortunately, there are also many stroke risk factors,  such as age, gender and family history that you can’t change.”

Diagnosing a stroke and receiving medical attention are crucial to recovery.

Dr. Moddel shares five signs you or a loved one may be having a stroke:

1. A sudden numbness or weakness in your face, an arm or a leg. Even if these symptoms go away, you may still be at immediate risk of having a stroke.
2. Trouble seeing out of one or both of your eyes.
3. A sudden confusion or trouble speaking when having a conversation with others.
4. Developing a headache that appears to be severe and sudden, with no real cause.
5. Having problems walking, feeling dizzy, and losing your balance, particularly if in combination with any of the above signs.

Seven signs of elder abuse

Nurse Practitioner Debbie Driver sees a patient in the Geriatric Assessment and Intervention Network (GAIN) clinic

In recent weeks, tragic cases of elder abuse and neglect have made headlines. It is important to be aware of the signs of elder abuse to ensure seniors you care about are not suffering physically, psychologically or financially because of someone else’s actions.

“Often seniors are embarrassed or ashamed to disclose abuse or neglect,” says Debbie Driver, Nurse Practitioner, at the Geriatric Assessment and Intervention Network (GAIN) clinic at The Scarborough Hospital. “They often have no other supports in the community, and are often isolated by their abuser. In many cases, English is their second language, and they are not aware of or able to ask about resources that they can access. This makes it difficult for the senior to trust and tell someone about the abuse.”

Debbie shares some signs that may indicate a senior is a victim of abuse or neglect:

1. Unexplained physical injuries
2. Poor hygiene or poor nutrition
3. Person is withdrawn, often looking to abuser for permission to answer questions
4. Fear, anxiety, depression in relation to a caregiver, family member or friend
5. Sudden decline in finances
6. Confusion about new legal documents
7. Unwillingness to talk about the situation

Eight reasons to have an annual check-up

Having an annual exam is a ritual for many, but others feel a trip to the doctor’s office is only necessary when something is wrong. But an annual check-up may help you stay healthy, longer. 

Why go to the doctor when you feel healthy?

“An annual check-up can provide your physician with valuable information should you become ill,” says Dr. Irene Polidoulis, a family medicine physician with The Scarborough Hospital. “It can also help diagnose disease early and allow your physician to provide advice on disease prevention. Everyone, regardless of age, should have an annual check-up.”

Dr. Polidoulis explains why an annual check-up is valuable:

1. Regular check-ups allow your physician to build a health history and gather baseline health information that is invaluable should you become ill.
2. Diagnostic tests, like blood tests, and routine screenings can diagnose disease before you show symptoms. Early detection of disease can result in better health outcomes.
3. Studying your family’s medical history and discussing lifestyle helps your doctor determine your risk factors and allows him to make recommendations about disease prevention.
4. An annual visit with your physician helps build a more comfortable doctor-patient relationship. When you feel comfortable with your physician, you are more likely to share pertinent health information.
5. An annual check-up isn’t just about your physical well-being; it is also about your mental health. This appointment is a good opportunity to receive counselling or advice about issues like depression, stress or anxiety.
6. Are you struggling with your weight or want to quit smoking? Advice about these kinds of issues can be provided during your check-up.
7. If you’ve been healthy all year and haven’t seen your doctor, the annual trip is a good time to ensure vaccinations are up to date.
8. Peace of mind. Any health worries you have may be alleviated with an annual check-up.

Six tips for protecting the frail elderly

With the end of Daylight Saving Time it is common to change clocks and check smoke detectors but it is also a good time to check in on elderly loved ones.

Our population is aging, and more and more seniors are living on their own. And while many are in terrific health, some are classified as frail elderly with a variety of mobility, cognitive and sensory challenges.

“The number one issue with seniors is safety,” says Dr. Joel Maser, a geriatric specialist with the Specialized Geriatric Unit at The Scarborough Hospital. “Usually, seniors have a network – family, neighbours – but not always. Sometimes, family is out of town or the neighbours go on vacation.”

Every day, Dr. Maser sees seniors who are at risk.

“Today, I saw two people with falls, one person who caused a stove fire, and one person whose eyesight deteriorated so badly that they lost their driver’s license,” he explains. “Other problems I see are cognitive impairment, poly-pharmacy and incontinence. This community is full of seniors and not all of them have family supports.”

Dr. Maser advises people who know frail elderly to check in with them regularly, and to look for specific dangers:

1. Check the expiration date on food products and medications. Many frail elderly have poor vision, and may not notice food or drugs are past their due date.
2. Remove trip hazards such as extension cords or loose rugs that could cause dangerous falls.
3. Replace batteries on smoke and carbon monoxide alarms twice annually—typically when the clocks are changed for Daylight Savings Time.
4. Clear porches, patios, steps and sidewalks of snow and ice.
5. Ensure mail and newspapers do not pile up outside the door. A home that looks unoccupied is an invitation for thieves.
6. Consider lowering the water temperature on the hot water tank to prevent accidental scalds.

The use of a personal medical emergency response service, such as Lifeline, can also provide peace of mind for both seniors and their caregivers. They allow for immediate medical response in the event of a fall or health-related emergency.

Seven tips to reduce your risk of cataracts and protect your vision

Cataracts can occur at any age, but they occur most commonly in seniors over 60.

“Cataracts are a gradual clouding of the natural lens of the eye,” explains Dr. Ying Lu, an Ophthalmologist at The Scarborough Hospital. “Light is unable to reach the retina, causing vision loss. Cataract surgery helps restore vision by replacing the clouded lens with a clear one.”

Cataract surgery takes only 15 minutes and patients stay in the hospital for about three hours. If there are no other eye diseases, patients can get all vision back within one or two days.

Each year, The Scarborough Hospital performs around 6,000 cataract surgeries. The hospital has one of the busiest Eye Centers of its kind in Canada, with two operating suites at the Birchmount campus dedicated exclusively for cataract surgery. The suites are equipped with the most advanced ophthalmic equipment in North America.

Although cataract surgery is very advanced, prevention is still key. Here, Dr. Lu shares her advice on how you can help reduce your risk of developing cataracts and prevent eye diseases:

1. Have regular eye exams to help detect problems early. If you are between 20 and 65, OHIP will not cover the regular exam unless you have cataract or other eye diseases. But regardless, if you do not see well, ask your family doctor to refer you to see an optometrist or ophthalmologist. If you are over 65, OHIP will cover your eye exam once a year.
2. Stay on top of your health. If you are diabetic, for example, you are at a higher risk of cataract and retinal disease. It is important that you take care of your blood sugar levels. With good control of diabetes, you can reduce complications significantly. If you have diabetes, you need to have a regular eye examination once a year. OHIP will cover the cost.
3. Wear sunglasses to protect your eyes. Ultraviolet light may contribute to the development of cataracts. All sunglasses do the same job regardless of brand or price.
4. Eat a healthy diet. Antioxidants found in colourful fruits and vegetables are good for your overall health, including your eyes.
5. Maintain a healthy weight. Weight does not cause cataracts, but being overweight will increase your risk for diabetes and vascular diseases which can result in eye diseases.
6. Quit smoking and increase exercise. Smoking can cause thyroid-related eye disease and macular degeneration. The eye has multiple tissues and you want to help to protect all the tissue.
7. If you have clouded, blurred or dim vision or difficulty with your vision at night, consult your doctor. If it is a simple cataract, then a simple 15 minutes procedure will restore your vision. If it is not cataract, then the cause of decreasing vision needs to be diagnosed and treated.

Ten signs of Alzheimer’s Disease

By age 85, one in three seniors have symptoms of dementia; by age 65, mild cognitive impairment starts appearing in two per cent of people, and that number doubles every five years.

Alzheimer’s Disease, the most common form of dementia, is a progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired. Tuesday, September 21 is World Alzheimer’s Day, an ideal time to get familiar with the warning signs of the onset of this disease.

“Watch for simple signs of forgetfulness; a little bit more than ‘where did I put my keys?’ or ‘where did I put the phone?’” explains Dr. Joel Maser, a geriatric specialist with the Specialized Geriatric Unit at The Scarborough Hospital. “Sometimes, they might repeat themselves, asking the same question over and over, or they miss dates, forget to turn off lights, tap or stove.”

Sometimes they may be temporarily confused: “Where did I put my car in the parking lot?” That happens to all of us at times, but if it happens a little too frequently, it might be a sign of “mild cognitive impairment” that we see in the elderly, and we start getting concerned, “Is this is the onset of dementia?”

Be vigilant and watch for the signs:

1. Memory loss that affects day-to-day function (i.e., cooking, forgetting to take pills)
2. Difficulty performing familiar tasks (i.e., such as driving, hobbies, etc.)
3. Problems with language (i.e., forgetting words and names)
4. Disorientation of time and place
5. Poor or decreased judgment
6. Problems with abstract thinking
7. Misplacing things
8. Changes in mood and behaviour
9. Changes in personality
10. Loss of initiative (i.e., feelings of apathy)

Five risk factors for developing arthritis

Arthritis is the leading cause of disability in Canada and it is estimated that 85% of Canadians will be affected by osteoarthritis by the age of 70.

“Although arthritis cannot be prevented in many cases, there are several things that can be done to help alleviate pain and reduce the severity of the disease,” says Dr. Michael Bushuk, Chief of Orthopedic Surgery at the General campus of The Scarborough Hospital.

In this, Arthritis Awareness Month, Dr. Bushuk shares some risk factors for developing arthritis:

1. Excess weight puts extra stress on weight-bearing joints like knees, hips and feet. Losing weight can ease pain.
2. Although arthritis can affect people of any age, the disease is most commonly found in seniors. A healthy lifestyle can help you age well and reduce your risk of arthritis.
3. Injuries to the joints or joint inflammation can lead to arthritis.
4. There are several different types of arthritis. The most common types are osteoarthritis and rheumatoid arthritis. There is a heredity factor in some types of arthritis.
5. Staying active is key. Pain, stiffness and swelling of the joint are common symptoms of arthritis. By keeping active, one can keep their weight down and improve muscle strength around a joing which reduces the stress on the joint.