Tag Archive | Going Gentle Into That Good Night

Profiles In Dementia: Winston Churchill (1874-1965)

Winston Churchill Vascular DementiaWinston Churchill had a health profile most of his adult life that pointed to the inevitability of cognitive impairment in his later years.

Churchill was an alcoholic (during War War I and II, when the British needed strategic decisions to be made in the middle of the night, an inebriated Churchill was in the thick of things because even drunk he apparently was a better strategist than most of his sober peers).

Churchill also had chronic and worsening hypertension, in part from stress and in part from an unrestrained diet of much rich and artery-clogging food.

As early as 1947, Churchill’s physician, who was complicit in the lies about Churchill’s health all the years he held public office and who propped him up with amphetamines and calmed him down with depressants, noted in his diary that “[Churchill] is no longer fertile in ideas…his once-teeming mind has run dry.”

Beginning in 1948, Churchill began to regularly experience TIA’s in different parts of his brain. Accompanying the mini-strokes, at times, was temporary numbness on one or the other sides of his body, which resolved in a few hours or a few days.

Churchill would also experience the temporary dysphasia in the 30 minutes to an hour afterward that is characteristic of TIA’s, but the language center of his brain was spared permanent damage until his last major stroke in 1953.

With amphetamines and carefully scripted speeches, therefore, Churchill was able, at least from a verbal aspect, to hide the neurological damage and the cognitive decline that those closest to him were aware was progressing rapidly.

But the signs were everywhere in retrospect. Churchill’s speeches and governing were rooted in the first and second world wars. He was glaringly oblivious to post World-War-II politics, issues, and legislation.

He was literally in the-all-too-common vascular dementia time warp of the past and increasingly unaware of the present and had no concept of the future.

With his doctors and his staff carefully concealing his progressing dementia from the public, Churchill managed to limp along in office through continuous TIA’s and three major strokes, until 1955, when he finally resigned because his cognitive impairment and the physical effects of the strokes and dementia were impossible to conceal anymore.

Churchill lived for 10 more years, but vascular dementia was his constant companion and as it progressed, he retreated and regressed until he remembered no one and nothing and it was impossible to see the man he’d been at the zenith of his life.

 

 

Global Dementia Report for 2015 Released

Global Impact of Dementia 2015

The infographic above was included in the World Alzheimer Report 2015: The Global Impact of Dementia, released on August 24, 2015.

Dementias of all kinds are on the rise, despite pernicious and false claims that the rate of dementia diagnoses is stabilizing. 

With an increasingly toxic planet – air, water, food, soil – our bodies and our brains are suffering irreparable damage over time, and dementias are the neurological manifestation of that damage.

Additionally, we have developed lifestyles – processed and fast foods with chemicals, too much salt, and too much sugar, neurologically-altering drugs (prescription and illegal) that have become the rule, not the exception, and increased alcohol consumption and abuse – that are harmful to our bodies and our brains, resulting in the dramatic rise in both physiological diseases and neurological degeneration.

With technology addiction and sleep disorders/deprivation layered on top of these, we, as a society, are choosing to further increase the odds of our widespread development of dementias.

And to top it off, the general population is getting older – Baby Boomers are about to bust all the rest of us in their old age – and medicine continues its march toward quantity of life (age) instead of quality of life (health).

With all of these factors in play, the reality is that most of us don’t stand a chance of not developing some sort of neurological impairment. It may not be full-blown dementia, but most of us are at high risk.

In some of these things – lifestyle, technology addiction, sleep habits, quality of life versus quantity of life – we have complete control. Our previous habits may have already done irreparable damage, but we have the choice today to say “Enough already!” and change.

But will we?

The pessimist/pragmatist/realist in me says most of us won’t.

I watch myself making every change I can and I watch most of the world around me continuing – even increasing speed and intensity – headlong into the very practices and behaviors we have complete control over that will lead to cognitive impairment.

I have sounded the warning here many times. But I realize that I’m just talking to myself. Nobody else cares, it seems.

At times, I wonder why I care if nobody else does. Talking to yourself is a waste of time, so I often wonder if I’m just wasting my time with this blog. Maybe I am.

But I keep doing the blog because if it helps just one other person on the planet, then that’s one person out of 7.5 billion people that I’ve been able to serve and if I stop, then I stop serving. My conscience and who I am won’t let me do that.

And even if nobody wants to hear it now, maybe in a few years, when I’m dead and gone, and their families are watching them go through the journey of dementias, their families will find this blog and it will help them.

If I leave a legacy, this might be it. I don’t have high hopes for any legacy. People are so hedonistic and narcissistic now that they don’t pay any attention to anything serious or important. I can only imagine that will get worse in the future too.

But even if there’s no use for this information, at least I know I’m doing the best I can to pay what I’ve learned forward and try to help others. The choice of whether they want to learn or ignore is theirs, not mine.

C’est la vie.

Insights: How Personality, Quirks, Foibles, and Flaws Factor Into Dementias and Alzheimer’s Disease

Personality - the way we consisting think, feel, behave in our lives is a factor in dementia behaviorsThis is the second post of a series that provides insights into the behaviors we often see in our loved ones as they – and we as caregivers along side them – walk through the journey of dementias and Alzheimer’s Disease.

In the first post in the series, we discussed how our loved ones’ life experiences factor into a lot of the behaviors we see as they travel the road through dementias and Alzheimer’s Disease.

In this post, we’ll take a look at how personality, quirks, foibles, and flaws thread their way through a lot of the behaviors we see in our loved ones with dementias and Alzheimer’s Disease. 

It’s important to understand this and to be able to recognize this because it can help us respond both more accurately and more compassionately and gently to the often baffling and frustrating behaviors that emerge as these neurological diseases progress. In other words, it gives us a context to both understand the behaviors and to minimize or eliminate, in some cases, the effects of the behaviors.

I group personality, quirks, foibles and flaws together because they’re so intertwined in what makes each of us the unique person that we are that to separate them would be like looking at a single piece of a puzzle instead of the whole puzzle.

They also represent both the positive and the negative, the humorous and not-so-humorous, the normal and the eccentric (spoiler alert: there is not a human being on the planet who doesn’t have eccentricities – some of us just hide them better than others), the sane and the not-so-sane aspects that make each of us human and each of us unique. 

All of these get exaggerated in one way or another with dementias and Alzheimer’s Disease.

Sometimes that’s okay. Sometimes that’s not.

If an endearing aspect of these gets more endearing, we tend not to appreciate it as much as we should.

However, if an annoying or obnoxious aspect of these gets more annoying or more obnoxious, we as caregivers will, at times, wonder if we will survive the journey we’re sharing with our loved ones intact and in one piece mentally and emotionally.

Personality is generally defined as the unique way each of us consistently thinks, feels, and behaves throughout the course of our lives.

Some aspects of our personalities are dynamic to some degree, changing as we mature and age or because the things we experience and encounter through the course of our lives, but the core of our personalities – the nuts and bolts of who we are at a stripped-down level – tend to be static.

Some of this core personality is genetic – nature – and some of it is early (first five years) environment/experience – nuture.

And this is the part that identifies us uniquely throughout our lives, because it is always there regardless of where we are, what what we’re doing, or who we are with.

Some of our core personality traits can be very good. If we tend to altruistic, optimistic, and malleable, those traits show up early and last even through the journey of dementias and Alzheimer’s Disease.

But even these positive personality traits can be a liability as neurological decline progresses.

If our loved ones tend to be generous and always doing for and giving to others, they very often might give away a lot of money or very valuable things to other people without understanding the financial hardship these losses may incur – and which are often unrectifiable – which may affect their own care. 

Additionally, these kind of traits can make our loved ones easy prey for unscrupulous people to take advantage of them and perhaps wipe them out financially.

Other of our core personality traits may present challenges to those around us all our lives. If we tend to be angry, stubborn, and self-centered, for example, these traits also get worse with the progression of dementias and Alzheimer’s Disease.

Unfortunately, it seems that most of us humans – and I will include myself in this (I’ve always said that if I ever develop dementia, they just need to put me down right after the diagnosis because I will be a gazillion times worse than any of the worst horror stories I have heard along the way about the negative side of dementia, and I don’t want anybody to have to deal with that) – have more negative core personality traits than we do positive.

When we have our full cognitive abilities, we have the ability – if we’re aware of these negative core traits and we don’t want them to have a detrimental impact on our relationships – to mute or override them in our interactions with other people.

However, once cognitive decline has progressed far enough to be seen behaviorally, the filters that we used to mute/override these negative core personality traits disappear as does the ability to know that we need to moderate them. And all bets are off.

Some of our core personality traits are so much a part of us that they are us. In other words, we can’t step back objectively and in clarity and self-awareness see them and remove or change them.

This is, in my opinion, just default programming (it may genetic  or environmental or both), but no matter how much we try – and some people don’t try (I am always trying to consciously avoid my own, but a lot of mine is already in play before I even know that I’m supposed to be avoiding it – it is one of the things about myself that drives me crazy) because they don’t know and/or they don’t care – it’s there anyway.

These things get exaggerated with the progression of dementias and Alzheimer’s Disease and they can be the some of the most taxing things we as caregivers can deal with because we don’t have the ability to neutralize them in our loved ones with logic, reason, and rational thinking. 

I have a very good friend whose father has vascular dementia. He is very demanding, always right, often the misunderstood victim, as obstinate as the day is long, and fighting against anything that takes away any of his independence.

My friend’s dad lost his driver’s license over two years ago when he was pulled over on the interstate for driving against traffic during the day. Fortunately, the police got him off the road before anything bad happened, but my friend’s dad has obsessed angrily about losing his license and not being able to drive since then.

His obsession with being allowed to drive ranges from conspiracy theories – the police, doctors, and his daughter have conspired unjustly against him to keep him from driving – to getting a new glasses prescription (“now they’ll give my license back”) to the humorously absurd (“everybody drives the wrong way down the interstate at least once”).

Additionally, because not being able to drive has made him more dependent on others, including his only daughter (who has a large and dependent family of her own), he expects everyone to drop everything they’re doing and take him where he wants to go when he wants to go and gets very angry if they can’t or won’t.

As his daughter and I were talking about his behavior, she said that her dad had always been narcissistic and demanding, even before any signs of cognitive decline. The world had always revolved around him so dementia has made this aspect of his core personality even worse as he loses ground neurologically.

Foibles, quirks, and flaws are, in many ways, extensions of personality.

Quirks makes us slightly off-kilter and can be cute or something joked aboutThe things that make us just slightly off-kilter (quirks) and perhaps are even “cute” or teasingly tolerated can really go off the rails quickly as dementias progress.

Foibles, which are inherent minor weaknesses, like the tendency to laugh at inappropriate times or to chatter incessantly, also become exaggerated during the journey Foibles are areas of minor weaknessthrough dementias and Alzheimer’s Disease. These also can be real testing points of our patience as caregivers because there are no boundaries around them for our loved ones as there were when there was no cognitive impairment.

And flaws (examples would be things like argumentativeness, impatience, quick temperedness, aggression, etc.) also become Flaws are the most serious personality aspects and potentially the most dangerous in dementiamore exaggerated as the journey through dementias and Alzheimer’s disease progresses and there are fewer and fewer inherent abilities for our loved ones to use to practice restraint.

Flaws are perhaps the most scary and the most dangerous aspects of personality that we as caregivers may have to deal with. Because the executive functions of reason and rational thinking are absent in our loved ones, so too is the absence of the understanding of consequences of actions (behavior), which is a restraint in normal cognitive functioning.

Therefore, for example, if our loved one has the flaw of being quick-tempered (which has the emotional component of lashing out either physically or verbally or both if not restrained), there is real possibility of physical injury or death (especially if anything that could be used as a weapon is within reach) by our loved one because they are only able to be in the moment and cannot foresee or even understand the long-term consequences of their actions.

This is why having the insight into the personalities, quirks, foibles, and flaws of our loved ones and how those are manifested in their behavior is so important for us as caregivers.

We can mitigate the possibilities of really tragic outcomes in the worst-case scenarios and we can also come up with effective strategies for neutralizing – it will be temporary at best and we’ll have to do it over and over (this can be a very frustrating part for us) – the behaviors in the moment to make them less disruptive for both our loved ones and for those of us around them. 

Do Good Grades and a Complex Career Lower the Risk of Developing Dementias?

Complex Careers Diminish Dementias Risks?A recent dementias study made the news with the assertion that it appears that people who make good grades in school and who have challenging and complex careers may have a lower risk of developing dementias.

I don’t agree with this at all.

I also think it gives false hope to all of us not yet showing signs of dementias.

Dementias are complex neurological diseases. Their development includes innumerable factors – most of which we don’t even know – that are involved in their genesis at the organic level (technology overload and addiction, which is rampant now, is definitely one of many lifestyle factors that are inorganic and not even included in the equation).

The reality is that I’ve known quite a few people in my life with dementias, including my mom.

Good Grades Diminish Dementias Risk?They were excellent students and had very complex and demanding careers, along with personal lives that were filled with learning new things and sharing them in a way to put those things into practice.

Application is the complex side of learning.

There are some people who learn for the sake of learning, but they never do anything with it or figure out how to actually apply it in their lives, so it quickly goes away.

The people who learn and then do something with that learning – application – retain the knowledge and grow in it.

Some of those people that I’ve known, including my mom, were scientists.

Some were multicultural historians and linguists (a study was done that suggested that being bilingual lowers the chances that you will develop dementias).

Some were teachers.

Some were accomplished musicians (there was a recent study that suggested that playing a musical instrument insulates you from dementias).

Some were engineers.

None of these people were slouches as students or in their careers.

In other words, the majority of the people I’ve known with dementias were at the top of their fields academically and professionally, and it didn’t make a difference.

We humans cling to false hope and what we want to be true because it’s easier than admitting how much we don’t know and how much uncertainty lies in not knowing. It’s a form of self-deception that we all are susceptible to.

The best we can do is educate ourselves about dementias. Then we do the hard part of applying that knowledge and making the changes we have control over (lifestyle is a huge factor) immediately to protect ourselves as well as we are able.

How do we do that in practical terms?

Education is the point of and the reason for this blog. I have developed and written and continue to develop and write posts so that this is an exhaustive and comprehensive educational resource on the types of dementia and on practical and in-the-moment caregiving.

There is not another blog out there that looks at these neurological diseases from a big picture aspect – covering all the dementias – and gives caregiving information that people can use today in appropriately responsive and loving caregiving for their loved ones.

Education is also the point of and the reason for the two books I’ve written on practical caregiving and practically understanding, walking through, and responding to the steps of the journey through dementias and Alzheimer’s Disease that we walk with our loved ones.

I urge all of us to know the facts and not get caught up in studies that promise things that are not provable or that are suspect.

Dementias are big-picture neurological diseases with a lot of unknowns that come into play for them to develop. Instead of focusing on a particular type of dementia, focus on what all dementias look like in real life.

Educate yourselves on real life caregiving and how to improve on being loving, kind, and gentle caregivers who also maintain the dignity and independence (as much as safety will allow independence) of your loved ones.

Educate yourselves on what steps you can take to eliminate some of the known factors in your own lives. Then apply that knowledge and eliminate them.

The reality is that the brain is the most complex system in the body and our insights into it have barely scratched the surface of what there is to learn about this incredible control center each of us have been given. The reality is that we will never understand it completely in a comprehensive way.

But Going Gentle Into That Good Night takes the comprehensive approach and, as much as can be understood about dementias from all the possible angles provides that information to you as a resource.

Take some time to read the posts listed on the right sidebar.

There is a search button at the top. Use it to search for topics you’re interested in.

If you don’t see a topic you’d like to see covered, send an email with the topic and, if it has merit, then it will be researched and discussed.

This is our blog. Your participation and input is valuable. I look forward to hearing from you.

Insights: How Life Experiences Factor Into Dementias and Alzheimer’s Disease

Life experiences are factors in dementias and Alzheimer's DiseaseThis post begins a series that provides us as caregivers a perspective into the behaviors of our loved ones with dementias and Alzheimer’s Disease that I’ve never seen discussed anywhere else. 

I’m a big-picture person. I believe that there are tangible connections among things for everything and everybody.

In other words, nothing is random, even if it appears that way. There’s a logic to everything and everybody. However, the only way to find the order and the logic is to back away from the immediate present and abandon the tendency to believe that it exists in a vacuum.

Nothing and nobody exists in the vacuum of a moment in time. Everything and everybody is the sum of their parts over a continuum of time.

By looking at the whole picture of our loved ones’ lives – life experience, temperament, and personality/quirks/flaws/foibles (which we all have, by the way) – we can gain insight into how those factor into the behaviors we see in their journeys through dementias and Alzheimer’s Disease.

Knowledge is power in this case. Because if we understand what factors of a lifetime are driving the behaviors we see, then we can find ways that are beneficial for us and for our loved ones to respond to those behaviors.

I will be the first to admit, from personal experience, getting our responses consistently right is not easy and, at times, because our own emotions (especially as children or grandchildren dealing with parents and grandparents where the landscape, even in the best of circumstances, is complex and complicated) are intimately involved, we will fail. We will fail miserably.

But, as with anything else in life, we have two choices after we fall flat on our faces. We can either quit in defeat or we can get up and try again with more resolve to move forward successfully.

It’s my opinion that a substantial part of the fatigue that we experience as caregivers for our loved ones with dementias and Alzheimer’s Disease is not physical, but instead emotional and mental.

And the resolve to not quit emotionally and mentally in going through this journey with our loved ones is a significant contributor to that fatigue.

Do it anyway. For them and for ourselves. Because when we stand alone at the end of this journey we will find out that we gained more than we lost.

We will know ourselves better than most of us probably really want to know ourselves.

We will find strengths that we didn’t know we had. We will be surprised at our endurance and the levels of adversity we had to persevere through.

But we will also find our weaknesses and we will see our shortcomings. A lot of these come to light in the years that follow the journey through dementias and Alzheimer’s Disease. They come to the forefront of minds slowly as we consider and reflect on the journey.

As painful as that is – and it is very painful – it is positive. Because once we see areas where we need to change, we have the opportunity to change. We have the opportunity to continue to reap the benefit of growth.

That’s why I personally advocate remembering, examining, and considering the journeys we’ve been through with our loved ones. Some people are not able to do that and that’s okay, but personally for me, it has been an unparalleled period of change and growth in my life.

Life experiences factor significantly into the behaviors of our loved ones with dementias and Alzheimer’s Disease. 

Because short-term memory is impacted more than long-term memory and the core of our perspectives on life are formed during the early years of our lives, the life experiences of the first twenty years of our loved ones lives seem to drive some of the behaviors we see.

For example, my mom’s mother died when she was three days old. Her 78-year-old grandmother and 80-year-old grandfather immediately took Mama and her dad – an absent binge drinker under stress (he disappeared for several days after his wife died while the maternal and paternal grandmothers fought over custody of his daughter) and a World War I veteran whose lungs had been permanently damaged in a mustard gas attack in France – into their lives.

Although Mama was loved, it was an unsettled start to life with constant moves and frequent absences of her father (hospitalizations at the VA hospital, drinking binges, and a few arrests for public drunkenness). 

Mama - 6 years oldWhen Mama was five, the fragile environment of love began to disintegrate.

Her grandfather, her best friend and trusty ally, died. A year later her father succumbed to pulmonary disease.

The memory that haunted her most of her life was the 30 minutes or so before her father died. He told Mama he wanted to talk with her, but she wanted to go outside and play with her cousins. Her father kissed her and said, “Go ahead.”

That was the last time Mama saw her father alive and her guilt over not knowing, because she was six years old, that he was dying and not staying with him when he wanted her to followed my mom all her life.

Shortly after her father’s death, Mama was sent away from the family she knew and loved to live with an aunt she didn’t know and who didn’t want her. For the next 12 years, Mama endured hell on earth. She was all alone in the world. She was mistreated, lied to, and stolen from.

Mama having fun with her grandkidsMama finally escaped and was able to overcome a lot of adversity to become an incredibly accomplished woman and the mother that I loved with all my heart, the wife that my dad cherished and was completely devoted to, and the friend that so many people loved and cherished.

But the road to becoming those people was strewn with a battle to overcome fear, anger, resentment, and bitterness, which Mama finally did in late middle-age. But the one thing Mama never completely overcame was her suspicion that people couldn’t be trusted and, given the opportunity, they’d take advantage of her.

When Mama’s dementias and Alzheimer’s Disease were in full bloom, those life experiences of her first 18 years were primary factors in her behaviors.

The loneliness came back. The fear came back. The anger came back. The bitterness came back. The resentment came back. In full force.

And her normal tendency toward being suspicious of everyone as a possible threat to take everything away from her blossomed into a full-throttle paranoia that I wouldn’t have believed unless I’d been the one who’d seen it and been on the receiving end of most of the time.

All of these things took me by surprise because they all came at once in high gear. I was overwhelmed and unprepared emotionally and mentally to deal with the onslaught.

At first I blamed myself. I kept wondering – and looking for – what I had done or said to trigger Mama’s behaviors. Every place I even thought there was a possibility that something I’d said or done was the trigger, I changed immediately.

But Mama’s behavior didn’t change. In fact, it got worse.

It was hard not to take it personally. There were many times when I’d walk away to defuse the situation and just sob because I didn’t know what to do and I couldn’t help Mama.

But I thought about the whys of Mama’s behavior day and night as I searched for answers and ways that I could help. And in the process, I found compassion, empathy, and patience.

Why? Because I realized my mom was that scared six-year-old little girl who had her whole life ripped apart and thought she was all alone in the world. And that six-year-old girl knew what lay ahead in the next 12 years of her life and she was determined not to let it happen this time because all of the emotions associated with that were front and center.

My understanding of how my mom’s life experiences were factors in her dementias and Alzheimer’s Disease gave me insights into why she was doing what she was doing and into ways that I could tangibly quiet her fears and soothe – not entirely – those raging emotions associated with the most disruptive time of her life.

So I urge all of us, as we’re able, to go back over our loved ones’ lives and see where the connections are, even as far back as early childhood, that factor into the behaviors we see as they walk the journey through dementias and Alzheimer’s disease.

I promise you that it will be worth it not only for us as caregivers but for our loved ones as well.

 

“A Deadly Wandering” – by Matt Richtel: Book Review and Recommendation

very inspiring blogger award nomination going gentle into that good nightAs I write for Going Gentle Into That Good Night, I don’t just think in a confined space of caregiving for our loved ones with dementias and Alzheimer’s Disease.

That’s important – and the focus of most of the posts here – and the information I provide is practical and addresses daily life for us as caregivers and our loved ones with dementias and Alzheimer’s Disease.

I work constantly with the goal of providing what caregivers need in one place and where they will not find anywhere else.

The two books I’ve written for caregivers about dementias and Alzheimer’s Disease – Going Gentle Into That Good Night: A Practical and Informative Guide For Fulfilling the Circle of Life For Our Loved Ones with Dementias and Alzheimer’s Disease and You Oughta Know: Acknowledging, Recognizing, and Responding to the Steps in the Journey Through Dementias and Alzheimer’s Disease – are written with the same goal.

I was the caregiver for my mom who had vascular dementia, Lewy Body dementia, and Alzheimer’s Disease, as well as congestive heart failure. Someone gave me a copy of the bible on these diseases – The 36-Hour Day – and not only was it written by clinicians who had never actually been through the day-to-day with these diseases, but it didn’t address the very specific things I was seeing with my mom and it didn’t address the in-the-moment things and challenges of daily life that we as caregivers and our loved ones with dementias and Alzheimer’s Disease face and need to navigate through.

Most disheartening for me personally was the absence of dignity and love for our loved ones with dementias and Alzheimer’s Disease in a lot of what I read.

These people that we love and loved fiercely were treated at worst as mindless, inanimate objects and at best as newborn babies who needed to be stripped of all control and input into their lives.

So after my mom’s death in 2012, I decided to do my best to give caregivers what I didn’t and couldn’t find, doing the research, drawing on experience, staying abreast of these neurological diseases and providing what has been the only – and still is – comprehensive resource for caregivers of loved ones with dementias and Alzheimer’s Disease that wasn’t just specific to my mom and didn’t focus on just a single aspect of the breadth and width and length of what caregiving and being cared for entails.

Make no mistake, though. My mom is a part of many of my posts because that’s where I got the practical experience, but except for my very personal posts on those days when missing her comes on me full force again, my mom is not the focus of this blog.

You the caregivers and your loved ones with dementias and Alzheimer’s Disease are. That is why I continue to take the experiences that you talk with me about and I continue to add to the resources here.

My work here will never be done. That is my commitment and my promise to each of you and to your loved ones.

One of the things that has become evident over the past few years is that our lifestyles – yours and mine – potentially make most of humanity headed for dementia because we’re creating a fertile environment for neurological degeneration.

One of the lifestyle factors that poses, in my opinion, the most significant risk of neurological degeneration to the most people is our increasing addiction to technology.

The research in neuroscience backs this up. We have too little absence in our lives from technology.

Technology changes our neuroplasticity (the part of the brain responsible for creating neural pathways) and, as a result, there are parts of our brains that are getting short-circuited and bypassed altogether. This leads to cellular atrophy and, eventually, death – the hallmark indicators of dementia. Nicholas Carr’s The Shallows is an excellent book on how this happens.

Attention, Technology, Increased Possibility of Lifestyle DementiaA Deadly Wandering: A Tale of Tragedy and Redemption in the Age of Attention by Matt Richtel looks at another aspect of how technology affects the brain in terms of attention.

My Goodreads book review of A Deadly Wandering: A Tale of Tragedy and Redemption in the Age of Attention:

“Excellent book that weaves an actual story of the unconscious attention deficit created by using technology (in this case, texting, but it applies to all technology) while driving a vehicle with the neuroscience behind the human ability to pay attention (stay focused) with multiple, seemingly-equal, stimuli coming at them all at once (multitasking).

The reality is that multitasking, for 99% of us, is a myth we’ve bought into and it’s making us more unable to pay attention to anything for long (there’s a dopamine hit that mimics the same hit that drug and alcohol addicts get with that first snort, draw, liquid ice in the veins or drink – the hit is short-lived, but we’re hooked and we first want it and then we need it), more unproductive, more unconscious in terms of critically thinking and keeping the big picture in focus, and more of a danger, in some cases, fatally so, to ourselves and others.

Everyone should read this book. It’s a tough read at times, both in terms of the pain and suffering revealed in all the people discussed in the book and in terms of the fact that when we look in the mirror, we’re most likely going to see the “bad guy” in this book with our faces looking back at us.

It’s a cautionary tale that we all need to take to heart and do something about TODAY.”

The Layperson’s Guide to Revocable Living Trusts, Guardianships, and Conservatorships

Contingency Planning End of Life Planning Elderly Parents and ChildrenWhen our loved ones with dementias and Alzheimer’s Disease reach the part of the journey through these neurological diseases where they are unable to handle their own financial and legal matters, we as caregivers have no option but to step in and act for them and in their best interests.

Here in the United States, there is an incomprehensible aversion to planning for the possibility of having to entrust our lives to someone else and for how we want to die

It’s as though we have this national collective mentality that if we don’t think about it, then it won’t happen.

The bad news? No matter what, it’s still going to happen.

And someone is going to be left holding the bag – maybe the person we would have designated or maybe someone we don’t want making decisions for us – to decide for us.

If it’s a person we trust, then they have the agony of trying to figure out what’s best and what we would have wanted. This is especially agonizing when dealing with end-of-life issues.

Too many people in this position of not knowing what we want, because we refused to talk about it, prolong our suffering and run up needless bills in the process, simply delaying what would have been the inevitable outcome anyway.

If it’s a person we don’t trust, all bets are off. And it is not going to be pretty.

The time to prepare for both of these inevitables – unless we die early and truly unexpectedly (I can’t help but laugh every time I see an obituary for a really elderly person that says they died unexpectedly: suddenly, perhaps; unexpectedly, no) – is when we have the ability to and can make sure what we want to happen happens.

A Revocable Living Trust is A Good Option for Ensuring Elderly and End-of-Life NeedsFrom the standpoint of appointing someone we trust to handle our financial and legal affairs (most of us do an okay job with medical powers of attorney, but even that gets ignored more than it should), a revocable living trust is probably the best and safest way to go.

The benefits of a revocable living trust are:

  • The person creating it retains control and can revoke control at any time as long as they are competent;
  • It can be set up with a small amount of money or a piece of property in the trust and the attorney’s fee (varies by state);
  • The person creating it designates the person/people they trust to handle their legal/financial affairs;
  • It eliminates the need for a will;
  • It cannot be legally contested;
  • The process of transferring control to the designated trustee in the case of incompetency requires a professional (psychiatric) letter with the diagnosis and evidence of incompetency;
  • It, with the professional letter declaring incompetency, is the only documentation needed for the designated trustee to handle finances and legal matters.

A revocable living trust is probably the easiest way to ensure what we want both in life if we can’t do it ourselves and in death after we’re gone.

However, it is of supreme importance to choose wisely and be absolutely convinced of the trustworthiness of the person we designate to be our trustee.

The bottom line? If we have any doubts as to whether we can trust someone completely, we do not choose them as our trustee.

It will not end well for us – in fact, it could end gruesomely and tragically – and all our careful planning will have been for nothing, to put it mildly.

But what if, as many Americans do, our loved ones with dementias and Alzheimer’s Disease reach the stage where they are not competent to handle their affairs without any legal documents in place?

There are two options, and by the time this is needed, it’s likely that the petitioner (us for our loved ones or our families for us) will need both of them granted.

Both options are very costly (much more expensive than the cost of powers of attorney and a revocable living trust), often take a long time to be granted, and, in many cases, set off a family war, which not only can delay a decision, but can also create irreparable rifts within the family.

One option is guardianship. Guardianships give the petitioner the legal authority to take physical care of the loved one who is incapacitated.

The process to obtaining guardianship begins with getting a professional letter confirming the person for whom guardianship is sought is incompetent to handle their own affairs.

That letter must be taken to an attorney to have a petition drawn up to submit with the letter to the court. The petitioner is responsible for all the attorney fees (general estimates are in the $2500 to $4000 range if the petition is uncontested) and court costs.

Petitioning for legal guardianship and conservatorship is a lengthy and costly processThe court will decide – slowly – whether to grant the guardianship and the entire process can take several months at the very least.

The second option is a conservatorship. A conservatorship gives the petitioner the legal authority to handle financial and estate matters for of the loved one who is incapacitated.

A conservatorship has the same legal requirements and process as a guardianship and has the same potential problems as well. That’s why if a petitioner has no other choice but to pursue these options, it’s prudent to do both of them at the same time.

There is an additional requirement for the petitioner who is granted a conservatorship for a loved one who is incapacitated. The petitioner will have to file a detailed annual financial report for the estate to the court for review to ensure that the estate is being managed as the court sees fit.

If the petitions for guardianship and conservatorship are uncontested, they will take a much longer time and much, much more money to obtain than having an attorney draw up a revocable living trust that settles everything.

If the guardianship and conservatorship petitions are contested by other family members, it’s conceivable that the legal fight could outlast the loved one who is incapacitated and the amount of money spent to fund the fight would be outrageously high.

We may have no choice in these matters with our loved ones that we are caregivers for, but I urge each of us to consider taking care of these things for ourselves now for our potential caregivers.

We need to tell our families what we want, carewise, for longterm care and at the end of our lives. We need to choose and discuss with the person we want to ensure that our wishes are carried out. We need to get the legal paperwork done and keep one copy in our home safe or a safety deposit box at the bank and give the other copy to the person we designate to carry out our wishes.

We never know when time and chance are going to happen. Today is the day to prepare for that. Tomorrow may be too late.