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Helpful tips for family caregivers

Dementia: safety and independence

Everyone with a memory loss condition deserves the opportunity to stay engaged in life for as long as possible. Early in the disease, your loved one will continue to do many things quite well. Your challenge is to balance respect for your relative’s independence with the need to ensure safety. All this while preserving a trusting relationship.

In the beginning, just keep an eye on things. Encourage engagement and support self-esteem. Over time, you may need to provide some assistance. Not to do things “for” him or her, but “with.” As abilities decline, suggest alternative approaches. And when you notice risky and unwise decisions, transition into taking over. Respectfully.

Finances. Managing mail and doing calculations can become confusing early on. Watch for unopened bills, an unbalanced checkbook, utility shut-off notices, or difficulty calculating the tip at a restaurant. Offer to “make life easier” by putting bills on autopay. At tax time, suggest doing it together. Or that you take it on, as he or she has “done that chore long enough.” Poor judgment may leave your relative open to scams. Look for odd purchases or erratic spending. Work with your loved one’s financial advisors to talk about money management options. Eventually, if you have power of attorney, you may need to activate that.

Driving. If your loved one is still driving, be the passenger frequently to check his or her capability. Dementia affects reaction time, spatial judgment, and decision making under pressure. Typical problems include

• not following right-of-way rules, for example at stop signs or when making a left turn.
• getting flustered at intersections or stopping midstreet when feeling uncertain.

You might suggest driving simpler routes and when traffic is less busy. Or facilitate rides from friends, public transit, etc. Eventually, call the doctor and ask for a driving evaluation.

Managing chronic pain

“Chronic pain” is pain that lasts for 12 weeks or more. The cause is usually nervous system misfiring, like a faulty car alarm system. Often there is no specific trigger, which makes treatment difficult.

Chronic pain is common, affecting 50%–66% of adults age 50 and older. Opioid drugs are recommended for pain control in serious illnesses such as cancer. For those with chronic pain, however, a mix of pain relief strategies is better.

With chronic pain, a full recovery to “no pain” may not be realistic. Instead, it’s a matter of finding ways to help your loved one adjust so he or she can continue activities that bring meaning to life despite the pain.

Pain is physical, and the experience of pain can be reduced with physical changes. Pain is also highly affected by mental perception. In other words, how negatively we think about it. These two qualities open the door for many nondrug strategies of pain management. For instance:

• Physical therapy. Exercises to gain strength and flexibility can improve overall comfort.
• Occupational therapy. Learning new ways to accomplish daily tasks may reduce pain.
• Exercise. Low-impact physical activity—walking, swimming—releases endorphins, the body’s natural pain killer.
• Quality sleep. Lack of sleep makes pain worse. Good rest supports resilient coping with pain.
• Relaxation techniques. Special techniques can train the mind and body to interrupt the pain cycle (in which pain triggers fear and tension, which brings more pain).
• Meditation. Mindfulness practice can help your loved cope by “seeing” the pain from a new perspective.
• Counseling. Counseling can help your relative identify and change the thoughts, feelings, and actions that amplify pain. Cognitive behavioral therapy is often the most helpful. It can also address depression and anxiety, which then lowers pain.