Senior Living LIVE! Dementia or Normal Aging?

Video Transcription

- Hello, everyone and welcome into "Senior Living LIVE". My name is Melissa and of course, I hope you all are doing very well today. We've got a very important topic we wanna talk about as it relates to aging and memory loss. Now, we all forget things, all of us. From your homework when you were a little kid to your car keys when you were an adult and old enough to drive, we all forget things. But how can you tell the difference between normal forgetfulness and something that is more serious? Susan Robbins is an expert on this topic and she is our guest speaker today. She will answer that question is it dementia or normal aging? Now, you'll wanna stick around through the end of the presentation because you will all have a chance to ask her questions and Susan will answer those questions. In order to submit your question you can scroll down to the bottom of your screen where it says Q&A, type out your questions there and we will be sure to get to all of your questions at the end of today's webinar which we expect to last anywhere from 45 minutes to about an hour. So with that, I will turn it over to, Susan Robbins. Susan, take it away.

- Okay, thank you, Melissa. I am so glad you have taken the time to join us today. I'm Susan Robbins and I have the privilege of working with the Arbor Company in training all our staff to understand and how to respond to those living with dementia. Those extra tips that you need to make sure that they have a good day. I've been with the Arbor Company for 10 years. I've worked in the industry for almost 30 and I absolutely love working in this environment. I feel it's a privilege every day to get to share the knowledge that I have gained over the past 30 years working in different roles and helping support people living with dementia and just normal aging. It's not always easy to get old even if you don't have any dementia or things that are causing problems for you. So I wanna start today with giving you some tips on how to determine whether it's just getting older normal aging or dementia. So with normal aging, excuse me There's normal aging and there is dementia. And I'll start with dementia is a big umbrella. Alzheimer's is the most common. And that's what you're gonna hear lots of times is it refers back to dementia but there are over 70 different types of dementia. But today, we're just gonna go with the broad term dementia. This kinda cover all of those. But with normal aging, you move a little slower. What used to take you five minutes can take you up to 15 minutes and if not longer sometimes but it doesn't mean you have dementia. The brain just processes information slower and your muscles respond slower so you move a little slower. You think you've noticed that when you go to the grocery store it seems to take you a little bit longer to get to the grocery store and get all the items that you want. And you realized you were only gonna run in and it took an hour. Whereas before you would have had the same amount of items and maybe taken 30 minutes. Maybe it takes a little longer to clean the house do things, that's okay. It's normal aging things. And also if you have a loved one that you're caring for and they say, "Just a minute, I've got to go back "and run to the bathroom really quick." That can take five minutes but it doesn't mean they need any assistance. Whereas somebody living with dementia has a hard time completing familiar tasks. I might miss steps such as putting toothpaste on a toothbrush or it can be even simpler things. I go to put my shoes on and I forget to tie my shoes. I don't remember to pay bills. I've always been real meticulous on paying my bills and I don't do that. Or maybe when you come over and visit you notice there's a lot of expired food in my refrigerator. That's always a big sign that I'm not taking care of the things I need to. And I might not like it if you remove them either. Normal aging, it has to take a little longer. It takes you just a little longer to make decisions and do things. One of the things you'll find yourself doing as you age is you stop before you head up a flight of steps or head down the steps. When you're younger your brain just quickly subconsciously processes there's 20 steps to go up and you know that you don't even need the rail. You just run up the steps because your brain processes it so fast. But as you get older, you kind of stop and you make note of where the rail is you came to hold of the rail and you may even eventually even normal aging gotta think which foot goes first? Because which knee is working good today and which one isn't? You're hesitating but you're aware of the safety need and the need to do that. You can still do all the things you used to do but you just may need some modifications to do 'em. The other big one that happens under hesitating more is driving. If you find yourself making that extra look maybe you look to the left, look to the right, look back. You may do that a couple times before you pull out because the brain is processing the information. Doesn't mean you're not gonna make a sound good decision of when to pull out from a stop sign but it will take a little longer, normal aging. But people living with dementia don't make good decisions. I may still be continuing to drive in the early stages and only look one direction and I'm not making good decisions. I'm not making safe decisions. They also can become withdrawn from you. If you have a family member that's been very outgoing most of their life and chatty and all of the sudden you find out they're not joining in conversations. It may be that I can't keep up with the conversation but I'm aware of it and I don't want you to know it. And if you see it in yourself, kind of pulling back why are you pulling back? What's going on? You may need to look into that a little bit and I can stop doing things altogether and make excuses not to do the things I used to enjoy. Difficulty with name recall, I love this one. I will remember your face and I'll remember details about you. But I've noticed as I've gotten older I forget people's names. This is normal aging. I know my neighbor but I can't remember her name and she's lived next door to me for 30 years. We've lived in the same houses and I just can't come up with her name in that moment. That's normal aging, that's okay. But what happens, people living with dementia I don't even recognize that person that's next door as my neighbor. Lots of times people living with dementia start to travel back in time. And as they travel back in time they don't recognize people because they want to place them in the age the time period in their life. I may remember her as my neighbor from 30 years ago and when she was 50 and now she's 80 and at 80 she doesn't look the same she did with 50. So I don't even recognize her. This happens too with family members. You will find some times if you have a loved one that they will not recognize you but they may call you by your children's name. You've mixed up with their grandchildren. Now, normal aging, I'll occasionally call my granddaughter by my daughter's name but I know the difference. And they kind of laugh at me but I know it instantaneously. That's not what I'm talking about. It's when people live with dementia and they actually think the granddaughter is their daughter because they are traveling back in time and don't recognize people. I don't lose, though for those of you caring for somebody with dementia at this stage. I wanna reassure you, people living with dementia do not lose their feelings and their emotions. I still love you, I just can't put you in the right mold of where you belong in my life. What role do you play anymore? And they may say things, "I don't know her. "I don't know who that is." And when you remind them of the name it's like, no, it's not because they're not in the right place of where my mind is traveling back in time. Pausing to find words, normal aging. As you age, by the time you're 75 you're kind of even without dementia on kind of a five-second delay. So it may take me a second to come up with the name or you may fill in the blank for me and that's okay. I don't mind that when that happens. But if I can't describe it, give me a second I'll come up with a name of something. Nouns are one of the first things that people living with dementia lose so they have problems finding their words but more importantly, understanding yours. I have trouble using my nouns. One of the first things you'll see is people will start to say instead of flip flops I may say, "Flop flips." Or I may describe something. I need to go to the grocery store and I need to get one of those yellow things. They're long kind of like this and you pull down the sides and you fill in. Well, mom, did you want some bananas? No, the yellow thing. That is a sign that it's dementia because what happens is banana is no longer part of my vocabulary so I get frustrated when you try to fill in the blanks for me. Whereas normal aging, may be a little embarrassing but you don't mind somebody filling in the blank for you or helping you out in some cases. Needing reminders, normal aging. Everyone needs reminders. We need a calendar to do things. It's okay to need a calendar or write handwritten notes. But people living with dementia have short-term memory. I can't hang on to recent information and you'll do things like write a note. You've got a doctor's appointment on Tuesday at two o'clock and you put it on the refrigerator or wherever you put something to remind you. But people with dementia don't remember to go back to where the reminder is and that's a good sign. And that may be why you get that repetitive question. I may remember I need to go, I have a doctor's appointment because the doctor's appointment is filling a physical or emotional need but I can't hang on to details. Details throw me off and I don't know how to go back and look them up. Also, I might say I've eaten breakfast. I think I haven't but I already have. This happens a lot with people living with dementia because the brain is no longer telling the stomach it's full. So I don't know and I don't remember eating or I can't hang on to it or I haven't done anything today but I have. And here is a picture of the brain and what happens to the brain when somebody is living with dementia? The brain on the right is a nice, healthy brain, excuse me, on the left normal aging guys. And the brain on the right is the brain of somebody living with dementia. And you can see they really are doing the best they can. Dementia is more than forgetfulness too. People living with dementia, it affects the brain. It affects how we think, impulse control. Frontotemporal lobe, if I think it I'm gonna say it. If you have a loved one living with dementia you have probably experienced an embarrassing moment out in public or in front of family members. You're in the grocery store. Well, look at that all those potato chips in that woman's cart. She shouldn't be eating all those potato chips, look at her. I just don't think. If I think it comes out of my mouth and it can be, I don't control myself. I have a hard time paying attention to things so in problem solving. So if you give me too many details at one time I can't follow and I may get really frustrated. Problem solving sequencing and memory all affect how someone thinks. And again, as you age you still have sometimes get distracted easily by outside things but you're able to pull yourself back in. It might take you a little bit longer to solve a problem but you can still come up with a good, safe problem solving. Dementia is more than forgetfulness. How we process language, our speaking and our comprehension. Many people living with dementia have word salad. And word salad is, I need to go to the yesterday. Well, what are you talking about you need to go to yesterday? You can't go back in time. I'm trying to tell you something about yesterday but I can't get a cohesive thought together to express what my needs are. I can't use words and I don't comprehend yours. And if I don't comprehend yours in order to help someone living with dementia they need simpler and less words. Communication becomes very frustrating with people living with dementia. And they'll just, oh, just go away. Just go, just be quiet. What they're really telling you is I don't understand what it is you want me to do or I can't get you to understand what I need. Those behaviors are actually the way that somebody living with dementia is trying to communicate but I don't have the words to express myself anymore. Vision is also affected, normal aging and dementia. By the time somebody is 75, your field of vision narrows. And again, it's not that you can't physically see it but it affects you with what you can comprehend at one time. And it's about a 45-degree angle. One of the things that you may find at 75 is when you go to back up it's a lot more difficult than it used to be in a car. Backing up, you might hit that trash can that didn't get brought in or tap a mailbox. And again, it's not that you can't physically see it but your brain doesn't comprehend it. So after this webinar you're gonna know now to be more cautious if any of you happen to be over 75 and still driving. You need to take that extra look back and forth. Minute progresses even further. People in the mid stages of dementia have what we call binocular vision. And you can do this with me where if you want to but it's like living with binoculars on. So as you look around you can see that you have to move your head quite a bit in order to see what's to the left or to the right of you. This can make it very hard. I may ask you for something that's sitting to you right in front of me but in my binocular vision, I don't see it. So hand somebody something instead of just saying it's right here. Help them get through that moment in that moment in time. Also, then it progresses even further and I may have what you call binocular vision which is one eye closed and just circle around the other eye. And if you bring your finger out you can see you also lose depth perception. This is why you see people touching things, reaching out. Lots of times, we think somebody's balancing themselves but it's actually a sign that my field of vision and depth perception is gone. And that's where safety comes in too making sure there's not too much clutter around 'cause I can't see things. Or maybe I'm sitting with you at a meal and I take your drink or I take something off your plate because my binocular vision allows me only to see not see what's directly in front of me but out a little bit because of that depth perception loss. How we move and process things around us. Fine motor skills, being able to do buttons being able to tie my shoes getting that lid off the medicine. Sometimes opening twist ties on bread. Those are little and hard to get off sometimes. Those are fine motor skills. And with dementia, you lose those things. It can be very similar to without dementia arthritis in your hands can also affect your fine motor skills which is part of that normal aging. So is it fine motor skill loss or is it physically my hands aren't working or maybe a combination of both? Which makes it really difficult for people living with dementia and just normal aging. That's where you have to make those justified change things how you're doing 'em. People living in the later stages of dementia do keep their gross motor skills, which means big movements but tiny things become very difficult. And I am apt to fall. I also lose my ability to stand up. We don't realize standing getting from a seated position to standing is fine motor skills. It takes planting your feet on the floor. So if you're assisting someone or you have a loved one that's in the later stages and you're wanting them to stand up and come with you it actually has to start with getting them to put their feet flat on the floor then maybe rub their back a little bit to get them going lean them forward and then the process of standing up. Sensory and tolerance needs. Hearing comprehending, it is very difficult for people living with dementia to have outside influences. If you're gonna have a conversation with me please turn the TV off because I'm gonna have a hard time and then I become frustrated. Outside noises I get distracted. Maybe you have to reconnect with me several times. When it's too light or too dark in a room I can't function. And I'm gonna share a little secret with you. Even your pupils change the speed they contract in sunlight. That is why as you age you need those sunglasses a lot quicker than you did when you were a teenager. A teenager can walk outside and the sun kind of bother them a little bit because there are pupils are acting out quickly. As we age, by the time you're 75 they're gonna respond slower. So that bright light. And if you've got dementia, you're gonna see lots of times if you're squirting somebody outside they're actually gonna stop before they move forward to go outside because they've gotta have a longer time for their pupils to adjust to the difference in light. It may be why I get really upset if you turn a light on bright in the room. I'm gonna have to get even more gradually than you have in earlier times in your life. How do you help someone living with dementia? Things that you have, you can't control or change. The person or who they have been. You can't change your loved one, you can't change yourself. You are who you are. You can't change the process of dementia. Everybody's dementia journey is a little different. Some people progress faster and slower. Some people have periods where it just kind of seems to stay the same and then drops drastically. And some people's personalities change differently. They're all a little different. Other medical conditions, we don't have control over those things. You also don't have control over who's part of your family. And that one might sound funny but if you are all jointly taking care of a loved one it does take a family to do things but it takes a whole family understanding. And everybody has their own niche on how to help somebody living with dementia. So it takes communication but you don't have control over everybody else. What can you control and change? Your approach to someone living with dementia. Be their friend not their boss. They don't want you to be the authority figure. Mom I've told you and told you to do that. You can't do that. Nobody wants to be told what to do. Figure a way out to do things together and not point out those mistakes. Learn to let it go and don't argue. You're right, mom, I shouldn't have done that. I'm sorry I said that and you will be surprised how much easier it makes the person living with dementia's life. Doesn't mean you can't come home and say, "I can't believe I said I was sorry. "I wasn't sorry." But it worked, it helped go with the flow. No reality orientation. We need to live in the world of somebody living with dementia. Understanding that they are doing the best they can. I'm gonna give an example. If you have a loved one who is in kidney failure you don't walk up to them and pat them on the back where their kidneys are and go, kidneys, start working. Come on kidneys, start working. That would be crazy, wouldn't it? And would it make the kidney start working? No, we have to remember somebody living with dementia it is a disease and the brain is dying. You can't say, "Brain start working." But because it is the brain we are so tempted to try to fix it for them. We have to accept where somebody is living with dementia. The environment, how you set things up. And again, this can go back to normal aging too. If you have macular degeneration diabetic neuropathy from your eyes any of the other eye diseases that happen naturally as you age need to make sure that you have proper lighting in a room. What does it look like? What does it sound like? As I said earlier, pull back those distraction sounds. And also when they hear something acknowledge they hear something else. Don't just say, "Oh no, it's nothing." Because whatever they heard they may have not been able to interpret what that sound was and it may have scared them and created a problem. Validate what they're saying and what they're using. And what does it feel like? Is the room too cold or too hot? They make a big difference. Same with food, is it too cold or too hot? Because I don't feel things the same way I used to. You start to lose the ability to feel temperature and tell temperature in your mouth. So I may tell you my coffee's cold. Why did you bring me this cold coffee? What's the matter with you? We've all heard things like that. Somebody living with dementia can't always tell the temperature of coffee or the temperature of something they're drinking. I'm so sorry, let me try to get it hotter for you. Let me try again. But remember, you probably can not get it hot enough for that individual to understand it's hot to feel the hot because they don't have that ability that skillset and sensory need has declined. Flow of the day, using old routines as much as possible. People living with dementia have a hard time changing. We all have a hard time changing but without dementia you can process the reasons why. Somebody living with dementia can't process or accept the reasons why a routine has to change. Help them feel valued. Find them something to replace the things that they used to do, to modify what you're doing to make them happy helpful. If they love to cook we've got holidays coming up and somebody wants to cook. The outcome of what they cook is not important it's let me stir it up, let me do it. And if I tell you to add a little more, add a little more. Be prepared to that but let them be a part of something so that they feel useful. And don't forget that the person you love is still in there spend meaningful moments with them. Maya Angelou, "I have learned "that people will forget the things you say. "People will forget what you did "but people never forget how you made them feel." This is extremely important for people living with dementia. I'm not gonna remember your acts of kindness but I am gonna remember how your acts of kindness towards me made me feel. I do hang on to feelings and emotions. Adapt your approach. People living with dementia need you to approach from the front. I shared earlier, how that field of vision by 75 it's here. You can even get startled yourself if you're 75 or more because if somebody comes in and startles you. So you always wanna approach somebody living with dementia from the front. Reach your handout in a friendly manner to show that you're wanting to get in that person's space or do something. And come in from the front but move to the side. You'll find that body language of staying at eye level get down to eye level, excuse me and moving to the side helps that person living with dementia feel they are in control. And actually everyone you interact with. If you move slightly to the side that body language changes your approach and helps that person feel in control. Remove distractions, we went over that sirens, radios helps them focus. If it's somebody new, introduce yourself or just use somebody's name to help even family members stay in touch with them or don't use names at all and just say, hello if they're not recalling what role you are in their life. Using fewer words and more visual cues. As people progress through dementia I need visual cues to be successful. Offer limited choices. This is a big one on how to communicate with somebody living with dementia. I have a hard time reasoning things out and making decisions. So if you give me choices then I'm much more apt to be successful and feel good about the interaction we're having. Would you like a Coke or a Sprite? Would you like to go to McDonald's or Arby's? Whatever it is you're gonna do instead of would you like to go get something to eat? That is a huge question for somebody living with dementia. Talk to me, get connected and let me know what you're doing and don't yell at me. I need things information one thing at a time Always allow you to gain trust in that person. And even though it may be your loved one you may have to regain trust with that interaction because they may not understand what your role is in their life in that moment when you're trying to help them. Give me a few seconds, let me try to respond. It gives them time to respond appropriately. And when you add more questions to something I become very uncomfortable. Again, that holding my hand. There are pressure points that calm people. Their hands, maybe rub my elbow or my shoulder especially if you're trying to provide care or help me with something. These pressure points actually calm somebody down. So you might be helping somebody do something but if you're touching my shoulder with just a little bit of pressure, light pressure it actually helps me calm and stay focused on what it is you're trying to do. And of course, don't restrain somebody. Don't forget, behavior is a form of communication for everyone living with dementia. If I can't communicate with you verbally or get you to understand me I may act out by yelling or frustration or stomping my feet or holding my breath, grimacing, any of those behaviors. You need to back off and allow that person time to calm themselves. They're gonna get overwhelmed when you have tried to share too many things with me. And try to figure out what it is I need help with. And remember, they are doing the very best they can. Try not to tell lies because lies get you in trouble because people living with dementia remember feelings and they can somehow figure that out. That's a little trick that happens to stay with people living with dementia. But no reality orientation as well. If I keep asking you, have you seen my husband? Or my wife or my daughter or somebody that's important to me in my life and that person is no longer living. It's really tempting to try to bring them back to reality and explain to them that that person is no longer there especially if you're missing that person greatly yourself. But what they're really telling you is I don't remember that person is gone and I'm missing them. I have an emotional need. Repetitive questions need a kind answer not reality orientation. Work with me, let me talk about my husband let me talk about my daughter. You're missing them, validate their feelings instead of trying to redirect it. Okay, thank you and I guess we'll go over if there's any questions anyone has.

- For those of you who have been watching obviously, that's a lot of information a lot of good information. And I think Susan has done a fantastic job of trying to simplify what is an extremely complex topic. So take your time. If you have any questions, we already have quite a few to get to Susan. Get your drink of water you're probably going to need it. We have quite a few questions to get to already. But before we do I just wanna put a quick disclaimer out there for those of you who may just now be joining us. Just a reminder, Susan is not a clinician. Therefore, she is unable to answer questions regarding medicine, supplements or general care provided by a physician. So I just wanna get that out there. So if you don't have any of those kinds of questions it is best to direct those to your personal physician or to the physician of your loved one. Okay, so Susan, I hope you're ready, here we go.

- Okay.

- This first question comes from Lisa and she wants to know, is it normal for my dad to take a nap and be confused after he wakes up?

- That is not unusual. Lots of times I have a hard time. People living with dementia is the reality of maybe I was dreaming and I'm having to reorient myself it doesn't make sense. I also not knowing what time it is. I think I've been asleep and now I'm awake and I'm not sure where I am because I should be in bed I just woke up. So there can be some unusual things going there. Now, sleep is and is how good is he sleeping? One question I would have and you might wanna question whether a physician there is, how good is he sleeping? Is he getting sound sleep? Is this when he's taking a nap and actually a nap in bed and laying down? Or is this when he's just falling asleep? And is he actually asleep? Because many times people living with dementia will sit with their eyes closed and may appear to be asleep. But what it is is I can't my environment because it's an environmental overload. So one thing you may try is to make sure that when he is getting a nap is it a quiet environment?

- The next question we have comes from Margaret. And I wanna preface this question by saying that at this time there is no one definitive test that can tell a doctor you have dementia. They do a series of tests that lead them to believe that one may have dementia but they really won't know that until after the person has passed on. So Margaret's question is, what is the process of getting a diagnosis for dementia with that being said?

- So it's finding a good neurologist that understands dementia. Dementia is still has a stigma attached to it. And there are a lot of physicians out there that don't always recognize dementia as dementia. So you want a specialist neurologist to help you make that determination. The other thing I can also share with you when you do go with the loved one to that doctor's office allow your loved one to have most of the conversation and allow them to answer the doctor's questions. In our hearts, we want to protect our loved ones. And when they're stumbling for answers and aren't answering correctly it's very hard not to fill in those correct answers. But that also helps that physician make that determination of what the next steps are for you.

- And that might actually answer the next question which comes from David. And David had a two-part question really a lot of personal information here guys. We understand and we know it's hard and this was about his wife. And he said he's getting some answers to some very specific questions about what's going on with his wife. His doctors have told him that she will need long-term memory care but have not said that it is dementia. She about to be 75 years old. So again, Susan, maybe some advice on how this gentleman can get that definitive answer that tells him, yes, this is what you're dealing with. This is what your wife is going through.

- I think it does it goes back to finding that physician that is willing to do that, willing to make that diagnosis. Share the behaviors. Maybe journal a little bit yourself of some of the things that you see that was different than normal. And some of the behaviors that you're seeing and how you feel to the physician that she's not safe and that we need to do that. And if it's not and they won't do that then what is it? That you need an answer to help them get on the right track. This is a type of dementia because there are over 70 different types of dementia and they do vary on how the journey looks. Unfortunately, the end results is all the same but the journey can be quite different. And making sure that you're getting those answers but you've got, unfortunately in today's world only 45% of people with dementia have diagnosis.

- Okay and 70 over 70 different kinds.

- Yes.

- It is a lot. And it's scary when you're going through it. It's certainly scary to see a loved one go through it. And David, I'm not sure if we were able to really answer your question there but again, we hope that you are able to eventually get those answers for your wife. So thank you for submitting your question. Daria has a question now. Are there stages in which the person begins to lose skills? Is the first thing to go the ability to find words so on and so on?

- Finding words does happen but actually the frontotemporal lobe is actually what's affected first which is your judgment and reasoning. What you'll start to see is a little bit of change in personality. Safety awareness can be things. Short tempered saying things that are inappropriate in inappropriate times. You know your loved one. Some people say inappropriate things their whole lives but it might get worse with that. And so, it's not just words. By the time somebody is losing their words they're progressing through dementia where they're not able to recall the words and the slow response. So beginning stage is actually behaviors. And usually people are not diagnosed in that time. But the frontotemporal lobe your judgment reasoning comes first and then they start to lose some of their words.

- And I know in our conversation that we had earlier this week, Susan when we talked one-on-one there are certainly different stages, right? Where someone can still continue to live at home. They can still live by themselves. May need just a little extra help. And then it goes to the next step. Maybe they need a little extra care and then it's maybe they need to be moved to senior living into a memory care community. So on that end, we have a question from Judy whose mother is at that point regarding keeping a routine. She says her mother is 91. Has been in a memory care facility for the past three years. When she went in, there were 11 other residents. Now there are only three and two of them are nonverbal. She wants to know or she wonders if she should move her mother to a facility where there would be more people and stimulation. She thinks her mother's dementia is vascular. And she knows who she is, her mother knows who she is. She knows that's her daughter and she can react to things in the current moment. She just has no short-term memory. So would a change in routine or facility be a good or bad thing?

- Well, it's really hard without actually seeing your mother but you've given me a lot of good information on that. She does need to be engaged in things because if she knows who you are that's a sign that she's kind more of the middle stages of dementia. Maybe judgment and reasoning are probably not there but she would like to be engaged in things. And being engaged, I will share it does not keep you from declining from dementia but it does make moments more enjoyable. So it may be something that you wanna look at. It's not necessarily putting her with more people unless she is reaching out for that. And if you're seeing that, you might wanna look at that. Your question is very valid and it would need to be reassessed if she is in the right place for what she needs right now.

- Excellent, we've got a lot more questions to go. So we're gonna try to take this everybody. Just to let you know, to the top of the hour. We've got about 15 minutes until then. And like I said, Susan, get ready more rapid fire questions on the way. The next question we have is from Rochelle. She says her mother is 95 and sometimes gets mean. What should we do?

- Well, Rochelle, I'm sorry that you're having to see that happen with your mom. The mean is a way of communicating slowing down, simplifying things and checking your own frustration level when you're dealing with her. I know that that is very hard and difficult and easy for me to just to say. But how you approach, when do you approach things? And also watch what's triggering her. Is it because you're telling her what to do? Are you giving her options? And I know lots of times I'll say well someone say, "We'll give them options "but she's gonna tell me no, I don't want either one." And at that point the response is, I guess this is not a good time to do this. We'll have to do it later, I'll come back later. Because usually it's ADL care that you're maybe helping them get dressed or shower. Whether they're gonna eat something or not. First pick your battles, which are most important. And a softer approach talk to me before you try to get me to do something. I know sometimes that can be hard if you've got a schedule and this is the time slot that you have to help somebody with something. But unfortunately, they're not able to function on that. So if you start to approach and you're starting to get that pushback you need to step back in that moment and reapproach. Offer me choices, slow down and don't correct me and tell me not to do something. When the word no comes out of your mouth with a loved one with dementia you have lost the battle because therefore, I am that much stronger in my emotions 'cause I'm acting out of emotions that I wanna be in control.

- Great tips, Rochelle I hope that that helps you and your family. Phyllis has the next question. Phyllis asks, can you talk more about the quote talk to me get connected section?

- First of all, always approach your loved one from the front. And the reason I say this, you can startle me if you come in. We talked about those field divisions. That is hugely important for somebody living with dementia because if you started out and until you get in my face, I don't see you. You've startled that person. And remember my response time is slow so it takes me longer to come back down to where I can get over the fact that you startled and scared me. You and I can get over that and move on. Somebody living with dementia hangs onto feelings. So, always approach me from the front. Get down to their eye level. Eye contact lets that person know you're talking to them and move slightly to the side. And the reason I share that if you come in and like here I get right up close to my screen. That's not real comfortable, is it? I need you to get up mom. Whereas mom, I need you to get up. That's a totally different feeling and that is accomplished by moving slightly to the side. So it changes that interaction. Use fewer words and always use visual cues in the mid to later stages. It's time to take a bath. It's time to take a shower, time for a shower show me a towel, show me the soap. And I'll share a little trick with you that happened many years ago with a resident. She would get in the shower all ready to go and when they would go to put the soap on the washcloth just did not understand and kept going milk, what the heck? Liquid soap was milk because in her mind where she was traveling back in time you didn't have liquid soap, you had a bar of soap. So sometimes it's simply as simple as changing that environment. And we moved to a bar soap and that woman loved her showers. And we found out that there was a special kind that she liked all her life. We found it and used that and the showers were peaceful and enjoyable for her. And the staff was able to enjoy giving her a shower and getting her all freshed up with a nice smelling soap. So sometimes it can be little things. Also the order you put clothes on. None of you had when you got on this call today thought about what do you put on your shirt or your pants first. But with dementia, the order I put something on becomes important to me. And if you're trying to put my shirt on before my pants I may be going no. And you think it's, I don't wanna get dressed but it's, no. Don't you understand my pants go on first? We have to meet them where they are. And it takes a lot of patience and slowing down to watch for the triggers and cues and offering choices.

- Yeah, it takes patience but it also takes a little bit of knowledge and that's why you're here today, Susan. And it's simple things but it's from a perspective that is not intuitive to us. It is not something we know. And so, having someone like you here today to help us understand this is it's just fantastic. It's news you can use and we really appreciate this. This is excellent information. Great question by the way. Patty wants to know if you suspect someone has dementia or Alzheimer's and they refuse to get tested. What can you do?

- That is always a struggle. Well, first of all, how important is it for that person to get that diagnosis? And it can be done through a regular physician. Don't have the argument and if somebody is in denial of having the disease you telling me I have it it is actually gonna alienate you from me. We go to doctors for all kinds of things regular checkups and different things. And you can let the physician know that this is a possibility and you as a family member. If a person has a regular physician that you've seen these signs and that you're concerned about them. When you use the word dementia, Alzheimer's it is a very, very scary word to all of us on this call but to the person living with it, it is horrifying. I may be fully aware of those things but until it's diagnosed, I feel like I'm okay and you're gonna treat me the same. So getting me to the doctor but not talking prior to going what we're gonna do and that it's going to be looked at. I've noticed these things, what do you think is going on? Because it could be other things too. Other things cause temporary cognitive loss. Mini strokes do, am I sick and just not recovering quickly? So, that's the approach to take to somebody that has hit that wall. It is not easy but you are not going to fix somebody's brain by reasoning with them. We really need to get this checked out, no I don't. And I'll also share people living with dementia many times when they get to the doctor's office it's like that brain clicks on and everything's firing which makes it hard. I don't have a one set answer for that question but it's getting to any physician and then referred for something else and avoiding the word until you have it definitively. But I will also share people that are aware of their diagnosis when possible, once it's done, actually function better. Because what happens is the things that happen where people with dementia become very paranoid. You might come home and from the grocery store and put the gallon of milk in there and you've left your keys in the refrigerator and the next morning you find them in there. Well, is that dementia or not or why I do that? But you can reason out you have the gallon of milk and your keys in the same hand and that's how it happens. You can come up with something reasonable but if you got up the next morning and you found your shoes in your refrigerator. Oh my gosh, somebody has been in my house. Who came in my house while I was asleep? I didn't hear anything. The dog didn't bark and put shoes in the refrigerator and now I'm paranoid. So but if I know I have dementia in the moment of clarity where I noticed the shoes are in the refrigerator I know that's what happened. And I don't have to have that panic attack because in my moments of clarity, I can reason it out. And when the dementia has kicked in I really don't care that the shoes are in the refrigerator or I may just take them out and not think anything about it. So, that's kind of where that importance comes through.

- Yeah, well, we are coming closer to the top of the hour and I'm just going to tell everybody watching we have so many more questions and we're not going anywhere until these are all answered. This is why we're here today. We will go over as long as we need to go over in order to get all of your questions answered. Keep them coming, next question comes from Marie. How do hallucinations relate to dementia?

- Well, Lewy bodies dementia is a dementia that has many, many hallucinations. And that's the one that has the most. All dementias have hallucinations and delusions. And it's an inability to process my environment. I've many times heard residents tell me that there was somebody looking in their window at night and they live on the third floor. Well, there wasn't somebody looking in the window at night but it's my own reflection. But as my brain dies and I can't process things appropriately I no longer understand what a reflection is. So at night, when the light's off sometimes in a window, you can see your own reflection. Also, if I've traveled back in time and I think I'm 20, which happens. That's one of those little pluses about being the person living with dementia. You get to be in your twenties again. But if I think I'm 20 and there's an 80-year-old reflection coming back at me I don't know who that is. Same with telling you there's a man in their bathroom and those type things. So those are more delusions but also hallucinations can be happy thoughts and unhappy thoughts. It can be just a memory that's becoming real to me. Many times, women see little girls and little children out playing. I can't tell you why they happen but I can tell you that it's very important that you live in my hallucination or my delusion. If I think somebody's breaking in my house our response is not, oh no, there's not. Because how would you feel if you'd gone out left your home and you came back and there shouldn't be anybody in the house and you open your door and you can hear somebody upstairs. And I happened to be with you. We don't know each other real well. And I say, "Oh no, I don't hear anything." Do you all the sudden feel safe? No, you still hear something upstairs and you need to call the police. So we don't need to actually have to necessarily always call the police. But we do have to agree with them, oh my gosh! There is somebody, let's get outta here. And then when somebody with those delusions you leave and you go do something else and then you back rather than trying to fix it. Go upstairs and show that there's not anybody there because now I'm in full fledged panic and people with dementia take a long time to calm back down. So you want to live within whatever that hallucination or delusion is. The other thing that happens quite often with this is they'll accuse you of stealing things. Most of the time I've hidden it from myself. Maybe you'll find that item, maybe you won't but a big one is like glasses. I can't see without my glasses. So when I take them off they always go right on my nightstand and the alarm goes off and my glasses go on, it's simultaneously. But if I've got dementia I may walk into my bathroom in the middle of the night take my glasses off, set them on the bathroom counter. I get up in the morning, they're not there. Somebody stole my glasses because my old routine would never to be leave my glasses in the bathroom. So that becomes that delusion of somebody. Now I've made up the story that somebody's come in my house. So what happens is I make up things to make them reality make sense to me. Such as somebody moved my glasses. Somebody put those shoes in that refrigerator. I hope that answered your question on it.

- It gave me more to think about. I'm sure it did to others listening. I feel like all of these questions are helping me to learn more and I know they're helping others to understand this disease a little bit better and how we can help our loved ones. Gerald had to go through this with his wife. And he said, it's not a question he has but something he wanted to share that on their refrigerator, during the time that his wife was dealing with Alzheimer's there was a little magnet that said, "I know what I want to say "but I can't find the words." And I know that that's something that you mentioned. Yeah, so let's get to the next question here. Thank you for sharing that, Gerald, very much and thank you for joining us by the way. Anonymous sent this question. My 98-year-old mother lives with me. She gets agitated during sundowning and often wants to call her husband, mother, et cetera. All these people long deceased. She says, I try to change the subject or tell her that they aren't home or can't get to the phone. But at one point I told her they were in heaven since she was insistent. Any other things that I can say to her?

- Okay, those are always tough and it makes it tough for you because it pulls at your own heart strings. So I wanna identify that we understand how or I understand how tough that is. Start talking when she's wanting to call her husband. You're wanting to call dad? Yeah, I haven't talked to him for a long time either. I remember one time when dad did dah, dah. Start talking about the individual because when I'm looking for somebody I'm missing I have an emotional need and you may not be able to fill whatever that emotional need that that person would fill. But many times, sitting down with me and talking about that person and then lead to another story. So whoever it is they're wanting to call is they're missing that person. That's a great time to fill out a photo album because that stage of dementia you can redirect if you validate first. Just starting to, well, dad's busy, he's at work. Well, no, he's not. He'd be home, something's wrong. Why do you think he's still at work? He would never be late. The things that can happen and backfire when you tell somebody well, they're at work or they're doing this. Many times people have a hard time with dementia going to bed at night. And if you tell somebody well, their husband's working late well, what do you mean he's working late? It's 10 o'clock at night. He must be out doing something else. And those stories can turn on you and then you've got another whole set of problems and concerns. Not implying that's the situation with you but sometimes the stories we tell they're broken brains fill in the blanks and they can fill in blanks in ways don't want them filled in. So telling a story about that person or tell me about when you first met dad or you first met this person or your first date or something that you know a story that she's always told or shared would be a perfect way to go back into that.

- Awesome answer, Rochelle is next. My mother, 95 sometimes just sits in a room, no TV not doing anything just sitting. One, is this normal? And she says she would like to get a recording of this to send to her sister as well. How do we do that?

- It's not unusual the lack of TV. TV becomes very hard to follow, stories and plots. So earlier stages of dementia 30-minute sitcoms and old ones that you can relate to back to that time period. Listening to some music, finding some music and things that she used to like. Picture books can be very enjoyable for something that if you're wanting her to do something. But it is not unusual for people in the later stages of dementia to just kind of not end catnap. But if she were didn't have dementia she may still take those catnaps but you might not recognize them. So sitting quietly is not unusual. If she engages with you whatever level she engages with you when you enter her room or spend time with her, that's okay. If she's happy there and happy doesn't mean that I'm smiling all the time but I'm able to respond to you in kind when you come into my room that I'm not frustrated with where my world is and their worlds do get very small and very simple.

- Helaine with the next question. My parents, 87 and 90 live out of state and my dad 90 is showing signs of dementia although his PCP calls it age-related memory loss. She says, my mom is having a hard time with his repetitive questions. And I would like to coach her. He has lost interest in all of his hobbies. He sleeps a lot, still drives not as talkative as he used to be but he's always looking for words from her mom. She says, "I'm concerned that this is progressing "and I don't know how to help. "Since the pandemic, I have not been able to visit them." Now that's a big one because that just adds a whole other monkey wrench into this issue that our loved ones could be having. So what can she do? What is some advice you can give her?

- So well, the repetitive questions. Repetitive questions are very common. And I will share that what happens is, I'm gonna ask you well, what are we having for lunch? What are we gonna have for lunch today? And you tell them. What are we having for lunch? People living with dementia actually don't remember asking the question. It's not that they're not remembering the answer. They don't remember asking the question and what that repetitive question what are we having for lunch? What I'm really telling you is I'm hungry. But with dementia I can't put it together enough that I should get up and go get myself something. Or do we have anything to drink? Do we have anything to drink means I can't make a decision but I know I'm thirsty so you need to get me something to drink not yeah, we've got this. Because I can't sequence through and complete a task or I have an emotional need. Things like when are we gonna do this? When are we gonna do that? Or I wanna go over here, I wanna go upstairs. I wanna do that. I wanna go upstairs may mean I need to go take a nap. I wanna go lay down and take a nap but I don't have the language to actually express what it is I need. So you have to be kind of a detective and figure it out. Also, it's very hard to answer the same question 15 times in an hour because we're human. And sometimes when you're caring for somebody with dementia it's almost as if you have to be superhuman. Because even if you understand and take this information to heart that they don't remember asking the question. The 10th time you've answered something your tone of voice is gonna go up a little bit. We're having grilled cheese sandwiches. Now you can't help that, that is your human nature. So their response sometimes back to you can be simple things like, well, what are you so mad about? I just ask what we were having for lunch because you're sharp tone didn't meet the requirement of me only asking you once. I didn't ask you 10 times in my mind and also haven't had my need met. I'm hungry, I'm tired. I need something to eat, I'm thirsty. I may not be watching TV because I can't figure the remote out anymore and I don't want you to know I can't figure out the remote. Things withdraw sometimes can mean I can't figure out how to do things. And that goes back to that question earlier in the room watching TV. If you put on certain shows she might wanna watch those as well but and then turn it back off so that it doesn't become irritating.

- Phyllis wants to know how important is it to have a clinical diagnosis of dementia?

- Well, you do want to have physician following you and the different diagnosis 'cause there are, I'm not gonna get into medications. There are some medications that work best with different things. There's diabetic dementia that people don't realize and where the blood sugars are affecting the brain. So those are the kinds of things and how it's affecting you other than just the brain loss and the other parts and functioning of the body. How am I processing information? And that's where that can be a good idea to have the diagnosis but having a diagnosis is not gonna fix the problem. There's not a fix for this, unfortunately.

- Sure, Loraine asks, how do you decide on the correct level of care when some days my mom is great and other days she has dementia when you don't want to limit their freedom?

- That can be tough. The things that you have to weigh is firstly, I don't know whether your mom's aware of her dementia or not. Good days and bad days, every dementia has them but the good days are never as good as the good day before and the bad days are always a little bit further. What I would question here is where her safety lines. How aware is she safe to things? Is she still driving? Because that's probably not a good thing because it's not necessarily good days and bad days. It's good moments and bad moments. And as you progress, the time periods that are good get shorter and shorter. You don't wanna restrict them but you want to enable them to do things and I think that was where you were getting at. So setting up things to do together or with friends if she's still doing things with friends are the friends aware of what's the diagnosis in doing things? You have to weigh the safety as opposed to what you think and finding how do you change things that she's doing? Maybe she's still driving to the grocery store so that you make that event you do together if that's possible in your schedule. Or would she have more freedom if she's not in her home in an independent type living or an assisted living where she had friends and those safety things are kind of have oversight on 'em? So that's a way that lots of people can live far more independent with safety oversight than they can in their own homes. So that may be a possibility. It is tough decision, I know that's a tough decision but that does allow that there's somebody taking them to the grocery store their meals are prepared. They're getting their hair done all the things that freedoms that people still want but they can be done safely with some oversight.

- And I wanna go back to the question before and that was about the clinical diagnosis of dementia. And is that important? Because somebody else asked, and this comes from Margaret is it necessary to have a diagnosis to get services for insurance reasons?

- Overall, yes.

- Yeah.

- Yeah, for the reimbursement on things yes. And that's where a good gerontologist is gonna understand that and understand the need and work with you for what you need to keep that person safe.

- Yeah, we hope that that helps answer your question. The next one comes from Sarah. My sister needs a power of attorney and medical care and is reluctant to give it to anyone. What is your advice in a situation like that if you can provide any?

- So, well, you can go get one at the same time. We're gonna do this. Your sister needs to get one for somebody. You want one over your sister. So maybe you work something out that you're doing this and you're giving it to this person she's giving it to that person so that it's not being pointed out that just she needs this. That's one thing that could happen. Being able to reason with somebody is very difficult. The longer you wait the harder that's gonna be to have accomplished. And again, you don't wanna wait till they're incapacitated to do it because you don't wanna have to bring the legal system into if you don't have to, into what you're doing to get power of attorney over health. Have a discussion. It's a whole bunch of people's discussion. It's not just focused on you have to have this. I need to go this, can we all do this together? Maybe it's three people in the family doesn't hurt anybody else to have them either. So I don't feel singled out that there's something wrong with me that I need to have this done. That might work, it might not. That's always a struggling point. And for anybody else that's still listening go do that now. For your own children, if you have adult children and you're on this call because you're taking care of your parents or loved one go do those things now while you can have that conversation. It's also nice if you can ahead of time know what some of their wishes are too.

- Absolutely, we've got about five questions left. This goes back to David who has earlier questions about his wife. He wants to know will dementia shorten her life span? And that's I guess a general overall question for anybody watching as well.

- Usually people live eight to 10 years after being diagnosed. And remember, it takes a while to get diagnosed as well. It doesn't shorten it per se. Other than, as it progresses, there are many things. Your body doesn't fight off disease as much. One of the things that people don't think about is your thermostat no longer works in your brain that tells you you have a fever. And that's why lots of times other infections can cause that. Dementia does eventually take you down to where your brain no longer tells you to breathe or for your heart to beat at the last stages of dementia. So it does in that matter, it can but usually, something else happens before that to be completely honest. It's usually an infection or a cold or those type things that can happen and just normal aging on top of it too. People with dementia have normal aging where your heart gives out if you already have a heart condition or different things.

- Excellent answer, Debbie, with the next question. And she says, her father has what we call Looney tunes. They're strange episodes and she says there's a pattern to this. Usually happens once a month or two months. He is normally present but on occasion, she says that they start to notice he'll start talking about his dead mother, father, aunts and thinks he has to go to work and can drive. You had a backstroke, he's wheelchair bound so he can't do those things. And there no reasoning with him that he wants his keys. And she says that when he gets like this he's up all night nobody gets any sleep. And this lasts about a day and a half or two. Then he sleeps for a whole day and night wakes up and is back to normal. She says it happens all the time, is this normal?

- It is not a normal does not sound like a normal pattern for dementia. Again, I'm not a clinician but that does not sound like dementia with the timeframe that's in between. It does sound like maybe there's something more vascular going on from the... I mean, I can't diagnose some strokes but if it were my loved one I would take them back to the neurologist and see if some small strokes or something. Again, I'm not a clinician so I can't really tell you what to do on that. But if it were my loved one that is what that sounds more like just from years of working in the environment and working with seniors. That does not sound like a dementia behavior to me.

- So on that end, when we talk about good days and bad days there's still a consistency though when we're talking about dementia, correct?

- Correct because people still get their good days and bad days but it doesn't drastically change.

- [Melissa] Okay.

- With somebody, now, you can have delirium which causes that and that can be from urinary. When you see drastic changes in behavior. If somebody is dehydrated, a urinary tract infection those are things that we often see where there's this change or little strokes where we need medical intervention to do that. With somebody with dementia sometimes it's hard to see until it gets really bad because the behavior totally changes.

- Excellent, Pam, she is next with her question. My 85-year-old mom sometimes seems to have a blank stare on her face when engaging with friends and family. Is this just part of the dementia process or is it part of aging?

- It can be both depending on do I hearing loss? Do I have some vision loss that's causing that little bit of different interaction? But it can also be some dementia where I don't quite fit in so I kind of become withdrawn and not as engaged with what's going on because I can't follow it. But I wanna be here, I wanna be around you but I don't want you to know that I can't follow the story that you're telling. What you may see signs of it is dementia is I'm kind of laughing inappropriate maybe. You'll say something and I just kind of laugh it off. That's actually a sign of somebody with some early stages of dementia. I'm just laughing it off 'cause everything's funny. Don't you remember his name? And then they make up names for people or they just respond with something in jest instead of when it's not appropriate to answer in jest. I'll just withdrawn.

- Thank you, Susan. Patricia is next, wonderful webinar and helpful answers to questions. I totally agree, great job. She says she appreciates your advice that you may have for her on sundowning behavior. And will try a different approach with her mother when she asks for deceased relatives. So what advice can you give her?

- Well, I'm not sure. Sundowning is actually of tired brain. What happens is as you age, you need more sleep but you don't sleep longer periods of time. Even with normal aging, you don't sleep as long at night but you're more apt to take naps or your sleep gets disrupted. You end up to go to the bathroom and different things. People living with dementia still have that same but my brain is tired. It's just like all of us. If you're really tired, you don't function you're not on top of your game. But with dementia, it's even more so and that's where the frustration. And the sundown because the lighting is down so that kind of changes the chemical response to things. But it's also a tired brain. People can have sundown syndrome first thing in the morning because I didn't sleep. So, allowing me to nap. I will share and I don't know whether you're doing this or not but lots of times, people will do this. They will try to keep people up and awake and stimulated during the day so they don't take a nap so they will sleep at night. It does not work because it's a loss of sleep pattern. If I need to sleep I need to sleep because my brain is really struggling to function on the best ability that it has left to function on and it needs more sleep. A dying brain needs more sleep. So allowing me to have more sleep so the important things and the things you want me to do need to be done when I've had the most rest and leave the other things that aren't so important and don't need to be done at that time. If meds have to be done at six o'clock get the doctor to change the meds to a morning med something so that it fits into that schedule of when you can get compliance for when you need to help them with something.

- Great information, Susan really just really good stuff. Just a couple more questions and then we are going to wrap this up for the day. Russell's question, picking up on the safety question. He says, "My mom insist she live in her house "and is resistant to moving to assisted living. "Living alone is not safe for her. "Any suggestions, at what point do we consider "naming one of us a guardian?" Probably now, right?

- Yes, now's a good time to have those important things. I'm gonna share with you though because if legal guardians is the way you need to go with your family, that's fine. But that does not change her attitude because you were her guardian does not make her want to go live in an assisted living. That means you can force it. So what you wanna do is depending on where she is and if she's just not safe and she has dementia find that moment of clarity. That moment when she's had enough sleep and things are going on and be honest with people. Mom, I know you wanna stay in your home and I understand that. And what I really want for you is to be able to stay in your home but it's no longer safe. I know you don't agree with me, validate her feelings. I understand you don't agree with me but this is the way it has to be. I have found this place and this place and we're gonna go look at them and you can decide which one you think is the best. It's again, back to that there's still some choice in what she's doing because you're gonna go do all that stuff before you place somebody anyway and look at different places. So being honest but not honest days ahead of time. You don't wanna linger. Like once you've made the decision this is what we're gonna do. Do your research, do your homework and then do it. Don't allow her time to stew and work over it because the transition is just gonna be that much longer and that much harder because she's gotten that angst and that anger, she's gonna be angry with you. And unfortunately, there's no magic to make somebody do something they don't want to do. But being honest, it usually ends up with the best results. Also find out before you make any transitions and this is anybody find out what's important in home to them. I always say, you even yourself if you had to move today and you could only have three items out of your home what would those three items be? And you'll be surprised because it may not be the things that you want or you think they would want. It may be that picture that's hanging in the downstairs bathroom behind the door that has wonderful memories to her that y'all don't know anything about. Giving that control of what you take. I don't have to have a brand new chair to move into an assisted living. Maybe letting me take my chair that I fit in just perfect and it allows me. Those are the things that can help that transition and those are some of the conversations. But it doesn't have to be start with a conversation about mom, what do you want? That can be a combination with the third person that's in the room with you. If you moved, what would be the three things you wanted out of your house? Engage them as a group not making somebody feel isolated and attacked and then build into those. That's a good way, a segue into that conversation.

- Good advice, Russell, we hope that that helps. Samuel asks, what's the best way to wake a person without startling them? I love that question, I think it's an excellent question.

- And it's a perfect question because that happens quite often. You wanna make sure that you are not in arms reach of their arms or they're able to kick you. If I am asleep in my bed you want to come to the end of the bed, call my name maybe I light a soft light on in a different area and you want to rub my knee that's a pressure point, good morning. Remember, do you jump out of bed when that alarm goes off? Probably not, some of you may but most of you probably don't. Pausing and allowing me time to wake up, good morning then you can move forward. Same thing, if I'm asleep in a chair you want to come up, call my name, if I don't respond then come up and again, get down to eye level off to the side so if their leg kicks out you don't get kicked or punched arm sleeves. And again, start with the knee. Lots of times what people do is start around your face and people startle this way. So if you just start with rubbing the knee it helps somebody wake somebody up. It's actually a nice way to wake anybody up.

- Great answer, so the last question we have comes from, Susan. And she says, "Hello, my 85-year-old mother has me confused. "She has some cognitive impairment "and still lives independently. Since COVID, her memory issues "and mood swings have heightened. "At times though, she says, I feel like my mother "is totally aware enough so even maybe to be manipulative. "She doesn't want to see or talk with a professional. "She keeps telling me that she will let me know "when she needs assistance, so in other words, back off. "Any suggestions or tips with how to address "or deal with this?"

- Well, again, this is that stage and we have seen people, especially living alone. It's hard through COVID because they haven't had the visitation or even the socialization with their neighbors probably especially living independent. So you want that oversight but again, it goes back again to having those conversations but not having the conversation of you got to do this. Mom, I see this. I go to the doctor but for whatever you're going to the doctor for. It doesn't have to be to assess what's actually going on in the moment. And validate, I know you don't think you need assistance but I feel like you do and I'm really concerned. I don't tell it to tell you what to do. I'm just concerned and I don't know what to do with my feelings, mom. How can we come to some conclusion that this works for both of us? Giving back that control. I mean, think about how you would have had a conversation with your mom 10 years ago. What would have you said to her 20 years ago? Not, I'm coming in as the parent. It is just as hard for you to take that role as parent as it is for your parents let you become their parent. And when you become their friend not their boss how would you have that conversation with a friend not your mom? Probably a little more delicate and think through, plan what you're saying. And I'll conclude with any conversation that is really tough with a loved one living with dementia. If you take the time to write that loved one a letter about how you're feeling and what your concerns are. It helps you get your talking points together before you have those conversations without them being critical of that person. They need to feel love and compassion not being told what to do. And when your thoughts come from your heart it makes it easier to have that conversation and have the compliance but it has to be well thought out. So any tough conversations with somebody living with dementia write your thoughts down, have your talking points. And maybe you can share that letter with them or maybe it's something you just wrote for yourself but it helps you put your thoughts together.

- Gerald is sliding in, he's still at home base on this one. We have got on more question here and it's a good one. And if you are searching for a memory care community or a place for your loved one this is something that happens quite often. So he says, "My wife and I agreed she could get better care "at a memory care unit. "Upon arrival, the staff told me "I should not visit for three days "to allow her to get used to depending on them "rather than on me. "How wise was this?"

- That is very normal. And what happens is it's that transition to where we become the caregiver for your loved one. Now, it doesn't mean that you should have gotten the communication of how she's doing, reports how she's doing. Sometimes with some residents it does make that transition easier because they also feed off your emotions. And what happens, I'll share is one of the things that happens is every time you leave I become upset and I feel abandoned. But with dementia I kinda start to get on a roll and we can redirect and distract and get them involved in different things. They start to make friends that are their cognitive peers. This is one of the things that's so important really to all the stages of dementia living in an assisted living, a memory care neighborhood or we have a bridges that is that kind of resident that's kind of in between which is really great when there need more oversight but not quite memory care is being able to make my cognitive peer friends. Because I don't have to be on guard and aware of my deficits on my language skills and I can just be myself around other people that have the same level of dementia I do or maybe they have a little more dementia so I can feel superior, which is great for somebody living with dementia. I can feel like I'm on top of the pile. So those are wonderful ways that they can adjust to those changes. So yes, sometimes that's what family members are asked and sometimes they're not but it wasn't that it was necessarily bad advice. Each case is different but it also is tough as it is it's little easier for you to kind of ease into that transition and they're not having you come in and go in and leave and it just makes it easier. Not easier on you, easier on your loved one.

- Susan, i have to say, thank you so much. We've gone over 90 minutes. This is the longest webinar we've had but the questions came in hot and you did a fantastic job answering every single one of them, thank you so much.

- Well, thank you and I do hope we answered all the questions.

- We did, we got to all the questions today. Now, Susan, if someone has additional questions that they may have, is there a way that they can contact or reach out?

- So well, they can contact me through my email. It's srobbins R-O-B-B-I-N-S @arborcompany.com and company is spelled out.

- Susan Robbins, thank you for your time. As always, we appreciate you and we appreciate all of you joining us today to be a part of the conversation. And as always, everybody, have a great day.