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More Caregiver’s Guide to Advanced Alzheimer’s

More Caregivers Guide to Advanced Alzheimers

00:00:02 – 00:05:13

Welcome to fading memories, a podcast with advice, wisdom, and hope from caregivers who have lived the experience and survived to tell the tale. Think of us as your caregiver, best friend. Now you can join important Alzheimer’s disease research from home in minutes with picnic health. Go to picnic, health, dot com slash memories to sign up and get $25. What does picnic health? Well, picnic health collects and digitizes all of your medical records into one online account. Then, you can consent to share anonymized data from your records with medical researchers. By examining this real world data from medical records, researchers can find answers that can’t be found in clinical trials. There is important information in each person’s unique healthcare journey, so share your story. If you care for someone with Alzheimer’s, you can sign up on their behalf and manage their medical records in a picnic health account. Learn more at picnic health dot com slash memories and get $25 when you sign up. Find the link in our show notes and on our website. Welcome back. This is part two of the busy caregiver’s guide to advanced Alzheimer’s. Today, doctor Jennifer stelter and I discuss specific challenges, ADLs and behaviors that most of us caregivers have faced in caring for our loved one. You will get specific advice on how to use her dementia connection model. So if you have not heard last week’s episode, then you definitely want to catch that one first and then come back to here. Back with us today is doctor Jennifer stetler. We were discussing last week her book, the busy caregivers guide to advanced Alzheimer’s disease and her dementia, connection model. And today we’re going to discuss how the model can be applied to different challenging situations, behaviors that we run across as caregivers, so thanks for joining us again, Jennifer. Absolutely. Thank you for having me. I appreciate it. You’re welcome. So I did a social media poll on basically all of the challenges that we face with showering, toileting, changing clothes. Let’s see what else. Eating all the things. Pretty much there was only I think toileting was the one that got the least votes, but it was still way up there. So I guess we should jump in because we have like all of them to discuss if we have time today. Absolutely. And so when we talk about ADL care, and so we can kind of rope in some of those challenges that you just named into ADL care, right? So how difficult it is to bathe them at times, how difficult sometimes is it for dressing, how to build sometimes is for feeding, right? The entirety is to look at this first, I always talk about why is this happening? Why is it more difficult during these things that you would think regularly come to an adult, right? And so just to recap from our first session, we talk about the dementia connection model, the first component is really the why, which is that theory of retro genesis that I bring into the framework of the model. And that theory was developed by doctor bara risberg and just briefly essentially his work has shown that individuals with dementia as they’re progressing through the disease and my book focuses mostly in moderate to late stage dementia, right? Is that those individuals are mimicking a developmental age of anywhere from 7 years old to four weeks old? And so it’s really important that we accept that that’s what’s going on with the people we’re caring for. Because a lot of times we have these high expectations, right? And older adults should be acting like an older adult, they can take care of all of these things. And we have these high expectations, then we set ourselves up for frustration and for failure because they’re not meeting those expectations because they thought that we don’t want to. They certainly would want to, they just can’t anymore. Their brain and brain functions have deteriorated to the point where it looks very similar to a young child’s brain. So just like a young child when they’re born as an infant, right? Their brain grows and it gets bigger and it gets healthier and it has more neural connections and all those things, right? Because they’re navigating life. And so in the same reverse, unfortunately when people dementia, it’s gets smaller, it deteriorates, right? It goes back to its rudimentary function, right? So with that said, it’s really important for us to accept that to say, there’s reasons why they can’t do these things anymore, and I’m sure that they would want to, but they can’t.

00:05:14 – 00:10:13

And as a caregiver, I’m willing to accept that. This is their new normal, right? Now, as we talk about the first episode let’s look at maybe the positive out of this is you get to know who they were as they get younger get to know who they were when they were 20 when they were 15 when they were 7. You get to know all of that, which is wonderful because you get to know that person as younger version. And let’s say you’re a caregiver like a family, a daughter or maybe your son, you didn’t know them at that age, obviously. And so the cool part is that you get to know them and it’s although they’re, of course, there’s this process that you’re losing that person you knew. Part of it is reframing it to say, how can I get to know the new person that I’m spending this time with? And celebrate who they were at that time when they were 20 when they were 15 when they were 7, right? It’s just a way to kind of reframe it in your mind. So when you’re dealing with the preview process, it settles it a bit more. And so one, it’s lowering the expectation of what we expect from the person we’re caring for, knowing that they aren’t capable of those things that they used to be able to do. But she would allow us to nurture some of that grieving process a little bit better through that theory of retro genesis. And so diving into ADL, I know last episode we did talk a little bit about bathing. And so the key here in the dimension connection model is repetition, right? So I talk about the three R’s, which is routine, which is that’s that repetition. Remind, which is sensory cues, we’re going to talk about here in a second and the third is the reward. So if you are consistently using sensory cues, the person you’re treating experiences the reward because they’re calm, cool, collected, and you yourself are feeling confident and successful because the person is responding to what you’re asking them to do. And so through that second component called habilitation, right, you’re going to use those three rs. That’s how do you implement the model, right? And then the third aspect, the actual intervention, which is sensory stimulation. And so you are going to be taking in or using different tools that will stimulate their senses in various ways through the biosensors. That will promote or influence positive feelings. Okay. Now you’re probably thinking, well, how do things that stimulate your sentences, promote positive feelings? How does that happen? So just really briefly when we ignite our senses, we are actually either directly or indirectly influencing our limbic system, okay? That’s how in our brain. And a very important organ in the limbic system is called the amygdala, which one of its major function is generating emotions. So depending on which you’re stimulating, you are basically influencing that amygdala to generate positive emotions if it’s a positive experience. What I mean by that is, let’s say you’re going to use auditory stimulation, you’re going to play music. You want to play the music that your loved one likes, not the music they don’t like, right? If you play the music they like, you’re gonna influence positive emotions. If it’s what they don’t like or has negative memories associated with it, then unfortunately they are going to act out negatively. So it could be you could work in your favor or it may not work in your favor. That’s why knowing their preferences are very important. Now, one key I want to know, we can talk about this in the first session. Is their preferences may change. Their preferences might be what they used to like to do or used to like to experience when they were younger. So what do I mean by that? Let’s talk about food really quick, right? So there’s been studies around this to say, sure, maybe mom dad had certain food types that as adults, but as they get younger, I would say that as they get a little younger towards their more developmental age, they actually might start liking sweets. Because children like sweets, right? So maybe they weren’t like a sweet person as an adult, but they more than like they’re going to move towards food that they like when they were children. And if it was sweets, then they’re going to want sweets, right? That’s the gustatory stimulation. So that’s just an example. So that’s really how the framework works between the three pillars, which is retro genesis and sensory stimulation. It’s the why, the how in the what, right? And what you’re going to do when you’re intervening. And so with babe, and we talked about last time, really, we talked about study of a structure way to stimulate their senses. So we talked about know when you’re going to provide the shower bath and when you have that experience every time you’re going to use a few things that will generate path of emotions by using different kinds of sensory stimulation tools.

00:10:13 – 00:15:14

So we talked about using aromatherapy. We talked about allowing the person to hold a loofah or sponge that’s your tactile stimulation. And of course Roman therapy is all factory simulation. We talk about maybe playing their favorite music, that’s auditory simulation. So just what those three approaches, if there was a positive response, which is that immediate response, and they are in a good mood and they’re going along with things, then you know that that success. So what you’re going to do is every time you bathe or shower them, you’re going to set this up the same way. Same aroma therapy. Same loofah sponge, holding it. Same music. Because over a period of time, about four to 6 weeks, they have the ability to learn through what’s called a learn positive response. That they associate this experience with you. Which really enhances that connection. They’re going to want to be more. They’re going to listen to you more during that. So on and so forth. And that’s why it’s called the dementia connection models to find a way to positively influence their mood, so they associate that with you. And that’s that whole concept of they may not remember your name. They may not remember who you are, but they remember how they feel with you. So I have a quick question on the music. Would you for showering maybe play a more calm peaceful spa type music not necessarily that specific style, but maybe not like their favorite pop rock and roll songs or whatever. It’s like, I know we’re talking about people in their 70s now, we’re talking about music from the 60s and the early 70s is really popular. So it’s hard for me to wrap my head around that sometimes because when I think of older adults, I don’t think of 60s and 70s because I was around them. So would you place like quieter music or just try different styles that they like that you are fairly confident they like to see which works better? I would try a different style that they like because although we associate going to the spot having this tranquil music that may not be their jam, right? So you can try it and see if that is very relaxing for them or you can try more upbeat music if that keeps them more alert and focused. So it’s really going to be a trial and error. In my book that is coming out here in October 19th, what’s great is a workbook style. So you can actually take notes of the I go through all various ADLs and behavioral expressions that are pretty common in the disease process. And I go through each sense and how you can implement tools associated with each sense. And then you’re going to take notes on what’s working and what’s not working. So by the time you’re done with the book, you have this full figuratively speaking toolbox tools you can use with your loved one and try to implement those consistently. So I asked about the music because I recently saw a video online of a woman with dementia. She was just rocking out to some AC/DC and I’m just thinking, you know, you might not want to choose highway to hell in the shower. But maybe what I actually kind of like upbeat music that’s because the morning you kind of want to get the blood flowing. So that’s definitely something to consider because at one point they switched my mom’s shower to the afternoon. My mom was positively not an afternoon showering person. If she had, you know, she was going to work on painting a bedroom or something. She got to three 34 o’clock in the afternoon. She might do a spongy kind of bath, just kind of clean up a little bit, and then just take care of it the next morning because at a certain point in the day, it’s like almost pointless and when they switched her back to the date of the morning, they had less resistance, but they didn’t try any of these methods that you talk about, which I think would be super helpful. I think they always felt rushed, I think we need a different model in our care homes so that we can make these connections and make life better for everybody. The caregivers, the person we’re caring for in the families and. I talk about too in the book to your point about the perfect day. And my business partner and I, Jessica Ryan, with my company neuro essence, we talk about the perfect day often. And it’s really a set up of what do you do in the morning what are you doing in the afternoon and what do you do early evening right before sundowning that incorporates some of these sensory tools and how you want to set up the day so that way the person with dementia is really set up for success just in how they’re circadian rhythm is going to be affected as a disease progresses.

00:15:14 – 00:20:05

So essentially, just to keep things. And this will help to one create an experience where they’re going to want to pay attention and focus more with you and the things you’re asking them to do. But two to mitigate some of those behavioral expressions that I talk about in the book, right? So there are sundowning, of course, potential depression, hallucinations, those kinds of things. So essentially, in the morning, I’m going to play off of three things. I’m going to play off of olfactory simulation, auditory stimulation, and then I’m going to talk about cognitive stimulation. So what we call our 6 sentence, right? So with that olfactory in the morning, you’ll want to diffuse like a peppermint and a citrus together. Both of those properties are known for helping with increased and focus and attention. And then that’s the peppermint. And then the citrus scent actually helps to improve mood. And so research has a backing with regards to how it works with your different neurotransmitters in your brain. And so that would be what you’d want to diffuse in the morning to get them started for the day. Now the citrus is going to be good too in the morning because citrus also we talked about this in the first episode, actually helps increase appetite. So we want to give them nice and full for the morning, right? So you want them to focus and pay attention in the morning course because of ADL care and then potential earning activities that you might have them engaged in and get their day started right. And then like I said, the citrus is gonna help to improve their mood and increase their appetite. From a music standpoint, there was research done at a Harvard University actually by a fellow named Josh Fritz, he wrote the book called the dementia concept. And so he talks a lot about music in the morning would be upping music with words. And the reason and upping music of their preference, of course, reason with words is because oftentimes when we hear music we like, we sing to it, right? So why this is great, of course it’ll help increase mood, but also it will help to get their verbal skills started for the day. We know the communication is a challenge and it will continue to be a challenge. This helps them practicing their words through very common sounds that they know because it’s a song they recognize and that they have liked for so long. So that’s the kind of music in the morning. And then in the activity that you want to do for cognitive simulation, would be anything that is more on the intent side. So if it’s physical activity, if it’s crossword puzzles, if it’s word searches, if it’s trivia, all that should be in the morning when they’re the most fresh. Now let’s transition to more of the afternoon around lunchtime. So the aroma that you want to diffuse then would just be lay a citrus blend because you want to continue to increase their appetite. You want to continue them to have improved mood, okay? The music that you’d want to play around lunch is upping music, no words, and because you want them to socialize. Their verbal skills have started in the morning, and you want them to now use their own words to socialize. So if you have words, they might unfortunately just mimic the song and not actually socialize with peers and things like that are family. And then the activity that you’d want to do at that time is we start to slow down a bit, right? So there might be some light stretching after lunch. There might be some relaxation after lunch. That might be the time that they go down for what I call rest period. I know, formally, people know it as naps. I like to call them rest periods to be more respectful. But they might go down for the rest period to rest their brain. And if you think about just side note, because we’re talking about how children function, right, because they’re going back to an earlier time in their life before the age of 7, most children before the age of 5 are a nap or nap schedules, right? And so just as important as for them to rest their brain, people with Alzheimer’s disease moderate to late stage is important that they rest their brain too. So I know oftentimes families are concerned why my mom sleep all the time or whatever it might be. It is important to look at why she might be sleeping because there could be other underlining issues, but there is a natural progression take more rest periods during the day than at night. So with that said, it’s okay that they do that after lunch, right? And so with that said that activity might be more relaxation, maybe some music after lunch that kind of thing, right? Then we get into right before sundowning. And I always say, you know, you’ll get to understand that time is at three isn’t four is at 5, about 30 minutes before.

00:20:06 – 00:25:01

We’re going to go through the three things again. With the aroma, you want to diffuse a lavender. That’s a very relaxing scent. And it’s something that is, of course, it’s been a scent used for centuries, but it really has just an overall calming experience to the body. It also has been shown to help improve mood and certain situations. So that’s good. Music. Okay. We want to start to go move into that more relaxing music. So think about music that’s more classical, but with one tone. So we call that non B hermit, which is like a flute plane, or a guitar or a piano. It doesn’t have all of these medical orchestra, because that’ll be too overstimulating, right? And then the more activity that you want to do is certainly something relaxing. So it could be a light massage. It could be reading, it could be if the area or at home you have a fish tank that they could look at or bird watching or something like that, right? Very relaxing because you want them to move into the sundowning hour, very relaxed and calm. And through the my experience with when working with patients, when I’ve done that is we’ve been able to minimize if not completely mitigate behavioral expressions during sundowning. So you get the immediate effect, right? You get to see your routine, what worked in those three did all three work for you in terms of mourning afternoon evening. And then you do this consistently on a daily basis. So you set yourself up with a routine, you’re saying them up or a routine. And really about four to 6 weeks, they will learn all of these things if you’re consistent and they will have this what we call learned positive response. And so with that said through this the three R’s routine remind reward, you will have really a way to rely on how our mom or dad are going to react. And they have a way to rely on you to know how you’re going to react. And that’s the win win. That makes sense. So you guys know, I’m not a coffee drinker, but man, do I need my tea? Unfortunately, too much tea and I get a real sour stomach. Thankfully, I found something that helps. It’s a drink that makes you way more productive and helps keep you focused on what you need to get done. It’s called magic mind, and it’s light on caffeine, which is real benefit for me. It’s created with all natural ingredients which is important for any of us interested in brain health. So what’s in magic mind? It’s got adaptogens that help decrease stress totally needed. Neotropics that boost blood flow and cognition and matcha that keeps you focused. The macho will help you crush your to do list while drinking less coffee or tea. I had never tried matcha before, and I’m really glad that I found it with magic mind. If you’re a tech geek then you’ll know that the creator of magic mine, James Bashar, he drank so much coffee, gave himself a heart issue. Looking to find a better alternative, James combined all these ingredients that help him stay productive and dominate the business world. Then he sweetened it up for the rest of us, which, you know, I like. The taste is better than I expected. You can take it all in one shot or in sips with your morning meal. That’s what I prefer. I’ve been using it to stay on task with our move and my podcast, which is seriously no easy feat. It’s helping me and I’m sure it’ll help you with all your caregiving responsibilities. Learn more or order your own at WWW dot magic mind dot CO slash fatty memories. Be sure to use the code fading memories 20 for a 20% discount. That’s magic mind dot CO slash fady memories. You can find the link in our show notes and on our website. It was that time of day between daylight and dark where there’s not a lot of contrast in the light. And so it’s very confusing. Is it also because they’re, you know, you got to get to the late afternoon and you’re starting to get a little tired, especially when your brain is working. So hard to just function. Do we know what triggers the sundowning behaviors? Is it both of those or neither? It’s both of those actually so it is because there is a confusion of day. So they don’t know their bodies getting tired, but they don’t know if it’s yet nighttime if their body should be tired. So it’s kind of like their brain and their body or not talking to each other. And one’s really tired and the other one is saying, no, wait, I’m still still stay up, right? So there’s that conflict. And that’s all I’ll have to do with circadian rhythm.

00:25:01 – 00:30:03

But the other is, of course, this how can you cope with the entire? As adults, you and I if we get tired, we know how to cope. We either will, maybe drink caffeine, you know? I would, of course, have some peppermint going for myself because that helps to kind of wake you up. Some people might go outside for a fresh air and kind of wake themselves up a little bit if they know that nighttime is still a bit of ways away. So as adults, we have a way to work through that. But unfortunately with people with dementia, they’re losing the ability to problem solve. And to anticipate what comes next. And that is all how is here in the frontal lobe, which unfortunately is one of the first areas amongst another area that is starting to deteriorate over time. And so they don’t know how to problem solve. So if I’m getting tired, I don’t know what to do. To fix that, how do I feel comfortable? So they rely on their caregiver to do that for them, right? The other thing, too, is they don’t know how to anticipate what comes next. So they say, okay, well, knight’s coming, but I’m tired. What’s supposed to come next? We all know that we’re going to lay down and go to bed at some point. They don’t know that, right? They don’t remember that anymore. So there’s that anxiety that starts to creep in. So it’s a combination of those things that are occurring is lack of coping skills, lack of problem solving, lack of napping and anticipate risks. They’re tired, what do they do? Now, the way I kind of picture it because we talked about this new world that they’re experiencing, right, which is anywhere from 7 years old to four weeks old. Developmentally. So think about this. Think about two year old who’s had no nap all day. It’s now 5 o’clock. What are we getting? Temper tantrums and screaming and yelling and sometimes hitting it’s very much mimics what person would dimension might experience during a sundowning, right? Now the key here is the interventions we’re talking about all have to be done respectfully. And with dignity. So by no means do we talk about, even though we’re talking about a way to conceptualize what’s going on with the person with dementia, we’re not saying treat them like children. That’s by no means is that what the models entail to do or what I talk about in the book and actually very much mentioned, this is not about treating your loved one like a child. It’s about understanding where they’re coming from. And then meeting them there, right? Which is basically their Anna developmental age that’s different. But there are things that we can implement, like I’m talking about with music and with aromas that are all adult like. But they do work very well with children as well. So yeah, so to your point, it could be several things that are occurring and why some then it happens. And not every person with Alzheimer’s disease sundowns, but it is very common. And it’s something that it’s not necessarily something that you want to say, okay, I want to fix it and we’ll go away forever. It’s not that it’s the case. It’s more, how can you minimize it as much as possible? And through this through my model, the dementia connection model, if you’re doing it routinely, you will be able to hopefully minimize it. Make sense about the disconnect between their brain and their body because my mom would sometimes ask me what time it is and I would tell her and she would say either, oh, is it that later? Oh, it’s that early. It was usually she always thought it was later in the day. And yeah. You know, I talk about the two year olds not having an app. I remember if my daughter didn’t have a nap when she was too. It was ugly. By a timer, I worked I had different days off than her dad. And so the two days that we were home together her and I and he was at work, he would come home from work and she’d just be like, here you could have an eye out here. Just like another time you’re making dinner, they’re having a complete meltdown because they haven’t taken a nap and it’s so it’s a really good analogy because we understand that one that’s helpful a lot. So and I talk about two in the book that the way to know if the person you’re caring for is on track with how much they should be sleeping during the day is kind of useless as a rule of thumb. When they’re in their early stages, they may or may not have naps or what I call rest periods. If they’re in their moderate stage, then they’re probably would have about one to two a day morning and afternoon. And if they’re in the later stages, they might have two plus, okay? So that’s normal. So let’s just say mom or dad is in the earlier stages and they’re sleeping all the time. Like there’s something else going on that you’d want to check with their primary physician with. Make sure they’re getting enough exercise and stimulation as well. Exactly. Because now, I know as I get further into the disease, it disrupts their sleep pattern because one of the things with my mom, she was a good sleeper until about the last of everything happened in the last year, which is not surprising.

00:30:05 – 00:35:05

But one of the caregivers would say, oh yeah, your mom gets up about two 33 o’clock and I was like, really? Her? Was just surprising. And she’s like, yeah, she’ll just sit with me and talk for a little while. And then I escorted her back to bed, so I know that’s really hard for family caregivers when their loved one lives with them because if you’re awake in the middle of the night or if they’re awake in the middle of the night, you’re awake and now your sleep is affected. So if they’re not sleeping through the night, should we try to limit the rest periods like later in the afternoon or is that just you know unfortunately what probably was going on mom is that it was mimicking more of an infantile sleep pattern. And so it is going to get to the point where they’re going to be up more during at night than it is during the day. Because that’s how infants sleep patterns are. It’s more sporadic, right? And they aren’t sure Wednesday night Wednesday. So yes, if they’re sleeping a lot during the day and it’s not indicative of their, you know, the stage that they’re in, then I would say, you know, talk with the physician about other underlying conditions to fix those so they aren’t seeking so much during the day and hopefully helping their sleep that night. But if they are into the late to final stages of the disease, they’re likely going to be more at night than during the day. And it’s one of those where caregivers then have to decide, you know, is this something I can continue to care for what was my loved one at home 24/7 or do I need assistance with this, right? If it’s getting too much. Because it is something where yes, those for those final year or those final few months can be very difficult. But again, let’s expectation wise when we have an when we just have a newborn baby, there’s filters you must. That first year is difficult and the caregiver is sleep deprived as well, right? So it’s a very similar fashion of what’s happening during those kind of late to final stages. So now I’ve never had anybody explain it like that, and I know there is many caregivers that literally lose their minds from lack of sleep and trying to solve that problem and it doesn’t sound like it’s 100% solvable. Right, right. I do have a sleep chapter in my book that talks about ways to enhance sleep with different types of stimulation. So one of those is you can use aromatherapy through the evening. What we’d recommend is that you diffuse all night and not just intermittent or not just for a certain number of hours and the great thing with the aromatherapy machines is once the water runs out they turn off. So it’s not really a fire hazard. So a diffuse through the whole night using lavenders would be the first one to first oil to try. Because of its relaxing properties. It actually has shown that it’s improved sleep in research and opponents of that is actually shown to promote balance physical balance. We know that falls are a biggie, especially when they get up in the morning. So this is actually has helped decrease falls in the morning. So with that said, I would try something like that. And there’s some other techniques in my book that you can look at. But yes, I would say it’s good to try but we also have to come to the realization of what’s really happening with mom or dad. And say, okay, this might just be the ultimate progression or the end of that progression. And then understand it that way. No, that’s really helpful, because I don’t think I was I knew that the progression affected their sleep, but I didn’t realize that’s something we should just expect that they will be up a lot more like a newborn. Which is horrifying. Although my daughter slept 5 hours at a stretch from birth to a month and then slept through the night at a month, so you guys can all hate on me. Which was good because at a month, when my daughter was literally a month old to the day, my mom, she hit a drunk driver that turned in front of her and she she hit her face so hard on the steering wheel that it damaged the nerve that comes right through your cheekbone, so her face on one side was always numb. And it shattered all of the blood vessels and capillaries in her eyes, so that was a very red Christmassy eye was very gross. But unfortunately, I don’t think that they never even did an MRI or I don’t think they did anything on her brain. And that was about two and a half two hours, two and a half. So like, yeah, about two and a half years before I think she started showing signs of Alzheimer’s. So I think that that did not help her brain at all. I couldn’t have done it any favors. But I don’t because she broke her ankle as well. They focused more on that because she was like 49, so it wasn’t like, I don’t think, you know, this was back in 1991.

00:35:05 – 00:40:04

It was like the old days. So let’s see. The one topic that I guess I don’t know, people wanted to hear about as much, but I think it’s important as toileting because I know that’s a challenge for lots of people and one of the topics that people don’t always want to talk about is toileting. It got the least amount of upvotes on the social media quiz about our conversation, but I know it’s something people struggle with. So before we talk about food, let’s just we’re just gonna go in the wrong order here. So how can we make toileting less of a nightmare? The lack of a better term. Absolutely. So a couple of things. And this is, again, when I’m recommending, obviously, at all ties into some form of sensory stimulation. So when we talk about, you know, we have to figure out what’s going on, why aren’t they necessarily going into the toilet, right? So a couple of things from an environmental perspective, this is where the visual stimulation comes in is it’s very hard for individuals with dementia as their eyes are changing and they are getting younger with their eyes, right? White is very blurry to them as it is very similarly to an infant infants can’t see white very well. And so but unfortunately, most of our toilets are pearly white, right? So manufacturers do make the toilet lids, seat itself. In contrasting color. So I would recommend some kind of bold color like a red or a green or a blue. I mean, obviously you want to try and match your aesthetics as fast as you can. But that’s going to really help drive the attention towards the toilet. So they know that’s where they need to go. Otherwise you’re going to have things like unfortunate accidents around the toilet or when they sit down. They might miss the toilet because they can’t really see it, those kinds of things. Or when they look into the bathroom, they don’t really see a toilet. It’s just all blurry, so therefore that’s not where I need to go to the other bathroom and as they’re searching, they might unfortunately have an accident or go someplace they shouldn’t, right? So that’s one thing we can do aesthetically. The other thing, too, is with aromatherapy. You can diffuse peppermint. I’m going into the bathroom itself. They’ll associate the scent, but also the biggest thing is that it does help with focus and attention. So that way they’re kind of staying in the moment while they’re going and whatnot. Now, this is the thing I know a lot of people say, like, my mom will say that she has to go to the bathroom, but she just went. I just took her. And then she just she has to go again. And so as silly as this sounds, I always say, well, associate some kind of sensory stimulating experience in the moment while she’s going to the bathroom. So for example, while she’s going to the bathroom, you might say to her mom, can you hold the toilet paper? And so, you know, the feeling of tactile stimulation, her hand, she’s feeling the toilet paper. And she knows that toilet paper is associated with going to the bathroom because she’s been using toilet paper for 60, 65, 70 years, right? So it’s not only of course the auditory simulation of hearing toilet paper associated with bathing or by the bathroom excuse me. Or tactile simulation, which we talk about in the first episode, what’s important about that is a process called neural plasticity is occurring in the brain and a side benefit to neuroplasticity is that it increases focus and attention. So the more they pay attention to the experience, they’re going to remember that it’s going on, right? So that’s different ways that you can kind of associate that she just went to the bathroom or when the toilet is flushing and you could say, oh mom, isn’t that a silly sound of the toilet flushing? So we’re using the word toilet, flushing all words associated that she’s been using with the going to the bathroom for a year, right? So try that and see if that helps or her remembering that she just went to the bathroom. But other things that you can do to toilet and schedules and maybe that is trying to encourage that person to go to the bathroom. Anywhere from every one to two hours can help decrease accidents. Because they’re, again, not thinking that they need to go. They’re not remembering. And unfortunately, over time, there’s a signal in our brain that initiates the ability to tell us we have to go. That will eliminate over time. And then they will unfortunately becoming continent. And that is the same process in reverse that infants go through. It infants when they’re born, don’t have the signal. And in about a year to two years, they start to have the signal and that’s when you start to see them run behind the furniture and they act like they gotta go. They go in their diaper, right? That is that signals forming.

00:40:05 – 00:45:06

So, of course, we tell everything in reverse, it’s going away for people with dementia. So with respect to that, doing the toilet and schedule, everyone to two hours and encouraging them to go can help prevent some accidents. And then again, trying to have them remember that they just went is using a some of the strategies I just talked about before. I wonder if the contrasting toilet seat would have helped my mom because one day, as we were leaving, she announced she had to use the bathroom. And when she got in, fortunately, when they remodeled the community, the tile was not white in the bathroom. And it was actually quite it had enough contrast that the toilet probably did stand out. Think about that one a little more. But she sat down on the toilet so if the toilet is facing north south, she basically sat on an east west, which of course, if you’ve ever tried that, very uncomfortable. So she sat down and it was not at all what she was expecting, and then she stood up with her pants on our ankles. It was just like, yikes. You know, and I’m thinking, you know, so then I’m trying to get her to move around to the front, but not trip over. He was not fun. And of course she got irritated because, as she sat down, it was uncomfortable. So that was a negative experience. And then I’m trying to move her before her because now our clothes are down and I know with me, it’s like blows off bladder is ready to do its thing. And so I didn’t want her to do that on her clothes on the floor at all. It was just like, yikes. And I wonder if a black toilet seat wouldn’t be the most hideous thing in the world to look at, you know? Why not be your aesthetic, but it’d be better than cleaning up potty mess all the time. Yeah. I would steer clear of black only because really anything above the knees that’s black is just disinteresting to them. They don’t really focus on it or pay attention to it. So it may not be the best if you’re trying to grab their attention towards it. And then anything that’s below the knees, that’s black can actually be very scary. They kind of see it as a whole. And so they might avoid it actually. So we’re not trying to avoid the toilet. We want them to get out of the toilet. Avoid the black seat, but yeah. I forgot about that, but the black, there was a gentleman that one of the caregivers, it was her dad when they bought him this really comfortable black leather recliner and he loved it, but as he progressed within his disease he started avoiding the chair and I remember having that conversation now and I’m like, oh yeah, you probably thought it was like this big gaping hole. So no black, apparently I forgot that already. So shall we touch on we’ve done everything except eating, correct? Have we missed any? Does it know we talked about it? Yeah, we didn’t eat a little bit in the first session, but I can certainly recap too. Yeah. So yeah, absolutely. So with eating again, we want to think about routine. And so the way that you set up the eating experience, the way that the meal goes and how you end the experience should all be just about the same for breakfast lunch and dinner. So you want to think about that first because the more consistency you have, there are going to go along with what you want them to do because it’s safe. It’s known. They learn it over time through the use of their senses. So a couple of things that you can do. I know we touched upon aromatherapy. I would definitely recommend citruses, any citrus, then it could be lemon. It could be orange. Because of the empirical evidence that we found around increasing appetite and improving mood. I mean, nothing’s better as a recipe for happy hungry patients, right? I mean, that’s great. Remember your load one with dementia. So I would definitely recommend that for aromatherapy. For a music, again, I would follow the schedule of the perfect date that I talked about for what you should play for breakfast lunch and dinner. That way it helps to facilitate the verbal process and also for the evening and for dinner you’re having more of a calming experience. For the setup, now if you are working in senior living, you’ll know to me my best is oftentimes dining rooms or multi purpose. And so you want to make sure that when you’re setting up for the dining process, it looks like a dining area. Meaning that there’s table with chairs around it. And if you already have the place where and all that kind of stuff, set up you want to use that. If you’re at home, what you can do is have your loved one help set up with you if that’s a normal routine that they can still do. You want to encourage as much as they can still do, even if it’s a minimal amount because the more you reinforce those skills, which I talk about in the second framework, which is called habilitation. The more you reinforce those skills and you provide praise and the associate a really positive emotion with that, then they’re going to want to keep helping you.

00:45:07 – 00:50:19

And that keeps that skill alive. But so setting up that way. Now in terms of plate wear, go and kind of going back on colors, you definitely want to use bold plate wear, either bright red, bright yellow, bright orange. Now, what’s been shown in research is they tested both red and yellow plates and they found that red makes you more hungry and yellow sustains your attention. Now that’s not specific to that study. They were looking at the plate where specifically. But let’s think about the red and yellow colors. I mean, isn’t McDonald’s a $1 billion business? Someone knew about that, right? So with that said, you know, you can use the plate where based on. So we typically those residents who are more so losing lots of weight I recommend the red plate. And for those who are at a healthy weight, maybe use the yellow plate to sustain their attention. When I did a small focus group with residents that I was treating in long-term in long-term care, I mean, the results were phenomenal. I mean, we were able to increase weight percentages. We were able to get a lot of the residents off of supplements. So it saved the family money, right? I mean, it was just unbelievable what we saw by just introducing bold flavor. I remember this woman. It was the very first day of the pilot. And this touches me so much. This woman, she never really gave breakfast in her younger years, but as a disease onset, and she stopped being breakfast. She was losing weight. Those kinds of things. We had the family there, some of the family members were there when we introduced this. And we served her cereal in a red plated bowl. And the daughter was like, you know, you can try and she hasn’t eaten breakfast in a couple of years now since she was diagnosed and whatnot. Okay, let’s just try it. So she literally took the bowl and didn’t remember how to use the spoon anymore, but she took the ball and literally drank the whole cereal till it was gone. And I remember looking at the daughter and her and I had tears of joy. We could not believe that she went for the ball. She ate the whole thing. She had a smile on her face. It was the most beautiful thing that I’ve seen really and that she’s obviously seen her mom like this. It just was unbelievable. And so we were able to get her weight up to a healthier weight. She was having a better quality of life and things like that. So I can’t say enough about how bold work can be a huge impact only if you just do anything bold plate where for the dining experience would be great. And we think about this the framework of the dimension connection model and talking about retro genesis. Everything’s going back to an earlier age, right is, I mean, go into any child store bye bye baby, I don’t think babies are in business anymore, but you know what I mean? Go to the feeding section. And what do they have there? Everything is bold colors. Bold plates bold, flatware, you know, everything is bold colors to draw the attention of the child to keep them sustained. So feeding is exciting for them, right? So we’ve got to have that same mentality with individuals who have dementias. How can we keep this exciting for them? And entice to want to eat. So that’s what those are some tips and tricks on. There’s a feeding section in my book as well. So my mom’s memory care used red plates, and I’m seriously racking my brain. And I may have to actually look through pictures. I don’t think they used red plates in the assisted living area. I would take my mom there for lunch. A couple I did that closer to the end of her life because it was easier to take her out. But in the community, we’d get in the car and drive around the building and get out. And so it was a production, but it was a good one and they understood either was like backup. It was much better than going to a restaurant. So that was helpful. But now I’m like, staring at me bananas to think about, I don’t think they had red plates in the assisted living because they wouldn’t need them. And I need to get new plates, so I will not be getting red because I do not need to stimulate my appetite. I think blue is the kind of like, well, cyan is the opposite of red. So for some cyan plates or something. Just for the color. Cyan is about sky blue for those people who are not photographers or artists like myself. So is there any last tips other than by the time this these two episodes come out the book is already out? I got an advanced copy. It was awesome. Thank you. You’re linked in the show notes. Does any last tips for anybody before we head off into the rest of our days? I would just say, you know, part of it is stepping into their world and what that means is understanding and accepting that they are living a more younger life than what we would imagine and to be able to lower expectations that this is the new person and they’re still themselves inside.

00:50:20 – 00:55:05

It’s just you’re seeing a younger version of them. And so celebrate that through this grieving process as much as you can. But through this, it’s understanding that you need to have consistency and routine with what you do. So the person feels safe and secure with you. And always remember to stimulate their senses and positive ways to influence positive feelings. And then they’re going to associate those with you. And I understand this is not always that easy. It’s not always one plus one equals two in this world. We’re dealing with humans here, right? And we know humans are unpredictable, but the biggest thing to know is that one is continue to care for yourself as the caregiver. Because if your cup is not full, you can not give any more. And so it is really important that you work in self care as much as possible. Even if it’s a few minutes a day, you will make a huge difference in your tolerance of being able to really connect to the person you’re caring for. And I do have a section in the book and self care, and then bonus chapter on brain health. So because I know a lot of families are concerned about also developing the disease, so that chapter will help in trying to provide some tips and tricks on how to decrease their chances of developing the disease. So. But yeah, check us out. The book right now as it stands, it’s sold at Barnes and noble, Amazon, Johns Hopkins press, and then also on our website at neuro essence dot org. We have a wellness tool shop filled with all kinds of fun tools for your brain health and the book is on there as well and you’ll get a signed copy if you go through us. So awesome and all that’s linked in the show notes as well, make it super easy. I think this is I talked to a lot of authors. This is definitely if you got a limited budget or a limited amount of time for reading, which is more likely, this is probably the one to pick up because it’s really, really helpful. And that’s coming from somebody who’s already gone all the way through this journey, and I talked to lots of people. So I think I can say that with some authority. And one thing on the appreciating where they are in life and you talked about, you know, maybe learning who they were, you know, 20 or 15. You know, that’s a real beneficial opportunity that I didn’t think about with my mom. And I really wish I had learned that before. So that’s a good tip, you know? It’s kind of like being a little bit of a detective, find out what they were like when they were teenagers, because you might have mental aha. You weren’t as good as you tried to tell me you were. Well, this has been fantastic. I have very much appreciate you taking double the amount of time is normal to talk to us. I appreciate it. Best of luck with the book and anything else you’ve got going on in this upcoming year. Thank you so much. I appreciate it. You’re welcome. Well, you should know this by now, but next week is my 200th episode. But you don’t care about that, you care about the guest. I have been keeping a secret since late September, but if you get the email newsletter, you’ll know that next week’s guest is none other than tip of snow. She is so much fun and we discussed her Jim’s model, which I know you guys are going to find super beneficial, especially in conjunction with these last two episodes. I can’t think of a better way to end 2021 and begin 2022 than with all of this fantastic information all of these guests are sharing with us. If you’re listening to this in real time, I want to wish you a happy new year and I look forward to bringing you more fantastic episodes. Easily access all of your loved ones medical record and help support our show by going to picnic health dot com slash memories that’s picnic, PIC, and IC, health, TH dot com slash memories. We thank you for supporting the show. When I learned that despite eating as healthy as possible, we can still have undernourished brains, I was frustrated. I also live in a farming community, so I’m aware that our food isn’t grown as well as we need. Learning about neuro reserves relevant and how its formulated to fix this problem convinced me to give them a try. Now I know many of you are skeptical as was I. However, I know it’s working because of one simple change. My sweet tooth is gone. I didn’t expect that and it’s not something other users have commented on, but here’s some truth.

00:55:06 – 00:55:49

My brain always wanted something sweet. Now fruit usually did the trick, but not always. One bad night’s sleep would fire up my sugar craving so much, they were almost impossible to ignore. You ever have your brain screaming for a donut? Well, for me, those days are gone. It’s been about 6 months since I started taking the supplement and I have no regrets. I believe in my results so much that I’m passing on my 15% discount to you. Try it for two or three months and see if you have a miraculous sweet tooth cure, or maybe just better focus and clarity. It’s definitely worth a try. Their link is in the show notes.