Memory Care with Teresa Youngstrom
Normal vs Not Normal Aging with Dementia
[music] Hey, care partners. Teresa Youngstrom with a better approach to memory care. Thanks for coming back to our podcast, Memory Care with Teresa Youngstrom. We have so much to talk about today and we have a special feature at the end, so you're going to want to hang around. But for right now, let's just dive in because this is a topic. You know, what is normal aging and what is not normal aging? You know, because by the time guys you get to my age, you know, like the halfway mark, that's when people start going, oh, I couldn't find my car in the parking lot. Oh, missed an appointment. Oh, you know, I forgot to call somebody back and we're like, geez, I'm getting this thing. Well, guess what? There's so much more to it than that. And so I wrote a program called normal versus not normal aging and it's probably still the most popular workshop that I teach. And mainly because it has a drama in it. And so I can't do the drama right here for you, but we improvised because, you know, during COVID, we did a lot of improvising, didn't we? And so we recorded a drama in my kitchen. And so you'll get a laugh out of this, but hopefully it'll bring some points home about normal versus not normal aging. Let's go to the slides and just start first and then we will bring up the video. But I just want to get you right into the groove of normal versus not normal aging. All right. So I think the biggest challenging thing is that you just can't tell a book by the cover. And so you'll notice that some people just have trouble recognizing what is a real, what is a real sign and what is not? What is normal aging? And so start by just checking your observation skills. All right, how about if I would ask you what's going on right here, what would you say? When what's going on with this patient? I know you're not all nurses, but you have skills. You've seen this before. You've probably had one. Okay, right. Could be a sprained ankle. Maybe it was a fracture. Maybe we are not sure what happened. Maybe that heel's bothering you. But you kind of have an idea when you see something like this, so we got a rest, eyes, elevate, maybe put a compression on there. Maybe have an ace bandage, but it looks like we're immobilizing and protecting something. But what about this one? What's going on with this gal? I know she's jogging and being pregnant. No, I didn't do that either, but that's the thing these days. You know, people are, they're super healthy and they take those pregnancies where they go and it's so great. But she's got her bottled water and she looks healthy. I would say she's pregnant, but she looks good. I'm not worried about this one. I don't have any red flags. Do you see any red flags here? Yeah, I know. Doesn't it make you think cancer right away? You see her with the head covering and all the white and all the sterile and yeah, yeah, yeah. I know it makes you worry that maybe there's cancer or something going on, but and that's what I would just assume that that's what this is. But what about this one? What's going on? I mean, can you see the dementia? This is my sweet mama. And I know right now you're thinking, well, she looks like a grandma. She's holding a little grandbaby on her lap and she looks pretty good looks happy. And I would say, yeah, she is in this moment. But there's dementia there. There's a lot of dementia there. There's dementia that's been there five, six years. Yeah. And we can't see it just by looking at it, can we? Because to be honest, you know what, you push the wrong button at this point in the game. Let me tell you, she would let you have it. It would not be pretty. But usually it was our fault because we were pushing buttons and she was doing the best she could with what she had left. And so let's talk more about this, though. How can we identify? What is a real dementia? Well, you know, Tifa Snow's taught me that facts about dementia, two parts of the brain are dying, no medications currently curing it. They're working on some things, you know, to break down the plaques and tangles are working on those things. And there's some, you know, treatments out there. We don't have anything to cure it at this point in time. It's a chemical and physical change in the brain, right? Like the brain cells can't just communicate so well. It's chronic progressive and it's always terminal at this point in time. Now we're optimistic. And there's lots of fundraising, lots of experiments going on. So we're going to figure this out someday guys. Hopefully it's in our lifetime, right? Hopefully so. But these are the facts about dementia right now. And and many of you guys know what the normal symptoms are, you know, memory loss. It might be might be short term, might be long term, might be getting lost. It might be not recognizing somebody. It might be not able to do the same as I could before. It might be just fear to go out and do something. Maybe I'm defensive, paranoid, suspicious, always the victim. And it's all your fault anyway. Dementia is a crazy thing, but we've learned that if you've met one person with dementia, well, you've met one person and your stack of symptoms will be different than mine. And I get the question all the time, well, what is the difference between Alzheimer's and dementia? Well, let me just throw this out there. Alzheimer's is an actual diagnosis, okay? They know it's a diagnosis saying that plaques and tangles cause brain cells to die. It's that's a problem in the brain. But for people that have dementia and all they say is they have a dementia, well, that's going to those collection of symptoms can look different. Dementia is really the collection of symptoms, right? It's not really a diagnosis. And we shouldn't really label someone, you know, as like it's a diagnosis, because really it's a collection of symptoms and maybe we need to do more testing and rule out the things that are treatable. A urinary tract infection can look like dementia, but it's treatable. So it's not what it is. You know, your thyroid can die and you can look like you have a dementia, but it's treatable, okay? So those are not dementias. There are other things. Maybe it's hearing loss that's contributing to your inability to remember and retain things. We need to investigate. That's why we go to our doctors and we figure it out. But it's good to be able to learn what is normal and what is not normal aging. And I'm helping after you see this video and we discuss the video that you might have greater insight as to what would be red flags for you and what really or not. And then there's always the part that there are some people that can't see their disease. They don't have awareness. Those are usually the more difficult people to figure out how to care for, but we can. And we do. And that has a little bit to do with what the surprise is at the end, okay? So you better stick around. Anyway, let's queue up the video that I made for you guys. It's, we'll go four minutes, hang in there with me, and then we'll discuss what you're seeing. Okay, let's go. I don't know what to fix for dinner. I'm tired of fixing dinner. You know what? I need a cup of coffee. Here we go. Here goes the phone. Well, hello. Hey, sweetheart, how are you? Yes. Well, of course, I know who this is. It's, uh, now hold on. Just a senior moment. Hold on. It begins with B. It's right on the tip of my tongue. Betty! Oh goodness, my friend Betty. Oh, the older I get, these senior moments, I tell you. How are you? Huh? Yeah? Oh, you know what? I love that. I'd love to get out of this house. Yes, I'd love to do them all. What time were you thinking? Uh-huh. Two o'clock? I'm there. Yes, where do you want to meet? Macy's. Let me think now. That's where the old JC Penny used to be. Okay, yeah, I'm familiar with that. Yeah, yeah. Inside, outside, inside. Okay, yeah, near the mens. Okay, yeah, I got it. What's that? Oh, no, I didn't know there was a new candy store. You know, I'm in. So, and I'm getting the corals because that's what I always get. And you get the, oh, the white flaky stuff in the brown. Yeah, you get the, you get the, um, the corals. I mean, you get the coconuts. Yeah, covered with chocolate. Yes, that's you. Uh-huh. Oh, good. I'm glad to hear about that. That'll be nice. Who? Oh, Margaret? You know, I can call her. Yeah, I can pick her up probably. Yeah, better work. Good idea. Yeah, from Margaret. Uh-huh. Well, yeah, let's go. What? Oh, the vacation pictures. Oh, honey, I do have them. Yes, and I can bring vacation pictures. Yeah. Oh my goodness. Wait till she sees herself. Huh? Oh, no. I was just talking to the dog. Yeah, sorry. Uh-huh. I'll bring those pictures. That was a good time. Yes, you're going to enjoy this. Uh-huh. All right. Well, I look forward to seeing you two o'clock. I'll be there. Okay, thanks. Goodbye. Oh, good. Get out of this house for a minute. Oh, what was I going to do? What was I got? I got up to do something. Let's see here. Oh, I hate when that happens. I was working on the recipes and I thought I need to get up. Do something? No. Coffee. Coffee. Yes. Coffee. Okay, we'll stop right there. Oh, word. All right, everybody. So we'll stop right there. We'll bring up some more slides. How about now you've seen my Hollywood version of my drama, right? So, um, let's talk about what you learned, what you saw, what your observations were. Okay, so why did she have trouble finding the lady's name? Why do you think? I mean, why do we have trouble finding people's names as we get older, right? It's just a part of it. You know, the files are only so big and, uh, and, and, you know, if we don't have the person right in front of us, even then, sometimes we don't have their name. I know people have walked up to me at church and I don't have their name, but I know the context. I know what we've talked about. I know what we have planned. I know how to follow conversation. So, so that was okay. She followed that just fine. No trouble there. How'd she? Yeah. So she followed the conversation just fine. That was important that she could follow the conversation. What about where is Macy's? Where's Macy's? Oh, so it's where the old JCPenney was. All right. Well, that's interesting because it's a lot of brain power to not only recognize where something is, but to go back there in a file and figure it out and bring it forward and have it come out your mouth in the right way. I mean, our brains are amazing. So she had to put in place that JCPenney used to be there. That's what came to her mind. But now there's a Macy's. That was really incredible. Okay. Good thought process. Now, what kind of candy was it? What kind? Car miles and yeah, coconut, the white flaky stuff. So it's interesting that we can usually, even if we don't have the word right there, we can describe it. Okay, good. That's still a good thing. All right. Don't let that worry you. If you're able to still describe it, great job. Okay. Did she have consideration when talking about those vacation pictures? She did. She pulled the phone away with her comment of, oh, she's wait till she sees herself and herself in that bathing suit, you know? And so she had that filter between her brain and her mouth, that ability to discern and to care for somebody else. Okay. She was able to do that. That's an amazing technique and we should all be using it. But you'll see with some people, mostly with the front of temples that they can have trouble with that. And then every negative comment comes flying out their mouth. You know, that's too tight. Oh, that's too low. This tastes terrible. Why couldn't you've done this better? And they're complaining hers and there's no filter. And you know, I heard a statistic once that people with front of temporal end up in front of a judge in a court of law about 10% before they end up in front of a neurologist. That's a wild statistic. But what it means is, you know, people around us aren't recognizing it as a brain failure. They're just knowing we're difficult and we're rude and we can't hold our tongue. And people lose their jobs and it can be depressing and devastating and we don't really know why. So anyway, she was considerate. And what happened to coffee? She finally did remember the coffee, didn't she? She was able to connect the dots, but it was almost like she had to put her bucket back down in the chair to get that thought back. Now, I don't know what putting your bucket back down in the chair has to do with your brain, but seems to work. So a lot of times, if you go back to where you started the thought and you had the thought, sometimes it'll come back. It's not perfect, but sometimes it'll work. So anyway, that's what we saw there. Let's review the normal aging that we saw with this woman. When we can't recall a word, well, you know, processing does slow after age 25. We don't really like to acknowledge that, but it's true. I mean, do you think your brain is improving or is it starting to decline? Well, it's really starting to decline. It may be in your 40s when you're having to write everything down, right? And keep a calendar and, you know, the kids are just like flitting here and there and they remember things. But, you know, we, as we get older, we have to use tools, use our phones to keep track of things. I mean, gosh, I'm surprised that it doesn't say breathe, you know, so many times a day in my calendar for all the things that are in there that it reminds me to do. But, yeah, so it's normal for brains to decline. You notice your eyes decline, right? So, but and we're okay with that. We're okay getting glasses or getting contacts or getting our LASIK or getting having our cheaters. But at the same time, guys, your eyes are changing, your brains are changing and your other parts of your body are changing too. Okay, normal to be slower to think and slower to do. Normal. I was happy to hear that. May hesitate more. May, let's see, more likely to look before we leap. Those of us that are, you know, our numbers are higher than the other ones, you know, so you're at 25. I remember being impulsive and at a group of friends and we decided to go skiing. It was in West Virginia. It was 12-hour drive. We drove all night. We slept in the car. We skied all day and then drove back. I mean, that wasn't wise. It wasn't wise at all. But it was impulsive. It was not smart. We probably didn't use our safety awareness. And that's interesting that, you know, now being as old as I am, I would never consider doing that. I would use a lot of my life experience to put forward and realize that would be a poor idea. Okay, so part of being older is great. We make better decisions, okay? You might know a person but not know their name. Normal aging, all right? You may pause when word finding. Normal aging. New data can remind me of old data. You can remember the last house where you lived or the first house that you had or what color the paint was on that first house or things like that. New data reminds me of old data. So she was able to place Macy's where the old JCPenney was, okay? And then usually with normal aging, we recognize we forgot. So even if an emergency happens and everything on my agenda to do tonight gets tossed up in the air because there's an emergency call. There's been an ambulance. I need to go pick up somebody. I need to get to the hospital. XYZ has happened. Everything I intended to do, whether it was email or call somebody or whatever gets tossed up in the air like all the plates that I was spinning. I mean, normally we can spin five to seven plates at one time. And you know, all the other stuff we've written down and have a list of things to do. You might have your legal pad or your Franklin planner or maybe it's just all on your phone now. But usually once the emergency is over, you can start getting your plates back with a normal brain. I mean, usually when your head hits the pillow, you're like, oh, I forgot to send that email, right? But that's okay. That's okay. Usually you do remember that you forgot with a healthy brain. Now, for those people who don't have a healthy brain, they won't remember that they forgot. And they're not able to spin as many plates. They might have two to three plates depending on where they are in their journey. And usually once it passes, it passes and they can't pull it back. The short term is usually damaged. Okay. All right, let's look at this not normal aging. Trust me, it's only four minutes for you to endure. You'll get some laughs out of it. And this is maybe what it might look like if your person is not coping. Well, here we go. That's it. I need a cup of coffee and the cup is on the phone. Goodness gracious. Hello. Well, who is this? No, who is it exactly? Betty. Betty who? Oh, well, why didn't you say so? What do you want? Hmm? The mall today? Huh? Could you call it earlier? Huh? What time do you want to go? Two o'clock. Oh, I can probably make that happen. Yep. Where should we meet? Macy's. Honey, there's no Macy's at that mall. Huh? No, it's a JCPenney. No, it's a JCPenney. I shop there. Well, I think you're wrong. Honey, that's a JCPenney because I got a credit card there. Yeah, well, I think you're wrong. I don't wear a talking. I can meet you there. Inside? What? Oh, no, I didn't know there was a new candy store. Well, you know what I'll get. I get the car moles because I always get the car moles. And you, you like that. Oh, you get the brown hairy ball and the brown stuff. Yes. You always get, huh? No, the brown hairy ball. You get it every time. What is wrong with you today? The brown hairy ball, you get it every time with the brown stuff on the outside. I think you might need to see a talk to her or something. I don't know, huh? Margaret? Oh, I'll call Margaret. You know what? Margaret don't do anything. Yeah. She don't go anywhere, but I'll get her. I'll get her. Yeah. I'll get her. Who? Oh, the vacation pictures? Oh, honey, I got them. Wait till you see yourself. I mean, you must have gained 20 pounds. I know. I'm just being honest. You must have gained 20. I mean, maybe eating too many of their brown hairy ball things, but I don't know. I mean, the girl or show on the bucket saying that, I mean, it is a sign. Excuse me for telling the truth. Huh? I don't know that. Well, excuse me. All right. I'll write that. I'll be there. Goodbye. Cute. She has to go and cop an attitude. Oh, geez. Now what was I doing besides not liking all this mess and recipes here? What? What was I doing? Now look here. Here's a half half drink cup of tea. Now I've been telling my son that people are coming into my house and stealing my stuff and look right there. You know what? I'm gonna save that and I'm gonna show that to him and I'm gonna prove to him that there are people coming into my house. Oh my word. You know what? That means they're stealing my toilet paper and you know what? A girl just can't be without toilet paper. I'm gonna have to go to store right now. All right, I'm going to store. So I've got a few things here and I've got another box of crackers and oh my goodness. Why are there so many boxes of crackers? My son must have got those. Oh well. Oh you don't know. You don't know. A little more peanut butter and you know what? I'm not going to put this in the bathroom because that's exactly where they're coming back to get it. You know what? I'll fix it there. I'm gonna hide it. I'm gonna hide it and hide it right in this closet right here and they won't know where to find it. Oh my gosh. Oh my gosh. This is where they're hiding it until we come back. Oh my gosh. Oh my gosh. Oh and the phone. Hello. Huh? What do you mean? Where am I? I'm at home. Where are you? At the mall? Honey, what are you doing at the mall? No, huh. I've been home all day. Honey, this is the first time I've talked to you all day. Yes. No, I've no idea what you're talking about honey. I've been here all day working on just doing recipes all day. That's all I've been doing. Honey, I'm worried about you. I'm thinking maybe you might be getting that dementia. I think you better see a doctor. I'm very sorry but I'm worried about you. Yes. All right. Bye-bye. Okay. How's that for some drama? Right? But I think maybe you've seen some symptoms of things that you've seen before. Let's bring up that that PowerPoint again and see what we can learn. So the not normal aging review. So how about that? Did she know who she was talking to? Did she know who she was talking to? Who is this? Who is this? No. Well, who is it? Really? No, she didn't know who she was talking to. Definitely not initially. And then when she said Betty, she's like Betty who? Right? The voice recognition and the name did not create a picture in her memory. Sadly, it didn't create the picture that she was hoping for. That's a bad sign. What about Macy's versus JCPenney? Yeah, she couldn't connect the dots on that, could she? And you know, if she's got no short term memory, nothing is being filed into her long term. And so there's a certain cutoff point and all she has at the long term. And there was no Macy's. Okay. Sadly, people have driven 300 miles out of their way looking for the JCPenney sign. And they get themselves in big trouble. We talk about putting locators on automobiles and things now because of that reason. But that's a very, very dangerous situation. Sorry, guys. How about carmals and hairy balls? Because in her mind, they were hairy balls. And it didn't matter or anything that it was offensive. That is just the picture that was in her mind. And she believed she was right. And she was the only one right. And nobody was going to change her mind on that. And we've got to learn to accept and agree. When we're dealing with people that don't have awareness about their disease, we're going to have to learn just to go with it and accept and agree. And she can call them hairy balls all day if she wants to. I don't care. But if that's what she came up with. But it's no, we don't argue with people. And we certainly don't dig our heel in just to be right. All right. It's not a competition about who's right and who's wrong. And we certainly have learned. And if you listen to me at all, you know that using your logic on somebody with a broken brain, it's wrong. It's absolutely wrong. And we're at fault when we do that. We are at fault. They've got a broken brain. I'm hoping that if the table were turned, she would use grace with you. And she would accept and agree and go with your flow. What about the vacation picture? She was ruthless. Wasn't she? I mean, she mortified that poor lady. Talking about, you know, all the weight gain probably eating too many of the hairy balls. I mean, it was hysterical later. But in the moment, oh, hurtful, hurtful. Remember what I was telling you? Unable to discern what should come out your mouth? No filters. The filters are out. And you know, when I'm counseling with families, I'm telling them, usually the filters are out for the people closest to them. And sadly, the spouses or that daughter son, you guys get the worst of it. I'm sorry. I'm sorry. And we just have to figure out how to bring help in to help you so that we don't take you down in the process, because you can get sick too, if you don't bring in help. Because it's very difficult to care for someone who doesn't have awareness and maybe doesn't have a filter. And they can be very condescending and rude to you, especially if you don't have good techniques. Someone stealing her toilet paper, paranoid and suspicious, paranoid and suspicious. She justified everything, didn't she? Go back and watch it again. She justified everything. Go back and watch it again and see if you see my dog several times. Jackson wanted to be a rock star apparently. And he was in several times. It's funny. But paranoia, suspicion, maybe some hallucination too. It can all get tossed in there. And sometimes it has something to do with the medicines we're already on too. So we complicate things. What happened to the coffee? It was nowhere to be found. She went on to whatever the next thing she saw, which was that half, you know, that half a cup of iced tea. And I went off on that with her own paranoia. That memory was lost for sure. The coffee was lost. What happened when she called her friend and of course whose fault was it? Her poor friend. It was her fault. And she cared. At least she did care for her in the moment, which was great. I mean, these people aren't terrible people. They have brain failure. And they're just trying to connect the dots in any way that they can. But sometimes you will see that they are never wrong and always the victim. Okay, always the victim. It's really tough. So they're unable to think the same when you have a true brain failure when you have something in there causing your brain, whether it's Alzheimer's, frontotemporal, Parkinson's, vascular dementia, whatever it is, lewy body. There are more than 120 diagnosis that can give us these symptoms. So unable to do as before, unable to get started on a task. So maybe your grandma could always just bake those apple pies without a second thought. And the recipe was just in her mind. You could call and ask her about a recipe on the phone and she could rattle it off. But now the sequencing is gone. She can't put those dots together. Maybe she can't initiate. Maybe she can't open the refrigerator to get herself something to eat and she's starving. I had a woman like that. There was great food in there. Already plated. The sun was amazing. He had plated homemade food in there for her. And she kept losing weight and not eating her food. And of course, if you ask her the yes, no question, are you going to have dinner? No. Well, wrong question. Did you want to? Maybe we just get it out in front of her. Maybe we don't ask any questions. That works sometimes. It's trial and error, isn't it? Until we figure out what works for your individual. So they'll get stuck in a moment of time. Maybe it's back in time. Maybe it's back in time when they were still with the second husband and not this guy that's hanging around now. That's a hard one, guys. That's a really tough one. They're unable to think things out. That's for sure. Unable to successfully place people. Words don't come even with a visual verbal or touch cues. Sadly, confused between the past and the present. And they may they may sail in between past and present while you're there over a course of a, you know, a couple hours and you just got to roll with them, don't you? Join them on the journey. Personalities and her behaviors will be different. May deny to blame you. Sorry, paranoid and suspicion. So things to consider before we just automatically throw, you know, throw them overboard that obviously they have dementia and start putting adding medications to their, you know, regimen regime regimen. Could it be hearing loss? Because if the information can't get to the short term to get to the long term, we're not going to remember anything, okay? Living with high stress can make us look like we have dementia. Being acutely ill can make us look like we have dementia. Being in the hospital can make us look like we have dementia. Not everybody who goes to the hospital and is confused has dementia. I've had folks get placed after going in for a surgery or something and I sometimes want to just hit the pause button. Let's bring them back home and see if they'll acclimate. But you know, you're in a hospital. I worked in hospitals for 23 years and guess what? It's lights are on, noisy. I mean, that is not a place to get rest, unfortunately. They're always waking you up poking you to do something, fill in your water picture or something. Could be thyroid disease, like I told you before, low B vitamin. These are things that can make us look like we have a dementia, medication problems, interactions with our medications. Sometimes it's good to take the medication list to your pharmacist and say, can you just look all this up and see if it's supposed to go together or not? Because maybe we've duplicated something. Maybe there was something was supposed to be just, you know, it was as needed or maybe it was something that was for a short, short time and it's been added on again. It happens. Maybe it's pain or psychological issues. So just real quick, a couple ways to do it better. We're going to approach them from the front. You know this by now, you're following me. You're going to introduce yourself and you're going to extend your hand and hopefully they're going to give you permission to touch them without much, much, much time and trial on your part. Give them a positive comment, bring a smile, try and push away the fears and go slow with everything. Don't rush anybody with dementia. Okay. Speak slowly in a low tone. Give simple and short instructions and then allow extra time for them to process your words. And you know what? If nothing comes back, you might just sit quietly and rest and see if they process. I was sitting with a woman the other day and eventually she reached out and patted my hand and then she was ready to interact. And I just thought her hearing aid wasn't working and so this wasn't going to be a very good interaction. But she was hearing me. She just needed to process. Okay. Thankfully, I gave her that. So review these survival tips. They'll be here. You can watch them again and again. Speak slowly. Clearly, make sure they're looking at you when you talk. Okay. Never correct. Never argue. Accept and agree. Don't rush them. Say you're sorry. Over and over again to diffuse their anger or fear and avoid those yes, no questions. All right, guys, you know, I'm all about bringing them joy in the moment. And that's what I want you to do. But I've got a special surprise for those of you who have stuck it out to the end. Okay, for tuning in and for listening to the end, we have added a bonus page for you. And so down in the info area in the comments area, you're going to be able to find in the description a link to go and get that bonus page that we've created for you. Something on a PDF, something it's two pages. I make mine on front and back, but you can download it. You can share it. It's copyrighted by me, created by me. Great information for you. I want you to have this a great tool that you can use just for being an amazing part of my community. And, you know, for showing up again and for liking and sharing and subscribing so we can reach more people. It's very exciting. But this bonus is exclusively for those of you who who stuck it out to the end, this bonus page. All right, I am so excited to be with you again today. Thanks for staying over a couple of minutes. My name is Teresa Youngstrom with a better approach to memory care. I hope you get your bonus page. And just remember, guys, you got this. [Music]