Best Designs for Comfortable Eating Part 3

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Alzheimer's and Dementia Weekly

Transcript

The LOW ASSIST objects are all about color-contrasts. In this comparison image, the left plate is a color which contrasts the food. People need to be able to locate the food in order to pick it up.

This logic follows through to the cup, allowing people to easily locate handle and rim.

The MEDIUM ASSIST pieces address dexterity. It can become quite difficult to pick food up.

This plate offers an overhang to help push the food onto the spoon.

This cup challenges the need to provide two handles, avoiding it resembling a baby-cup, as shown earlier. The easiest grip to offer is that of putting your hand around the entire cup. The grip is thus insulated with neoprene to facilitate the drinking of hot liquids.



In this comparison image, the left plate is a color which contrasts the food. People need to be able to locate the food in order to pick it up.

The HIGH ASSIST range is aimed at creating a set of tools for assisting residents who can no longer feed themselves.

They are designed to be light and easy for carers to hold, which encourages them to bring the food into the sensory range of the residents, so they can see and smell what they are eating.

Another area that we have been looking at is the table. When used in a common area, it should be set 30 minutes in advance of mealtimes to encourage anticipation and appetite.

Use objects and patterns which are synonymous with dining to reinforce what activity is about to take place.

We have also made the underside flat, for wheelchair access. Existing tables like this one, which have support structures underneath, make it difficult for residents to get close to the food.

This means they have to lift the food over their laps, leading to spillages. This, in turn, could lead to having to wear rather stigmatizing bibs.

Finally, we have been looking at hanging additional lighting directly over tables, some older people needing three-times as much light as that of a younger person.

The light toggles through three light-levels by passing one's hand closely underneath, the idea being that a carer can tune each table-light to the residents' need, without having to run around to locate dimmer switches.

I have talked about eating, but we are only half-way through what we are planning. Next year, I will be joined by another designer, Nick Reisenbury and together we will be looking at activities and bedrooms. The results will join our findings in eating and culminate in design-guidelines this time next year.

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Best Designs for Comfortable Eating Part 2

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Alzheimer's and Dementia Weekly

Transcript

Esthetics matter because people can't help but judge the identity of a person through the objects they surround themselves with.

By creating a coherent table service, we can reduce the stigma attached to using assistive products.

In order to design a range that will help the widest amount of residents possible, I looked at disabilities which are common to aging, such as arthritis and visual acuity.

This area includes cataract, the yellowing of the lens with age, or the loss of depth-of-perception, which is common to Alzheimer's.

We then combined these findings with the degenerative nature of dementia to create three distinct groups that we felt could benefit from assistive tableware.



In this comparison image, the left plate is a color which contrasts the food. People need to be able to locate the food in order to pick it up.

LOW ASSIST is for people who can eat competently but may have sight problems.

MEDIUM ASSIST is for people beginning to lose their skills.

HIGH ASSIST is for those who can no longer feed themselves

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Best Designs for Comfortable Eating

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Alzheimer's and Dementia Weekly

Transcript

This year, I have been working with BUPA (British Healthcare) to improve the quality of eating for elder people with dementia in care.

Although dementia is not limited to older people, the chances of getting a form of dementia increase with age. Recent figures suggest that as much as one in three people over the age of 65 will be affected in their lifetime.

There are currently an estimated 700,00 people in the United Kingdom with dementia, over a third of which live in care homes.

In a recent interview with the Alzheimer's Society, Barbara Pointon said that the brain controls absolutely everything that we do, think and say. When that master computer goes wrong, it cannot be mended. The whole body starts to disintegrate.

In care homes across the country, you will find some of the most extraordinary people who daily have to overcome high levels of mental disability, physical disability and dependency.

This year, with the help of BUPA, we have humbly entered the world of care to understand it more deeply and see what role design can play.

I adopted an immersive research method which included background reading, interviews with residents, interviews with carers, and observation. I also attended carer training.

A resident remarked to me last week, "I may be an invalid, but I do not want to be treated as one."

It has been our aspiration to improve the lives of older people with dementia in care, and use design even in the smallest way to help them live at the highest level of their ability.

The focus this year has been on eating in particular, that is, assistive technologies. Today, I am going to briefly talk about some of the prototypes completed and that you will be able to see on this website.

There are plenty of assistive technologies on the market, but few have been specifically designed for the care environment.

This means they have some basic failings. They don't stack, they age badly, or they make the food look un-appetizing.

As a result, they don't fit in a commercial kitchen, people don't buy them, or if they do, they get frustrated and throw them out because they are not doing their job.

The negative side of this is that residents are not getting the tools they need to retain their eating skills for longer.

So I have adapted some of the tried-and-tested features already on the market and looked at how they could be used to improve existing tableware.

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When to Stop Treatment for Advanced Dementia Patients

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eHow

Deciding when your loved one with dementia is ready to die is difficult. Letting go is a challenge. Understanding what advanced dementia is and preparing for it go a long way in dealing with this hard process. Grieving for your loss is necessary and will bring meaning, healing and wholeness back into your life.

Advanced Dementia
In the last stage of dementia, people lose the ability to react to their surroundings, the power to speak and at the very end the ability to move. Often those affected are unable to understand the meaning of words and the ability to speak except for occasional words that make no sense. These folks need assistance with eating and may not have the ability to recognize or swallow food. They cannot control their bowels or bladder. People with advanced dementia lose the ability to sit without support. They cannot smile or hold up their head. Their reflexes become abnormal and their muscles grow stiff. They may be in pain but cannot express it.

Prepare Early
There are many things you can do to prepare for the time to stop treatment. When your loved one still has the capacity to make his wishes known, make sure he picks the person to make health care decisions when he can't. In other words, execute a health care proxy. Second, be certain he makes known the kind of medical treatment he wants or does not want. Third, get all finances in order, seeking financial and legal advice while your loved one is able to participate in the process. Doing these things makes everything easier.

Care Options
If you are choosing to care for the person with advanced dementia at home, understand that the process is going to become increasingly difficult, Physical needs and the 24-hour care requirements of the final stages of caring often prompts outside help. If, as a caregiver, you want to keep your loved one at home, make sure you have the stamina, space and support from others to do so. You may choose to place your loved on in a skilled nursing facility. You can be there as many hours a day as you want. You have the option to take a break if you need to. You can still direct the care of your loved one without the physical burden to yourself. Many resources are available to help you with placement and service options. Contact your local area Alzheimer's Association for help.

Manage Pain
Managing pain and discomfort necessitates daily observance and re-evaluation of not-so-obvious nonverbal indicators. Especially after a dramatic decline, you may choose to discontinue all other medical interventions and focus on soothing and calming care for the discomfort and symptoms related to dying. Small behavioral changes often indicate unmet needs. Keeping a journal may help you keep track of this. The soothing comfort of massage, touch, music, pleasant smells and your loving voice can also reduce pain. Try different techniques and watch your loved one's response.

Hospice Care
Hospice care concentrates on the management of pain and the comfort of your loved one at the end of life. Hospice is available anywhere, including a nursing home. Hospice offers family support during and after the dying process. Stop hospice care at any time if you so choose.

Family Issues
Your family may have difficulty,,,,read all of When to Stop Treatment for Advanced Dementia Patients

How to Care for Elders With Senile Dementia

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eHow

Senile dementia, an incurable brain disease, affects thinking, memory, communication and behavior. Because of the brain changes associated with senile dementia, caring for these elders presents many challenges. Achieve success with knowledge, patience, planning and flexibility.

1Learn all you can about senile dementia and the elder with senile dementia as well.

Step 2Establish a routine because those with senile dementia respond best if you do things in the same time frame everyday. Because each elder with dementia is different, the time for doing everyday tasks is different. Observation determines the most successful way to establish a schedule.

Step 3Keep potentially dangerous and fragile objects out of a dementia sufferer's reach.

Step 4Console the elder with senile dementia by helping him cope with day-to-day challenges of not remembering things.

Step 5Develop a positive attitude by having a support system so when the task of care giving is overwhelming, you have people who will help out.

Step 6Join a local support group or become a member of an online group.

Step 7Learn how to communicate, by breaking down tasks into small steps and speaking in short simple sentences. If you have to repeat something, say it the same way or simpler.

Step 8Manage problem behaviors by careful observation of triggers for the unwanted behaviors. Do not take aggression against you personally. It is the disease talking, not the elder with senile dementia.

Step 9Provide healthy meals and snacks. Allow the elder the opportunity to help in planning and preparing simple meals and snacks. Keep things simple. For many this is a meaningful activity.

Step 10Engage those with senile dementia in.....read all of
How to Care for Elders With Senile Dementia

Family caregiving brings joy with support

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Sharon brothers MSW

I've been a part of a neighborhood book group for several years now. We meet once a month, rotating homes, and spend a few minutes chatting about our lives, families and work before plunging into what usually turns out to be a rousing discussion of our month's book.

All of the members are women roughly similar to me in age and life situation. Most of us are mothers or grandmothers; most of us can readily identify with the life of the family caregiver.

Last evening as we discussed John Steinbeck's "Grapes of Wrath," we shared stories from our parents and grandparents of the hardships of the depression. Many stories brought tears to our eyes, as we talked of parents recently lost, or parents we're currently caring for in one way or another.

One thing we each acknowledged was the life changing experience of being a caregiver for our parents. We talked of how hard it is at first, how the role-change is awkward and unwelcome initially. We shared how, in the end, the rewards of caregiving can far exceed the challenges.

The shift in roles from child to adult, from care recipient to care provider requires each of us to find our way through sometimes challenging, unknown territory. As we support each other, sharing our stories and offering support and encouragement, the way seems less overwhelming and just a little easier to bear. Knowing we're not alone makes all the difference in navigating our way to a place where we find joy and reward in the role of caregiving.

Progress towards Alzheimer's vaccine: Israeli researcher

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The Gazette



JERUSALEM - An Israeli researcher working on a vaccine to combat Alzheimer's disease said on Monday he had made important progress following tests on gene-altered laboratory mice.


"We have been able to stimulate an immune response and forecast the effects in inoculated mice carrying human genes," Alon Monsonego, who works with British and US researchers, told AFP.


"It is an important development" that could help find vaccines which could be used for individuals with a predisposition to Alzheimer's, the University of Beersheva researcher said.


Monsonego added that "inoculated mice were able to reduce plaques of beta-peptides, as well as inflammations and neuronal damage associated with the disease."


Monsonego's work which is aimed at finding a vaccine capable of reinforcing the immune system were published in the specialised Journal of Immunology.


A report on Monday by the Alzheimer's Disease International (ADI), which groups Alzheimer associations around the world, predicted that cases of the disease and other forms of dementia are expected to soar in the next few decades, due largely to a spike in cases in developing countries.


Just under 36 million people will be living with dementia in 2010, an increase of around 12 million on how many suffered some form of dementia in 2005, the report said.

How Long Can a Person Live With Alzheimer's?

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eHow

After a diagnosis of Alzheimer's disease, a person lives from three to 20 years. Many factors influence how long he will live. Knowing the life expectancy of someone with Alzhemer's is valuable information for helping him and his family. Quality of life is key

Age of Diagnosis
Life expectancy with Alzheimer's depends a lot on the age of the person when it is first diagnosed, researchers at the Johns Hopkins Bloomberg School of Public Health have found. The older the person is at the time of diagnosis, the less time she will survive on average..

Gender
Seattle's Group Health Cooperative and University of Washington researchers have found that following a diagnosis of Alzheimer's, women tend to live longer than men, surviving about six years compared with mens' four years. But this difference between the sexes is less noteworthy as people age.
Severity of Symptoms
Other diseases and conditions shorten the life of a person with Alzheimer's. Poor survival is noted in those who have diabetes or congestive heart failure. Another health problem that lowers life expectancy is trouble walking and a history of falls.

Drs. Kenneth Covinsky and Kristine Yaffe of the San Francisco Veterans Affairs Medical Center and the University of California, San Francisco, say that someone who receives a diagnosis of Alzheimer's through specialized memory tests will likely have a longer life because these tests pick up changes in memory long before noticeable symptoms appear.

Catastophic Event
Many with Alzheimer's are able to function because they have a routine and know what to expect every day. When something happens to seriously change this, the result can be devatating to the Alzheimer's sufferer. An example: Someone falls and breaks a hip, arm or other bone requiring surgery or rehabilitation.

Surgery of any kind is difficult for a number of reasons.The person with Alzheimer's is in a strange environment, which can cause panic and uncertainty. Anesthesia is difficult because it takes Alzheimer's patients longer to recover from its effects. Sometimes they do not recover at all.

Rehabilitation is difficult too, because people with Alzheimer's have trouble learning new things. If they suddenly cannot get up alone or have to use a walker, they may forget and further injure themselves. They may become combative because they do not understand what is going on. Often they do not remember the initial fall no matter how often you remind them of it.

Quality of Life
It is not only how long people with Alzheimer's live, but how comfortable and happy they are in daily life. Here are some questions to ask about people with Alzheimer's. Do they.......read all of How Long Can a Person Live With Alzheimer's?

Sleep Problems & Alzheimer's Type Dementia

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eHow

Inability to get a good night sleep and resulting daytime drowsiness is displayed in many older adults, especially those with Alzheimer's disease or other forms of dementia. Sleep problems contribute to physical deterioration and mood problems. Caregivers of those with Alzheimer's disease have difficulty getting a good night's rest because of the patient's wandering, getting out of bed repeatedly and talking in bed.
A program of stimulating daytime activity for those with Alzheimer's disease and education for their caregivers may be helpful in controlling sleep problems. Prescribing sleep medicines is an option, too.

Alzheimer's Disease
Alzheimer's disease, a brain disorder, is the most common form of dementia. Dementia, a general term for memory loss, difficulty learning and behavior changes, seriously interferes with daily life including problems sleeping. Many people with Alzheimer's disease exhibit changes in their patterns of sleep. Scientists do not completely understand why this occurs.

Normal Aging Sleep Changes
As we age our sleep changes. Sleep quality, quantity and type of sleep change. Older people have more trouble falling asleep and sleep for a shorter period of time. The time you are in deep sleep decreases, as well, as you age.
Sleep changes in Alzheimer's disease
Many people with Alzheimer's disease wake up more often and stay awake longer during the night. Brain wave studies display decreases in both dreaming and non-dreaming stages of sleep. Those who cannot sleep may wander, be unable to lie still or call out, which disrupts the sleep of their caregivers.
Daytime napping is common because of Alzheimer's medications. Because of napping during the day, night time sleep diminishes. Persons with Alzheimer's disease often become restless or agitated in the late afternoon or early evening. This is called "sundowning." As Alzheimer's disease progresses, these individuals spend more time in bed sleeping during the day and less time sleeping at night

Treatment Without Medication
There are some simple lifestyle changes that can help a person with Alzheimer's sleep better at night, according to a study called Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial, published in the Journal of the American Geriatrics Society in May, 2005. Learning about good sleep habits, the benefits of moderate exercise and spending time in the sun helped those with Alzheimer's disease, this study reports.
Caregivers should encourage loved ones with Alzheimer's disease to go to bed at the same time every night. By observing a person with dementia, a good bedtime is discovered.
Finding triggers that awaken patients at night are identified. These problems include snoring by a bed partner, playful pets, or traffic noise, just to name a few. After learning what the triggers are, steps to eliminate these problems should be taken.
Eliminate daytime napping. Keep those with Alzheimer's disease mentally and physically active during the day. Adult day care programs help a great deal.
Remember to go outside with the person with Alzheimer's disease. Have him sit in a sunny room while watching television or other sitting activities. Some have suggested using a light box if there is not enough sun naturally
At night, make sure the room is dark. Keep heavy shades on the window to block early morning sunlight.

Treatment With Medication
In some cases, non-drug therapies do not work or the sleep changes are accompanied by difficult nighttime behaviors. Experts feel that.....read all about Sleep Problems & Alzheimer's Type Dementia

Quality of Life (part 5)

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Alzheimer's Society
Alzheimer's Care
Ethical Guidelines

What can be done to enhance the quality of life of people who provide care?
Strategies to enhance the caregiver's quality of life include:

Learning about Alzheimer's disease, understanding how it progresses and learning how to communicate with people with the disease.
Talking to close friends about one's needs, the needs of the person being cared for and where the two sets of needs conflict.
Finding ongoing support from groups or from one-on-one relationships.
Taking regular breaks from caregiving, for a few hours, days or weeks, and finding activities that help one get away from caregiving responsibilities and tasks.
Recognizing the signs of stress and developing ways to deal with them.
Taking satisfaction in the work one is doing to provide quality care.
Learning to ask for and accept help.
Making sure the doctor knows that one is caring for someone with Alzheimer's disease, to ensure that one's health is monitored and appropriate treatments obtained.
Becoming aware of one's own feelings and reaction to stress. Taking care of one's needs throughout the course of the disease.
Planning for changes, recognizing that there may be difficult decisions ahead.
Acknowledging the need for companionship and physical intimacy. Relationships with family and friends should be fostered as much as possible.
Listing the negative and positive aspects of caregiving, and seeking help from others to increase the positives and decrease the negatives.
Learning about available community resources by contacting the local Alzheimer Society.
In closing...
The quality of life of the person with Alzheimer's disease must be a central focus of care. It is vital that those providing care respond to that person's needs, wishes and values. The ultimate goal of care must be to provide a sense of well-being for that person.

At the same time, it must be recognized that the quality of life of the caregiver can be as important as that of the person with Alzheimer's disease. When conflicts arise, communication, information, self-awareness, support and understanding can help caregivers find solutions to ensure that their own quality of life does not become a casualty of the disease.



Resources:

From the Alzheimer Society of Canada:

Are You Caring for Someone with Alzheimer Disease? Remember to Take Care of Yourself Too!
Guidelines for Care
Other:

The Best Friends Approach to Alzheimer's Care. Virginia Bell and David Troxel, Health Professions Press, Baltimore, MD, 1997.
Dementia Reconsidered: The Person Comes First (Rethinking Ageing). Tom Kitwood, Open University Press, 1997.

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Quality of Life (part 4)

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Alzheimer's Society
Alzheimer's Care
Ethical Guidelines

What can be done to enhance the quality of life of people with Alzheimer's disease?
People with Alzheimer's disease are individuals and need to be treated with respect, integrity, compassion, dignity, and with concern for their privacy and safety. People with mild to moderate symptoms may need support in finding opportunities to enhance their quality of life. As the disease progresses, preserving the quality of life of the person with the disease will require the provision of appropriate social and physical environments.

Some key elements to consider include:

Learning about Alzheimer's disease, understanding how it progresses, and knowing how to communicate with the person with the disease; for instance, learning how a particular person's facial expressions convey emotions such as joy and fear.
Consulting the person to learn more about particular likes, dislikes and opinions; and, when the person is unable to communicate this, talking to someone close to the person who can.
Knowing the person and being aware of people, activities and things that are known to give pleasure to the person.
Providing the necessary support to preserve as much independence as possible.
Building on the person's strengths and abilities, and encouraging a sense of feeling useful and valued.
Giving the person opportunities to make choices.
Ensuring that the person's overall health is monitored and assessed, and that appropriate treatments are given. A diagnosis of Alzheimer's disease does not automatically prevent the presence of other health concerns and diseases. Failure to treat other illnesses can worsen the symptoms of Alzheimer's disease.
Providing living space that is safe, familiar and provides a sense of security, while allowing the person to maintain remaining abilities.
Respecting the need for companionship, including physical intimacy. Relationships with family and friends should be fostered as much as possible.
Providing care that responds to each person's needs and focuses on abilities rather than losses.
Acknowledging and recognizing that the person's interests may change over time rather than trying to impose former values and expectations.
Ensuring that all who provide care for people with Alzheimer's disease recognize that people with the disease are to be valued and should be treated as individuals.
Recognizing that all actions and behaviours of people with the disease are meaningful and reflect a desire to communicate something.
Recognizing that the quality of life of the person with the disease is closely linked to the quality of life of the caregiver. As the disease progresses, the connection between the two becomes stronger.
What can be done to enhance the quality of life of people who provide care?
Strategies to enhance the caregiver's quality of life include:
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Quality of Life (part 3)

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Alzheimer's Society
Alzheimer's Care
Ethical Guidelines

For health-care professionals:

Lack of understanding, training and human resources: Some health-care professionals who provide care for people with Alzheimer's disease lack an understanding of the issues relating to quality of life in Alzheimer's disease. Consequently, they fail to implement preferred care strategies. Long-term care facilities may also lack appropriate educational, human and financial resources to provide quality care for people with Alzheimer's disease.



Preferred choices
Quality of life for people with Alzheimer's disease
All those who participate in the lives of people with Alzheimer's disease should know or learn that, despite changes and loss of abilities, people with Alzheimer's disease are able to find pleasure and experience satisfaction. The disease does not remove a person's ability to appreciate, respond to and experience feelings such as anger, fear, joy, love or sadness. Recognizing an individual's abilities, interests and life-long skills helps to maintain and enhance that person's quality of life.

Quality of life for family members and caregivers
Family members and caregivers must strike a balance between their own quality of life and the quality of life of the person they are caring for. If they are unable to do so, then those close to them should help them recognize this need for balance. If a balance is not struck, the quality of life of both the caregiver and the person with the disease might suffer.

Care strategies for health-care professionals
Health-care professionals who provide care to people with Alzheimer's disease must recognize that they play a role in influencing the quality of life of both the person with Alzheimer's disease and the caregiver. Professionals should try to devise care strategies that enhance the quality of life for both.

What can be done to enhance the quality of life of people with Alzheimer's disease?
People with Alzheimer's disease are individuals and need to be treated with respect, integrity, compassion, dignity, and with concern for their privacy and safety. People with mild to moderate symptoms may need support in finding opportunities to enhance their quality of life. As the disease progresses, preserving the quality of life of the person with the disease will require the provision of appropriate social and physical environments.

Some key elements to consider include:

Learning about......read more about quality of life and come back for more information

Quality of Life (part 2)

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Alzheimer's Society
Alzheimer's Care
Ethical Guidelines

For family members and caregivers:

Determining someone else's quality of life: Determining how another person would define quality of life is not easy, but it is extremely important. It is vital to avoid imposing one's own personal values and interpretation of quality of life on someone else. The abilities and interests of someone with Alzheimer's disease will change over time. However, every effort should be made, especially as the disease progresses, to provide an optimum quality of life for the person.

Effects of caregiving: Many caregivers derive a sense of satisfaction and growth from caregiving but may have difficulty balancing their own needs and those of the person with the disease. The tasks and responsibilities of caring for someone with Alzheimer's disease can have positive and negative effects on the quality of life of family members and caregivers. The degree to which their quality of life is affected may be influenced by:

the nature (parent, spouse, friend, lover) and strength of the relationship between the person with Alzheimer's disease and the caregiver;
the personalities of the person with Alzheimer's disease and the caregiver, and the ability of each to adapt to changes caused by the disease;
the psychological, physical, spiritual and financial resources of the caregiver;
other day-to-day roles and expectations, such as being an employee, parent, business person, volunteer;
the caregiver's location and place of residence, in relation to that of the person with Alzheimer's disease;
the opinions, views and demands of people outside the caregiving relationship;
a health-care system that seems to be placing more responsibilities on caregivers while providing less and less support.
Young children in a caregiver's family may find their own quality of life affected, as they may need support and attention that the caregiver is unable to give.

For health-care professionals:

Lack of understanding, training and human resources: Some health-care professionals who provide care for people with Alzheimer's disease lack.....read more about quality of life and come back for more information

How Long Do Most Patients Live in the Severe Alzheimer's Wing?

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eHow

Many people with late-stage Alzheimer's disease live in the severe Alzheimer's wing of a long-term care facility. They live there from several weeks to several years, depending on the reasons for their decline to this stage of the disease. Maintaining dignity and comfort for them is key.

Severe Alzheimer's Disease
Alzheimer's disease, a brain disorder, robs people of their memory, thinking skills and normal behavior. People with severe Alzheimer's disease lose the ability to respond to their surroundings. Often they don't recognize what is being said to them or how to say things to other people. They need help eating and using the bathroom. Eventually they cannot swallow and have no control of their bladder or bowels. Many lose the ability to walk by themselves. In time, sitting is difficult without support. Their reflexes become abnormal, and their muscles grow rigid.

Preventing Skin Breakdown
Because people with severe Alzheimer's disease often become bedridden or chair-bound, their lack of movement causes skin breakdown and rigid joints. Staff on the severe Alzheimer's wing relieve body pressure by changing their position every two hours and providing them with special cushions and pillows.

Eating and Drinking
People with severe Alzheimer's disease often develop trouble swallowing, which can lead to pneumonia and even death. Staff on a severe Alzheimer's wing have to be alert for this.

Hospice Care
A person with severe Alzheimer's disease requires 24-hour care. Many caregivers choose hospice. A hospice facility provides, care, comfort and support services for people with terminal illnesses and their families. People with severe Alzheimer's symptoms qualify for hospice benefits under Medicare if a doctor determines that they have less than six months to live. Contact a local hospice group for more information.

End of Life
Try to make sure.....read all of Live in the Severe Alzheimer's Wing

Quality of Life (part 1)

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Alzheimer's Society
Alzheimer's Care
Ethical Guidelines

Background
For each person, the definition of quality of life is different and deeply personal. One person may define quality of life as enjoying the beauty of a sunset. Another person may describe it as sharing a holiday celebration with family; worshipping at a church, synagogue or mosque; playing a game of bridge; washing a car; listening to music or solving a crossword puzzle. Each person has a unique standard of what has value and what gives quality to life.

In defining quality of life, many different factors may be considered, such as:

the ability to think, make decisions and have control in one's daily life;
physical and mental health;
living arrangements;
social relationships;
religious beliefs and spirituality;
cultural values;
a sense of community;
financial and economic circumstances.

The issues
For people with Alzheimer's disease:

Influencing one's own quality of life: As Alzheimer's disease or a related dementia progresses, a person will lose many of the abilities considered important to quality of life. Some people think that quality of life is lost once a person is diagnosed with Alzheimer's disease. Others feel that quality of life can be maintained well into the disease process.

People with mild to moderate symptoms of Alzheimer's disease usually know what gives them pleasure and contributes to their sense of well-being. They may seek help to adapt to changing abilities and participate in meaningful activities. However, if the person can no longer communicate or make choices and decisions, then caregivers, family members or health-care providers will need to make them.

For family members and caregivers:

Determining someone else's quality of life: Determining......read more about quality of life and come back for more information

Reduce the risk of falling (part 2)

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San Diego Union Tribune
R.J. Ignelzi



IMPAIRED VISION. Age-related vision diseases such as cataracts or glaucoma can alter depth perception, peripheral vision and susceptibility to glare, which increase the risk of falls.
Prevention tips:
Have regular checkups by an ophthalmologist.
Use color and contrast to define balance-aiding objects in the home, such as grab bars and handrails.
Clean eyeglasses often.


MEDICATIONS. Sedatives, antidepressants and antipsychotic drugs can contribute to falls by reducing mental alertness, worsening balance and gait.
Prevention tips:
Know the common side effects of all medications taken.
Talk with your doctor about how to reduce your chances of falling by using the lowest effective dosage, regularly assessing the need for continued medication and using a walking aid while taking some medications.
Limit alcohol consumption when taking medications.


ENVIRONMENTAL HAZARDS. At least one-third of all falls involve common hazards in the home.
Prevention tips:
Repair cracks or gaps in sidewalks and driveways.
Install adequate lighting by doorways and along walkways leading to doors.
Avoid throw rugs.
Maintain night lights or motion-sensitive lighting throughout the home.
Install grab bars on walls around the tub and beside the toilet.
Add nonskid mats or appliqués to bathtub or shower stall. Add a bath or shower seat.
Avoid using floor polish or wax to reduce slick surfaces.
Use television remote controls and cordless phones to minimize having to rush to get the phone or getting up to change channels.
Spread out large furniture so you can easily move around it.
Adjust the height of the bed to make it easy to get in and out of.
Install tightly fastened handrails running the entire length and along both sides of stairs. Apply brightly colored tape to the face of steps to make them more visible.

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Reduce the risk of falling (part 1)

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San Diego Union Tribune
R.J. Ignelzi



When a senior citizen falls, the impact is more than the pain and impairment of a broken hip or head injury. For many aging adults, a fall could mean the beginning of the end of independence.
“Falls are the leading cause of death from injury among older adults. But even if falls aren't fatal, they're life-changing for this age group,” says Pam Smith, director for San Diego County Aging and Independence Services.
Falls are reported by one-third of all people 65 and older every year. Two-thirds of those who fall will fall again within six months. About 50 percent of the elderly who sustain a fall-related injury will be discharged to a nursing home rather than return home.
“Falls aren't inevitable as you age. People need to know that falls are preventable,” Smith says. “There are many things (seniors) and caregivers can do to minimize the risk of falls and improve safety. This can be life-saving stuff.”
Here's a look at the five key risk factors of falls among older adults and how to prevent them.


OSTEOPOROSIS. A decrease in bone density makes bones more prone to fractures. Brittle bones not only break after a fall, but can also break when stressed and in turn cause a fall.
Prevention tips:
Eat or drink sufficient calcium.
Get enough vitamin D to enhance the absorption of calcium.
Do weight-bearing exercise regularly.


LACK OF PHYSICAL ACTIVITY. Failure to exercise can result in poor muscle tone, decreased strength and loss of bone mass, all of which contribute to falls.
Prevention tips:
Walk, swim or do other exercise at least every other day to increase muscle strength and improve balance.
Practice gentle stretching or yoga with a class or DVD.
Wear proper-fitting, supportive shoes with low heels or rubber soles.

more tips tomorrow

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Caregiver's Guide to Understanding Dementia Behaviors

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Family Caregiver Alliance

Caring for a loved one with dementia poses many challenges for families and caregivers. People with dementia from conditions such as Alzheimer’s and related diseases have a progressive brain disorder that makes it more and more difficult for them to remember things, think clearly, communicate with others, or take care of themselves. In addition, dementia can cause mood swings and even change a person’s personality and behavior. This Fact Sheet provides some practical strategies for dealing with the troubling behavior problems and communication difficulties often encountered when caring for a person with dementia.

Ten Tips for Communicating with a Person with Dementia
We aren’t born knowing how to communicate with a person with dementia—but we can learn. Improving your communication skills will help make caregiv-ing less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.

1. Set a positive mood for interaction. Your attitude and body language communicate your feelings and thoughts stronger than your words. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice and physical touch to help convey your message and show your feelings of affection.

2. Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter sur-roundings. Before speaking, make sure you have her attention; address her by name, identify yourself by name and relation, and use nonver-bal cues and touch to help keep her focused. If she is seated, get down to her level and maintain eye contact.

3. State your message clearly. Use simple words and sentences. Speak slowly, distinctly and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If she doesn’t understand the first time, use the same wording to repeat your message or ques-tion. If she still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns or abbreviations.

4. Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended ques-tions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show her the choices—visual prompts and cues also help clar-ify your question and can guide her response.

5. Listen with your ears, eyes and heart. Be patient in waiting for your loved one’s reply. If she is struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.

6. Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what he can, gently remind him of steps he tends to forget, and assist with steps he’s no longer able to accomplish on his own. Using visual cues, such as showing him with your hand where to place the dinner plate, can be very helpful.

7. When the going gets tough, distract and redirect. When your loved one becomes upset, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”

8. Respond with affection and reassurance. People with dementia often feel confused, anxious and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support and reassurance. Sometimes holding hands, touching, hugging and praise will get the person to respond when all else fails.

9. Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.

10. Maintain your sense of humor. Use humor whenever possible, though not at the person's expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you.

Possible new Alzheimer's therapy studied

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UPI.com

DALLAS, (UPI) -- U.S. scientists have found the harmful effects of the beta-amyloid protein associated with Alzheimer's disease might be mitigated with another brain protein.

University of Texas Southwestern Medical Center scientists said their findings from an animal study suggest a new therapy tactic against Alzheimer's.

Beta-amyloid is found in the brain and, when functioning properly, suppresses nerve activity involved with memory and learning, thereby keeping nerve cells from becoming "overexcited" when they receive stimulating signals from neighboring cells. People with Alzheimer's disease, however, accumulate too much beta-amyloid, resulting in nerve cells become less responsive.

But the scientists found applying another brain protein, called Reelin, to brain slices from mice prevents excess beta-amyloid from completely silencing nerves.

"If we can identify a mechanism to keep the nerve cells functioning strongly, that might provide a way to fight Alzheimer's disease," said Professor Joachim Herz, the study's senior author.

The research is detailed in the early online edition of the Proceedings of the National Academy of Sciences.

Homewatch CareGivers ‘We Care for Veterans’ Program Provides 20 Hours of Free Care to Veterans and their Families

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Business Wire

GREENWOOD VILLAGE, Colo.--(BUSINESS WIRE)--To honor the service and sacrifice of U.S. military personnel, Homewatch CareGivers ), the largest and most experienced international franchise providerof home care, is offering up to 20 hours of free in-home care to disabled or injured U.S. military veterans of any conflict — from World War II and Korea to the wars in Afghanistan and Iraq — through its “We Care for Veterans” program.

“We know that thousands of returning veterans depend on family members as caregivers. Often these family members are responsible for childcare and elder care as well,” said Leann Reynolds, president, Homewatch CareGivers. “We hope our donation of home care can directly help meet the veteran’s care needs and support family caregivers by giving them a respite to recharge and care for themselves or by providing additional support services for their loved one.”

Official reports from the U.S. Department of Defense indicate more than 31,000 military personnel have been wounded in the Iraq and Afghanistan conflicts. Veterans care and support organizations estimate nearly 20,000 these injured and disabled veterans depend on others for daily care. Service members or a family member can sign up for the “We Care for Veterans” program by visiting www.homewatchcaregivers.com to access program details or by calling toll free 1-800-777-9770. The program is available to one veteran per location and is issued on a first come, first serve basis. Care can be secured for any purpose that falls within Homewatch CareGivers’ existing service offering. Applicants must sign up for “We Care for Veterans” by November 30, 2009.

Information on this program at Homewatch CareGivers,

Coffee Does Little to Protect the Aging Brain

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ABC News

NEW YORK (Reuters Health) - Sorry coffee lovers -- downing a few cups of coffee throughout the day may spark alertness, but it's unlikely to protect the aging brain from mental decline or dementia, according to researchers from Finland.

Some studies have suggested that coffee has a protective effect on brain function in old age, while others have not shown this association.

One of the latest studies on the topic, which appears in the September issue of the American Journal of Clinical Nutrition, found no association between coffee consumption and declining cognition or dementia scores in either men or women.

Dr. Venla S. Laitala, at the University of Helsinki, and colleagues assessed the coffee drinking habits, as well as other social, demographic, and health data, of a large population of twin pairs who were 50 years old on average.

At this point in time, 75 percent of the men and 83 percent of the women drank more than 3 cups of coffee a day. Only 4 of men and about 1 percent of women reported no daily coffee consumption.

When the group was just over 74 years on average, the investigators conducted telephone interviews in 2,606 of the study participants (48 percent women) to specifically screen for declining cognition and dementia.

They found that each year of increasing age was associated with declines in thinking abilities, regardless of gender.

However, in this study, middle-age coffee consumption was not protective against "cognitive decline or preventive against dementia," Laitala told Reuters Health in an email correspondence.

As expected, heart disease, diabetes and dissatisfaction with life were significantly associated with lower cognitive performance, the researchers report.

Therefore, Laitala's team suggests further investigations concentrate on the role heart disease, diabetes, and life satisfaction play in altered and age-related thinking and analytic abilities.

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Helping families keep helping

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Sharon Brothers MSW

She's been sleeping on the couch for over a year now. Her mother is in her bedroom, and her brother, who helps care for her mom, is in her guest room.

I asked her how she does it, and she says simply, "This is my mama. She wants to be with us, and we want to be with her."

At the same time, she works full time and sleeps poorly these days.

I worry a lot about her.

I worry that one day the lack of sleep will combine with an especially tough work day, and then her mom will be just a little more difficult that evening.

I worry that my friend will snap - like I might do, in the same situation. Like more than half a million caregivers each year snap and do something they'd never dream of doing.

They become abusers of an elderly person. And despite what we read and hear about on the news, more often than not, it's a family member who is the abuser, not a paid caregiver.

You can see how it could happen. Deprive someone of sleep, demand tasks of her that she was never trained to do, and anyone of us could reach a breaking point.

But what if we provide her with easy-to-access help in caregiving, and with some support in tasks at home?

"Just a little help would make a world of difference," my friend says, as I tell her about training available to her online. "I want to do what my mama would want, as long as I possibly can."

Club eases the pain of dementia

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BBC News

The families of people with dementia often do not get the support they need until a crisis occurs.

That is the conclusion of the Nuffield Council on Bioethics, an ethics think-tank.

I went to meet a group of carers at a community centre in east London.

The Monday Club are, on the face of it, a jolly group.

Card games are being played - and Harry Brown has brought along some apples from his garden.

The weekly group is run by the Alzheimer's Society and supported by the local council in Redbridge.

It provides solace, companionship and fun for dementia sufferers and their carers.

Difficult circumstances

These are strong people, often coping with very difficult daily circumstances.

Gerald Hale, who was a fireman for 35 years, is joining in the sing-song. He attends the group along with his wife of 62 years, Pat.

He is now 84, smartly dressed and was diagnosed with dementia about a year ago.

Mr Hale told me: "The main thing is not knowing or remembering anything. Your life is very limited.

"I dread to think about the future."

The illness is further along for the family of Gunvor Lasocki.

They are familiar with the ethical dilemmas mentioned in the new report - such as, when is it acceptable not to tell the truth?

Daughter Gillian has spent the past three years looking after her 86-year-old mother, whose parents died some time ago.

She said: "My mother gets inconsolable if anyone tells her they're dead. She asks about them nearly every day.

"We decided we had to lie to her, because what's the point in upsetting her?

"I hit on the idea of telling her they're on holiday. She's quite happy because she thinks they'll be back soon."

Continue to come

Some members of the Monday Club were caring for partners or family who have since died.

They are still included in the activities - and are an important source of support for the more recent members.

Coral Kathro runs the club for the Alzheimer's Society.

She said: "People come here and they are totally accepted - whatever their disabilities or problems.

"They become part of a family of concerned friends."

The Nuffield Council on Bioethics is also concerned about difficult practical decisions that families face - such as, when should the sufferer give up their privacy?

In need of help

Peter Pettigrew brings his wife Mary to the Monday club.

He is proud that he has done all the cooking, cleaning and personal care during her seven years of illness.

But he sometimes feels isolated and it is a strain - his eyes well up as he talks to me.

However, Mary will not tolerate having a stranger to help.

He said: "When she came out of hospital, they sent someone to change her in the morning and put her to bed at night.

"But she wouldn't have that, so it only lasted a couple of days.

"She likes her privacy still. She won't have anyone else in the house. So I'm just there on my own."

The UK's health departments are trying to develop policies that will respond effectively to dementia as the number of cases grows.

However, the authors of the Nuffield report point out that Gordon Brown's newly proposed Care Service for England would help people only in the later stages.

The report says people with dementia can still have a reasonable life.

Getting to that point seems to still be a case of "work in progress".

Dr. Laura helping out Caregivers Sailathon

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VeturaCountyStar

By Stan Whisenhunt

The annual Caregivers Sailathon, which raises money to help frail, home-bound seniors, is getting a huge boost from best-selling author and nationally known radio personality Dr. Laura Schlessinger.

Dr. Laura will be “competing” in the Sailathon on Sunday, Oct. 11, in Perfect, a J-100 and she has already garnered more than $8,000 in pledges. Skippers and crew try to sail as many laps as they can and get supporters to pledge amounts per lap.

Schlessinger, a noted yachtswoman, says she will try to sail more laps than any other participant and hopes to break the record for laps held by Bill Gibb’s 52-foot catamaran, Afterburner.

This Sailathon is being hosted by Pierpont Bay Yacht Club, which will hold a skippers’ meeting at 9 a.m. Coffee and donuts will be served.

Action will start at noon of the Ventura Pier and participants will have two hours to see how many laps they can sail. Skippers, crews and volunteers will then gather at 3 p.m. at PBYC for awards, prizes and chili/chowder dinner and cornbread.

Last year, Alan Ferentz raised the most donations. Ventura Isle Marina had the most participants. Gibbs sailed the most laps for a multihull and Brian Shaw for monohulls.

Schlessinger, who has been promoting the event on her Web site and on her radio program, last sailed locally when she won PBYC’s Milt Ingram Trophy Race. Her crew will include Taylor and Cody Schlub from PBYC, “who have been racing with me since the Milt Ingram Race when I met them,” she said. “They are wonderful, wonderful boys.”

It is already assured a record amount will be raised for the Caregivers on Oct. 11. Last year’s event raised $7,500.

Skippers who would like to register in advance can do so by calling Caregivers at 658-8530 or by going online to http://www.vccaregivers.org.

Some Fun and Stimulating Dementia Activities

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Nursing Home Activities Resource

Dementia activities should focus on enjoyment rather than achievement. A caregiver would want these dementia activities to reduce boredom but not to over stimulate either.

Laughter is always the best medicine. Though the patient may not always understand your humor, they can appreciate a good tease, a little nonsense and some clowning around.

Movement is very important for many dementia patients, as they can become prone to sit for long periods in one place doing seated activities like board games and crosswords. Walks outside or mild exercises, either seated or standing, can help to get the blood moving again and ward off boredom and a sense of isolation if they've been without much group activity.

With Alzheimer's and dementia activities care should be taken to eliminate expected outcomes and focus primarily on the activity itself. Cognitive dysfunction makes remembering game rules, sequences and strategies very difficult, if not impossible in later stages of the diseases. Slower paced activities involving simple repetition can prove most effective. Sometimes it is just a fidgeting type of activity that can best keep these seniors occupied.

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ABC Online

Researchers have developed a computer system that reminds patients about their daily appointments.

The computer-generated face known as MANA can talk, recognise faces and turn itself on when someone enters a room.

MANA, or Memory Appointment and Navigation Agent, is designed for older people with early onset dementia, who have trouble remembering even basic things.

Flinders University Professor David Powers says carers can use the internet to enter appointments into the system.

"Doctors appointments, maybe information about how to get there, what bus to take, when it comes, what bus stop, reminders about taking pills, which pills to take in the morning, have you taken them yet," he said.

Kylee Nash from Alzheimer's Australia says the technology eases the pressure on carers.

"There are times when their loved one will need to be technically alone, so the MANA will be able to help, to help provide that type of reassurance and security," she said.

A trial of the system will begin in the next few months.

A touching video about Alzheimer's

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Brian Willie

I Know."

I'm a bit overwhelmed to be quite honest. It was just released
and it's already quickly sweeping the internet and has had thousands of views!

Emails and comments have been pouring in. I'm so pleased that it has already
touched so many people.

You can watch it here:

Short Alzheimer's video

Movies are meant to move you, and to make you think. This is a very
special project for me. So often caregivers forget to take care of
themselves.

You may feel hopeless watching the man or woman you
know changing before your eyes. But just always keep in mind that
they are still the person you love and will always live on through
you.

Please watch and if you like what you see, I would appreciate it if you pass it on
to families, friends and co-workers.

What is Elder Mediation?

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Georgia Daniels

Eldercare mediation is a growing field that will increase in prominence as the number of elders increases. As parents age, conflicts can erupt between parents and their children over living situations, driving, or the need for more help with daily activities. In addition, conflicts may spring up between siblings about their parents' aging, such as when it is time for more in-home care, assisted living, or which sibling is responsible for what aspects of a parent's care. Mediation can also address more complex issues, such as estate planning and inheritance or healthcare choices, and may be used to develop alternatives to conservatorship. Mediation offers an opportunity to explore options and develop the best plan possible for the elder and family.

Usually, the elder's adult children or friends are quite clear that "something needs to be done." How this "something" can be accomplished is less clear, and can generate heated disagreement among those concerned. In addition, the spouse of the elder may be committed to maintaining the appearance that nothing is wrong.

Family members who are locked in ongoing conflicts may be unaware of elder mediation and its benefits. An example may help:

Example—Without Mediation: Daughter Darcy files a petition to be appointed the conservator of her father Hank's person and property. Her stepmother, Monica, insists that everything is just fine in their home, and is extremely angry with Darcy for interfering. Monica feels that Darcy is publicly declaring that Monica's caregiving is inadequate. The rhetoric escalates, and bitter litigation ensues. The judge ultimately appoints a third party (non-relative) as conservator of Hank's person and property. The conservator moves Hank into an assisted living facility, and Monica moves with him. The litigation causes a permanent rupture between Darcy and her father.

Example—With Mediation: Darcy contacts a mediator, and then calls Hank, Monica, and her sister Bella, to explain that she has some concerns which she would like to discuss. The mediator meets with all parties in a joint session, and they agree on ground rules. Each party takes a turn to air his or her concerns. The mediator helps them to identify what they really need for a successful outcome. Monica is reassured that the daughters are not trying to separate her from her husband; she learns that the daughters are worried that the caregiving burden on Monica is overwhelming her. Monica admits that she is struggling to care for the two of them, and her own blood pressure is soaring. She starts crying. With the mediator's help, they agree that Bella will contact a home care agency, to request someone to help a few hours per day with cleaning, shopping, cooking, driving, and dispensing medication. They agree to meet in a month to see how the new plan is working. The parties all feel that their concerns have been heard, respected, and addressed. The parties have a plan to continue working together for additional solutions if it turns out that more than a few hours per day of assistance is required. Unnecessary litigation is avoided.

Convening the Elder Mediation

The first step, and sometimes the most challenging one, is convening the mediation. This means ensuring that all necessary parties are invited to participate and are informed about the nature and content of the mediation. Frequently, either the mediator or mediator's staff will contact the potential parties for an intake interview and to confirm attendance. When mild to moderate dementia may be an issue, the elder's capacity to mediate should be considered and handled with sensitivity. An elder may be more comfortable having a trusted representative present to give voice to his or her concerns. It is also important to establish that participation in mediation is truly voluntary.

Benefits of Elder Mediation

The benefits of elder mediation include improved communication among family members, avoidance of unnecessary litigation, respect for the elder's dignity, and imaginative problem-solving. The plans and agreements which form the end product of the mediation are made by those who are directly affected by the situation. Parties usually report greater satisfaction with the outcome of mediation than with decisions imposed by a court. Finally, practice with conflict resolution techniques during mediation may allow the parties to resolve future conflicts without assistance.

Stages of Elder Mediation

Elder mediation takes place in a variety of settings, from senior service agencies, to elders' homes, to offices of private mediators. Where mediation is available from senior service agencies, the scope of mediation may be limited to a defined range of issues. The potential scope of private mediations can include a broad range of complex, multi-party issues.

The number of mediation sessions required may vary considerably. Sometimes, one meeting of two or three hours with all parties present is sufficient. In other cases, there may be several meetings over a period of weeks. Occasionally, out-of-state parties may participate by telephone or video conference.

When the mediation begins, the mediator typically explains the process to be followed, seeks input on proposed ground rules, and confirms that participation is voluntary.

Next, each party tells his or her story without interruption. The mediator may ask clarifying questions and summarize what has been shared. Frequently, the speakers feel that their perspectives are finally being heard by others in the family. Feeling heard and having their concerns validated can be an empowering experience for the participants.

After summarizing the various perspectives, the mediator identifies the issues, and may sort them into positions (wants) and interests (needs). The mediator notes areas of agreement and disagreement, and may start building an agreement by working with one small issue at a time.

Once the issues are identified, the parties brainstorm possible solutions, ranging from fanciful to practical. The mediator encourages imaginative responses as well as tried-and-true options.

The next step is to evaluate the potential options to see which ones might actually work, by asking questions such as "Can you live with this?" or "Would this meet your need for ___?" The mediator assists by rephrasing options and offering reality checks. Probably, some areas of agreement will emerge. The mediator continues to refine responses to the disagreements, looking for ways to bridge the gaps.

Finally, the parties come to a mutually agreeable solution, or perhaps even a graded series of results—first A, then B, C, and finally D. Usually the mediator prepares a written agreement to be signed by all parties.

As with any process-oriented endeavor, no two elder mediations will proceed in exactly the same way. Whether the topic is an elder's independence and continued ability to drive, planning for end-of-life health-care decisions, or anything in between, each mediation is as unique as its participants.

Reprinted with permission of www.mediate.com.