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March 19, 2017

Caring for Elderly Dementia: Understanding the World A Dementia Lives in

Grandma insist on using a chopper to chop mushrooms to prove that she is still useful.
Our domestic foreign worker, Ati, is a widower. Her husband died a few years back and her daughter is relying on her income to working in a foreign land for her education and daily expenses. Ati has a sweet disposition, hard working and is mature enough to understand how dementia has taken hold of Grandma's mind. Even though she has worked with another dementia patient in Taiwan, the initial acclimatization was still a shock to her and often drive her to tears in the first few weeks.

Grandma is able to curse fluently in 4 different languages (Mandarin, Hakka, Hokkien and Cantonese) and can go on for hours once the dementia demon took hold of her.

I have heard of stories from my friends whereby the dementia patient will always have a number one enemy which causes all the ills and confusion in the parallel universe of a dementia patient. In our household, poor Ati bore the brunt of the verbal and physical attacks when Grandma becomes agitated. We often sat down with Ati and work her through Grandma's history and why she behaves this way to help her understand better.


In order to take care of a dementia patient, we often have to step into their dementia world and see from their point of view. In my Grandma's demented world, Ati is seen as:

1) A threat to Grandma's usefulness
Grandma's greatest joy is to cook, clean the house and sew new clothes for the rest of the family. With her incapacitated by both a stroke and dementia, she is no longer able to perform these tasks without putting herself in risk. She already had a couple of hospitalization due to her insistence to perform these tasks as a results of falls. The feel of being useless and Ati replacing her role puts her in the crosshairs

2) Waste of Money
Grandma's brought up two sons after WWII and she is proud of her ability to be frugal. When Ati first came on board, she was angry that we are wasting money and she is well enough to do whatever is Ati can do, Many a times, she will try to convince us that Ati is expensive and a waste of money in order to chase her away. A few months later, she gave up on that idea and turned to more aggressive ways to try to get rid of her

3) Thief
A dementia patient will often forget where she places her valuables. Dementia patientw may also think that they still have old possessions which no longer exist today, and start looking for them. When they are unable to find the missing objects, and believing that their mind and memory is still sound, the only explanation is that someone stole her valuable possessions. Being the only outside in the family, Grandma often accuse Ati of stealing her bra, underwear, dentures, soap box, money, earrings, pillow and many other things which does not make any sense. Showing her the missing objects will not convince her that the items were not stolen. Rather, she will choose to believe that Ati took it out of hiding after she exposed her. The solution to this is to try to distract her, or if she is in an ugly mood, let her rant and hopes that she forgets about this the next day.
 
4) Husband Stealer
As Grandma desperate attempts to convince us that Ati is a thief did not convince us to chase her away, she came to one conclusion: That she is sleeping with me and my Dad, which made us took her side rather than hers. No amount of convincing and arguing can convince her of otherwise. We also have no idea how to resolve this situation and the doctor advise us to continue to assure her, even if its not working.

5) Torturer
"She is starving me to death!"
"She is trying to boil me alive by turning the heater to the maximum!"
"She is trying to freeze me to death by turning off the heater!"
"She is giving me smelly clothes to wear!"
"She is trying to kill me by locking me up in the bathroom!"

All these allegations are often as an indirect results of Grandma's actions, such as forgetting how the heater works or forgetting how to open the lock after locking herself up in the toilet. In her demented world, her mind thinks that she never had such a problem before and all these occurrences only started when Ati came aboard after her hospital stay. Grandma thinks Ati is trying to kill her and usurp her place as the head of the house hold.

Do we have solutions to many of the misunderstanding and parallel universe thinking of a dementia patient? Frankly speaking, we don't have any perfect solutions and we try to cope with a combination of coaxing, walking off and letting her rant and sometimes, force to prevent her from hurting herself and others. However, the first step is which any caregivers need to do, is to forgive the dementia patient as we have to understand that it is the illness that made her this way, or not herself. The only way to forgive them is to stand from the angle of a dementia patient and try to empathize as much as we can, and laugh about the various curses and insults which are thrown at us. Also, it is important to help each other out as care-givers, whether we are employers or foreign domestic worker.

It is an illness that we not only have to care for the patient, but also for the care-giver.  

February 26, 2017

Caring for Elderly Dementia: Communication Culture Shock

Grandma complaining to dad about her things being stolen

Caring for an elderly dementia patient is nothing like we have ever experienced before, even for mum and dad who have brought up 2 of their own kids and is now in the process of coaching my nephew and niece. With our limited exposure during her hospital stay, we initially thought that she will be her usual self, except for a few messed up names and places. Little did we realize that we have to totally change the way we communicate with her and there is no hard and fast rule on how that is to be achieved. As every dementia patient is different, we often have to use trial and error to see what works best for her and any judgement lapse in communication will lead to a very uncooperative grandma or even suicide attempts, which pushes the family to the brink of break-down. Here are some of the lessons we learnt during that first few weeks.

Logic doesn't work.

"Ati (Helper) tries to steal my dentures!"

Wrong Answer

"Why will Ati try to steal your dentures? It's not valuable and she has no use for it!"

"Who says she has no use of it! Who says! Who says! You rather believe her than believe me? She is your second mum izzit? Go go go! You don't need me! You are one family! I am useless! Let me die!

Correct Answer

"I will ask Ati why she wants to steal your denture! I will scold her and make sure it doesn't happens again!"

A few days later, she will forget that hers claims of her denture being stolen.


They cannot be disciplined
When grandma was discharged, the doctor emphasized that routine and cleanliness are very important when it comes to taking care of dementia elderly. We took the advice too literally...

The doctor advise us to let grandma wear diapers before she goes to bed in order to ensure her hygiene is taken care of in the middle of the night, just in case she cannot control her bladder. The act of putting on diapers have lead to many cat fights between grandma and the rest of the family. Dad tries to employ the methods of discipline which he will use on my nephew, such as hitting her bum bum and speaking to her sternly. Imagine the chaos in the tight constraint of a toilet as Grandma is struggling against the diaper, dad is holding on to her and smacking her bum bum, mum yelling at dad and helper trying to avoid grandma's failing arms while trying to strap the diaper onto her.

Pure chaos and unspeakable stress.

We thought that after a week or so, she will resign to her fate to wearing diapers. One week became two and two weeks became three. We than realize that what every coaxing, logic, reasoning or punishment we dish out to make her comply, she will simply forget about it after a few days later.

The idea of discipline is simple, the person being disciplined will remember the pain or pleasure as a result of their actions, and they will modify their behavior to perform pleasurable actions and avoid painful actions. The problem with a dementia patient is that they will simply forget about all the coaxing and yelling we done to her and continue to perform as usual. At the end of the day, we decided that the nightly 1 hour worth of diaper struggle is not worth the effort and we gave up. We choose to train ourselves to be more efficient in changing her soiled PJs and bed sheet whenever that happens. This simple act of giving up without all the nightly diaper drama made grandma happier and improved the mood of the family tremendously.


You have no answers for their delusions
Grand has this delusion that she has another male grandson, the son my mother always wanted but restrained by the government's two child policy, and my phantom brother. She will often come to my room and ask, where is Wen Song? Where is your brother who is sleeping in the same room as me.

I will often reply, "I am Wen Song. I have no brother!"

"Do not lie to me! You are called "Ah Wen" Did you chase him away while I am at the hospital?"

"We never have a brother! Look! This is our family photo!"

"Why did you take a photo without your brother inside? Show me a picture with his photo now!"

..fustrated...

"Look, I never have a brother! There is only me and sister!"

"Your poor brother!" She wails," What have you done to him? He is only thirteen and you all chase him out of the house! Ask him to come back or I will haunt you when I become a ghost!"

...................... and she rages on throughout the day wailing about my poor brother. Family stress goes up.

Our Solution?

We have a cousin that seldom visits grandma and visits only during Chinese New Year. He became our scrape goat whenever grandma asks about my "brother" by lying to her that our cousin is my brother. I mean, we are "brothers" in some sense right? So we told her that my "brother" lives with uncle and he visits irregularly. We had a picture on standby in our phone in which he is shown to be talking to grandma. Very often, grandma will remark, "How come I don't remember him talking to me?" But she will quietly accept the fact that my "brother" is staying with our uncle and the raging incidents died down as a result.

This is of course not the only delusion she has but it illustrates on the creativity needed to handle them.


The picture of cousin, wife and son which we used to convince that "brother" is no longer 13 years old and has moved out


They can erupt at a drop of a pin
Last weekend, we brought grandma to Sentosa. When she got back home, she searched her pocket and suddenly shouted, "Where's my purse! Who stole my purse!" Of course she did not bring out a purse in the first place. My mum did the wrong thing by trying to logic with her, "You did not bring a purse in the first place!"

We can see the signs of an impending volcanic eruption!

Luckily, Dad came to the rescue. He took out a ten dollars note from his wallet and waved it in front of Grandma. "You did not bring a purse but you brought along $10! You passed it to me for safekeeping! Here, you can have it back."

Grandma gratefully accepted the note.

This event passed peacefully, but during the earlier days, we have a volcanic eruption almost every everyday due to our inability to cope and answer to her sudden illogical outbursts. Over the months, we learn to lie, to cheat and to wrongly blame someone else, in order to keep grandma emotionally stable.

If you think doing sales is a tough job, try working as a caregiver to a dementia patient. It's much harder persuade them to behave in a certain manner than getting someone to purchase an insurance policy.

January 20, 2017

Caring for Dementia Elderly: Looking for Helper


When Grandma was diagnosed with stroke, the doctor advised us to engage a trained helper to take care of grandma. The goal is simple, the family should be able to function as normal while ensuring that grandma is well looked after and ensure that essential activities such as bathing and toileting are well taken care of. As a result of the stroke, grandma suffered from both vascular dementia and a deterioration of motor skills, especially in her ability to walk, in which the helper has to help to ensure that she does not fall down.

We were informed by the doctors that we would not be able to bring grandma home, unless we are able to employ a trained helper to help take care of her needs and we were given 2 weeks as the hospital is simply too crowded to grandma to stay any longer. The search for an experienced helper was on with my sister working to interview the helper, while I took care of all necessary legal documentation and coursework to get the helper to our place ASAP. Meanwhile, Mum and Dad started to procure new furniture and home configuration to prepare for a disabled elderly. After extensive interview sessions, my sis managed to locate an experienced Indonesian helper who had 7 years of experience working with dementia elderly in Taiwan. She is able to speak mandarin and hokkien, which is crucial in daily communication with a dementia patient. However, the paperwork took longer than expected and we were unable to complete all the requirements by the end of the 2 weeks period. The doctor than decided to move grandma to St Andrew community hospital and we were told by the doctor that we have another week extension to bring in the helper.

Luckily, there is no other hiccups with the application and soon, our helper, named Ati, touched down at Singapore shores. However, before we can bring grandma home, the helper had to undergo training at the hospital and it was another week later, that everything was in place to welcome grandma home.

We breathe a sign of relief that we have gotten the house and helper in order and that was 4 very stressful weeks as the family banded together to put together a safe environment for grandma and we looked forward to bring grandma home.

A week after bringing grandma home, we began to realize that the journey has just started and the mad rush for the home preparation and helper scouting are the easy parts of the journey.


January 9, 2017

Caring for Dementia Elderly: Home Configuration

While I was in Europe in October, my parents came back home and found grandma on the floor, unconscious, laying beside her sewing kit. Grandma had a stroke. She was immediately sent to hospital and soon after, the effects of the brain damage as a result, she was diagnosed with vascular dementia. Other than a slurring of speech pattern, coordination skills and a weakening of her legs, her memories became confused with time, place and people.

For example, she will think that her mother, who has died over 70 years ago, is alive and well at home.

She also got confused with the number of family members at home. She strongly believes that I have an elder brother called "Song Song", whom does not exist in the first place. "Song song" is the pet name. We had to keep her updated on the number of family members by constantly showing her her family pictures



December 6, 2016

Announcement - Regular Blog Post Activities will be Disrupted!

Dear Friends,

I will have to apologize that blog posts from SG Unfit Runners will be erratic for a while.

The reason why is because my 93 years old grandma suffered a stroke while I was away in Europe and that has caused her to suffer from a serious form of dementia. She also has mobility problem and we have recruited the help of a helper to assist her in her daily activities. As a strong and independent person, this blow took a toll on her mental state and she is unable to cope with her loss of independence. Combined with a dementia problem, she has transformed into an angry lady with an extremely foul mouth, leaving my mum and my helper often in tears. She also started to have suicidal tendencies in recent days which we have to monitor constantly.



I have to spend more time to help out with the family in taking care of Grandma and as such, I have to slow down on my writing on SG Unfit Runners. The other members of the Unfit Runners have offered help but they are unable to write as constantly. They blame it on their rusty writing skills which they have seldom used ever since they left school and everyone started comparing their GP (English) scores trying to compete who has the worst score.

On the bright side, I see this episode as a caretaker to an elderly suicidal dementia patient as an experience which I can share with my readers. There has been many incidents so far, some funny, some not so funny... and I will share them here.

Afterall, this is a health and fitness blog!

And I will continue on with our adventures in Poland, Krakow at a later date.

Yours Sincerely,
PES E
Editor of SG Unfit Runners.
 

Event Alert - Income Eco Run 2017

The SG Unfit Runners are a group of long time friends who joined, Green Project, an environmental awareness club, during their high school days. We became the Garang Guni (A Singaporean slang for used goods collector) of the school and often engage in the less glamorous activities of recycling used goods for the school.

Seems like the Green movement has come a long way since than with now a run with a focus on environmental friendliness.

Income Eco Run 2017, which will take place on 30 April 2017 at the F1 Pit Building, will
continue to drive the green message amongst runners and people in Singapore at large,
calling members of the public to take to the run to show their pledge for green practices.
In fact, Income will up its ante on its green commitment next year by embarking on a detailed
‘green’ audit partnering Green Future Solutions, which helps organizations address
environmental challenges and identify green opportunities.

To hit home the message on reduce, reuse and recycle, Income Eco Run 2017 will introduce
the ‘ Zero-Waste Runner’. As a ‘Zero-Waste Runner’, participants will not receive a finisher
tee and race medal to help reduce wastage from producing race entitlements. The
registration to be a Zero-Waste runner is limited to the first 1,000 participants. They will be
recognized as ‘Zero-Waste Runner’ with a special silkscreened symbol on their race tee and
given a BYO bottle.



For more information, please visit www.incomeecorun.sg

November 4, 2016

Budapest - Hungary: The City of Thermal Spas

We wanted to run in Budapest but just couldn't find the strength or motivation to do it. The many days of sinful living eating nothing but meat and beer has sapped our will to crawl out of the bed early in the morning. The intensity of our "Death Marches" around the Castle Hills of Buda and museums have left our feet sore. We badly need a good massage or a hot soak in an Onsen.

Budapest, the capital of Hungary, is also known as the City of Spas with more than 100 thermal springs dotted all around the city. The Unfit runners have been to many baths in the world, ranging from the Onsen in Japan, Wenquan in Taiwan and Moorish baths in Spain. I will say that the look and feel of the thermal bath in Budapest is definitely different. While the baths in Spain and Japan have a more exclusive and private feel to them, the baths in Budapest are bigger and are often visited by families.

September 26, 2016

Vienna - Austria: Breathtaking Gardens and Architecture


It's 730am at Vienna, Austria....

PES E, "Hey guys, want to do a run?"

<Deadly silence and snores>

PES E, "Holy shit, there is a Charmander near our apartment!" 

Big Boned Guy, "Where where? I need one!I killed my low IV Charmander and need a new one to walk with me!"

PES E, "We have 10mins left! Let's change to our running attire within 5mins!"

Big Boned Guy, "Rigghhtt! GET UP ALCOHOLIC! Time to run!!"

Within 5 mins, we have changed to our running attire and off for a run.

Vienna in the early morning is a quiet city. Our hotel is located right next to the main shopping district of Mariahilfer Straße which is also known as one of the longest shopping street in Austria. The entire length of the shopping street is almost deserted, with only the cleaners hard at work. In fact, the shops at Vienna closes pretty early at 6-7pm and all the activities move to the pubs and cafes. The shopping street connects the bustling Vienna central railway station and the historical, cultural and political hub of Vienna. 


The first area that you will encounter is the Maria-Theresien-Platz , which is the site of two museums, the Natural History Museum and the Art History Museum. Beyond the Maria Platz, lies the historical district of Vienna where you can find famous buildings such as the Vienna State Opera, St Stephan Cathedral and the Austria Parliament. A myriad of beautifully curated gardens surrounds the historical down town area and I promise that you will be distracted by the beautiful bulbs of roses, blooms, fountains and statues along the way that you will inevitable stop to take some pictures.

Overall, Vienna is a beautiful city to run and explore. The traffic is light in the early morning and the pavements are wide and smooth to run. The good mixture of interesting architecture and beautiful parks keep the run interesting. I will strongly recommend anybody who visits Vienna to plan a run.

Now, if they will just improve their breakfast selection, than it will be perfect...





September 23, 2016

Salzburg - Austria: Mozart and The Sound of Music


Salzburg is the birth place of famous music composer, Mozart and the location where the 1965 film: Sound of Music was being filmed. With the old and new city flanking the Salzach river, the city is a mix of gardens, castles, rustic town halls and modern town houses making the city a delight to run and explore. The Salzach river is lined with well paved running and bicycle track and the track is designed to run under the bridges which allows undisturbed running all along the river. To make the run even more interesting, you can either run into the old town area which houses famous landmarks such as the Hohensalzburg Castle, Salzburg Cathedral and the old district lined with beautiful town houses and the birthplace of Mozart.


The other bank boosted newer buildings and the famous Mirabell Palace where the scene in which the song "Do Re Mi" from the Sound of Music was featured. The streets are also lined with modern buildings, chic restaurants, fountains and water features. It is one of the perfect spot to chill with a cup of hot tea/coffee in the day and a class of Austrian wine during the evenings.




There is always something new and interesting around the corner at Salzburg, which makes the run always interesting. Combine that with the perfect autumn temperature of 10-15 degrees, the running environment is one of the best I have encountered. I will definitely anybody who visits Salzburg to plan a run and you will be amazed by new encounters and sights.



September 19, 2016

SG Unfit Runners Eastern Europe Trip - Oktoberfest




It's the time of the year that the Sg Unfit Runners go on a month long trip to different parts of the world and discover the joy of running in strange new places and discovering new things. Running is probably one of the best way to explore the city, often along with a beautiful sunrise to accompany us on the run. This trip consist of PES E, Big Boned Guy and Alcoholic and while touring eastern Europe is the main objective, the hidden agenda is to actually attend the Oktoberfest at Munich and gorge ourselves silly with beer and pork knuckles before setting off to Salzburg, Vienna, Budapest, Krakow, Prague, Nuremberg and back to Munich. Since we will be walking quite a bit every day, we probably won't be doing a run in every city as it will be absolutely exhausting to do that.

Meanwhile at Munich, we probably will not do any run as the weather consist of rain and drizzle. Attending Oktoberfest under such condition is actually quite miserable we are unable to participate in many of the outdoor activities.

Meanwhile, here are some of the pictures we took during the fair and if you are curious which beer tent and beer is the best and most happening, let us share with you a tip: Ausgustiner.

If you do visit Oktoberfest, that is the tent and beer you must definitely try out. We have talked to locals and visitors who have came from far and abroad and so far, the Ausgustiner tent has been consistently rated as one of the best place to chill out. However, do go there early, probably at 4pm, else you will probably be barred at the entrance by the security to prevent overcrowding.

If you have any questions on Oktoberfest, feel free to leave your comments below!

Meanwhile, many Mr Mime have been spotted at Silberhornstraße area.


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