Monday, 23 January 2017


As my regular readers know, I'm a huge fan of technology. It is my pleasure to host an exciting guest post about virtual reality possibilities for dementia care.  This is really exciting stuff! Today's guest blogger is Gillian Douglass, medical writer for Oxley Homecare in NSW, Australia. 

We’ve all heard the jokes about not giving Grandma or Grandpa the remote control, or leaving them alone to program the DVD player, but what about technology that could literally transport Nonno back to the canals of Venice, or take Grandma back to the seaside village where she grew up, without her going anywhere? It’s real and it’s already making a big impact on how we look after and engage dementia care patients. Alzheimer’s Australia has been trialling various virtual reality technologies, and an app, throughout care facilities in Victoria, and it’s taking off. The impact on patient wellbeing, and carers, is dramatic too.

As more and more facilities give patients access to virtual reality helmets, kinect technology like that found on the X Box, or an app, the positive results and heart-warming stories continue to flood in. Patients can see a screen projected on a wall, on a monitor, or when they wear the helmet and select from various scenes including aquatic, travel, animals, relaxation and adventure. A trip to Bali, the sea, the snow, are all made possible again.  The sights, sounds, colour and 360-degree views provide a full immersion for the senses.


As a way of stimulating and engaging dementia patients, virtual reality is non-invasive, portable, and the the envy of most 15-25 year olds around the world!

Stories of the positive impact include residents who have been screaming or moaning stopping, or who cry tears of joy at the memories and sensory stimulation provided by different scenes they can live again through virtual reality. There are others who begin laughing again, and improvements in patient management are starting to become well documented among residents who get to try out a Virtual Reality helmet.

Trials of a simple screen projected Virtual Forest have even lead to a 64% reduction in the use of antipsychotic medication among participants. Engaging elements such as butterflies floating around, flowers blooming and rowboats have a calming effect. “If we can actually reduce the amount of medications that patients live on, they have a much better quality of life,” Dr Tanya Petrovich, a Tech Developer with Alzheimers Australia, told the ABC for a news report.

For caregivers, access to the virtual reality experience is helping occupy long hours when patients might have nothing else to do, or no stimulation, as well as manage patient behaviour. They can also see what the patient is seeing, so they’re able to guide them through the experience, and tell what they do or don’t like. 


Apart from the usefulness for caregivers, different aspects of the technology are also teaching those who don’t have dementia empathy.

A smartphone app, called the VirtualDementia Experience, is also being used in workshops to enhance the learning and increase compassion. Alzheimers Australia has reported a threefold increase in empathy and compassion markers from participants who used the interactive game, which is projected onto a wall through the smartphone or tablet with the app, compared to those who learnt the same information without the game.

The app has been around since 2013, with more features being added since then. Another app from Google, called Cardboard, is also available.

It might not be physically possible to take an elderly relative with dementia on a plane, or transport them to the forest or the beach, but their senses can be taken back there once again in the safety of their armchair. All it takes is a simple helmet to be worn on their head.

Friday, 20 January 2017

How to Recognize and Manage Substance Abuse in Seniors

It is my pleasure today to host a guest post by Trevor McDonald, a blogger who is expert in the area of addictions, substance abuse and families. I read the studies cited below and they are surprising and worrying! 

Did you know that alcoholism is higher among widowers over the age of 75 than any other demographic group? If you were surprised, you’re not alone. It’s a shock to most people, but these stats shed light on an increasingly invisible problem.
It’s difficult to put a true number on the problem because many seniors hide substance abuse from family and caregivers. It’s easy when they live on their own, as many seniors do, but the evidence is mounting to show that seniors in nursing homes and assisted living facilities are also abusing alcohol and/or drugs.
The dangers of senior addiction
Think for a moment about your aging relatives. How many medications do they take daily? Would you be comfortable with them mixing those meds with alcohol? And would you know if they did?
In an informal poll, one in ten adults admitted that they don’t know exactly what substances their parents take, and 11% acknowledged that a parent over 60 consumed alcohol while taking prescription medication. How would your answers fare?
The biggest problem with substance abuse in seniors is that it can be deadlier than in other age groups. Many popularly prescribed medications, including pain killers, cough suppressants and allergy remedies, contain more than one ingredient that can interact with alcohol. And that’s just the tip of the iceberg.
Even if a senior isn’t taking any medication at all, aging slows the body’s ability to break down alcohol and other substances. This causes the substance to remain in the person’s system for a longer period. So while one drink every few hours may have been safe in younger years, that’s no longer the case.
How to spot substance abuse in seniors
One reason substance abuse is so difficult to spot in seniors is that it is so easily explained away. It’s easier to chalk behaviors up to old age than it is to face an issue like elderly drug and alcohol addiction head on. But it’s time for us all to pay closer attention to the seniors in our lives.
Look for the following warning signs:
·       Changes in sleep patterns
·       Unexplained appetite changes
·       Increased falling/balance loss
·       Doctor “shopping” (changing doctors often to get multiple prescriptions)
·       Using multiple pharmacies to fill prescriptions
·       Empty liquor bottles in the trash
Noticing one sign on its own may or may not be cause for concern, but it could give you a reason to get more involved in your aging relatives life.
What to do about substance abuse in seniors
If you notice that your aging relative or patient is hitting the wine bottle too often, the worst thing you can do is stay quiet. This is a serious issue that has potential to shorten this person’s life, so you’ll want to take action. Talk to this person and offer to help find a treatment plan. If he or she is close to your heart, you may also want to offer more of your time. Substance abuse, especially in seniors, is often an outward sign of loneliness and depression.

Monday, 16 January 2017

What Some Doctors Don't Understand About Us

I've been thinking a lot lately about how we communicate with health care professionals. When our loved ones are very sick, they are usually in the hospital and as we gather information to make important choices, we are forced to navigate the uncharted waters of conversations that are so complicated, they are almost impossible to describe.

Take, for example, this scenario that played out recently with my mother. Mom was hospitalised just prior to Christmas for respiratory distress. A young, bespectacled respirologist strode into the room. He smiled at Mom and began to make notes on his clipboard.  "Have you ever had trouble breathing before?" he asked.  "Once when I was about twelve, I was at camp..." Mom began.  My eye was drawn to the doctor's foot. His polished loafer began to tap rapidly, but his smile remained fixed.

I thought, "he is trying to have a business conversation here. But Mom thinks this is PERSONAL!"  I jumped in and re-directed Mom to her more recent health history.

I found myself wishing that this doctor had been trained by Arthur Kleinman, a wise man of medicine whose work I great admire. Kleinman has offered some thoughts on re-imagining the way in which professionals care for the vulnerable and their families.  He begins by suggesting a major transformation of training for health professionals and proposes a new methodology that is rooted in ‘empathetic listening, translation and interpretation’.  The practical steps in building this new professional training would begin with recording a ‘mini-ethnography’ or life history of the patient and his or her family.  The neurologist treating my son’s first seizure would have discovered in my life history that I had been traumatized as a teenager by witnessing my father having a post- stroke seizure while the two of us were alone at home.  I was almost immobilized by fear when I realized years later that Nicholas might have epilepsy. 

Next, Kleinman proposes ‘the explanatory model followed by negotiation’.  Once a professional understands the lived experience of a person requiring care, he or she can converse with the patient and family to compare understandings of the illness, the treatment options and how to agree on a course of action.  Everyone in the room might answer questions such as “What do you think is wrong?  What caused it?  What do you want me to do?  What do you think will happen if you have this or that treatment?”  Of course, no one is going to take time to build consensus in this manner if there is an emergency situation, but in chronic care, consensus is critical to minimizing regret, frustration or anger over the long term.

Illness IS personal to the patient. Understanding the illness experience will never be achieved by professionals who sever the personal from the conversation in the belief that it isn't relevant to treatment. Seasoned patients and their families have a role to play in training physicians how to take histories and gather information about how illness intersects with emotion in a life story. We need medical schools to provide this training. 

Wednesday, 11 January 2017

The Truth About Toxic Friends vs Good Friends

Telling the difference between good friends and toxic friends is especially important for caregivers.  Caregivers simply don't have the dual luxuries of boundless time and energy to invest in friendships that are not reciprocal.  So, here's a quick guide to recognising good friends and toxic friends.


For caregivers, there are two common types of toxic friends; the troll and the narcissist.  

The troll is someone who calls and visits often.  He or she will ask many questions about your loved one and may even visit in hospital to chat over coffee or lunch.  They will appear warm and concerned, while inquiring into the minutiae of your loved one's symptoms and treatments.  This type of toxic friend does not offer help of any kind.  They simply want to know.  The human drama of a caregiver's life provides vicarious interest and fodder for their dinner table chat, but that is all.  This type of friend cannot make the intellectual leap between listening to your experience and offering to sit with your loved one or doing your grocery shopping.

The second type of toxic friend is the narcissist. 

Narcissists rarely, if ever, ask how you or your loved is doing.  They are bored by others' experiences, so constantly direct the conversation back to themselves.  No matter how difficult a caregiver's situation may be, it will always be worse for a narcissist - and they will want you to listen and sympathise.


Caregivers soon find out that longstanding friendships don't necessarily translate into good friendships when the going gets tough.  Some lifelong friends do show their loyalty and generosity, while others suddenly become too busy to call or drop by.  The messy and often sad events in caregivers' lives may be too difficult for some people to witness and absorb.  The fact is, not everyone is cut out for helping others through the toughest times. The trick is to determine quickly who will be a good friend for the long haul and who may be limited in their ability to walk with you through your caregiving journey.  Wise and experienced caregivers will forgive friends who disappear upon hearing your loved one's diagnosis.  Holding on to bitter feelings will only make it more difficult to spot new friends who genuinely want to help.

The extraordinary friend is one who intuits your needs, listens without judgement, visits often and always brings food.  The new friend is an acquaintance who, upon hearing that you are giving care, offers help that is truly helpful.  The kindness of new friends is always a surprise - often the most helpful friends are those you would least expect.  Whether a good friend is old or new, it is clear that your friends are those who truly want to help.  Friends who have a capacity for generosity combined with the character to suffer with you will want to give what they can.  Some may not cook, but their keen wit can suddenly flip fear into dark humor - that is a gift to a caregiver.


Caregivers have the obligation of reciprocating friendship, too.  Most often, this means accepting kindness and saying thank you.  The sincere expression of gratitude is not a sign of weakness or evidence that the caregiver is incapable of handling a loved one's needs independently.  The gracious acceptance of help and friendship in the full knowledge that love flows both ways, is the key here.  Good friends say,  "You look tired. Here, let me help you." The second friend answers, "Wonderful! Thank you so much." That's just what good friends do.

Saturday, 7 January 2017

Why Using Hospice Doesn't Mean You're "Giving Up"

None of my own family members have ever been in hospice care, but our son Nick has been on palliative care for some time now. We support Nick's decision not to have any more surgery or invasive procedures to correct the effects of his disabilities. Between 2006 and 2011, we lived in London, England. During that time, Nicholas was often ill and we used the wonderful services of our local hospice, but as an outpatient. Our compassionate and clever palliative care physician made frequent home visits and so did the hospice social worker. For soothing treatments such as massage and reflexology, I took Nick in to the hospice. I'm a huge supporter of both palliative and hospice care. They're nothing to be frightened of - on the contrary, when a cure is no longer the medical objective, these services are there to make living a lot more pain-free and enjoyable. - Donna

The final stages of life’s journey can be difficult. But using hospice care does not mean you or your loved ones or your doctors are giving up. Hospice is a shift in your health care goals and objectives with an emphasis on comfort and quality of life.

Through hospice care, a patient and their family have the opportunity to enjoy life and celebrate memories in comfort and with peace of mind.

Hospice is not the end, but the beginning of a different journey.

What Does Hospice Really Mean?
Hospice care is a specialized form of medical care designed specifically to provide comfort and a better quality of life to patients with an advanced illness. Instead of searching for a cure, hospice enables patients to live each day to the fullest.

While hospice does involve admitting that most terminal diseases cannot be cured, eliminating pain while helping patients remain alert is the ultimate goal of hospice care. But there is still a great deal of healing that can be done in hospice.

For example, hospice care is holistic and is designed to support the entire family through compassionate care. There are several different types of hospice care, including spiritual services, 24-hour or on-call care, palliative care and bereavement counseling.

These programs are designed specifically around the needs of the patient and their family.

Quality vs Quantity
Hospice care is about quality versus quantity: It’s about making sure the patient is comfortable more than extending the patient’s life, and that is an important distinction. As a family member facing hospice care for a loved one, it’s important to keep an open line of communication with your patient and other family members.

Hospice care doesn’t mean your doctor is no longer involved in the process. It’s quite the contrary actually. It’s important that your doctor is present whenever any major medical decision is made.

“Hospice care doesn’t mean your doctor is no longer involved in the process.”

If you’re still having difficulty understanding the benefits of hospice, it may be time to ask another family member or a trusted friend to help out. Being the primary caregiver of a terminally ill patient is a big responsibility and understanding their wishes is integral to the process.

Ensuring your loved one received the quality of care they deserve may mean removing your own personal bias from the equation – which is easier said than done. The patient’s needs and preferences should take precedence over all else.

Celebration of Life
Hospice is more about looking back and celebrating the life lived, than it is looking toward the end of life. It’s a care program designed to ensure patients have as much quality time with their loved ones as possible. So it is important to approach hospice with a positive attitude.

Hospice patients can live for months and even years with the advanced treatment methods available. This is especially true for children and young adults facing hospice. It can be difficult to celebrate life when you’re dealing with a child, young adult or a patient with memory loss in hospice.

Under these circumstances, quality of life should take top priority.

Dignity and comfort are important in life and even more so when one is approaching the end their life. While hospice does not seek a cure, it does help patients and their families cope and it provides important quality time.

It is not the end, but the beginning of a different journey.

Dennis Silva is Co-Founder of Omni Care Hospice, a  provider of compassionate, quality home hospice care in Las Vegas that meets the needs of people with life-limiting illnesses and their families.