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Creating a Caregiver’s Toolbox

Although Kate and I have experienced “ups and downs” while “Living with Alzheimer’s,” we’ve been able to live joyfully from the time of her diagnosis. There are many reasons for our success, but I believe having a large “caregiver’s toolbox” has been one of them.

We began our journey with 22 years of caregiving experience. That included all four of our parents and my dad’s significant other after my mom’s death. Three of them had dementia. We learned a lot during that time, and it made it easier for us to approach our personal experience with Alzheimer’s. That gave us the first tools for our toolbox.

My professional experience also provided relevant knowledge about caregiving. For ten years I was a social psychology professor. As I transitioned to a career in market research, I directed a master’s degree program for alcohol and drug abuse counselors. That fit well with my social psychology background and greatly expanded my knowledge acquired in academia.

Several years later, I joined the Stephen Ministry program of our church. This program links individuals who are facing personal and/or family problems with church members who serve as understanding companions who meet with them regularly until the service is no longer needed.

Despite that background, I felt the need to know far more. Each of the people for whom we had caregiving responsibilities was unique.  I wanted to know how other people dealt with their situations.

My first step was to visit the Alzheimer’s Association website where I found an abundance of information and sources of help for caregivers as well as their loved ones. I read a fair amount of posts on various message boards but found it a little depressing. It was a comfortable place for people to express their problems and seek help, but I wanted to find a source with a more positive outlook.

That led me to check books on Amazon where I found Alzheimer’s Daughter by Jean Lee. Both of her parents had been diagnosed with Alzheimer’s on the same day. She carried a very heavy load as a caregiver. It was far more challenging than any of the experiences with our parents. Although facing significant struggles, she came away with an uplifting message for others facing similar situations.

I liked that. It led me to write her a letter. I was surprised and pleased when she replied. It turned out that she did much more for me than that.

When I created this blog, I communicated with her. It was she who introduced me to AlzAuthors, a not-for-profit organization of people who write about dementia. Becoming a member expanded my knowledge about dementia and caregiving. It also provided me with a much wider range of support. Most of them were caregivers or former caregivers. Others were people who were medical professionals who studied dementia. Still others had been diagnosed with the disease. As a result, I have been asked to serve on panels of workshops on various aspects of dementia and to be interviewed on several podcasts.

It wasn’t just the authors themselves, but many of them were also active on Twitter (now X). I, too, became active. That brought me in contact with a host of other people whose experiences have influenced me.

In addition to the impact that Alzheimer’s Daughter had on me, I was highly influenced by an article I read. It dealt with the importance of a team for a caregiver. The article’s focus was on a team of medical, legal, and financial professionals. I shared the author’s view and already had those in place, but I took that one step further.

I’ve always enjoyed being around other people. I decided to consider everyone with whom I came in contact to be a member, or potential member, of my team. That began with my family and friends but expanded to social media like Facebook and Twitter and the many strangers I encountered. This didn’t require anyone to do anything special. Even people who checked and bagged my groceries became part of my team. Servers in restaurants were especially important. As I look back, having a large team of supporters has played a big role in helping me as a caregiver.

Thus, I began life as a caregiver for Kate with a toolbox of useful tools. That toolbox has expanded considerably over the years. A carpenter always encounters situations that require new tools. That is certainly true for me as a caregiver, In future posts, I’ll talk about other tools that have been especially valuable to me. Stay tuned.

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Reflections on Living with Alzheimer’s: Part 2

In my previous post, I talked about our pre-diagnosis experiences and my belief that they have helped us deal with our post-diagnosis experiences with Alzheimer’s. Many other things we have done since the diagnosis have also been valuable.

One is the way we responded at the beginning and continued throughout our journey. We both accepted the diagnosis. We were helpless to change that. Instead, we directed our attention to “What next?” Planning was a critical first step. We talked a lot during the first few weeks. We didn’t arrive at a detailed plan, but we set a goal that has guided us from the beginning to the present time: to enjoy life and each other as long as we were able. We began binging on the activities we had most enjoyed throughout our courtship and marriage.

That included going to more movies and theatrical productions. We took advantage of our local theaters as well as those in three other cities that were within a 2-hour drive from our home. We attended many musical events locally and out of town. We also traveled domestically and internationally.

We made a change in our dining habits. At first, I tried my hand at fixing simple meals and bringing in meals from some of our favorite restaurants. I quickly discovered that I didn’t like fixing meals or cleaning up afterward, so we started eating out for lunch and dinner. That continued until the beginning of the pandemic in March 2020.  We had eaten out more than 6000 times since her diagnosis. In addition to eating out for our daily meals, we went to a local Panera Bread each morning where Kate got a muffin. After lunch, we went home for a break where she rested. Later in the afternoon, we went to the café at Barnes & Noble where we spent an hour or so before going to dinner.

We did all this for convenience and pleasure, but the most important benefit was totally unanticipated. We were never socially isolated. We often ran into friends and acquaintances. We also became better acquainted with the servers and managers of the various establishments as well as other regular customers. Doing all of these things meant we led very active lives. We were living well, and we were achieving our goal of enjoying life and each other.

It wasn’t until 2018 (7 years after Kate’s diagnosis) that I understood why we had gotten along so well. That’s when I read Dementia Handbook by Judy Cornish. She introduced me to the significance of rational and intuitive thought and its relevance for people living with dementia.

Rational thought deals with the kinds of things we learn from our parents, teachers, and many others we encounter. These include the rules of behavior as well as factual knowledge like language, history, math, spelling, names of people, places, things, etc. Intuitive thought involves experiential learning that occurs directly through our senses – touch, taste, smell, sight, and hearing. We put so much emphasis on rational thought that it’s easy to overlook the significance of what we learn experientially. That is probably why so many people believe that all is lost with dementia. That’s a big mistake. As Cornish points out, intuitive thought provides us the ability to enjoy the world around us like music, art, and the company of other people.

When I learned this, I immediately recognized that Kate and I had done just what Cornish suggests. When we focused our attention on enjoying life that led us directly to the things that Kate could appreciate even as her rational thought declined. Music, theater, dining out, travel, as well as time with family and friends were all things she could enjoy.

That is not to say that we could continue all of these things while “Living with Alzheimer’s.” For example, she reached the point at which she could not follow the plot of movies. Interestingly, the last two movies that she really enjoyed were Won’t You Be My Neighbor which was about Mr. Rogers,and RBG, a documentary about Ruth Bader Ginsburg. Both films were filled with humor and touching emotional moments that she could appreciate.

All of these things have enabled us to live joyfully with Alzheimer’s. Best of all, we continue to do so at this late stage of the disease. I firmly believe the improvement Kate has experienced over the past year relates to the attention she receives from the residents and staff of our retirement community. Of course, our primary caregiver and I make sure she gets the same attention at home. This attention is something else that she can enjoy via her intuitive thought/ability.

You might ask, “How long will this last?” I ask myself the same question. The answer is I have no idea. One thing I do know. We will continue to enjoy life and each other as long as we are able.

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A Day to Remember

Twelve years ago today shortly before noon, Kate’s doctor delivered the news we had expected but did not want to hear. The results of her PET scan showed signs of plaques and tangles associated with Alzheimer’s. Our lives have never been the same.

We went to lunch right after leaving the doctor’s office. We talked about the results and the implications as well as we could understand them. We decided to make the most of whatever lay ahead, but we never knew that we would be able to live so joyfully. That was true from the beginning and remains so to this day.

Looking back, I see that we lived in a big world filled with activity and social engagement. Our world today is much smaller. The highlights of every day are our afternoon trip downstairs for ice cream and our dinner in the dining room of our retirement community. You might think that is sad, but we have found that both activities involve a good bit of social connection with residents and staff that is invaluable to us. Our move to a life plan community came at the right time. We may engage in fewer activities now than in the past, but the support we receive is powerful enough to keep us happy.

So, I am grateful on this day. I’m grateful that she is still with me, and I mean that in several ways. First, she is still alive which beats the average life expectancy from diagnosis. In addition, she still lives with me, sleeping right beside me. Finally, although I don’t think she ever remembers that I am her husband and rarely remembers my name, our relationship remains strong. That means the world to me.

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An Anniversary I Won’t Forget

Ten years ago today, Kate was diagnosed with Alzheimer’s. That led to the most significant life change we’ve ever experienced. That night I made the first entry in the journal that became this blog . I have posted it below with a few of my present thoughts about “Living with Alzheimer’s.”

JANUARY 21, 2011 BY RICHARD CREIGHTON

Getting the Diagnosis

Today Kate and I met with Dr. Reasoner to get the results of Kate’s PET scan. She had gone in for the scan a couple of weeks earlier following a routine appointment with Dr. Reasoner. I went with her for that appointment to give my own impression of Kate’s lapses of memory and to hear what Dr. Reasoner had to say.

Dr. Reasoner suggested that she have a PET scan and a behavioral evaluation by a neurological psychologist. Kate had the scan about 2 weeks ago. On Wednesday of this week, January 19, she had an initial visit with the psychologist. Kate is scheduled to have her evaluation on Wednesday, February 16, at 12:30. She has been told this will take as long as 5-6 hours.

Kate and I have not talked much about the PET scan and the potential results. We both knew what was possible, and I think neither of us wanted to drag ourselves down in worry of the worst news. For the past few days I have had some trouble sleeping and have found myself thinking about how she and I would react if the test came back positive. I am sure that every cancer patient would understand this reaction.

As we went to the appointment, I kept telling myself that we might get good news that the test was negative. That was not the case. Dr. Reasoner presented the results matter-of-factly but not coldly. She said the test did show signs of “early onset Alzheimer’s.” She went on to explain what that meant (the tangles in the brain) and how it can be addressed (initially with Aricept and after a few weeks another drug that has, in the past, been used at later stages of the disease).

Dr. Reasoner told her the average life expectancy for someone who is diagnosed early (the starting part was not and, I suspect, cannot be known) is about 12 years but that she could live much longer. She also gave a few examples of people she had known whose quality of life was good even with the memory loss. She is especially interested in Kate’s behavioral evaluation. That evaluation will determine whether the disease has affected other things than simple memory.

Kate handled the news with a good bit of control and later in our meeting, she said that in some ways, she actually felt relieved to know what was causing her memory problems. Her greatest concern is having to depend on family or professional help to take care of her personal care, something that she feels could be required for a long time should she live as long as her parents.

I tried not to give in to the emotion I felt on receiving the news. At one point as we were discussing Kate’s care in the future, I reached for her hand and tried to assure her but choked up. Dr. Reasoner gave me Kleenex to wipe my eyes.

After leaving Dr. Reasoner’s office, we went to Casa Bella, a restaurant that holds a special place in our hearts. We were introduced to it in the early 70s by one of Kate’s best friends. In the last 10-15 years, however, we have eaten there more frequently. We came there after both of our dogs died. She got her veal piccata and amaretto cheesecake that she loves so much.

We talked briefly about having to decide when to tell our children and friends. We both agreed that now is not the time. We know that once other people know they can’t help but treat you differently, and she doesn’t want that. We are just going to take it a day at a time right now and trust that we will know when we should let it be known. This is going to be very hard for both of us as there are people we might look to for support, but there will be a time for that down the road, hopefully a long time down the road.

At that time, I had no idea of what the future held. We were just determined to make the most of whatever time remained to us. I’m grateful that we’ve been able to do just that. We’ve not only enjoyed life but each other as well. Kate can only live moment-to-moment now, and I mean that literally, but I continue to focus on that initial goal. It has served us well in the past, and I am optimistic that it will do so in the future.

I am mindful that we haven’t done it alone. I’m grateful to a host of people who have lightened our load in numerous ways. They include our healthcare professionals, especially her doctors and their associates, but they extend far beyond them. I’m thinking of family, friends and even strangers who have boosted our spirits so many times in so many ways. I am thankful to those of you who are readers of this blog. You, along with my Twitter friends and fellow AlzAuthors, have given me a focus beyond that of being a caregiver. You have played a key role in keeping me going. I consider all of you as members of my “Caregiver Support Team,” and I thank you.

I also recognize there are many others “Living with Alzheimer’s” who haven’t been as fortunate as we have. Some of you reading this post may be among them. My heart goes out to you. My wish is that you will find your own ways to experience moments of peace and joy in the midst of the inevitable challenges that face all of us who travel this road.

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Noticing the Signs of Dementia

Earlier this week I saw the following tweet from Dr. Oz.

I recently found out that my mom, Suna, has Alzheimer’s disease. Hearing the official diagnosis was devastating. But just as painful for me was the realization that the signs were there all along. I had just been overlooking them.

His tweet caught my attention because I believe his experience is very common – and with good reason. My mom also had dementia, but I have no idea how long she had experienced the early signs. She and my dad lived in South Florida while Kate and I lived here in Knoxville. They made their decision to move here in 1993. At the time I knew they were experiencing aging issues common to people who are eighty, but it never crossed my mind to suspect that she might have dementia. I don’t even recall the time that I recognized it for myself. I know it was earlier than 1998 when her doctor’s social worker gave us the results of her routine memory test. She was very careful in the way she told my dad and me. She didn’t want to shock us. She needn’t have worried. We were not surprised and told her we were aware of the problem.

She died in November 2002, just four years after the diagnosis. Looking back, and given what I know now, I believe she was at Stage 7 of the 7-stage model of the progression of Alzheimer’s at least a year or two before her death. I am sure that Dad must have known the problem before their decision to leave Florida even if he didn’t recognize it as dementia. He never said a word to me before the diagnosis and very little afterwards. What I knew came only from my personal observations. I had arranged for their purchase of a condo that was near our home, and was with them a lot. Yet, when the doctor suggested it was time for hospice a few months before her death, I was surprised. How could I have been so blind?

I have a better understanding now that Kate and I have lived with the disease 13 years since we noticed her first signs. I believe there are two interacting reasons. First, it makes a big difference to be with a person for an extended period of time and even better if you live with the person. That is particularly true in the early stages when so much of a person’s behavior is normal. Second, changes are gradual so that it is difficult to recognize them until the behavior becomes obviously abnormal.

I am pretty sure that I missed the early signs of my mother’s dementia because I wasn’t with them very often. They were still in Florida. When they moved here, I wasn’t looking for them and still wasn’t around her enough to see anything but a memory problem. I attributed that to aging. I recall my mom’s saying, “I don’t know what’s wrong with me. I can’t remember anything anymore.” My standard answer, even after the diagnosis, was “Everyone forgets things now and then. That’s especially true as we get older.” Sometime over the two or three years after their move to Knoxville, I could tell that her problem was more serious than simple aging.

Kate recognized her Alzheimer’s symptoms before I did. For several years, she periodically said, “I think I have Alzheimer’s.” I responded the way I had with my mother and suggested it was part of aging. Over time, I began to realize she was right. That was about five or six years after the first signs.

I have heard others say they were as surprised as I when medical authorities suggested hospice for their loved ones. I believe that, too, is also understandable. It is easy to adapt to patterns of behavior, and not be sensitive to the progression of the illness. My mom had been uncommunicative for a period of time before the doctor mentioned hospice, and I didn’t notice any signs of the end. The doctor, a gerontologist, could see what I couldn’t.

I am also reminded of the passing of Kate’s mother. The day before she died neither Kate nor I had any thoughts about her having only a day to live; however, the caregiver on duty that morning told us she had begun the process of dying. By that afternoon, we could see that she was right. She died just after 8:00 the next morning.

I see how Dr. Oz failed to recognize his own mother’s dementia. It’s not that hard to miss unless you are around the person a lot.

I should make one other point. It makes perfectly good sense for people in their seventies or older to think that their memory problems are normal. That is usually correct, but about one in every seven people over the age of seventy has some form of dementia.

I did not sense a great need to get an official diagnosis for Kate. I knew there wasn’t a cure and felt that it would not change anything we were going to do; however, once we had the diagnosis, we became much more intentional in making the most of our time together. I know that has paid off for us. We are still living well almost nine years later.

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Kate’s Brother Ken

Since Kate was diagnosed with Alzheimer’s seven years ago, I have read quite a number of personal experiences with the disease. Most of these have been written by caregivers of a family member with Alzheimer’s, a smaller number by people with it. It hasn’t surprised me that despite having certain things in common, people (both caregivers and their loved ones) respond to the disease in very different ways. Throughout our own journey, I have tried to be sensitive to this fact. I’ve tried not to write as though others’ situations, experiences, and responses are like our own. Even within a family, there are often differences. Let me tell you about Kate’s brother Ken.

In October 2013, two and a half years after Kate’s diagnosis, we learned that he, too, was being tested for Alzheimer’s. They received the diagnosis in November of that year. He is a little more than two and a half years younger than she. That means he and Kate received their diagnoses when they were about the same age. He and his wife, Virginia, live in San Angelo, so we don’t see them very often. We have, however, tried to visit them each time we visit our son and his family in Lubbock. In addition, Ken and I talk periodically by phone and also exchange email messages.

From the outset of their diagnoses, Kate and Ken have approached their situations quite differently. Kate has always wanted to be very private. Other than Ken and Virginia, she has only told one other person about her diagnosis. That was her best friend. Kate hasn’t wanted to join a support group or read anything about Alzheimer’s or other people’s experiences with the disease. She has simply wanted to live her life as normally as she could.

In the early years, she experienced a good bit of frustration from her memory lapses and difficulty completing tasks like working on the computer or dialing numbers on the phone. She has thought a lot about Alzheimer’s, but she has not wanted to talk much about it. We have only obliquely approached the subject. Nowadays, we never mention it. I don’t believe she thinks about it at all except when we go to her doctor’s appointments. She had her latest appointment a few weeks ago, and nothing at all was said about Alzheimer’s. I believe she still recognizes she has the disease, but I don’t believe she associates it with any special problems she has. I never mention it to her. At this point, I don’t see any benefit in her fully understanding the disease, where she is on her journey, and what lies ahead.

Ken, a retired psychology professor, has approached his diagnosis differently. Shortly after he was diagnosed, he informed his family and close friends. He found a support group of others who have dementia and continues to participate in it. He once appeared on the TV news in San Angelo that featured his group.

I’m not sure whether it is his background in psychology or his personality or both that account for his approach. He has also been more deliberate in learning more about Alzheimer’s, ongoing research on the topic, others’ experiences with it, and exercising his brain.

Since I launched this journal as a blog in January, Ken and I have had phone conversations and emails about ways that we might include his experiences and approach to Alzheimer’s within this blog. I don’t think either of us knows exactly where this might lead, but we are going to take a first step.

With that in mind, I thought I would first give you a glimpse of him via a letter he wrote to his sons. The letter, which is copied below, was written in January 2014. This was very shortly after he had received his official diagnosis. He had previously informed them by phone of his test results. This letter was the first in a series of annual letters in which he provides updates. I may share the others in subsequent posts.

Let me point out several ways Ken has responded differently than Kate.

  1. Ken informed his children very shortly after he knew the diagnosis. He and his wife, Virginia, had been with us in Knoxville in October to celebrate my dad’s 100th. At that time, he told us that he was undergoing testing. That was completed in January. After we got the word from Kate’s doctor, we kept the information to ourselves for a long time after that. It was three years later that I told our children because I thought they needed to know.
  2. He was already thinking about a support group and exercising his brain with his photo albums and Lumosity.
  3. He considered some of the most disturbing manifestations Alzheimer’s and wanted to protect Virginia from any potential aggressiveness he might display.
  4. He wanted to clarify his preferences about his care and his desire that she be able to spend her summers in Michigan as she has done for most of her life.

Here’s the letter to his children.

February 2, 2014

Dear (children)

 Virginia and I had a recent meeting with our neurologist to update my diagnosis and discuss strategies for the future.

 He again went over the lab results with more detail, but you already know the general essence of the findings.  To summarize, the results show that I do indeed show clear evidence of mild Alzheimer’s.  While there is great variability and no precise predictability, he said that we are probably looking at a 10 – 12 year time span progression for the disease.

 The good news is that we caught the diagnosis relatively early and that new medications are being developed.  Also, I am in good general health.  Virginia and I are walking together, and we are looking into a “memory support” group for early Alzheimer’s patients.  I faithfully exercise my brain with my photo album projects and play “Lumosity” on almost a daily basis.  The bottom line is that we are being proactive in our efforts to extend the cognitive quality of our lives together.  We hope to have many good years left together for us and our families.

 I inquired about the possibilities of future aggressive behaviors on my part.  Again, Dr. Smith said there are no clear predictors.  It helps to start out with a non-aggressive nature, so I have that on my side.  Some people become passive and withdrawn. However, there does come a time when the disease takes over and “Ken” will no longer be in charge. I saw this with Mother and her stroke-induced dementia, when she occasionally became somewhat combative and argumentative –traits I never saw even once in her normal existence.

 I am writing this letter so that there will be absolutely no future doubt about my feelings on this matter.  If I exhibit aggressive or combative behavior toward Virginia, I want Virginia to have no hesitation to use prescription drugs to control that behavior, even if it further impairs my mental abilities.  I also instruct Virginia to physically move me to a separate living facility when she decides that it is time for that to occur – and I trust her judgment on this issue.  I hope that you will provide advice and counsel on these and related matters, but the ultimate decision will have to be made by Virginia.  I want the decisions to be in her best interests.  I have absolutely no fear of not being well cared-for, or that such a decision will be made “before it’s time”.  In contrast, it is the thought of my not being removed from such a situation that scares me more than anything else – thus, this letter.  Please save this letter and, if I later protest, show it to me as a reminder when the time comes. 

 On a related matter, I want it clear that I wish Virginia to be in Wisconsin during the summers with our children and grandchildren, even if I am unable to make the trip.  If I have to stay in San Angelo, she will get a well-deserved break.

Virginia is not aware of this letter.  I will show it to her the day after I mail it.  I want you to know that I am writing this of my own volition and that she has not requested that I write such a letter.  Please store this letter in your lock box or a safe place where it can be retrieved in future years – if need be.

 I love you all so very, very much.  I also look forward to many good years in the future before we need to face the decisions outlined in this letter.

 Love,

 Ken

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Is it better to know or not to know?

I am currently reading (that is, listening) to The Inheritance by Niki Kapsambelis. It is a fascinating account of two true stories. One is about the efforts of medical researchers to understand Alzheimer’s and uncover a way to prevent and/or cure it. The other is about a family that has experienced the disease over several generations. The part I read this morning deals with the family members’ opportunity to be tested for the gene that is the carrier for the disease. Most of the family chose to know. Others did not. What do you think you would do?

This question led to my reflecting on our decision to find out if Kate’s symptoms were just part of normal aging or if she had Alzheimer’s. Too much time has passed for me to recall clearly when we started asking ourselves that question or exactly how each of us felt about it. I do remember that Kate wanted to know. I also recall that I didn’t have the same desire. Knowing how little there is that one can do to change the ultimate outcome of the disease, I believed we could just go on living our lives as fully as possible.

I recall that by the time we initiated the process for her to be tested, we were pretty sure, but not confident, that she had dementia. Kate had been the first to notice the symptoms five or six years before. I began to notice more after she had mentioned her fear that she might have Alzheimer’s. We seem to have reached the decision to find out at the same time.

When her doctor gave us the results of her PET scan, Kate said she was relieved to know. I remember that she accepted the diagnosis quite calmly. I can’t say the same for me. Immediately, I felt a deep sense of sadness. I choked up. The doctor handed me a tissue to wipe the tears. You might think that if we were already prepared for the answer the doctor delivered to us, I would have responded more like Kate. In retrospect, I think we both responded in ways that are consistent with our personalities. I remember our daughter’s having a bicycle accident when she was twelve or thirteen. As we were with her in the emergency room, it was Kate who was as steady as a rock. I don’t know that I showed it on the outside, but I was a wreck on the inside.

The impact of the news wasn’t limited to that moment. Kate remained calm, but the news did take its toll on her for a short period of time after that. We talked talked a good bit in the weeks that followed. We talked about the implications and how we should respond. When should we tell our children? Our extended family? Our friends?

It wasn’t long until we began to realize that there really was no impact on our day-to-day lives. We began to feel the way we did before the diagnosis, but, for me, the impact has remained as a central part of my life. I made an abrupt change in the way I responded to her forgetfulness and other symptoms of her illness. Now I understood why she was doing so many of the things she did. I became a more understanding husband.

I tend to be a planner and quickly went into planning mode. As her caregiver, I haven’t stopped yet. The plans are always changing as necessity demands. I believe that getting the diagnosis was the right thing for us. Knowing was the catalyst for our taking advantage of our time together. We thought we were already doing that, but the diagnosis caused us to shift into high gear. That is how we plan to live as long as we are able.