Welcome to “It’s My Turn To Care.” We know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support as you navigate your role as caregiver. Let's get started. [00:15.6]
Dave: Hello, and thank you for listening to It’s My Turn To Care: Secrets for the Dementia Caregiver. My name is Dave Parks and I'm a certified senior advisor and owner of Home Care Assistance. The purpose of this podcast is to bring you tips and strategies, and ideas on how to help your loved one that you're caring for that’s suffering with dementia, some things that you can do to make your life better—and the word I've come out with is “surthrive.” I want you to suthrive the journey, not just survive.
Today, we have a special guest. Of course, I say this every week, but all my guests are special, and our guest today is Daniel Bruce and he's going to talk about anxiety, depression, and how this can relate to dementia. [01:11.5]
He actually started a program called Safe Choices, a dementia care planning program for a home health agency, and now he's the owner of Elder Care Solution Services. What they do is they provide counseling and senior care planning, so Daniel is a licensed counselor and a geriatric care manager. He has special credentials and biofeedback therapy and EMDR, which is Eye Movement Desensitization Reprocessing. I hope I said that correctly.
He's been in healthcare for 30 years, working as a hospital director of case management. He has also been in hospice, a social worker, grief counselor, a senior care planner for families, skilled home health administrator, and geriatric psychiatric hospital as a counselor. [02:09.7]
So, Daniel, thanks so much for being on the program.
Daniel: Dave, thanks for having me today. It's a pleasure, and thank you for what you're doing to give tips for our families that are working with patients with dementia. It is a challenging time.
Dave: I appreciate you coming on. I'm excited to talk about anxiety, depression, and dementia, because I think we all experience anxiety, those of us that are not suffering, so I can imagine the toll and the stress it puts on those that have dementia that also have anxiety. But let's talk a little bit about Elder Care Solution Services and the services that you provide families and seniors, so tell us a little bit about that.
Daniel: I'll give you my elevator speech. That’s where you're able to give a quick shout out about what you do. [03:02.2]
Daniel: But Elder Care Solution Services utilizes licensed counselors, mainly LCSWs and certified case managers, and we basically provide two services. One is counseling for seniors related to grief, depression, anxiety, loss of functioning, loss of independence, and some other more serious mental health issues that people deal with even as they get older, such as bipolar. That's a big part of our services. It’s just straight counseling. We do that through telehealth visits and some mobile person to person in their home and also at our office in Grapevine.
The second part of what we do at Elder Care Solution Services is we act as a consultant to families who are trying to do some planning in advance of a crisis. Although you and I both know that we often get those calls and everybody's already in the middle of the crisis, we try to do some preplanning with people, letting them kind of be aware of what their options are as they start caring for a loved one. [04:15.7]
When is it time to stop driving? Should I move Mom or Dad out of their home? All of these kinds of questions. And if I do, how much does it cost and where do I get the money, and does Medicaid pay for any of this? Hey, Dad was a veteran. Can Mom get any of those benefits? So, kind of putting together kind of the financial package, as well as the community resources. That's part of that service, the planning part of what we do.
Dave: I think that's a great service. We run into families all the time that need maybe not a lot of counseling, but they at least need to be pointed in the right direction, if nothing else, but in some cases they need a lot of counseling. When you do provide counseling, there's probably some testing that you have to do when you first start working with a patient, so talk about that a little bit. [05:05.6]
Daniel: Anytime we're doing strictly mental health counseling, we are a certified by Medicare, and we take a Humana, Aetna and Cigna for psychological services, and so our initial assessment of a patient, we'll, of course, talk to them about what they see the presenting problem—what is the reason that they think that they need counseling or what problems are they having that would warrant talking to a counselor?
But, in addition to that, because we're working with seniors, we do some testing to differentiate what's really going on with the senior. So, we'll do Beck's emotional inventory. We'll do the depression scale, geriatric depression scale. We'll do the anxiety inventory. We do the St. Louis University mental status exam with people, and if we need further up, we'll do Montreal cognitive exam and even MMSE if we need to. So, there's a whole line of tests that we can do. [06:10.4]
Essentially, what we're trying to get at is do they have depression and anxiety or do they have dementia, or do they have both? Because oftentimes depression gets confused as dementia. I'm not walking as fast. I'm not concentrating as good. I don't seem to respond as much. I can't remember things. My focus is off. That kind of sounds like dementia, right? I'm beginning to kind of lose memory and thought, and processes.
But those are also symptoms of depression. So, it's very important to see what we're dealing with, and sometimes the depression is because of the dementia and becomes a chicken or the egg, if you will. But we want to know how much depression does a person have, how much memory loss do they have, if any, and we want to be able to make sure we're treating things appropriately as to what they've got going on. [07:05.6]
Dave: Okay, because I do hear that a lot where I'm not sure if my mom or dad has…I don't know if they're just depressed or maybe they have some early-onset Alzheimer's disease. I just don't know.
Dave: So, you'll be able to help them through that process.
Daniel: Absolutely. Absolutely. That's what those tests are geared to do and they're validated, and we go over that with families and patients to kind of show them where they're at.
Dave: Sure. Okay, so let's talk about kind of the topic at hand being anxiety and depression, and let's talk about what actually can happen to the body when anxiety and depression come on.
Daniel: Anxiety and depression have a physiological response, and that generally is caused by the stimulus of stress and there is what we call an immediate stimulus of stress, and then there's kind of the ongoing stimulus of stress. [08:03.2]
Let me give you a couple of examples. The other day, our neighbor called early in the morning and about 6:30 in the morning—we live in the country a little bit, Sandy and I, and have chickens and goats, and lots of fun things like that down in Mansfield—and in a panic, in a stressful moment said, “Hey, by the way, there's a black panther and a cub in our backyard.
You would think, How could that be in this neighborhood? But they're declaring a lot of land in the area, building new houses, so we've seen a lot of wildlife, bobcats, coyotes, things like that. I haven't run into any face to face, but if you did run into a bear, so to speak, or almost had a car accident, for example, it's what we would call an immediate stress and you'll notice physiologically some things happen. The heart rate increases. It starts just racing, right? Your hands might become very cold, sweaty and clammy. You'll notice your breathing becomes very short. You may feel some tension in your shoulders, arms or back. [09:13.4]
So, you began to have all of these responses in your body to stress, and then as that stress alleviates, Okay, I didn't run into the back of them. Everything is good. Let's get rolling. And you get a little bit of recovery time, you kind of come back to a normal, but that ongoing stress that we have tends to kind of keep us at this hyped up level.
It might be financial troubles. In our economy right now, there's a lot of that going on. It could be issues in a relationship with somebody, and it could certainly be dementia, the stress of now I can't do the things that I used to be able to do. I can't find things I'm trying to cover because I know something's not right with me. And so, even the fear of what if I can't take care of myself? Who's going to take care of me? [10:07.5]
And so, now you have this heightened sense of anxiety, if you will, that's having all of these physiological impacts on your body and causing depression and anxiety.
Dave: Yeah, I think we all experienced some of that, but I can imagine a senior experiencing that and maybe not really know what's going on. It sounds like you can help guide them through that. Where does our anxiety come from in the brain? How kind of does anxiety relate to dementia?
Daniel: I think anxiety for a dementia patient is similar to us with a few differences, and that is that there's a physiological reason for anxiety, but there's also some biological reasons. Again, we talked about coping and daily living, and loss of control and fear, but one of the things that happens is that when you have stress, you release cortisol and cortisol is a hormone that can cause hippocampus atrophy. [11:12.4]
The hippocampus is the region of the brain where you have your memory and your learning ability, and so, in that region of the brain, the more anxiety and stress, and cortisol, you have, the more atrophy you have, so it almost becomes like a vicious cycle. I can't remember things. I'm afraid of the future. I don't know who's going to take care of me. I'm trying to hide all these things. Now I've got stress and cortisol being released. I feel anxious and I'm deteriorating the very part of the brain that I'm trying to preserve through all this anxiety and worry.
Ironically, the cortisol and the stress in the hippocampus are closely related to a part called the amygdala, and the amygdala is what I like to call the fire alarm. Maybe you remember in eighth grade some prankster—it wasn't me, although I was a prankster, Dave—but maybe you remember some prankster coming along and pulling the fire alarm, and everybody running out of the building. [12:13.6]
The amygdala is kind of the fight or flight to our stress response. It's the fire alarm in the brain and it's not logical. It doesn't have logic. It does remember past events and it has a hypersensitivity that it develops. That's where PTSD comes in. Firecrackers are going off and, all of a sudden, now we think it's M16s because there's a hypersensitivity in the amygdala. So, when this fire alarm starts to go off, we start to feel all the physiological response, shortness of breath, heart racing. You also have vasoconstriction. That's where your vascular system begins to clamp down and the blood begins to flow away from your hands to your major organs. [13:00.6]
And so, the dementia patient has all of these worries and concerns that are going on, and they have a less effective hippocampus and a less effective amygdala, so sometimes behaviors and anxiety can be harder to cope with and they tend to trigger it a little faster than they would normally.
The emotions also are part of this area and oftentimes the stress response is not logical. You may have a response to something and, all of a sudden, be feeling panic and there's no reason for that panic. And you don't know why you feel panicked. Why do I feel panicked? And it's because your amygdala is protecting you from something maybe that happened in your childhood or many years ago, and so that memory is keeping that protection up around you to keep guard. Then, as you get older and you get dementia, it gets even less discreet, so it’s ability to go off is even more sensitive causing more anxiety, and anxiety and depression go hand in hand. [14:06.8]
Dave: Part of it is a natural part of aging, the sensitivity going, or is it typically when you have dementia?
Daniel: It’s specifically when you have dementia. It's not a natural part of aging. I mean, there are many people that are aging whose minds are very good, and their ability to deal with stress and cope with stress is just as good as it has always been.
Dave: So, what can we do to kind of monitor our anxiety and stress in our body?
Daniel: There are different ways that we can monitor more intuitively what's going on with our body, and one of those I brought here today, Dave. I know our audience can see it, but if you want to take that piece of tape and tape that on your finger, and we'll kind of monitor you for a minute. How about that?
Daniel: Put that little blue thing under the tape there, the blue temperature…yeah, under the tape, just on the finger right here. And what this is, Dave, is this is just nothing more than a thermometer. That's all that is. [15:07.6]
And you say, What does a thermometer have to do with stress? It's very simple. When you get stressed, when you have the stress response and you have anxiety and the like, what happens is you have increased heart rate, increased blood flow, increased blood pressure, and you have vasoconstriction.
Now, I like to explain this like a hose in your yard, your vascular system running all through your body. When it constricts, it forces the blood away from what we call extremities, your hands and your feet. And when the blood goes away from your hands and your feet, what happens? They get cold. All right? So, the temperature in your hands is a direct indication of your stress level. [16:00.5]
Now, before you think I'm a genius for telling you this, this is widely known. In fact, you and I are probably about the same age. You may remember the ’70s mood ring. Do you remember the mood ring, Dave?
Dave: Sure. Oh yeah.
Daniel: Okay. So you put the mood ring on, and if it's purple, you're cool and calm and in a good mood, and if it turns red, you're stressed out. All that is is a temperature gauge. It's simply measuring the temperature.
Dave: Didn’t it say whether you are in love, [crosstalk]?
Daniel: No, it did say that. Whatever to buy it, right?
Dave: Yeah, right, because I'd wear to school and it was always showing I was in love.
Daniel: Yeah, good to know. But, simply speaking, the temperature of our hands is a direct indication of our stress level. [16:48.5]
So, this little gadget here I got, you can put that on your finger and you can kind of get a baseline. You're just talking. It's 78, 80 degrees temperature. Then you can introduce something stressful. You can talk about something stressful and you can watch your temperature in your hands go down because of that stress response, the amygdala kicking in and going, Danger, danger, you start to see the vasoconstriction.
Also, you can teach people how to actually relax and warm their hands. Breathing is a big part of relaxation. You may know on the Apple watches, for any of our listeners that have Apple watches, if they start to get stressed, it'll come up and say time to take some breaths, because it's measuring what's going on with your stress level based on your blood flow—and that's simply what this is, too.
What happens when you actually see it or hear it is it's a form of your body giving you external feedback about what's going on in your body, biofeedback, biological feedback. And when we see that information, and we have some counseling and training to teach us how to relax, we begin to internalize the ability to nothing more than warm our hands, which is a direct indication that we are relaxing. [18:15.2]
As we do this, we began to lower our overall stress level, because stress begins to become like a stair-step. You get a little bit stressed. You come back and it just continues to build until, Hey, man, I’ve got to have a vacation. I’ve got to do something to come back down.
Daniel: So, this is a way to teach people to not only see what's going on with their body, but also to learn how to calm down their anxiety. We look for triggers, what's triggering it, and as people have dementia, they have different triggers, so we need to know what those triggers are.
And then, in the early stages of dementia, where they can still learn, they can still communicate and participate in counseling, we teach them a coping mechanism of learning to calm down that anxiety, and then physiologically get the feedback that's proof that they're actually doing it. That helps them have another element of control when they feel like they're losing control. [19:16.4]
Dave: All right, very good. So, am I supposed to be reading this a gauge here on how much?
Daniel: What does it say, Dave? I'm not looking at it.
Daniel: All right.
Dave: Does that mean I’m dead?
Daniel: No, that sounds about normal.
Daniel: Sounds about normal. If we did some breathing and yoga and relaxation with it, we would hope for it to go up to 88.
Dave: Daniel, I tried to do yoga one time and I laughed at myself because I could not touch my toes. I couldn't… I was not very limber at all.
Daniel: I can relate. I did it with my wife as well.
Dave: So, what can people do to help reduce their anxiety? Let's say, my anxiety went up to…this thermometer said 91.4.
Daniel: Okay, that would mean you're relaxed. Remember it's the opposite.
Dave: Oh, it’s the opposite? Okay, so it’s 71.4.
Daniel: If it went down, that would mean you're having vasoconstriction and you would need to do some relaxation. [20:06.2]
Daniel: One of the things that is the easiest to teach people is how to take some deep breaths, how to do deep diaphragmatic breathing, and I call it my 57 or Heinz 57. Five seconds of inhaling in seven seconds of exhaling.
Daniel: Now, for you listeners at home, if you try that five seconds of inhaling, that feels like an eternity, and seven seconds of exhaling. What we're talking about is intentional, slow calming of the mind and the body. This causes the opposite of vasoconstriction. This causes vasodilation. Now my blood system is opening up. My heart rate is slowing. My blood pressure is going down, and I'm getting deep, full breaths of oxygen. [21:03.5]
The challenge is, psychologically, we have to get our mind to turn off. So, as those worries and things come into our mind, we have to say, Yeah, I know I need to think about that, but I'm going to take a break from you. Right now is my time to just relax. I'm going to put you aside and I'm going to concentrate on getting my body in the most relaxed state that I can.
Sometimes music is good or often some of my patients like me to play the beach, so we'll have a little ocean waves in the background. I'll walk them through some exercises, visualizing the beach and practicing that deep breathing, relaxing their muscles.
There's also progressive relaxation for your more action-oriented type-A person. We're all different personalities, so we have to try different methods. And that's where you actually walk through the body tensing and relaxing different muscles in the body, which also brings about that relaxation response. The muscles begin to stop tweaking as much. The heart rate slows. And, again, with the relaxation response, you have vasodilation, so you're warming your hands as a way to measure it. [22:18.6]
The full biofeedback measure, you can hook everybody up to all of those things and have them see it on a computer screen, but just for the purposes of teaching people to lower their anxiety, lower the relaxation, they can get one of these little devices and practice every day, just trying to do some breathing, visualization and calming so that their level of stress is brought back down to a normal level.
Dave: One of the things we do with our clients is we do something called social reminiscing, so we try to focus on pleasant memories from the past and have people share their stories. It helps build a relationship with their caregiver so we can focus on things like holidays, which in some cases could be more stressful. But when we're kids we try to think, What was your favorite holiday growing up? Of course, I get all kinds. I do this in a group format and I get all kinds of answers. One time someone told me Columbus state was [inaudible]. [23:16.2]
Daniel: Okay, you're right.
Dave: But anyway, Daniel, I appreciate you coming on. This is actually very informative. I always learn something new when we spend time together. So, if someone wanted to find out a little bit more about what you do and some of these anxiety concepts that you talk about, how would they get in touch with you?
Daniel: There’s a couple ways they can get in touch with me and just let me say that anxiety is one thing that we treat, but just sometimes people just need to talk and they need to get some things off their chest. They have conflicts in their family, and so, we do a lot of listening, too, Dave.
Dave: Sure. That’s true.
Daniel: You can visit our website, which is ElderCareSolutionServices.com, and that solution is singular and services is plural. So, that's the ElderCareSolutionServices.com, or you can give us a call at (817) 300-4073. [24:12.1]
Either one of those, again, (817) 300-4073, and we'd be glad to do an assessment of your loved one and try to help them with some counseling in their home. Or like I said, we're doing a lot of telehealth with the pandemic.
Dave: It's great to have you, Daniel. We always encourage you to reach out to our guests who are very knowledgeable in the industry, and our website at Home Care Assistance is HomeCareAssistanceFortWorth.com and our office number is (817) 349-7599.
If you visit our website, you can download our caregiver survival guide. It's got the top 10 things that you must do in order to survive being a family caregiver. [25:03.6]
Thanks again for listening, and we look forward to talking to you next week.
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