Episode 14

October 08, 2022

00:39:30

S1:E14 Dr Elizabeth Landsverk - Living in the Moment

Hosted by

Tony Siebers
S1:E14 Dr Elizabeth Landsverk - Living in the Moment
Parent Projects
S1:E14 Dr Elizabeth Landsverk - Living in the Moment

Oct 08 2022 | 00:39:30

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Show Notes

Our guest today, Dr. Elizabeth Landsverk has over twenty years of experience providing medical care to the elderly will be talking to us today about ways we can help our aging loved ones have a better quality of life. Dr Landsverk is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families. Dr Landsverk was an assistant professor of Medicine at University of California, San Francisco, an adjunct professor of Medicine at Stanford University, as well as consultant to the San Francisco Elder Abuse Forensics Center and Hospice Medical Director.
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Episode Transcript

Speaker 2 00:00:06 You're listening to parent projects. Speaker 3 00:00:11 Welcome to this week's, uh, show. If you and your family are working through dementia, or at least stages of dementia, working away through family care, taking of dementia as it sits, if you are one of those members that has a generally messy situation, you've been asking for help, you're in luck. Uh, Dr. Liz Landberg, uh, is with us today. We're gonna go through assessments. We're gonna go through plans of actions. We're gonna go through interventions. We've got a great opportunity to help you and your family find some joy and live in the moment, uh, with Dementia Stand. Speaker 2 00:01:06 You're listening to Parent Projects, a Family Media and Technology Group Production. Now, here's your host, Tony Seeber. Speaker 3 00:01:16 Uh, you guys have asked, uh, for a little bit of help in the messy stuff, and we, uh, I, I think, are gonna deliver today. Uh, Dr. Liz is a fantastic expert when it comes down to sorting through everything from the, the wealth of information that comes at us. What's snake oil, what might be real, uh, the order in which that we're tackling some of the problems, uh, some of the, the past, um, historical challenges that people have, But better than that, got a great way to pull you out of, uh, that guilt and that fear, and to tackle some of this with a bit of love and laughter. Now, Dr. Liz, thanks for joining us today. Speaker 4 00:01:52 Well, thank you. I, you know, I'm very excited about your project, and I can't wait to like, let people know that there is more help for them out there, But I'm also very happy to be here and share what I've been up to, uh, working with folks with dementia and making, you know, the things that can seem overwhelming and horrible kind of manageable. And then allow the elder to enjoy their life as well as the family to have part of their life back. Speaker 3 00:02:21 Yeah. What, what is it that, uh, you've dedicated an entire career into this? Um, is that something you started out to do at that front end, or did you just, did one experience kind of lead to the other in your own kind of a assessment of what was going on? Could I ask that? Speaker 4 00:02:36 Um, well, so I started out as an internist, um, and then I went back and did a fellowship in geriatrics. And about that time, my mom was in her sixties and developed frontal dementia, and the doctors really didn't quite know what was going on. And part of her agitation was because she had horrible pain. Um, and from the training I had for my fellowship, I helped figure out what to do about and her pain, and it just kind of snowballed from there. Speaker 3 00:03:02 No, that is, uh, so what I love into that is that is one of the things that what our personal experiences tend to move, a lot of us that are in here, uh, in the past, especially those that wanna help others do better. So thanks very much for stepping into that breach and joining us. I, I think one of the first things I really wanna kick off with, We, we've had some great conversations offline and, and before even sitting down to do the show, um, talking about we, how do you assess the situation that's in front of you when the family maybe, maybe it's, maybe they've already done the first doctor's visit that's come back and said not quite yet, maybe some early stages of stuff, but the family's still struggling to figure out what's going on. Uh, they're looking at a lot of commercials online. They're seeing a lot of advertisements thrown at 'em in Facebook and, and Instagram and in whatever else they're sitting there. Bottom line of an, when you're assessing the situation, is there a common path that, uh, that a family can kind of expect that the disease would un unfold, a dementia maybe in general, Um, or something along the line, or there kind of way points that they could expect to start learning around, or organizing themselves and assessing their own situation? Speaker 4 00:04:10 You know, so often people say, Oh, I wish we would've, um, found you two years earlier. So it can take several years before you get a diagnosis. Unfortunately, dementia is not well, uh, taught in medical schools. Um, mainly doctors know that you should do a mini mental status exam where you do, you know, 30 point, uh, uh, questions. You know, what's the day, what's the date where you located? They ask you to remember three words, spell world backwards, draw design. But you can get a perfect score and still have changes in your brain, changes in your judgment where you can't take care of your finances. You, you know, maybe your memory's okay, but you've become paranoid or you've become delusional, or your judgment is off. One woman, um, was living on her own, you know, um, didn't want any help, but she was going out at 11 o'clock and she's like 85 years old going out 11 o'clock at night looking for people to help her in the house. Speaker 4 00:05:08 That's not good judgment. Even if her marine was 28 and they say the cutoff is 24, you know, she's not safe. So I think if you're looking at situations are not safe from driving to financial to behavior, um, that's when you definitely need to start, you know, ramping it up. And even if the doctor says, Oh, they're just fine, or, or they're just old, you know, you need to have a better diagnosis. Um, yeah. And locally, if you can find a medical school with a geriatric division, that's a good start. Um, calling the Alzheimer's Association is a good start. Um, we're doing telehealth on Dr. Liz Geriatrics, So there's a number of different resources out there. Speaker 3 00:05:48 Yeah, that's great. And, and again, it, I, I think it's fully, appropriately for, for you to pitch to Dr. Liz Geriatrics and in those tools that you put up, that's, it's, um, ladies and gentlemen, this is, this is somebody to go to for the messy stuff. So if you're running into that, if you've had those difficult things, this is somebody that you want to talk to for those, um, you know, how about weighing in, because our audience and our members gen, they're the, they're the family members, adult children. Um, what are, um, what should we be weighing in when we're figuring our own, assessing our own capabilities to deal with the situation or when it needs to be somebody that, that understands things maybe easier than us, or maybe I live across the country. Do you gotta be close by to understand this? Or does somebody have to be there, or are, are there any tools you can really think about that or considerations? Speaker 4 00:06:36 Right. So the first, there's, there's two, three big issues. The first one is for this elder, what makes life worth living? There's a lot of people who don't want anyone to do anything for them, except for bring them groceries once a week. You know, often happens with vascular dementia where they, it, it's rumsfelds unknown unknowns because of the small strokes. They think they're okay, but they don't recognize that they're forgetting things. They're not taking their medications, they're not taking the, um, they're not getting to their appointments. You know, things are, they're not paying their bills. Speaker 3 00:07:07 Um, interestingly, they're not connecting the dots on that either. No, Speaker 4 00:07:11 No. In the moment they're like, I'm fine. Leave me alone. Um, sure. There's also, uh, sometimes people will get really, Oh, covid, oh my goodness. So I've seen a lot of older people, The long covid is really bad news. It's inflammation of the brain. It's not like just having a, a head cold. It's inflammation of the brain, so it can make it so you're fuzzy. You have trouble focusing, um, and taking care of things. I think it's when you notice someone is having difficulty doing their daily tasks that, you know, we need to step in, um, and figure out for them what makes life worth living. If they really wanna be independent, well, can we, you know, if, if there is, often there's one adult child that lives close, and then everyone else is somewhere else, it's not okay to leave Susie to take, you know, spend five or eight years taking care of her mother. So everyone has to come together and figure out how are we gonna do this? The next thing to know about is how much money does the elder have for their care that's going to, you know, determine whether you can have someone come into the house, or whether they're gonna have to go to a facility, or whether the family's just gonna have to come together. Um, I have old about those sorts of things. Speaker 3 00:08:28 Well, and understanding as well. Then, then you, you could also start turning, there's a whole nother learning lesson to the nonprofit world or to the other, you know, foundations receiving your living or, or, or others that might, or, or government grants or things that might be able to step up. But, um, that can be a whole dementia, it could be a whole group of things to learn about the good ab it becomes overwhelming, I think, in its own right. So, Speaker 4 00:08:52 Well, actually, I think you, that brings up a very, very good point. I mean, early on, I, I was just talking about kind of overall planning for the family, but then there's the second layer. There's the, um, the day programs. There's the, the, um, let's see, the aging divisions where they have social workers and maybe a day program. Um, there are, um, there's a number of resources in the community that you guys are really good about helping, you know, coordinate families to, And I, I think that is important. I think there are, there are people in the community that can help you sort through all of this stuff. Speaker 3 00:09:31 Yeah, yeah. With, with that doubt. I think the important part to come through is ensuring that you're taking that time to make an honest assessment of both, you know, where, where your family member's at ensuring you've got that you're starting to assemble that team around you. Um, that, that, uh, whether it be doctors, professionals, your own emotional support team, I, you know, I, I've, if you find yourself as that family member that is the only one that's in state or in town, uh, that is finding that ways to, to be able to communicate the challenges and just recognize those challenges would happen. If your plan is that you're gonna stand in that, in that gap for eight years, that's probably not gonna be the strongest plan. Uh, and it could leave a some hole. So Speaker 4 00:10:12 Starting to set those things up, that's dangerous to the caregiver. You're right. That, you know, studies show that, uh, caregivers, particularly for folks with dementia, are much more likely to have serious medical issues and die sooner themselves. So I think it's gotta be made clear, confront that the elders assets need to be used for their care. It's not that Susie's gonna do it for free for five years and give up her year Yeah. Her life. And then they're still gonna divide, you know, the estate, you know, the way they would've, if Susie done nothing. Um, the money needs to be used for caregivers. One person cannot take care of someone else by themselves nonstop, you know, for a long time. So I think that, um, that would be the way I would start to approach it and have an honest Speaker 3 00:10:54 Conversation. Yeah, that, and, and that's great. And those may be, you know, if, if you're having that difficult time having those honest conversations, we, I know we've got some other resources out there about figuring out what you do have to deal with and what you don't have to deal with in family, and the, the barriers, obviously, there's a lot of challenges that come within that. But boy, Dr. Lewis, I think you really point out though that, that you deliberately, if all the family can understand from that get go, that there's gonna be, those resources are gonna need to be leveraged to take care of the parents. And you can't pin that on one family member to try to step in and just pour everything off of that, um, that they will, I, I see more often than not, they will, they'll, they'll focus into that because they'll do, it has to be done. Speaker 3 00:11:34 But that is, that would be one of the first places that, uh, family could start and pull something together to, um, uh, collectively. Well let you know. One thing, I wanna take a break. I, if we could, and this is a, a fantastic time to take a knee, I think, and see the project that you've been working on, Love to highlight it and see, uh, the, the Lay's book project and how other people can reach out to you and get some custom one on one, uh, advice for them, particularly if they've got that messy situation. So let's, let's, uh, stand by to that, Speaker 5 00:12:07 This is Dr. Liz Geriatrics. Speaker 4 00:12:09 Hello, I'm Dr. Liz House calls geriatrician in the San Francisco Bay Area. In my 18 year practice, I have seen it all the complications of pain, agitation, elders being swindled, too many doctors, too many medications. Now we're taking that information and distilling it down into simple, easy to understand training modules that families can use to learn about what's going on with their loved one and what they need to do to help them and to care for them. Please see us at dr liz gert tricks.com. I look forward to hearing from you. Speaker 5 00:12:51 If you enjoyed this video, we'd love you to watch the next one. Speaker 3 00:12:57 And so the next step, uh, seems to be, uh, pretty relevant here. If you are a family that is struggler working through the Jerry or through the, uh, dementia aspect, uh, we've got, um, Dr. Liz with us today. We're working through that helping families. We started with assessment. That next step, uh, kind of naturally that we would, that we'd point to in, in parent projects is the plan of action and setting up a, a solid plan of action. One, that, that leaves room for change, knowing that like a pebble in the pod, when that, when that first rock hits and ripples start, everything, everything really changes. But Dr. Lee, can you talk with us about, um, some of those aspects when we're planning how we're going to do that? So the family's understood, We think we understand what we're doing. We've got the team that's helping to assess. We, we've agreed as a family that we're going to use mom or dad's resources, um, to help mom or dad the way that mom or dad would wish to be helped. And different family members might point in one, maybe more than others. But now, as we're doing that plan of action, can we talk through things like the, the order to start tackling stuff or keeping people safe financially, uh, physically while we're working through those issues, addiction and, and those types of things. What are your, where do we start with a plan of action? Speaker 4 00:14:12 So I always start with, for the elder, what makes life worth living? What do they want to do? I mean, someone who's never really, like, never been a joiner, you know, you're not gonna get them out to a day program versus someone who's been very social and still really enjoys people. You know, to have that home with a one on one caregiver who may not, you know, be engaging is just awful. As opposed to going to a day program where they're gonna see the guys and they're gonna play Majong and, you know, and, and tell their stories that they've told 300 times before. Um, so for the elder, you know, what, what's important to them? Um, the other is you, What medical problems do you have? What do you have to deal with? You know, do you need, you know, supervision of the diabetes? Are they having trouble with emphysema and heart failure, and do you need, you know, some more skills? Speaker 4 00:15:05 Um, I also, a huge one is their behavior. You know, so are they behaved well enough to go to church to go to the day program? Um, that's often where we come in, because I, I, I am heartbroken when I hear, you know, I had another doctor say, Oh, well, my grandma's just, you know, mean, and, you know, and so there's nothing we can do about that. So we're just not having anything to do with her, You know, because she's mad at us. Well, um, that's the changes in the frontal lobe with dementia can make people more angry than they used to be, and that can be medicated. So when I hear that, um, you know, we're just not gonna, we don't, we just don't talk to her, or we just don't take her anywhere because she's so mean, you know, it's sad because those people can still engage, but you have to take care of it. So those are the, And Speaker 3 00:15:59 Almost, Yeah. And almost becoming a self-fulfilling prophecy of decline, um, if you start thinking through that. Right? Speaker 4 00:16:06 Right. Because if you leave someone to just sit in a chair and watch tv, their legs are gonna get weaker. They're gonna get contracted, they're gonna get pressure ulcers, and they're gonna line a lot faster. Um, Speaker 3 00:16:17 Good. There you go. Speaker 4 00:16:17 Yeah. Yep. So those are the things I think about, you know, what are the resources in your community really excited. I'm also, um, on the board for the connected horse, uh, which is something that can be in rural areas. You can look it up online connected course.org, um, where it's at a barn where they've had training, and they have the caregivers and the person with dementia spend an afternoon there. And they don't ride horses, but they groom horses. They talk about horses, and they're engaged in there together. And it's a group of people socializing. And you break the diad of, you know, one person telling the other one, Don't do that. Don't touch that. You know, there's enough people to watch 'em, so they're gonna be okay. And you have fellowship, and it's really quite powerful. So those are the sorts of things. Finding whatever, you know, staying engaged with your church, you know, the garden club, uh, if going to the restaurant is to overstimulating and it gets people agitated, have a picnic out at the local park, you know? Speaker 4 00:17:14 Yeah. I think it's, it's really engaging where they want to be and then looking at the problems. So I often see that, um, once you do get a diagnosis or something like, well, excuse me, often before you get the diagnosis, that's when people are most at risk for financial elder abuse. And I find particularly out here where every little house is worth a million dollars, you know, there's everyone from your grand grandson and your nephew Jimmy, to the neighbor, to sometimes it's the, the lawyer that kind of steers people and can take control of them. Or it, you know, sometimes it's faith leader. Um, and there are things to do, you know, if even even charities, I mean, charities are not, you know, by nature predatory, but they sell the list of people who donate. And if someone feels like, Oh, oh, I've gotta give a hundred dollars to everyone who asks me for money, and they sell that list, and then that becomes, you know, 30 or 40 requests a month, and they don't have the money for that, that's predatory. Speaker 4 00:18:18 And so, you know, understanding, getting a diagnosis, setting up a structure to protect the elder. Um, and then sometimes you need to get them conserved to, to protect them from that sort of thing. And, um, then making sure that you're supporting them to enjoy their days the way they want to. I mean, that is, that is job one for the family is, is, yeah, keep people engaged. Um, and, but also having time for the family away, You know, you can get really burned out. You can get, you can, you can start to hate the way they breathe, you know, and find that you're, you know, at that point, you need to big step back. You probably need at least two weeks off. Yeah. You know, and it's probably really good to have other members of the family come in and stay with mom Yeah. For two weeks while you're gone so they can see what actually is going on so they can, you know, stop being so critical of you. Speaker 3 00:19:13 And there are, there are great resources for that. Uh, respite, uh, is, is, you know, you know what we hear along those, for those, uh, those members of those, uh, that are watching, uh, and, and actually I know a A R P has great resources to connect into grants, and, and there is, there are whole resources that will push in to provide respite for family caretakers that are there. Um, and that there, that's a thing. So if, if you are a family caretaker, if you're not tracking what that is, make sure you look at that. Go find that out, plan that into what your plan of action is. Essentially, what I'm hearing there is you can't, You, you have to, you have to plan that for that long haul. You can't just look to burn. You're gonna push everything in, or you're gonna cross the finish line, and you're gonna be just as spent. Speaker 4 00:19:55 Right. You can't say, I do this all myself. Yeah. I often hear from spouses, it's like, I have to take care of my wife and I can tell you about, you know, uh, a tragedy from someone who had that, uh, idea, and it just cost him his life and his, his wife just did not do well from it. The, the other thing that is really important is you've gotta look out for the medications that cause problems. Yeah. So often, you know, if someone's not sleeping or they're a little anxious, the doctor will give them avan or Xanax. That is really bad news. Or, you know, as my dad was taking Tylenol pm you know, even over the counter medicine, the, the Benadryl is anticholinergic and nerve cells talk to each other with colon, and if you give something anticholinergic, the nerve cells don't talk to each other well, and people can get more confused and agitated. Speaker 4 00:20:42 So it's, it, I've seen, you know, time after time that just getting something from over the counter or over the counter sleep aids unsom or allergy pills, Zytech, Yeah. Not good. Um, yeah, or prescription medications like, um, a common seizure medication, uh, Keppra, uh, can make people more angry and paranoid. And it is often that the medications or the disease has caused bad behavior that makes it really difficult for the family. Um, and if the medications were fixed, the elder would be fine. And I've seen situations where, you know, it's obvious dementia, it's obvious, you know, problems with the medications, but then they've hit someone and then they're charged, and then, you know, there's a court case, or I mean, Speaker 3 00:21:30 It's, and it snowballs from there. And, and therein, I think is, um, you know, that, I think that makes a, actually, I think what I'd really like to talk into when we come back from this next break is, uh, those interventions that come through, there has been a lot since the original publishing of the 36 hour day. There is, there is, which, which is an empowering. So in fact, I think it's one of the first books that, that most of the time gets handed to a family or gets referred to a family. It opens the eyes. It kind of helps to build empathy to understand what might be happening. And there's some great conviction to that. But we just are learning a lot, and we are learning it in our hurry over the course of the last especially decade. And then when you pitch in Covid to watch how something like that interacted, it seemed to accelerate some knowledge about other things. Speaker 3 00:22:16 It was enough medical issues and things bouncing around that we've learned a lot too. So when we, when we look at the connectedness of interventions, not just prescription medications, but over the counter medications, activities that we might be doing, the combinations of those things to sort out, uh, what might be driving the activity we're seeing, or the, um, the behavior that we're seeing. It, it, the truth maybe that there's a dementia there, but that doesn't necessarily make it true that everything that we're seeing in behavior comes from dementia. And therein becomes a very complicated thing for the specialist to do let loan of family caregivers. So I think when we come back to this, I'd really love to talk with you, uh, on those interventions that we're sorting that out, maybe the connectedness of that, um, if we could. Speaker 4 00:22:59 Sounds great. Speaker 3 00:23:00 Brilliant. So we'll stand by and get this from, uh, our sponsors. Speaker 6 00:23:05 Hey guys. Uh, this is Tony at the Parent Projects podcast. And if you are powered by Coffee the way that I'm powered by coffee, I think you'll appreciate knowing a way that you can help the last lost and least of us that didn't have a great transition. You see, The Refuge Coffee Company is a social enterprise operated by Catholic charities of central and Northern Arizona, where they use this coffee in this business model to help homeless veterans at the Mana House transitional community get back on their feet, help a veteran turn a handout into a hand up by giving them the opportunity to earn your business. Purchase coffee [email protected] That's the refuge az.com. If you order six or more bags, shipping will be free. And if you tell 'em that parent project sent you, I'm gonna send you a travel coffee mug. Thank you again, and let's get back to the show. Speaker 3 00:24:01 We've got Dr. Liz, Dr. Liz Geriatrics that, um, that is, or that is working and helping us really wrap our arms around the complexities of family care taking in dementia. Uh, Dr. Liz, again, thanks for joining us, uh, this week, um, in, in talking with us about it. But before we went out, uh, to break, we started moving through, you know, we, we've talked about assessments of the situation of those people that are around what we're getting in the situation, even ourselves, our plan of actions, how to take those things into account interventions. We started leading into how these medications are different over the counter stuff that we just don't even, we maybe we never gave a second thought to. And it's something that they've used for years, might be driving some of the activities that are hiding, getting an honest assessment of the situation for crying out loud or impacting the effectiveness of this plan of action that seems to be right in line with what mom really wanted. Um, we, uh, prescription meds over the counter medications, the activities, it can go where, where do we start there? What, what do we know now? We've learned so much. What, what are those golden nuggets? Speaker 4 00:25:07 Um, well, I would think, uh, the number one thing is do not use sleeping pills or sedatives, uh, long term. I mean, if you must have a procedure, you know, like if you have a bad gallbladder and you need surgery, and mom's really nervous and kind of wound up in the hospital, you can give out Avan for a few days. But I often see Outof Van Lorazepam, Xanax, uh, Alpr, uh, just given out like Chiclets. And I would say that is the number one mistake that doctors make, uh, hands down. Okay. And the, the problem is that people can get early, easily addicted to it, particularly with dementia. And they say give it, you know, three times a day as needed. And you might start giving out, you know, once or twice a week. But then people with particularly older people and people with dementia, or if they're not sleeping, um, it can, uh, withdraw and they can get more irritable. Speaker 4 00:26:02 So they give more, you know, and then they give it, you know, more regularly than they give one every day, and then they start withdrawing from that. So they give, you know, it twice a day, and then they up the dose. And sometimes I've seen people, you know, to me, a half a milligram once a day is a good size dose. I've seen people on two milligrams a day, eight milligrams a day. It just, it snowballs and it doesn't get better. Um, and then you've got a complete mess. And then if you just stop it, then they go into complete delirium. Um, there's a lot of other medications that's on my website, dr liz geriatrics.com, and in the book, um, living in the moment overcoming challenges and finding moments of joy in Alzheimer's and other dementia. I think that if we taught geriatrics and, uh, which medications cause more problems more widely there, I, I think, you know, 60% of my business would evaporate, which would be fine, You know, because break my heart that these elders are, you know, deemed to be, you know, not appropriate for my program. Speaker 4 00:27:09 Or, you know, if anyone's been delirious, you know, no one wants 'em in the nursing home. No one wants them in assisted living. No one wants 'em in their day program. What are you supposed to do? Um, it it, and it is so treatable, and it's not an occasional thing. And it's not that mom's just, you know, angry and she's just always been angry, so we're just gonna stay away from her. You know, I can tell you family after family where you get the meds right, and they're nicer, and they're like, Mom hasn't been like this in 20 years. So, you know, and, and then you can bring them back in the family. You can bring 'em to church, you can bring them to, you know, gatherings. And that, that's huge. I mean, that is the quality of life, and that is what I want to, you know, communicate. Um, can I give that example of that couple? Speaker 3 00:27:56 Yeah, let's, let's talk about the couple on the fire and Yeah. I, I I really would. Speaker 4 00:28:00 So this is kind of tragedy, like when you don't, um, identify early cognitive decline, and then I wanna talk about the bits where we could have done things differently and how, how things can be better, You know, when it seems like there's nothing to be done. So this is a couple, you know, that had been, uh, married for 30 years. Um, the man had trouble had, was legally blind for 20 years, uh, felt like he really needed to take care of his wife. His wife was in her sixties. Um, she was drinking alcohol and had cognitive decline, and she got admitted to the hospital because she had behavioral problems. And they kept her there for a while, and he kept saying, Nope, it's my job as her husband to, to take care of her, although he really couldn't. Um, yeah. And his medical problems got worse. Speaker 4 00:28:48 And then, um, more recently, uh, he got very weak and I think passed out. She was very angry at him. She was back drinking alcohol and a fire broke out in the kitchen, and, um, the family member had to come rescue them. Uh, he ended up in a coma and then died in the icu, you know, a couple weeks later. And she got placed. The rest of the story is, you know, and, and it was interpreted as a murder suicide. It's like, No, no, no, not at all. And the family member was telling us that, um, they've been trying for two years to get help, but the husband would never, um, allow them to take her away. He was saying, It's my job to take care of her. Even though what I think should have happened was that the, um, the husband should have had cognitive evaluation, probably probably neuropsych testing. Yeah. Because even if his memory was okay, his risk assessment, his judgment, his, what we call executive functioning, his, uh, frontal lobe functioning was not good. Yeah. And if you had in place that he didn't have capacity, but you want to honor his wishes, well, you start out with, um, you have someone take care of the finances. Yeah. And then you put a caregiver in the house to see if you can support both of them and manage her from being angry and keeping her from drinking. Speaker 3 00:30:15 You know, how often is that? It's not, um, it gets presented that it's an either or, and fear and guilt get us to think that that's where it may be. And, and perhaps that's where he was thinking that it was either, either I'm doing it or it's not happening, or working to that. So often in my life, I've just learned it's both and it's almost always both and Right. And, and that there would be that solution to come in when it works through. And I think I remember that he was blind, or he was legally blind. Legally Speaker 4 00:30:39 Blind years. Yeah. So he, he functionally couldn't do everything that needed to be done. They could have had one assist them, um, Yeah. And someone to manage her. So she wasn't drinking or she wasn't abusive to him. Um, the, the way it ended up is when he died, she got discharged to a dementia community who can hand, I mean, she, she does get pretty irritable and agitated. The medications have been adjusted, and so she is no longer, um, so aggressive. Um, she's loving the programming, You know, like the first day she was there, they had a Crosby Stills and Nash cover band, and she was singing along with them. And so she's having a great time. She's gained back the weight. She's been, she's now strong. Again, she really couldn't walk when she came, and now she can. Um, and she's happy as a clam. So, you know, if, if it came down to they can't manage her in the home, you know, then the next step would've been to place her. I mean, of course, you have to make sure that you've gotten the dpoa set up for her as well. So you have a decision maker. You know, sometimes it's, if it's not the spouse, it's a family member, or if you have nothing written up and then you, no one has capacity, you have to get a conservatorship with a drag. But, Speaker 3 00:31:56 Well, and those are other resources. If, if, if we're using some, if you're not tracking the dpoa and those powers of attorney and the types of them check out, we've got a great resources on, on, uh, on, you know, on the website, especially for financial caregivers. We just recently have been working through a series, uh, with the Bureau of Consumer Finance, uh, to help. And they've got some tremendous materials that are sitting, uh, and with F D I C, that's, that's, that's on all, all of our platforms, including on the, in the Facebook clubhouse. But those are, uh, a whole series of good, those documents to get in line, good time to get 'em in, good time to start thinking about it. It gives you options longer term, if not, if nothing else, it'll give you more options or arrows in your quiver, uh, to be able, able to work with. Speaker 3 00:32:39 I think when you're responding to some of these, you, you know, 1, 1, 1 thing that I, I do wanna say, because I, I think a very common hangup that I hear, uh, for this, uh, is that they, you know, when they're, you're trying to do what mom and dad want to do, Mom or dad, or who, whomever it might be, and, and Susie, uh, getting them to want to do something or tell them what that is, where that thing is, getting that out of them is a difficult conversation a lot of times. And this is one you reminded when, when you were, the way you were talking about, um, you know, taking stock of your, I don't think you said constraints and limitations. That's what came to my mind. Are those things that, that could impact you, or, or what did they want to do? It reminded me of what we do in senior move management when we're working with a family. Speaker 3 00:33:25 We start with why our initial start for a plan is figuring a why. Finding a why. When we have a difficult time getting a family member to move, um, outta seeing themself moving out of that situation, One thing that can break that is get them to think of one thing they'd like to accomplish so that they're not waiting to die in the grief of the current situation or the gravity of the current situation. Right. What is one thing, just one thing you wanna accomplish, or you wanna learn to take a picture of this or work from this, and you can start developing a plan around accomplishing that one thing. And sooner than not, you can become, you can start being seen not as somebody who's coming to them and telling what to do, but as an enabler of something that they want to do. And, and starting that small, I'm thinking there's something like that could play in as well. Um, with, with helping, maybe you're helping another family member who's working in care taking, uh, finding a goal that they want to do with that. So you can, you can push in and help them as well. Or maybe helping mom and dad figure out Yeah. What they, what they do wanna accomplish, even living with dementia as they're moving forward and not just giving up or packing up or waiting, um, you know, die from the disease. What, how would that reflect? What, what's your experience? Speaker 4 00:34:38 Well, so for the elder who's having cognitive decline, if it's early, they can tell you. If it's later, they can't tell you, but they'll show you, you know, what do they enjoy doing? You know, I've had families where, you know, dad only used to use like to go to the opera, so he's not gonna wanna play bongos and sing, and dad might be really happy playing bongos and singing and being in a day program because, you know, he's got moderate dementia. So I think it's really important, you know, Sep as a friend of mine, Stephanie Howard, who works with a lot of families, says, you know, first we're gonna talk about what does your loved one want, and then what do you want? And you have to always remember that what you want. It's important to acknowledge. But what is really important to focus on and to support is what does the elder want? Speaker 4 00:35:23 You know, do they not like doctors? Do they not like to go to the hospital? Don't make them do it. You know, you can be more palliative, you can still give them care, but, you know, if they go to the hospital and get tied down and sedated, what's the point of that? You know, unless they have something like a hip fracture, and it's just pain. So you need to, um, make sure that, you know, you allow that sort of situation to be treated, but then, you know, don't follow up on an ultrasound for a cortid, you know, narrowing and that sort of thing. Um, I didn't get to talk very much about, um, treating agitation, but there's a lot on our website, Dr. Liz Geriatrics, and on our Facebook page, um, Dr. Liz Geriatrics, and we do have the book, um, and also telehealth, uh, and telemedicine for folks in California. Um, please check us out. Speaker 3 00:36:17 Yeah, I, I love that. And in fact, you know, I, I'd really, uh, I think what I'd love to see is we can put together a good q and a session with our group, maybe get you on, uh, and have groups really ask those questions, set that up ahead of time, um, to, especially on maybe on a topic that specific into that, working with that agitation and some of those other things. I think you, you just have a wealth of information. I'm so appreciative for Speaker 4 00:36:40 You. Well, I'm, I'm available for any groups. I just had, there was an insurance company, you know, of like 500 people, and I had like 175 asking me questions. And it was great. I mean, that's, that's kind of my goal these days, is to help families learn more about what they need. Um, because once you have that structure, it's not overwhelming and scary. It's like, Oh, okay, we have to do this, and I need to get that. Um, and it becomes manageable. So I appreciate what you do, Tony. I mean, what a gift you're giving. Speaker 3 00:37:10 Oh, thanks Peter. God, that we get the opportunity to do it. And, uh, ladies and gentlemen, you know, please, you know, join me please in banking, Dr. Liz Landsberg for joining us today. Please check her out. And if you are one of those families who have come to us and ask about some help for the messy stuff, again, this is definitely one of your next step. For those of you that are also looking to get to some of those resources, you're gonna find them on parent projects.com. You'll also find some of those resources. I know we're gonna take some links to her website. We'll be posting them also in our clubhouse at the Facebook clubhouse, Uh, and you'll find some below in the show links for today. Thanks very much for joining this, doctor. Speaker 4 00:37:47 Thank you. Speaker 3 00:37:48 God bless you. Speaker 7 00:38:15 Well, that's it for this team this week, and thanks for joining us. If you've enjoyed the content, remember to subscribe and to share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspectives. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication with, with your stakeholders, and verify the professionals that you choose. You can find us on YouTube, follow us on Instagram and Facebook. Thanks again for trusting us. Until our next episode, behold and be held. Speaker 2 00:38:48 Thank you for listening to this Parent Projects podcast production. To access our show notes, resources, or forums, join us on your favorite social media platform, or go to parent projects.com. This show is for entertainment purposes only. Before making any decisions, consult a professional. This show is copyrighted by Family Media and Technology Group Incorporated and Parent Projects, llc. Written permissions must be granted before syndication or rebroadcast.

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