I spoke to a group of professional and family caregivers last week. After talking for an hour and a half, I was gathering my belongings (including some delightful chocolate turtles and a classy purple umbrella that the Alzheimer’s Association gave me for speaking) when a professional-looking woman walked up to chat.
Her mother has Alzheimer’s. Although they’ve discussed a memory care community, she lives at home with her husband, and she has a lot of good days. Once in a while she can’t find the bathroom. She’s no longer able to drive. And they gave their beloved dog to a family member because they were worried she was going to let it outside and forget about it. However, life is okay right now.
She goes to church every week, and she has a great group of friends who pick her up for lunch regularly. She still cooks every evening even if her husband has to help a bit more than in the past. She even volunteers at a local nursing home to help the “old people” play bingo.
But they’re scared. They understand Alzheimer’s is a fatal disease. They’ve watched the Glen Campbell documentary. They’ve scoured the Alzheimer’s Association website. They want to know everything they can to be as prepared as possible for the journey ahead. In many ways, they are the type of family that I appreciate working with–they actively seek out information to assist their loved one now and in the future.
Yet, there’s a point at which people can become too fixated on the diagnosis. There’s a point where education and preparation morph into worry and anxiety.
“All I think about all day is my mom,” the woman tells me. “I think about what her future holds and when she’ll be in a wheelchair. When I close my eyes, I picture her in a smelly nursing home being taken care of by people who don’t even know her.”
She asks me about a timeline. She was diagnosed a year ago, and the doctors says she’s in stage 4. How long will it be until she can’t live at home anymore? How much longer will she be able to walk? And talk? When will she be incontinent? And when will she die?
“We just need some estimates so we can plan, you know, financially,” the woman tells me. I’m a planner by nature, so I understand.
Although I understand, I’m not much help.
You may have read about the seven clinical stages of Alzheimer’s. If you haven’t, you can learn more here:
There are times I find the seven stage conceptualization useful. When professionals communicate with other professionals, it’s valuable to be able to indicate a person is in stage 3 or stage 6 to quickly relay information. (I will add that I hate when people are referred to by their stage, as in “She’s a stage 6;” she may be in stage 6, but she’s not a stage 6. There’s a difference to me.)
I’ve found that sometimes my attempts to discuss the progression through stages with families have not been successful. When I say someone is in stage 4, they want to know how long stage 4 lasts. They are unsatisfied when I say something vague like, “It varies.” They want to know why their loved on is classified in stage 3 when their verbal skills appear like the verbal skills of someone in stage 6. I say something like, “Various areas of the brain decline at differing paces.”
I typically end up saying that these stages aren’t an exact science…and they’re not. It’s not like a person goes to bed in stage 5 and wakes up having transitioned into stage 6.
I have started to use the terms early stage (mild), middle stage (moderate), and end stage (severe) rather than the seven stage model when I talk to families. Still–families want to know the length of each stage. I don’t know how long early stage will last for each person, nor do I know how long middle stage and end stage will last. My hope is that most of the duration of the disease is spent in the early stage. When I share that thought with families, they usually agree.
I give families a really hard task when I visit with them. I tell them to be prepared, as much as possible, for the realities of the disease. Obviously, you have to look ahead to be prepared. In the next sentence, I tell them to focus on the moment–because that’s how you find joy when you live with dementia.
And, if you think about it, it’s how we find joy in life more generally. We lose the joy in the moment if we think too much about what could happen in the future. Yet, if we fail to plan we plan to fail (or so my high school economics teacher told me).
Plan ahead and live in the moment.
How do you even do that?
I struggle to do it in so many areas of my own life. Sometimes I can’t even enjoy a Sunday evening at home because I’m too focused on the tasks I have to accomplish in the week ahead. And, if I’m being honest, I have anxiety that boils down (like most anxiety) to not being able to focus on life in the moment. Like many of us, I can’t shut down a fixation on potential future events that may or may not ever actually occur.
A few years ago I read a book called Always Looking Up: The Adventures of an Incurable Optimistic by Michael J. Fox, who is an admirably optimistic person, as you might guess by the title of his book. He points out that we often worry about the worst case scenario, and the worst case scenario rarely happens. He also mentions that, even if the worst case scenario does occur, worrying forces you to live that experience over and over when you really only need to live it once.
This part of the book had such an impact on me that I remember exactly where I was when I read it. I was sitting in the Minneapolis airport right next to a fast food Chinese place called “Wok & Roll.” Now whenever I pass that same “Wok & Roll” during layovers in Minneapolis I think of Alex P. Keaton and Marty McFly. Never in my life has a book had such a strong association with a place.
Michael J. Fox is right, of course. Worry is a waste of time. Although it may be that simple, it’s not that easy. Worry cannot be that easily turned off by those of who are prone to it. Logically reasoning yourself to shut down your anxiety isn’t necessarily effective. In fact, it may increase worry because then you worry that you’re worrying too much. Meta-worry.
As you can probably sense, minimizing worry because worry isn’t productive is something that’s challenging for me. And I know I’m not alone in this.
How am I supposed to give people tips on how to plan ahead and live in the moment in the face of a dementia diagnosis? I can think of few things I’m less qualified to do.
The woman I spoke with last week was trying to planning ahead. I couldn’t fault her approach. She had toured memory care communities. She had taken her parents to speak with a financial planner. She’d put a package of Depends in her parents’ laundry room…for when the times comes. She was trying her best to, as she put it, “brace for a storm.”
I want her to be able to find joy where her mom is at today. I try to figuratively pat her on the back for her efforts to prepare for the future. Then I tell her that there are no estimates for when her mom will reach certain milestones. She pushes me again to guess how many years her mom has left. I’m tempted to throw a range of numbers out, but I resist. Alzheimer’s is fatal, but each individual has their own trajectory.
She gives it one more shot.
“My daughter is three,” she tells me. “I want to know if Mom will be around when she graduates high school.”
“I’d be pretty surprised if she were,” I say. I don’t know if this is the right thing to say. I’m sure I could have been more eloquent. In that moment, she seems grateful to me.
She thanks me for chatting, compliments my sweater, and wishes me a safe drive home.