Dementia-what is it? We hear this word thrown around lately by anti-Biden people, anti-Trump people, the media, and people in general. And it is not a term to use lightly, yet I see it more and more daily. The National Institute on Aging states, "Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—to such an extent that it interferes with a person's daily life and activities." The Oxford Dictionary defines it as "a condition characterized by progressive or persistent loss of intellectual functioning, especially with impairment of memory and abstract thinking, and often with personality change, resulting from organic disease of the brain."

There are many variants of Dementia (but for now, we will focus on two). The most common is Alzheimer's, which is typically progressive. When I hear the word, I picture a shriveled-up little old lady sitting in a corner languishing, waiting for the day when she doesn't wake up again. The other common form of Dementia is due to vascular changes, i.e., mini-strokes, each one slowly killing off a piece of the brain, making it more challenging to function, live alone, and perform ADLs (activities of daily living), and the progression can be slower. One day, a loved one may notice that mom or dad isn't the same. They get lost when driving, forget to turn off the burner or take their meds, have a short-term memory that isn't good, and may exhibit personality changes. They may be short-tempered and get angry when they are challenged about remembering something that you KNOW you told them ten times. But it would be best not to get angry because they know something is changing and are often frustrated and scared.

A physician typically makes the diagnosis after possibly talking with loved ones who are concerned, verifying it with a neurologist or geriatrician, gathering medical history, and perhaps performing a MoCA cognition test. It is a quick test used to accurately access short-term memory,

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Six years ago, I left my job as a Physician Assistant in Oncology and Hematology and took the plunge: I became a Board Certified  Patient Advocate. I had been interested in advocacy for quite some time, and, working in oncology, I readily advocated for my patients and their loved ones. There are so many different ways that advocates can help, and I decided my niche would be working with those newly diagnosed with cancer and helping them navigate the healthcare system without the use of Dr. Google and well-meaning friends.

 Over time, it has morphed, and while I am still working with cancer patients, I am working more with people with impending death and their loved ones, as well as people with chronic, often terminal diseases. We work on their Advance Directives, which are so vital. Many people do these along with their wills with their attorneys, yet if you ask most attorneys, unless they are elder care attorneys, they don't "do a great job." To do a thorough job with advanced directives means explaining and understanding all of the moving pieces, and it can take hours to have an Advanced Directive where everyone is "happy." As a PA, I have stood over too many bedsides with loved ones arguing

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I find myself in no man’s land this weekend, and I am not alone. Two days ago, I was “under the weather,” had a low-grade fever and cough, and was just exhausted. I have had all my shots, but we just returned from a trip to the mountains with the grandkids (and their parents), gone to restaurants, and figured it may be time to give up my banner as “Covid Unscathed.” I took a test, it was negative, and I went to bed. My fever inched itself up towards 102 and stayed there. (I am of the belief that you treat the symptoms, not the fever). The next day, it was the same thing but worse: more coughing, fatigue, and a fever. Oh, and when I swallow, it feels like a knife sticking in my throat. But, what to do? I took another Covid test and it was negative again. Go to the ER where I will be exposed to more illness, and I am not an emergency. So I will sit for hours, and feel guilty because people are really there and deserve to go ahead of me. Go to a free-standing health center, whereby I can at least get tested for flu and strep and be sure I don’t have pneumonia. But despite the fact that insurance does pay, it is ridiculously expensive. Or ride it out in the comfort of my home.

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If you have been to a doctor, had a medical procedure, or found yourself in the emergency room, you were asked: “Do you have an Advance Directive?”  We are also reminded about the importance of a Will, and speaking to loved ones about our wishes, but I venture to say many of us have not done any or all of this. The thought of dying is terrifying, so we may do one or more things and “shut the box” metaphorically.

I have done my Will (six years ago, and it is currently being evaluated and possibly re-done). I have completed my Advance Directives, and I am trying to do some talking with my family about my wishes. But often, the conversation is difficult to have; there is no time, grandchildren want our attention, and we are willing to use any excuse to avoid it.

Meanwhile, there is so much more to preparing for death than just the above. Look around your house; suppose you become ill, have an accident, and never return home. Would you be embarrassed if your daughter-in-law looked in your nightstand drawer? Have you left everything in order for your spouse and children? I will admit that I have not, which is unfair to those I love. I don’t plan to die tomorrow, but things are not in order, and they need to be.

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Virtually all of us make resolutions for the coming year. In years past, I used to think about them and write them out, and within a few weeks, most of them had been “broken.” That is because once I didn’t exercise every day (a typical one), I didn’t “forgive” myself, considered it broken permanently, and that was the end.

But as I get older, I no longer agonize, and they don’t necessarily have to be starting January 1. They can be January 4, February 10, or June 10. And I no longer call them “resolutions” but “intentions.” And if I don’t exercise or don’t meditate for a few days, I pick up and do it later. I am kinder to myself.

There is no magic in a new year; it is whenever we decide to adjust or change our lifestyle, family, or whatever we choose. And we need to constantly make changes because this is how we change and evolve.

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As the New Year begins, many of us have been fortunate enough to have spent some or all of the holidays with our loved ones. Perhaps it was in person or over Zoom, but enough time to have concerns as our older family members may be showing signs of aging, be it memory, confusion, walking a little slower, out of breath, etc. And we wonder whether they can still live alone or take their required medications. We worry as we may not live near them.

Should they still be driving or managing their finances? Are they taking their medications as directed? When asked, they may not know why they are taking the drugs, who prescribed them, or for what medical issue.

And we worry, often with good reason. We also realize that they will probably go to their doctors' appointments unaccompanied, but 1-you live out of town, 2-you are busy with your children and work, and 3-they are stubborn and won't accept your help or suggestions.

So, what do you do when faced with these problems?

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I would venture to say that most of us (and probably everyone reading these posts) are going through excessive stress right now and are unsure how to handle it. As we all know, stress can accelerate illnesses and cause illness. I don't know about you, but my stomach is a ball of knots, and sleep is sometimes elusive.

So, what do we do?

1. Take time for yourself, even if only for a few minutes. Breathe. Close your eyes, sit in a chair, and slowly take in a breath (I picture this breath blue), hold it for a few seconds, and let it out slowly (this is pink). You will be amazed at what a few minutes of mindful breathing can do.

2-Write a gratitude journal, and make it specific, not just "I am grateful for my home" but "I am grateful for my home, and know that I am safe." "I am grateful for my cellphone because I can keep in touch with those I love." If not, use phrases like "my bed," "fresh coffee," and "a new dress." A gratitude journal can help you slow down and appreciate the simple pleasures in your life.  Also, spin them in a positive way.

3-Watch less (or no) news. Some people are glued to the news. While it is important to be apprised of what is happening, news doesn't change significantly (or affect us) over a few hours. Take a news break; the news will still be there when you return. 

4- Put on dance music, as loud as you want, and dance around the house for 5 minutes. It will help you emotionally and physically.

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My mother-in-law Mildred used to say, “What is the difference between major and minor surgery?” “Minor is everyone else and major means it is you.”

About two years ago, my husband complained of knee pain, the sensation of his “knee locking,” as well as difficulty walking and getting up and off the floor. Like many wives, particularly those of us who have worked in health care (oncology), anything short of hemorrhaging, a large mass, or chest pain was something that would “work itself out.”  But it got worse. He got injections and tried heat, ice, and physical therapy. He saw different doctors and was told that he was “bone on bone” and would “at some point” need a knee replacement. Routine, except when it is you, then not routine.

It took him six months to choose a physician and more than four months to schedule the surgery. My biggest fear was that it would be canceled for some reason (Covid, the doctor being ill, etc.), as the timing was perfect, and if delayed, it would have affected a vacation and time with our children and grandchildren.

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I will bet if you look into your medicine cabinet (or linen closet or toiletry kit), you will find many bottles of unused medicines. Sometimes, our prescriptions are changed, and we are left with a 90-day supply of a drug we no longer need. Many of us have our medicines on a 90-day auto-refill because they are cost-effective and easier. While I believe it is essential to be sure we always have extra medication in case of an emergency, many of us pick up our prescription even if we are not sure we will need it because “it is covered by insurance and is only $10, $15 or even free.”  I don’t know about all the pharmacies, but we get some of our medication from CVS and selected “auto refill” at some point. All of our medicines from CVS are filled, whether we need them or not. We receive a text when the prescription is ready, including the ones we take PRN (as needed) because our medical providers will often check for 3 or more refills. That’s a lot of medication when it’s only taken occasionally! I will mention that Costco (which we also use for cost-effectiveness and, in my opinion is one of the best pharmacies) does not offer auto refills; they will send a text asking us if we need the medication and will fill it out upon request.

I recently cleaned my linen cabinet, where we kept our medications, and was surprised at how many pills we no longer take. I am amazed at the waste.

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