Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

Nurturing the Nurturer: The Use of Doll Therapy for Older Adults

As Aging Life Care Professionals®, when we are asked to assist with securing placement in a nursing home, there are many questions we ask beyond the physical and cognitive conditions that are prompting the move. Primary among those questions is: what was mom or dad’s occupation? Those families who have parents in their mid-eighties and beyond often reply by giving dad’s occupation and the fact that mom was a homemaker.

Remembrances of lifelong professions can be retained long after actual employment or the responsibilities of raising a family have ceased.  Take Gene, a retired fireman who had been diagnosed with dementia.  On the day he arrived at the nursing home, being the conscientious firefighter he once was, he spotted a fire extinguisher and was headed straight to his job. Fortunately, his daughter positioned herself to block his access.

For mothers and wives of this era, the role of family nurturer is often rooted in the person. This is not to say that fathers have not played prominent roles, but for mothers or other women that have been employed in caregiving roles, it is not a job that finished at five. In later years, should there be cognitive loss accompanied by agitation we, as Aging Life Care Professionals, look to guide the family in ways to lessen the anxiety their loved one may be experiencing. Nonpharmacological approaches are preferable. One such method is doll therapy.

Doll therapy is just what it says. It is providing a person with a doll, that she/he can hold, cuddle, talk to, even dress and undress.  The latter helping with finger dexterity and hand-eye coordination. The doll can give a person a sense of comfort and purpose with the goal being redirecting the anxiety and bringing a parent to a sense of calm and contentment. Beyond this, a doll can be a starting point for reminiscence, asking a parent to recall their days as a new parent, bearing in mind that it is the long-term memory that is most vivid.

Research studies have shown both increased happiness and increased social interaction using doll therapy. But doll therapy is not without controversy. Some feel the dignity of a parent is compromised using a doll.  Other concerns are that dolls are demeaning and infantilize older adults. A passerby may look at a person with a doll and remark that the senior looks “cute” holding a doll. Not the way a relative wants their spouse or parent to be perceived.

As Aging Life Care Professionals, our approach is a person-centered one. To each client, we bring a toolbox of suggestions, techniques and resources. While the use of doll therapy is one such example, we customize the guidance, recognizing the unique needs of each client while working together with families to ensure practical and realistic outcomes.

Can an Adult Senior Remain at Home? …That is the Question

Can an Adult Senior Remain at Home? …That is the Question

As an eldercare consultant, I am familiar with the statistic that close to 90% of adult seniors, have expressed a desire to remain in their homes for as long as possible. The terminology in the world of eldercare is “aging in place.”

My lack of surprise about aging at home, while corroborated by AARP, has its source in the adult children who visit my office frustrated that their parents feel there is no compelling reason for them to move out of their house. A typical scenario as described by a son or daughter: no bathroom or only a half bathroom on the main floor, stairs that must be ascended or descended to get to the kitchen, no direct access to the outside without holding on to a hand rail that is unstable accompanied by a walkway that is crumbling, nonstop repairs both large and small.

Sitting across from these adult children, I understand their unease. They are often wakeful at night, distracted at work, consumed with the responsibilities of calling the plumber, roofer or making sure a path has been shoveled after a snowstorm.  I also know from talking with adult seniors the comfort that comes with continuing to reside in a lifelong home. Change is never easy or welcomed.  So, what’s an eldercare consultant to do?

For this consultant, the major consideration is safety. There is no compromise on this issue. To ensure this safety there are three necessary requirements. First, the willingness of a parent to agree to whatever modifications should be made to the house. First, the readiness of the parent to accept home care if necessary and first, the financial wherewithal and/or community support services to achieve these outcomes.  Yes, they are all number one priorities.

To this end, I frequently visit the parents in their home. Often, mom and dad need to be heard and understood, with a focus on empathy. Once they know I understand their situation, it is easier to start to effect change. The secret is small steps. With each step, it is validating their willingness to undertake necessary changes. That validation provides the incentive for the next step until a safe living environment is accomplished.

But please don’t think I come with a magic wand. Sometimes the ideal, or even close to it, becomes unachievable. It may be the staunch autonomy of a parent or it is the symbiotic relationship of husband and wife who create such a strong wall (yes, this one is achievable), that adult children, the family favorite, or even this eldercare consultant cannot convince them that they are putting their safety at risk. Then Father Time steps in and removes aging at home as a choice. A fall, noncompliance with medication, or one of those all too frequent storms we’ve been having here in Westchester County, may result in a whole new aging in place definition and destination.

A Flower and a Shower: Caring for Someone with Dementia

A Flower and a Shower: Caring for Someone with Dementia

Several years ago, I put a new bathroom in our new home. When it came time for the shower, I described to the salesman the type of showerhead I was looking for. “It’s called a sunflower,” he said and off we went to the display.

To this geriatric care manager, the notion of a sunflower showerhead, AKA a rainfall showerhead, suggests something very soothing. But enough about what I imagine. From a practical point of view, a shower for a person with Alzheimer’s Disease can sometimes take on an entirely different aura. Why can bathing be such a challenging task?

For some, it is the loss of independence. A caregiver or a family member is now either in the bathroom or outside the door. Privacy is trumped in the name of safety. Especially challenging when the aide is female and her client a male. Also, the person with dementia may not recognize that something is wrong, and becomes agitated, even belligerent. Why are all these people telling me what to do?  The senses may also contribute to this encounter. The water streaming out of the showerhead or the spigot, can be frightening to the person with dementia. Even the sound of the water can be unsettling. Stepping into a bathtub may bring a fear of falling.

The following strategies may help to reduce the stress of bathing:

  1. Choose the right time of day. If the person is experiencing sun downing, mornings may be the preferable time.
  2. Use a strength based approach. Have the person help in the bathing process as much as possible.
  3. If a person is resistant to a bath, try bringing in some favorite music or say something like: “a short bath and then a big scoop of strawberry ice-cream.” A reward system works well.
  4. Know thy self. If you have had a long day, put off the bath.
  5. If these strategies fail, try some non-rinse body soap and shampoo.

The explanations for why a person resists bathing is as varied as the person. By exploring various techniques combined with the acceptance that what is not achievable today may be resolved tomorrow or the next day, brings a degree of calm to an otherwise unsettling illness.

A Doctor’s Simple Request

A Doctor’s Simple Request

In the last weeks of Helene’s life, she entered Calvary, a hospital devoted to end of life care or as Calvary likes to say, “where life continues.”  A short distance from her home in Pelham, New York and my office in New Rochelle, as her geriatric care manager, I visited regularly.  While I could easily acknowledge that my visits were to support her caregiver who was there daily, I also knew my final good-bye was not far off.

But before my good-bye came, there were conversations with clergy, the social worker, nurses and the sharing of information with the family. The reputation of Calvary has always been stellar so I was not surprised by their responsiveness to Helene’s needs and my queries.  What I was not prepared for was the request of her palliative care doctor. It was not medical history or questions about next of kin, but a simple request to see a picture of Helene in the years prior to her decline.  I could not think of a doctor, in almost three decades of practice who ever made such a request.

As my relationship with Helene had extended over seven years, I was beyond eager to share pictures and tell stories. The doctor was an enthusiastic listener.  There was the photo of a just finished visit to the beauty parlor, another of Helene showing me the house in which she once lived and one of her oldest grandchild standing proudly by her side. Her life as a magazine illustrator was also shared minus pictures.

As geriatric care managers, we are usually called into service when there is a life changing event. While our attention is focused on a presenting issue, we are always mindful that a lifetime preceded the current situation. Illness alone does not define the person. The doctor in his thoughtful gesture understood this and let me tell Helene’s story one last time. Sometimes I think it was for my benefit more than his. Nevertheless, his patient became a person and my good-bye, when it came a week later, was softened by his simple request.

Tea with a Purpose

Tea with a Purpose

Too much coffee and tea can be a good thing. Let me explain. A few days ago, after visiting a client at White Plains Hospital Center, I stopped by their recently opened café for a cup of coffee and a freshly made gluten free blueberry tea cake. The hospital is known for its good care and the café is now following in that tradition, albeit gastronomically.  As for the tea cake, it was delicious. I do not have food allergies, but a weakness for a good piece of plain cake.

Twenty minutes later, I arrived in Harrison, New York at the home of a nearby client.  The taste of the coffee was clinging to my palette and I secretly wished I had bought another of those sweet treats for later. Hearing the bell, Helena reluctantly opened the door, always suspicious of who is knocking (not a bad thing). Recognizing my name, she let me in. Sometimes I am sequestered in her foyer for the visit and other days I am escorted into the kitchen. Today was a kitchen day. We started our conversation and then, as it progressed, she asked if I wanted a cup of tea. Did I really want to forgo that lingering taste of coffee for tea?  Truthfully, no, but I happily accepted.

Why did I say, “Yes” when I could have just as well said “No?”  It all has to do with purpose in one’s being. It’s a life quality that starts to wane as one gets older. You’re told to stop driving because you had a couple of fender benders. So now you can’t visit your home bound friend or be a volunteer driver for Meals on Wheels. And then the greatest upset of all, your spouse passes away. No one to cook that special dish which brought such accolades despite its simplicity.  Such was the case with Helena. There was no longer anybody to make that cup of tea for, so how could I ever think of saying, “No.” I sat at the kitchen table and watched her take the crackled and stained mug out of the cabinet.  Water boiled, she carefully handed me my tea, mystified as always, that I take it plain.

The act of making the cup of tea for this geriatric care manager, was both an act of kindness and the momentary gift of purpose. As for the taste of the coffee no longer lingering on my palette, it was surpassed by the opportunity to return to Helena a memory of time sweet, if not sweeter, than my blueberry teacake. It was a very good visit.

When A Parent is Fine: Five Strategies for Keeping the Status Quo

When A Parent is Fine: Five Strategies for Keeping the Status Quo

Sometimes I do a family consultation and after many questions and no red flag responses, I tell adult children, continue what you’re doing. Count yourself and your parent(s) as fortunate, but, like a good scout, be prepared.

So what is it I am saying?  It’s something like car maintenance. No squeaking brakes, or dashboard lights on, but you bring your car for maintenance.  Some older adults, if you excuse the analogy, are just like that. Blessed with good health, realistic about their needs, they can remain safely in their homes.

So for the parent who is fine, I do suggest five strategies to help keep that status quo:

  • A medic alert pendant or bracelet. Particularly, one that has a fall alert built into its sensor. Unlike the commercials, there is no need to dial the phone, the sensor picks up on the fall and calls the designated numbers.
  • A current list of all medications.
  • A notation of any medications a parent is allergic to.
  • If there is a DNR, I am referring to a Community DNR, (different than a hospital DNR) it should be prominently displayed.
  • A daily check-in call. Such calls allow for the adult child (or designated caller) to pick up on the slightest of changes in a parent’s cognitive status. Infections in older adults travel at lightning speed with altered mental status one of the hallmarks that something is wrong. Urinary tract infections are notorious for causing this altered status.

One particular service that facilitates much of the above is the Vial of Life (www.vialoflife.com). The Vial of Life is a program that allows individuals to have their complete medical information ready in their home for emergency personnel to reference upon arrival.

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These small but essential steps can go a long way in helping an adult senior maintain his/her independence and at the same time be safe in their beloved home.