We all face the five stages of grief when a loved one dies, but it can be shocking to recognize that we must actually go through a variation of these stages each time we face a major life change.

When a loved one is diagnosed with Alzheimer’s, when outside life is cut off as you care for a chronically ill spouse, when your own health takes a dive – any of these can precipitate a distinct grieving process.

While it’s helpful to be aware of the stages of grief, it’s also important to know that the process isn’t a straight line. Like a pendulum meeting an obstacle, newly emerging aspects of a change can swing you backward for a while. Each of us moves through these five stages at our own pace and in our own way.

Shock/Denial

Symptoms: A sense of surprise and unreality. You may try to continue to function as if the change really isn’t happening. You may put off deciding on next steps. You may experience numbness, a sense of isolation, confusion and even memory loss. Value: Denial carries you through the first wave of pain. It helps buffer the shock.

Anger

Symptoms: You may find yourself directing anger at anyone associated with the situation and even those who are not – medical practitioners, friends, family, even the dog. You may plunge into blame. Value: Anger lifts your energy and temporarily masks that awful sense of vulnerability. It helps you feel safer.

Bargaining

Symptoms: Feelings of vulnerability and seeking some control. Many folks try to make a deal with life. “I’ll do this, if you do this.” Value: Bargaining offers a measure of needed respite from the pain of reality.

Depression

Symptoms: These include sadness, regret, and worry about practicalities. Old losses and failures come up and vie for attention. Questions such as “who am I if…” and “what happens if…” loop and yammer. Value: You subconsciously begin to get ready for whatever is next.

Acceptance

Symptoms: You begin to explore options, plan realistically, and take care of yourself with more sleep, good health choices, and social contact. You notice positives. Value: You begin to move forward, to reaffirm life and to notice what feels good again.

© 2011 Friends and Neighbors Magazine

Writer Darlene Hutchins is the granddaughter of the late Wilma and Mirl Andersen. For more, read Managing Life’s Losses.

By Darlene Hutchins

Reading sympathy cards sent after my grandmother’s death, I was not surprised how many people loved her. She made everyone she met feel special.

My grandma was the youngest girl in a family of seven.  She grew up during the Depression, learning frugality and making use of everything.  Clothes were handed down from two older sisters, and it was a treat when her mother sewed them new dresses for Christmas. Morning chores started at 5 a.m., followed by more chores after school. If my generation worked as hard as hers, she would say, kids wouldn’t have time to get into “mischief.”

My grandmother married as World War II began. Those were also frugal years. She cleaned and reused aluminum foil and plastic bags. She saved the waxed bags inside cereal boxes to store baked goods. She saved the boxes themselves, cutting them into strips to use for grocery lists. She was the queen of green long before it was fashionable.

Life as a war bride was difficult, but with a baby on the way, she was happy. Shortly after their daughter (my mom, Carolyn) was born, my grandfather was drafted. After returning from service in Africa, he took a job with a construction company. After moves to Idaho, Alaska, Washington and Oregon, my grandfather in 1957 took a job with the Tuolumne Telephone Company and never moved again.

Words used in Grandma’s eulogy – resolute and meticulous – describe her to a T.

She was an elegant woman who grew more beautiful as the years passed.  She would spend hours putting on makeup or making sure her hair was just so.  “Take pride in your looks,” Grandma said, “because your husband still has eyes.”

She was a great cook. Often I would walk into her home smelling something heavenly baking, usually for a neighbor or friend who had a baby or had suffered a death. Grandma also had a great sense of humor, and even when doing something as mundane as washing dishes she would say or do something to make me laugh until tears streamed down.

After my grandfather retired, he and Grandma went on a two-year church mission to New Zealand. When they returned, she would tell me stories about life there, usually while teaching me her secrets of crimping a piecrust, baking or dipping chocolates.

We celebrated Grandma’s 80^th birthday at a restaurant. She couldn’t remember how to order from the menu. It marked the start of an illness that took her personality from us long before she died. In the months that followed, she became more and more forgetful. Eventually, a neurologist gave the diagnosis we feared: Alzheimer’s disease.

Medication helped slow the disease’s progression, but eventually Grandma could no longer drive, make the bed or clean house. She started believing she was not at home, and would beg my grandfather to take her home. She forgot who family members were, except for my grandfather: She often told him she loved him.

When she began to wander away from home, my grandfather realized he couldn’t leave her alone. My mother and I began helping with her care. We also started using services offered by the Area 12 Agency on Aging, which helped us deal with some of the frustration and confusion we felt.

As my little girl started talking, Grandma would sing nursery rhymes with her, surprisingly remembering all the words.

My beautiful grandmother, who had taken such pride in her appearance, eventually ceased to care. But sometimes my daughter would give her a mirror and comb her hair. “I’m getting dolled up,” Grandma would say.

Over time, more things became confusing and scary to her – like getting a shot, or having blood drawn. She only knew that someone was inflicting pain. This made it difficult for her nurses or lab workers, as she would scream, “You’re hurting me!”  Washing hair, trimming fingernails and showering became terrifying. It was so sad to see the confusion in her eyes: “Where am I, and who are these people?”

Shortly after her 88^th birthday, in the eighth year of the disease, my grandfather moved Grandma to a full-time care facility. Two weeks later she passed away.

Yes, the disease had robbed our family of her mind. Still, she was physically present – and we could feel her essence.

I am grateful she lived long enough to meet my children. Even though she didn’t really know who they were, she showed them love – the same love she had shown my brothers, my cousins and me.

I am so proud to have been part of her life for 47 years.

Darlene Hutchins is the granddaughter of the late Wilma and Mirl Andersen of Tuolumne.

© 2011 Friends and Neighbors

If you’re caring for someone with Alzheimer’s or some other kind of dementia, you also need detective skills to make sure your home is safe for your loved one. There are some very good home safety checklists available from the Area 12 Agency on Aging (532-6272) or go online and search “home safety for Alzheimer’s.” Each one is a bit different, but they’re a great start for building your personalized home safety list.

In general, you need to keep your home as simple, organized and clear as possible.

·    Remove what you can live without and once you’ve organized furnishings into safe, easy travel patterns, don’t move them.

·    Consider installing handrails, ramps and other devices.

·    Increase lighting throughout the house and add nightlights for after dark.

·    Install locks on cabinets or use other means to secure sharp kitchen tools, hazardous materials (from drain cleaner to alcoholic beverages), all weapons, and outdoor tools.  If you can remove them from your home, even better.

·    To prevent wandering, secure outside doors with keyed deadbolts or latches that are extra high or extra low. Put safety covers on doorknobs.

·    Keep a front door key handy outside in case your feisty loved one locks you out. Also take locks off of bathroom doors so you can’t be locked out.

While this list gives you a few examples, it is by no means complete. Reassess your total home environment periodically – perhaps with the fresh perspective of a sharp-eyed family member or friend.  As dementia progresses, new safety issues will arise. A bar of soap may be mistaken for food. The pretty crystal vase filled with flowers becomes a tipping or throwing hazard when the disease triggers a temper tantrum.

One family caregiver describes leaving her peacefully occupied husband alone briefly to attend to an important task in another room.  Only a few minutes later, an explosion in the backyard had her racing outside to find her husband – a high-powered and inventive man, now with dementia – about to throw a second spray can onto their outside fire pit.  Unaware of the danger, he was delighted with his first big boom and ready to create another.

There is no one who knows your loved one as well as you do, but don’t beat yourself up if you don’t catch everything the first time around. Securing your home is an ongoing process.

Joan Jackson is a partner with Peter Carrillo in Practical Dreamer (588-1835), providing clinical health education and other services, including caregiver support groups sponsored by the Area 12 Agency on Aging.

© 2009, Friends and Neighbors Magazine

Family Physician

As we stepped outside the door of her mother’s apartment, I could see tears welling up in the daughter’s eyes. We spoke softly so as not to be heard through the closed door, but the low tone didn’t dampen the obvious emotion and pain.

“I have only tried to help, I have always had nothing but her best interest in mind. How could she think that I would do something like that?” she asked, reaching for an answer that might explain her mother’s sudden distrust.

The question hung in the air for a moment, and as I mustered up what I hoped would be a helpful response, I looked into her face and saw that a simple medical explanation – describing the disordered thinking that accompanies dementia – was not going to diminish the pain she was suffering as a result of her mother’s disease.

Short-term memory loss is the hallmark finding and often the first noticeable symptom in early Alzheimer’s disease and other related dementias. But it is by no means always the most problematic. A broad range of dysfunctional behaviors and cognitive defects may afflict patients with dementia from early on in the disease process through the late phases, often with wide fluctuations in their severity and potential to disrupt social interactions. Close family members and friends are not only the first to notice these changes, but are also the most likely to bear the brunt of the emotional impact.

In this instance, my patient became convinced that someone was consistently going through her mail, removing any checks, and using the information to deplete her bank accounts. Her daughter, the one family member who visited regularly, had been responsible for making arrangements on her behalf, from securing her mother’s apartment to setting up accounts and monitoring her assets.

I suppose that on the face of things, if the daughter were inclined to steal from her mother, she had the best access and would be a prime suspect – if indeed there had been a theft. In fact, on a previous visit my patient reported to me that several items (of dubious value) had been stolen from her room, although no one could confirm that the items had actually been there in the first place and she had been known to misplace things. As is often the case, the truth of the situation became increasingly evident over time.

I did my best to console my patient’s daughter, and to reassure her that there was no true change of heart on her mother’s part, or thoughtful disregard for her love and devotion. Rather, what she saw in her mother’s angry eyes was the fear and confusion wrought by the progressive deterioration, destruction, and disruption of the brain’s normal cellular functions.

I cannot be sure that my words helped assuage her pain, and I suspect that she shed many more tears over the next few months. I don’t know if she was able to step back a little and see the humor some weeks later when her mother called 911 and filed a police report claiming that someone had read her mail, and maybe she never will.

The good news is that time has a tendency to heal all wounds, and my patient no longer suffers from the same paranoid delusions. The last time I saw her, we sat in her front room – my patient, her daughter and I – and talked about the weather, her appetite, her worsening fatigue. Gone was the tension that had hung like a dark cloud over our previous visits, and I smiled as I looked across the room and watched a mother and her daughter in simple, earnest discourse.

I know that tough times loom ahead, but life is like that, and we all tackle it one moment at a time.

© 2008, Friends and Neighbors Magazine

Dementia, Alzheimer’s disease and other illnesses that interfere with normal brain function can trigger anger, abuse or delusions in the person you’re caring for. While medications may help reduce the number and intensity of episodes, there are also techniques you can use to help both of you. Here are three suggestions:

1. Keep it simple

It’s important to remember that your loved one’s anger may be a reaction to fear, confusion or pain. Keep daily routines simple – one step at a time if possible – and consistent. Keep choices to a minimum. These are progressive illnesses and your loved one may no longer be able to handle life skills that were feasible a month ago, or even a week ago. Also, it’s not always possible for a person with dementia to notice or tell you when they are ill or in pain, but they may be responding to it with anger.

If your loved one is simply angry it’s best not to confront. Try changing the subject or removing yourself from the situation.

2. Take a time-out

Time-outs for adults are different than those for children.  Instead of telling your angry husband or mother to “go to your room,” you take yourself out of the situation. You might say, with no other explanation, “I need to go outside. I’ll be back in 10 minutes.” Then leave for a brief period. Be sure to tell them when you will return. If you don’t feel it is safe to leave your loved one alone in the house, you may simply say, “I’m going to the bathroom now.” Keep a good magazine in the bathroom and lock the door. Return in a few minutes to see how things are going.

3. Enter their reality

Entering the other person’s reality can be very effective for defusing a difficult situation.  For example, Jane has taken her dad to the doctor in his wheelchair. He becomes agitated and angry while waiting for the doctor. He keeps getting out of his chair, saying, “I have to catch my plane.” At first Jane reminds him he’s in the doctor’s office. He remains agitated.  Jane takes a deep breath and “enters his reality.” She points out that the captain of the airplane has put the seat belt sign on, so he must remain in his seat.  Dad, relieved, settles back in his chair to wait quietly. Use your imagination.

While there are many great books and Web sites, an essential resource for anyone dealing with the difficulties of Alzheimer’s or dementia is a book titled “The 36-Hour Day,” by Nancy L. Mace and Dr. Peter Rabins. It’s available at local bookstores or online at amazon.com

Joan Jackson is a partner with Peter Carrillo in Practical Dreamer, providing clinical health education and other services, including caregiver support groups sponsored by the Area 12 Agency on Aging. Contact her at (209) 588-1835.

© 2008, Friends and Neighbors Magazine