Thursday, October 31, 2019

The Art of Utilizing a Fiblet



Based on an article called “Telling a ‘good or white lie’: The views of people living with dementia and their carers” by Dympna Casey, Una Lynch, Kathleen Murphy, Adeline Cooney, Mary Gannon, Catherine Houghton, Andrew Hunter, Fionnuala Jordan, Siobhan Smyth, Heike Felzman, and Pauline Meskell

What is a fiblet?
In the world of dementia, you may understand the term fiblet as a “lie” or “white lie.”  In order to increase the quality of day for the person living with dementia, the caregiver must create moments of peace and reassurance.  I would like you to reframe the term fiblet as a “therapeutic non-truth.”  In general, caregivers prefer to tell the truth.  In the world of dementia, it is referred to as reality orientation.  This choice may not be in the best interest of the person with dementia.

If we think of a fiblet as a therapeutic intervention rather than a lie, we can create moments of decreased anxiety and stress for the person living with dementia.  This published article explains it very well

Why use a fiblet?
In these moments of unfamiliarity and fear, if we choose to use truth or our reality about the current situation, it will only escalate the person’s feelings of discomfort and pain.  Here is an example of how using a fiblet worked.  Mary, 85 years old, living with Alzheimer’s was attending my day program.  Towards the end of the day, she is beginning to feel anxious and is pacing by the door and looking out the window.  Mary asks, “When is my father coming to pick me up and bring me home?”  If we choose to reality orient, or tell the truth, our response to Mary would be, “Mary, your father is dead; you are 85 years old; your ride is coming soon; you should sit down while you wait.”  Mary’s dementia disease has robbed her of remembering she is 85 years old and that her father is deceased.  Mary is now crushed, and her feelings of fear and anxiety are now escalating.  We, as caregivers, can create either negative moments, or positive moments in that person’s day.   The dementia disease is already responsible for creating negative feelings such as sadness, grief, despair, apathy, and poor self-esteem.  Trained caregivers commonly use fiblets in order to change those negatives into positives.

How do you use a fiblet?
In order to succeed when using a fiblet, your fiblet must be believable.  The only way to create a believable fiblet is to know the person.  Even in the delusional reality of the person living with dementia, if the fiblet is not believable, the person will call you out on your dishonesty.  If you know Mary well enough, you would know that Mary’s father worked in a shoe factory.  Mary will most likely believe you if you use that piece of history in your fiblet.  Here are a couple of steps could use to make Mary feel better.  “Mary, I hear you are asking when your father will be here to pick you up.”  She now knows you heard her.  “Mary, I can imagine how you are feeling. It is the end of the day, and I would like to go home too.”  She now feels that you are empathizing with her. “Mary, your father is finishing up his work at the shoe factory, then he’ll be here to pick you up.”  Even though this is not true, Mary feels reassured.  After that reassuring statement, you then will have higher potential of success by asking “Mary, would you please help me fold the towels, laundry, dry dishes, set the table, etc.”   This is a fabulous re-direction technique.  You first validate, then empathize, use a believable fiblet, and creatively re-direct.

When do you use a fiblet?
You must know the person’s history to create a believable fiblet.  When a person living with dementia expresses anxiety, stress, and fear, the goal is to reduce those symptoms.  When we validate, empathize, fiblet, and re-direct, we have a better chance of succeeding.  My experience has taught me that you need a toolbox.  This toolbox has a variety of strategies, interventions, and fiblets. Some may work for Mary; others may not.  Therefore, building a toolbox helps to provide you with creative interventions based on Mary’s history, likes, dislikes, interests, abilities, and preferences.

A fiblet is an effective therapeutic intervention for people living with dementia.  If utilized properly, the person is relieved and reassured.  As a caregiver, your goal should be to produce moments of peace and calm resulting in positive feelings for the person living with dementia.

Tuesday, October 15, 2019

13 Tips to Keep Your Bladder Healthy



People rarely talk about bladder health, but everyone is affected by it. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.

As people get older, the bladder changes. Visit Bladder Health for Older Adults for more information on how the bladder changes and common medical problems, including bladder infections, urinary incontinence, and urinary tract infections.

While you can’t control everything that affects bladder health, there are some steps you can take to improve bladder health. Follow these 13 tips to keep your bladder healthy.

  1. Drink enough fluids, especially water. Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. Water is the best fluid for bladder health. At least half of fluid intake should be water. Some people need to drink less water because of certain conditions, such as kidney failure or heart disease. Ask your healthcare provider how much fluid is healthy for you.
  2. Limit alcohol and caffeine. Cutting down on alcohol and caffeinated foods and drinks—such as coffee, tea, chocolate, and most sodas—may help.
  3. Quit smoking. If you smoke, take steps to quit . If you don’t smoke, don’t start.
  4. Avoid constipation. Eating plenty of high-fiber foods (like whole grains, vegetables, and fruits), drinking enough water, and being physically active can help prevent constipation.
  5. Keep a healthy weight. Making healthy food choices and being physically active can help you keep a healthy weight.
  6. Exercise regularly. Physical activity can help prevent bladder problems, as well as constipation. It can also help you keep a healthy weight.
  7. Do pelvic floor muscle exercises. Pelvic floor exercises, also known as Kegel exercises, help hold urine in the bladder. Daily exercises can strengthen these muscles, which can help keep urine from leaking when you sneeze, cough, lift, laugh, or have a sudden urge to urinate.
  8. Use the bathroom often and when needed. Try to urinate at least every 3 to 4 hours. Holding urine in your bladder for too long can weaken your bladder muscles and make a bladder infection more likely.
  9. Take enough time to fully empty the bladder when urinating. Rushing when you urinate may not allow you to fully empty the bladder. If urine stays in the bladder too long, it can make a bladder infection more likely.
  10. Be in a relaxed position while urinating. Relaxing the muscles around the bladder will make it easier to empty the bladder. For women, hovering over the toilet seat may make it hard to relax, so it is best to sit on the toilet seat.
  11. Wipe from front to back after using the toilet. Women should wipe from front to back to keep bacteria from getting into the urethra. This step is most important after a bowel movement.
  12. Urinate after sex. Both women and men should urinate shortly after sex to flush away bacteria that may have entered the urethra during sex.
  13. Wear cotton underwear and loose-fitting clothes. Wearing loose, cotton clothing will allow air to keep the area around the urethra dry. Tight-fitting jeans and nylon underwear can trap moisture and help bacteria grow.


For More Information on Bladder Health
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov

National Kidney and Urologic Diseases Information Clearinghouse
1-800-860-8747 (toll-free)
1-866-569-1162 (TTY/toll-free)
healthinfo@niddk.nih.gov
www.niddk.nih.gov/health-information/kidney-disease
www.niddk.nih.gov/health-information/urologic-diseases

National Association for Continence
1-800-252-3337 (toll-free)
memberservices@nafc.org
www.nafc.org

Tuesday, October 1, 2019

Be a Healthy Caregiver



As a caregiver, you may find yourself with so many responsibilities that you neglect taking good care of yourself. But the best thing you can do for the person you are caring for is stay physically and emotionally strong.


See the doctor
Be sure to visit your physician regularly (at least annually), and listen to what your body is telling you. Any exhaustion, stress, sleeplessness, or changes in appetite or behavior should be taken seriously. Ignoring these symptoms can cause your physical and mental health to decline.

If you are caring for someone in the late-stages of Alzheimer's, talk to your health care provider about the seasonal flu shot. Being vaccinated protects both you and the person you are caring for.

Get moving
No doubt you know that exercise is an important part of staying healthy — it can help relieve stress, prevent disease and make you feel good. But finding the time to exercise is another story.

Use these tips:
  • Take friends and family members up on their offers to help.You can get in a good workout in a short amount of time — even a 30 minute break. Help coordinate a schedule where you have breaks to exercise and take care of your health.
  • Start small. While it is recommended that you get 30 minutes of physical activity at least five days a week, even 10 minutes a day can help. Fit in what you can, and work toward a goal.
  • Exercise at home.When the person with dementia naps, pull out a yoga mat and stretch, set up a stationary bike, or try exercise tapes.
  • Find something you love.If you enjoy the activity, it will be easier to make it a habit.


There also are many ways you can be active with the person with dementia. Here are a few ideas:
  • Take a walk together outside to enjoy the fresh air
  • Go to the mall and take a stroll indoors
  • Do seated exercises at home
  • Dance together to favorite music
  • Garden or do other routine activities that you both enjoy


Eat well
Heart-healthy eating patterns, such as the Mediterranean diet, are good for overall health and may help protect the brain. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits, vegetables, fish, nuts, olive oil and other healthy fats. Try new recipes and involve the person with dementia.

Need ideas on how to go healthy?
Try these resources:


Five tips to help you cope
  1. Manage your level of stress. Stress can cause physical problems (blurred vision, stomach irritation, high blood pressure) and changes in behavior (irritability, lack of concentration, change in appetite). Note your symptoms and discuss with a doctor, as needed. Try to find relaxation techniques that work for you.
  2. Be realistic. The care you give does make a difference, but many behaviors can't be controlled. Grieve the losses, focus on positive times as they arise, and enjoy good memories.
  3. Know you're doing your best. Remember that the care you provide makes a difference and that you are doing the best you can. You may feel guilty because you can’t do more, but individual care needs change as Alzheimer’s progresses. You can’t promise how care will be delivered, but you can make sure that the person with the disease is well cared for and safe. For support and encouragement, join ALZConnected, our online caregiver community.
  4. Take a break. It's normal to need a break from caregiving duties. No one can do it all by themselves. Look into respite care to allow time to take care of yourself.
  5. Accept changes as they occur. People with Alzheimer’s disease change over time and so do their needs. They may require care beyond what you can provide on your own. Becoming aware of community resources and care options — from home care services to residential care — can make the transition easier. So will the support and assistance of those around you.