Dementia as a Chronic Condition

Posted on April 06, 2016 by Anne Ellett

I am consulting with a lovely Assisted Living community that is looking to update their Memory Care program. As I talk with their team, they tell me the stories of the families that tour and move in their loved ones. The Administrator seemed frustrated as she was telling me about the most recent resident to move in. She said he had recently gone through so much trauma! In the past year, he had lived in 2 different Assisted Living locations, and had also been in a hospital and skilled nursing facility and most recently, his wife called 2 days before he was getting ready to be discharged from the nursing home looking to relocate him again!
“Why can’t they make a plan? It seems like they only call when they’re in crisis!” the Memory Care Administrator expressed.
This story is not untypical as families with dementia are often left without guidance on how to put together a plan, reacting and making decisions only in a time of crises. Dementia is a long-term chronic condition that a person may live with for well over a decade. And unlike other chronic conditions, such as heart failure, COPD, or hypertension, there are not multiple choices of treatments and therapies the medical team can recommend to help manage the condition and improve quality of life for a lengthy period of time. It is up to the person affected and their family members to piece together a plan. So often, families don’t know where to start!
Consumers, meaning the person living with the dementia and their family members, may be unknowledgeable about what constitutes good care, what type of support may be needed, and where are the professionals who can assist them? And there is no single template of care that will benefit everyone – every person living with dementia has individual abilities, interests, and resources.
If we look at dementia as a long term condition, it makes sense to educate ourselves and make a plan, in order to avoid, as much as possible, reaction during time of crises. If decisions are made during crises, there will be less time for thoughtful choices and less choices to select from. And any crises, such as a hospitalization or relocation to a new place of care can be traumatic, requiring reorientation and readjustment. The only way to stay in control is to educate yourself and make plans.
If you or a loved one are affected by dementia, contact Memory Care Support for assistance in putting together a personalized plan of care to provide enjoyment, choice and dignity.

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation

Have a great day!

Anne Ellett, N.P., M.S.N.                                                                                           
949 933-6201

Posted in

Preventing Memory Loss

Posted on January 26, 2016 by Anne Ellett

Public awareness of Alzheimer’s and other dementias has increased fears for us as we age. According to a study by Met Life, for people over 55 years old, Alzheimer’s was the most dreaded condition after cancer.

As fears rise about developing dementia, so does the number of products that are touted as preventing it. Diets, supplements and brain stimulation games all promise to prevent or delay the start of dementia.

Some of the diets are a bit bizarre – Dr. Oz’s website includes information about “superfoods you must include in your diet to prevent Alzheimer’s and boost your memory” – his recommendations include foods such as chicken giblets, clams, and elderberries as necessities to prevent Alzheimer’s……

It is predicted the anti-Alzheimer’s product industry will follow in the footsteps of the multibillion dollar anti-aging, anti-wrinkle industry. And as we know, most of the anti-aging products are not worth the money we spend on them.

Along with supplements and diets, there are many electronic game-type products which promise to stimulate our brains and delay cognitive decline. One of my personal favorites (a great way to kill time while waiting at airports…) is Lumosity. However this “brain training” company has recently agreed to pay 2 million dollars to settle Federal Trade Commission charges that they deceived consumers with unfounded claims that the company's web-based games can reduce or delay cognitive impairment associated with age and other health conditions.

The quote from the FTC is very telling…. “Lumosity preyed on consumers' fears about age-related cognitive decline, suggesting their games could stave off memory loss, dementia and even Alzheimer's disease. But Lumosity simply did not have the science to back up its ads.”

All of us should remember that in the world of diets, supplements and computer games, the strength of evidence does not have to be much! There are not rigorous scientific trials testing the outcomes and manufacturers can make unfounded claims of their products. And yes, we’re all fearful of developing Alzheimer’s or other dementing illness.

Maybe someday there will be specific prescriptions to prevent these conditions but unfortunately, not right now. But science is giving us clues – with over 75% of dementias not linked to genetic causes, it makes sense that there are lifestyle choices we can make to help keep our brains healthy.

We know that some health conditions such as obesity, inactivity, diabetes, high blood pressure can all increase our risk of dementia and there are many choices we can make to lower our incidence of these conditions.

Like many other health conditions, it would be easier if we could just “take a pill” and not have to do any hard work ourselves but decades of research in heart health and cancer research validates that the most powerful intervention we can do to keep ourselves healthy often lies in our own lifestyle choices.
And guess what? Research also shows us that our body organs and systems do not exist in “silos” but all interact and influence each other. So what is healthy for our heart will be healthy for our brains.

Here’s what we know about strategies to reduce our risk of cognitive decline:

1. Physical exercise is good for our brains. In one long-term study of 18,000 female nurses, those who were most physically active appeared to stay cognitively intact up to 3 years longer than those who were inactive.

2. Don’t smoke…goes without saying…

3. Take up new cognitive challenges. Strategy games such as chess and scrabble, solving puzzles, learning a new language or musical instrument, taking classes, writing poetry, are just a few examples of activities we can start. Go wild - choose something new and interesting to you! In a randomized trial with over 2,000 older adults, those who received ten 60-75 minute brain training sessions showed benefits for several years.

4. Avoid or control health conditions such as diabetes, obesity, hypertension and high cholesterol.

5. Eat a healthy diet patterned after the Mediterranean, MIND or DASH diets. For more information on healthy diets, see my blog from Sept. 2015.

None of the above recommendations involve buying expensive equipment, games or supplements… Maybe instead of spending $50/month on vitamins and supplements, use it to take guitar lessons or learn to tango – now that sounds like fun!

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation

Have a great day!

Anne Ellett, N.P., M.S.N.                                                                                           
949 933-6201

Posted in

The Best Gift of All

Posted on December 02, 2015 by Anne Ellett

I invite you to read this holiday blog from a friend of mine, Pam Oldham, who writes about sharing gifts with her mother during the holiday season:


Many families will visit loved ones living with dementia this holiday season. Often, we make the mistake of trying to recreate family holiday celebrations of our youth. But over time, I’ve taken a new approach, thanks to lessons I’ve learned from my 87-year-old mother who lives in a long-term care facility far from my current residence.

Here are six lessons Mom taught me about holiday visits (plus a couple bonus lessons). I hope sharing them will help you and your family, too!

One really great present is all that’s needed. The family of my childhood celebrated Christmas and featured a massive stack of gifts under a tree. Carrying on that tradition is not longer appropriate for Mom. Too many gifts (and too many visitors) at once can be overwhelming to a person with dementia. Last year, I visited with Mom alone and gave her an interactive holiday ornament that came to life with lights and music at the touch of a button. Mom’s joy and wonderment was evident every time she pressed that button and the light and music show began. She played with the ornament every day during my week-long time with her.

Sing happy songs. Yes, sing and sing boldly. It doesn’t matter if you have a good voice or not. Holiday sing-alongs weren’t among my family’s traditions when I was a child, so I didn’t realize until recently how much Mom enjoys belting out holiday favorites. Sticking to songs with simple lyrics from old standards, like “Jingle Bells,” ensured Mom’s participation, to her great happiness. We began in the dining hall after dinner and continued singing all the way back to an activity room where a holiday event was about to begin for the enjoyment of residents. Hearing Mom’s laughter each time as we stumbled over lyrics warmed my heart.

“Selfies” aren’t just for the young. Mom first learned about smartphone cameras three years ago, and she loves our tradition of taking at least one official selfie during every visit. For our holiday pic, we don Santa hats that I bring and then we mug for the camera. As we check out the resulting images, we reminisce about past holidays and visits with Santa. I usually print the best image locally, frame it, and then give it to Mom before I leave for home.

Holiday lighting displays are still magical. Since Mom lives in a cold climate, it’s usually impractical to take her out to view neighborhood lighting displays by car. However, because her community is located in a residential neighborhood, displays can be viewed easily and warmly from inside the facility. We move our personal holiday party to an activity room with big windows facing decorated yards, turn out the room’s interior lighting, and then gaze with wonderment at all the beautiful lights outside.

It’s okay to be silly. Mom hates regimented exercise, but when I suggested that we take our song and dance routine to the halls of her facility, she eagerly agreed. I strapped some bells to her walker and we headed down the halls, singing holiday tunes and fancy stepping as went. Staffers and residents were delighted, and we had great fun. As an added bonus, the exercise invigorated Mom’s body and spirit at a time when she needed it most.

Your presence is the best gift of all. Visit regularly and often. During the holidays, a long-term facility can be a very lonely place for residents and staffers. Instead of planning one “big” celebration on a single visit, return several times during the holiday season for many smaller celebrations.

When I was a child, Mom taught me to be on lookout for people who need cheering up during the holiday season. Many long-term care residents don’t have any family members or visitors during the holidays. So, I always reserve time at the end of each visit with Mom to stop by open doors on my way out of the building. I greet each resident and wish him or her a happy holiday. Judging from their smiles and hand waving, this simple recognition brings them great joy.

Lastly, when you visit during the holidays, consider bringing some special snacks for staffers to share. They have sacrificed time with their own families to care for your loved one. It’s been my experience that cookies and veggie trays are especially appreciated.

Happy holidays!

Based in Austin, Texas, Pamela Oldham is a professional writer and care advocate for people living with dementia. Contact her at and follow her on Twitter @pamelaoldham.

Posted in dementia, holiday visits, Pam Oldham, six lessons

3 Tips to Support Family Care Partners When Their Loved One Moves to Assisted Living

Posted on October 28, 2015 by Anne Ellett

3 Tips to Support Family Care Partners When Their Loved One Moves to Assisted Living

If a person living with dementia moves into a full time care environment, such as Assisted Living, the family is often assaulted by a myriad of conflicting feelings…..Guilt (I told her I would always take care of her), Inadequacy (I should be able to take care of her), Fear (will they really take good care of my loved one?), Anger (it’s not fair that I have to deal with these difficult issues), Exhaustion (I can’t go on like this) and Relief (thank goodness I’m getting some assistance).

When Assisted Livings or other LTC settings accept a new resident, they are also accepting the family.  Caring for the families of residents living with dementia can be as important and complex as caring for the actual residents!  All of their fears and doubts have to be addressed and the Assisted Living needs to have a program to “wrap their arms” around not just the new resident but also the family members.  Most likely the family has had a long struggle to find the right level and type of care that would be best for their loved one.  Recent trips to the hospital, changes of medications or health status, and finally the realization that they can’t continue to do full time care at home, can leave them emotionally and physically exhausted.

Here are three strategies that Assisted Living communities can use to support the family care partners and give them confidence in your care:

1. Assign one leader in your community as their case manager.
Every leader is assigned a group of residents that they “case manage” and are responsible for.  Initially the case manager is in frequent contact with the family, getting to know the family’s preferences, priorities and “hot buttons”. 

For the new resident and their concerned family members, moving into a care community can be like that first day at a new school – so many new faces and names.  By assigning a case manager, the family feels they have one person as the point of contact and don’t have to “tell their story” over and over again to many different people.  As they become more familiar with other staff and develop trust, the family will begin to talk with others.  Initially however, by assigning a case manager, they will feel they have a person who is accountable for the quality of care and will be their advocate and answer their questions. This can go a long way towards building family confidence in your Assisted Living community.

2. Have an on-site support group for family members.
From my experience of working in Assisted Living, I have utmost respect for the important role that support groups can play in helping families feel comfortable, encouraging them to take good care of themselves and begin to let go and trust you.

Invite new families to join the support group.  This can be a great source of comfort and information.  Other family members have an appreciation for the trauma and fears that new families are experiencing and participation in a group can give the members an outlet to share their emotions. 

Members of a support group also encourage other members to take good care of themselves.  A simple question such as “What did everyone have for dinner last night?” can bring to light problems such as sadness from eating alone, and risks of poor nutrition.

3. Plan fun social events for family members off site.
Sponsoring a gathering for Happy Hour at a local restaurant, a meet-up at a Museum or an afternoon of bowling, can add some normalcy for family members and give them something to look forward to.  For a short time, they are just a group of adults having a social time that is not necessarily linked to caring for someone living with dementia.

Many care partners have necessarily put their own lives and interests “on-hold”.  Friendships may have slipped away and they may be out of practice or not have the energy to arrange social events.  Inviting them to a fun occasion can give them permission to begin to enjoy life again and explore their community.

I’ve seen wonderful friendships forged from family support groups. 

If you work in Assisted Living and care for residents living with dementia, what is your plan of care for your family members?  Are you meeting their needs?

If you work in Assisted Living and want
To make your dementia care program even better,
Or if you need assistance in
Planning care for a loved one,
E-mail or call me for a free consultation


Have a great day!

Anne Ellett, N.P., M.S.N.                                                                                                    
949 933-6201

Posted in Alzheimer's, Anne Ellett, Assisted Living, Dementia, Tips to support family care partners

What Should We Be Eating?

Posted on September 30, 2015 by Anne Ellett

There are many research studies being conducted about lifestyle choices and effect on prevention of cognitive decline.  Many studies are validating the benefits of a healthy diet and an active lifestyle on maintaining brain health.

It’s impossible to report on all of the recent and current studies but from time-to-time, I want to highlight results of some key research studies related to diet or lifestyle.

The MIND Diet - adherence to the MIND diet was associated with significant lower rate of cognitive decline.  The MIND diet divides our food choices into 15 groups:

The good choices includes these 10 groups:

  • Green leafy vegetables (like spinach and salad greens): Six or more servings a week
  • Other vegetables: At least one a day
  • Nuts: Five servings a week
  • Berries: Two or more servings a week
  • Beans: At least three servings a week
  • Whole grains: Three or more servings a day
  • Fish: Once a week
  • Poultry (like chicken or turkey): Two times a week
  • Olive oil: Use it as your main cooking oil
  • Wine: One glass a day
The choices to avoid include:
  • Red meat: Less than four servings a week
  • Butter and margarine: Less than a tablespoon daily
  • Cheese: Less than one serving a week
  • Pastries and sweets: Less than five servings a week
  • Fried or fast food: Less than one serving a week

The MIND diet is healthy for your heart and vascular system, and will also decrease your risk of stroke and heart attack!  This is great news – this is something we can all do to decrease the possibility of brain and cardiac disease – there isn’t any medication that can offer all of those benefits!

You can start following the MIND diet with the Healthy Mind Cookbook by Rebecca Katz and Mat Edelson.  It will inspire you to make good choices!

In another recent study, a link was found between being obese or overweight in mid-life and increased risk for earlier onset of Alzheimer’s disease.  This study was conducted by the National Institute on Aging (NIA).  The body mass index (BMI) of people 50 years old was followed for many years, and results showed that people who were overweight in mid-life were more prone to developing Alzheimer’s disease at a younger age than those people who were not overweight. Perhaps the link between being overweight and earlier development of Alzheimer’s disease is related to the increased risk of diabetes and hypertension that obesity can cause.  

All good reasons to pay attention to what we put in our mouths – Now go enjoy a glass of wine with some hummus and whole-grain crackers – sounds wonderful!


Posted in Edelson, Healthy Mind, Healthy Mind Cookbook, Katz, Mat Edelsen, MIND, MIND Diet, Rebecca Katz

When Less is More….

Posted on August 25, 2015 by Anne Ellett

Sometimes “Less is More” when it comes to good medicine and I’d like to tell all of you about a wonderful initiative by the American Board of Internists– this initiative is called the Choosing Wisely Campaign.

Having less can be a desirable goal in good medicine – having less interventions, less medications, less tests done, and less hospitalizations. Having less doesn’t mean less care, it can mean more judicious and beneficial care and less exposure to unnecessary risks.

Choosing Wisely aims to promote conversations between clinicians and patients by helping patients choose care that is:

•  Supported by evidence
•  Not duplicative of other tests or procedures already received
•  Free from harm
•  Truly necessary

As part of the Choosing Wisely Campaign, the American Geriatrics Society (AGS) has identified tests and procedures commonly used with older patients whose necessity should be questioned and discussed.
Many of their recommendations are directly related to good care for people living with dementia. A few of their recommendations include:

•  Don’t put feeding tubes in patients with advanced dementia.
•  Don’t use antipsychotic medications as the treatment for behavioral symptoms of dementia
•  Don’t use benzodiazepines or other sedative-hypnotics in older adults
•  Don’t prescribe cholinesterase inhibitors (i.e. Aricept) for dementia without periodic assessment of perceived benefits and adverse effects
Don’t use physical restraints to manage behavioral symptoms

Many of these recommendations seem obvious but these are still medical practices frequently used throughout many areas of healthcare.

The full list of “Things Providers and Patients Should Question” will spark discussion about the need—or lack thereof—for many frequently ordered tests or treatments. You can read the entire list of recommendations by AGS.

If you are caring for an elder parent, discuss these topics together – plan for quality care but minimal intervention!

Have a great day!

Anne Ellett, N.P., M.S.N.

Posted in choosing wisely campaign, patient choice, things providers and patients should question

Pioneer Network Annual Conference

Posted on July 28, 2015 by Anne Ellett

There’s an exciting event happening next week for those of us interested in change in long-term care. The Pioneer Network’s annual conference is in Chicago Aug. 2 - 5th.  Pioneer Network is a national coalition of people interested in changing the culture of aging and how the aged are cared for.  As advocates for older people, they are working for changes that allow the choices of older individuals to be respected, whether they live in their homes or in a nursing or community facility.  Their upcoming conference is all about culture change in long-term care.  

One of Pioneer Network’s Initiatives includes setting standards for person-centered training on dementia care.  Person-centered care moves away from impersonal, fragmented and regimented care towards care that includes the psychosocial, spiritual as well as the physical being. 

Imagine an environment where the caregivers are trained to stop and listen and validate instead of walking on past that person affected by dementia who is holding out their arms? A friend of mine who recently toured a nursing home told me he was so saddened by the tour director who focused entirely on him, ignoring the pleas of the residents for assistance.  While trying to impress him with their compassionate care, the director disregarded the needs of the residents.  My friend is continuing to look for a better place for his mother to reside.

There is free live-streaming from the Pioneer Network conference next week Aug. 3 and 4th.  Tune in and listen to a few sessions:

Posted in dementia, pioneer network conference, videtostream