There are 4.5 million Americans living with Alzheimer’s disease, and many of these individuals require care 24/7 due to the progression of the disease; care is most often provided by a family caregiver, usually an adult child or spouse.

Caring for someone with Alzheimer’s can be physically demanding and emotionally trying since the individual’s personality may change drastically, or they may become physically or verbally abusive to those around them.

Tips for Caregivers

1. Be prepared & learn about the disease – read about the disease and its affects so you are prepared for how it may progress

2. Exercise patience – remember not to take their behavior personally, they’re not trying to make your frustrated or angry; it’s a direct result of the disease

3. Avoid correcting – if they are confused about a person or situation, avoid correcting them to limit frustration; instead, ask simple questions about their statements and involve them in conversation

4. Encourage independence – while your care recipient may not be capable of doing everything self sufficiently, you can prompt them to begin tasks on their own but with you available to step in should they need assistance

5. Seek support – you don’t have to do it alone, have family friends, or a caregiving organization step in to give you a break. Also consider joining a support group for caregivers of individuals with dementia/Alzheimer’s as it can be helpful to talk to someone who understands what you’re going through

6. Use resources – there are professionals who can assist you with the legal factors of caring for someone with Alzheimer’s; such as making senior care decisions, learning about elder law issues and Power of Attorney, asset management and creating a will

7. Get professional assistance – having a professional caregiver assist with everyday tasks, can give you the chance to spend more quality time with your loved one

8. Eliminate distractions – too much aural and visual stimulation can be overwhelming to someone with Alzheimer’s, try to maintain a quiet, comfortable environment whenever possible

9. Know how to communicate – speak slowly and clearly and control your pitch and tone

10. Use positive body language – individuals with Alzheimer’s are sensitive to physical signs; try not to demonstrate tension in your body to avoid causing anxiety

I saw him today walking down the street. I now think of him as Sasquatch Man. It made me catch my breath and clutch my heart to see him like this. It made me cry to see the shadow of who he was. I cried for him and for myself, as I miss my old friend.

He is a very large man a little over 6 ft tall and probably weighs 350 lbs. He lumbers down the street, wearing his stocking hat that looks like it belongs to a lumberjack. He has taken to even wearing it with his shorts in the warmer weather. The Birkenstock sandals are always there, as they always have been, come rain or shine.

He walks everywhere now, as his license was taken away. I believe his motorcycle got sold for his and others' safety. That alone is probably enough to make him want to die. He practically lived on it. You would see him weaving down the street, like a child does on their bicycle, just loving the feel of it.

Quite a unique individual he was. Strong and powerful in many ways. Extremely intelligent, with a very high I.Q., to the point of being almost a crazy genius. He had a very twisted sense of humor, and loved the shock effect it had on people. Folks would either be horrified at his bizarreness or laugh themselves silly. There were plenty who actually hated him, and more who loved him. He could drive you practically insane if he wanted to, by pestering you to death for attention or for drugs when he was out. That was what he always referred to as "The Malaise". After a 40 year meth addiction, I would imagine it felt like malaise to him.

He is a product of the 60's. There are many who spent their teens and early twenties dabbling with all kinds of drugs during the 60's. Not just pot, but L.S.D. (acid) was popular then. It was the Hippie Years and he was no exception, but almost the rule. He lived the bizarre life then in the city. He later moved to the mountains to escape that which he ended up bringing with him.  He desired a better place to raise his family and found it.

He changed from City Hippie, to Organic Hippie, to Hippie Journalist and  Editor.  Later he became a professional in the field of Law. A brilliant, self-taught professional. He was at first scoffed at, then held in high esteem by some, and disdain by others. He was called a maverick and a lunatic. Many reasons were behind all of this. He was a "horse of a different color". He had heart. He stood up for what he believed to be right and just.

He was right much of the time, but pushed things more than to the limit. He would push them way over the edge. His creativity knew absolutely no bounds. All of this was due not only to his nature, but to the cranked up beast raging inside of him. He was husband, father, friend, philospher, professional, and a drug addict. An amazing man in so many ways.  A doomed man in others.

Years went by, with the same behavior continuing. His family felt the ill effects of the drugs raging. His friends felt the effects. His employees felt the effects. His career felt the effect.  His mind felt the effects as did his health.

His family life became more and more strained.  Love gave way to stress and hopelessness and embarrassment.  His relationships at work became more and more strained. Trust and respect gave way to disrespect and embarrassment. His career ended in a hugely scandalous way, devastating his family, his employees and co-workers, his friends and himself.

He was never the same after that, but steadily went downhill. At first his nervousness and devastation were calmed some by tranquilizers. His mind had already been slipping for the past few years. What one would have thought was just early aging and forgetfulness turned out to be dementia. I believe that at least some of the dementia was caused from the holes that the meth had put in his brain over the years.

His drug use and the consequences were not only felt by him, but by his wife, children, grandchildren, friends, and co-workers. The consequences were huge and life changing to all concerned.

Eventually each one dealt with the stress and strain and devastation in his or her own way. We all moved on and left him behind. We left him behind trapped in a body that did not operate in the same way that it had before. The body that now walked similar to "the thorazine shuffle", as it is known in mental wards. The eyes that did not have the same intelligent light in them as before but looked blankly into the beyond.

Confusion is written on his face. The sadness in those eyes haunts me to this day. The sadness, I believe is a little glimmer of awareness in him that is left. The awareness of all that he has lost. The huge strength and power that he had once exuded is now gone.

Yes, I saw Sasquatch Man today. He used to have another name, but now I cannot make the name fit him anymore as he is a different person. It made me catch my breath again. It made me clutch my heart again, to see him like this.  It made me cry once again to see the shadow of who he was. I cried again for him and again for myself, as I will always miss my dear old friend who is no more.

He is a very large man a little over 6 ft tall and probably weighs 350 lbs. He lumbers down the street, wearing his stocking hat that looks like it belongs to a lumberjack. He has taken to even wearing it with his shorts in the warmer weather. The Birkenstock sandals are always there, as they always have been, come rain or shine.

He walks everywhere now, as his license was taken away. I believe his motorcycle got sold for his and others' safety. That alone is probably enough to make him want to die. He practically lived on it. You would see him weaving down the street, like a child does on their bicycle, just loving the feel of it.

Quite a unique individual he was. Strong and powerful in many ways. Extremely intelligent, with a very high I.Q., to the point of being almost a crazy genius. He had a very twisted sense of humor, and loved the shock effect it had on people. Folks would either be horrified at his bizarreness or laugh themselves silly. There were plenty who actually hated him, and more who loved him. He could drive you practically insane if he wanted to, by pestering you to death for attention or for drugs when he was out. That was what he always referred to as "The Malaise". After a 40 year meth addiction, I would imagine it felt like malaise to him.

He is a product of the 60's. There are many who spent their teens and early twenties dabbling with all kinds of drugs during the 60's. Not just pot, but L.S.D. (acid) was popular then. It was the Hippie Years and he was no exception, but almost the rule. He lived the bizarre life then in the city. He later moved to the mountains to escape that which he ended up bringing with him.  He desired a better place to raise his family and found it.

He changed from City Hippie, to Organic Hippie, to Hippie Journalist and  Editor.  Later he became a professional in the field of Law. A brilliant, self-taught professional. He was at first scoffed at, then held in high esteem by some, and disdain by others. He was called a maverick and a lunatic. Many reasons were behind all of this. He was a "horse of a different color". He had heart. He stood up for what he believed to be right and just.

He was right much of the time, but pushed things more than to the limit. He would push them way over the edge. His creativity knew absolutely no bounds. All of this was due not only to his nature, but to the cranked up beast raging inside of him. He was husband, father, friend, philospher, professional, and a drug addict. An amazing man in so many ways.  A doomed man in others.

Years went by, with the same behavior continuing. His family felt the ill effects of the drugs raging. His friends felt the effects. His employees felt the effects. His career felt the effect.  His mind felt the effects as did his health.

His family life became more and more strained.  Love gave way to stress and hopelessness and embarrassment.  His relationships at work became more and more strained. Trust and respect gave way to disrespect and embarrassment. His career ended in a hugely scandalous way, devastating his family, his employees and co-workers, his friends and himself.

He was never the same after that, but steadily went downhill. At first his nervousness and devastation were calmed some by tranquilizers. His mind had already been slipping for the past few years. What one would have thought was just early aging and forgetfulness turned out to be dementia. I believe that at least some of the dementia was caused from the holes that the meth had put in his brain over the years.

His drug use and the consequences were not only felt by him, but by his wife, children, grandchildren, friends, and co-workers. The consequences were huge and life changing to all concerned.

Eventually each one dealt with the stress and strain and devastation in his or her own way. We all moved on and left him behind. We left him behind trapped in a body that did not operate in the same way that it had before. The body that now walked similar to "the thorazine shuffle", as it is known in mental wards. The eyes that did not have the same intelligent light in them as before but looked blankly into the beyond.

Confusion is written on his face. The sadness in those eyes haunts me to this day. The sadness, I believe is a little glimmer of awareness in him that is left. The awareness of all that he has lost. The huge strength and power that he had once exuded is now gone.

Yes, I saw Sasquatch Man today. He used to have another name, but now I cannot make the name fit him anymore as he is a different person. It made me catch my breath again. It made me clutch my heart again, to see him like this.  It made me cry once again to see the shadow of who he was. I cried again for him and again for myself, as I will always miss my dear old friend who is no more.

*   Never ARGUE, instead AGREE

*   Never REASON, instead DIVERT

*   Never SHAME, instead DISTRACT

*   Never LECTURE, instead REASSURE

*   Never say, "I TOLD YOU SO," instead, just REPEAT

*   Never say "YOU CAN'T," instead say, "DO WHAT YOU CAN"

*   Never COMMAND or DEMAND, instead ASK or MODEL

*   Never CONDESCEND, instead ENCOURAGE and PRAISE

*   Never FORCE, instead REINFORCE

Seniors' Choice at Home employees are patient and creative care givers.  They are experienced  and  creative when working with clients with memory loss. They practice the above principles and more.  For information about help for seniors in Minnesota, call Marilyn or Jim at 763-546-1599.  Check out our website at www.seniorschoicemn.com.

Primary progressive aphasia (PPA) is a form of dementia caused by frontotemporal lobar degeneration. Unlike aphasia due to stroke, in which the association between particular aphasia profiles and insight has been well characterized, this relationship has not been investigated in PPA. Reduced insight is seen in other neurological conditions, but tends to involve right hemisphere damage, whereas PPA is predominantly a left hemisphere disorder. The aim of the current study was to examine whether fluent aphasia with less meaningful speech output, associated with diminished insight in stroke, is also characteristic of PPA patients with reduced insight. Fourteen PPA patients were studied. Results indicated that reduced information content in speech and poor performance on a nonlanguage test, the Pyramids and Palm Trees test, predicted reduced insight. This study has implications for the anatomical network involved in insight and clinical implications in terms of selecting interventions appropriate for individual patients with PPA.

Abstract:

Staff and patients on acute psychiatric wards report high rates of exposure to violence (Chaplin et al.,
2006). Aggressive behaviour by older people with mental illness is associated with dementia, frequently directed at staff providing personal care and other patients, and does not generally result in severe injury. The National Audit of Violence (Healthcare Commission, 2005) revealed comparable rates of staff and patients experiencing aggression on older adult (OA) wards and wards for adults of working age (WAA wards). This study aims to compare numbers of staff and patients experiencing physical assault on OA wards with those working on WAA wards and document the severity of aggression against nursing staff working on OA wards.

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

In caring for someone with dementia, always be aware of symptoms, such as major confusion and no recollection of events that happened over the weekend.

I watched her try so hard to put back the weekend in her mind. It was so overwhelming and frustrating for her. I have to always remember as a caregiver that this behavior is due her brain disease and is very uncontrollable. I take time to always reassure her that it’s okay and that everything is going to be fine.

I’ve found using tactics of distraction, changing the subject, move to another activity, all work well for mom. Being aware of these factors can help to better plan activities or anticipate problems.

I failed to say, mom may not have remembered this past weekend but she sure had a great time and for that I thank God. This illness might take away mom’s memory, but that does not give me the right to deny her the joy of life in her golden years.

In a perfect display of synchronicity, the daily barrage of phone calls from my father wound up the very week I began interviewing for the article. Every day, I spent hours on the phone connected with despair. My sources poured out their tears and their hearts, clinging to the island of intimacy created by our shared experiences with dementia. My father presented his demands almost hourly some days, frantic to avoid the pain of watching his wife slipping away and not understanding how his own dementia has brought him to this place of persistent presence.

It was not the best few weeks of my life.

Every day that I struggled through my assignment and the unceasing telephone calls, I connected with someone else who is coping with Alzheimer's and dementia. The problem will only get worse as more Americans enter their sunset years. I'm not sure how we will cope -- my article did not leave me with a brilliant sense of hope.

Nevertheless, the day after I received a copy of the published article, my family and I bundled into the car to head to the local Alzheimer's Association Memory Walk. And I decided that to continue walking was all I could really ask. Keep walking, with compassion and courage.

It's all we can do, for now.

Photo by Azmil77 at Flickr via Creative Commons.

With much deference to Tim Dunlop, it would be remiss of us not to observe EX PM John Howard's latest running commentary on all things political after he promised not to do so.

Mr Howard, who addressed students at the Gold Coast's Bond University today, said the Coalition had struggled with public perception.

"Any government that's been in power for as long as we were inevitably develops a problem with longevity," Mr Howard told the crowded auditorium.

"We were the second-longest serving government since federation, (so) I think longevity played a part in it."

He said Australians had become accustomed to their wealth, and faced with an alternative leader who differed from the government on only a few "symbolic" principles, deferred to the new guy.

"Prosperity in Australia had continued for so long that people rather took it for granted," Mr Howard said.

This was a speech delivered by the ex-PM delivered today.

Anyone suspect that he might be somewhat basking in his own inherited perceptions of his own brilliance of the past, rather than focusing on the issues that confront Australians today?

Or is that just me...?

Abstract:

This study provides an empirical evaluation of Cognitive Behaviour Therapy (CBT) alone vs Treatment as usual (TAU) alone (generally pharmacotherapy) for late life depression in a UK primary care setting.

Participants in both treatment conditions benefited from treatment with reduced scores on primary measures of mood at end of treatment and at 6 months follow-up from the end of treatment. When adjusting for differences in baseline scores, gender and living arrangements, CBT may be beneficial in levels of hopelessness at 6 months follow-up. When evaluating outcome in terms of numbers of participants meeting Research Diagnostic Criteria for depression, there were significant differences favouring the CBT condition at the end of treatment and at 3 months follow-up after treatment.

CBT alone and TAU alone produced significant reductions in depressive symptoms at the end of treatment and at 6 months follow-up. CBT on its own is shown to be an effective treatment procedure for mild to moderate late life depression and has utility as a treatment alternative for older people who cannot or will not tolerate physical treatment approaches for depression

For the full-text of this article please email: susan.jennings@lancashirecare.nhs.uk

What is Dementia?

Dementia is more than just memory lapses, which we all experience from time to time, it is caused by actual changes in brain function which can dramatically alter memory, personality and behavior. Dementia is not always permanent and can be reversed; causes can include vitamin deficiencies, poor nutrition, reactions to medication, or thyroid problems. However, if dementia is a result of mini strokes or Alzheimer’s disease, the affects are permanent.

Characteristics of Dementia

• Repetition of questions
• Disorientation, even when in familiar surroundings
• Decline in personal hygiene or nutrition
• Poor sense of time
• Inability to recognize known people

What is Alzheimer’s Disease?

Alzheimer’s results from the death of numerous brain cells due to a deterioration to the nerve cells in the brain from a build up of plaques and tangles. Doctors have been unable to determine why this occurs, and unfortunately, no cure has been discovered to date.

But it seems as though Dad is beginning to settle down again, thank God! And when he settles down, he often stuns me with the most breathtakingly profound spiritual thoughts and reflections, as he did again tonight as he, Mom and I read the Bible together (Psalm 119, to be specific...)

You know, my Dad is not 'crazy'... he is definitely not well as he struggles against the dementia, but he is still live in there, overcoming the power of the disease whenever he possibly can. And we are deeply appreciative of all of our friends who don't see a 'crazy person' when they look at Dad, but see instead a hurting and lonely soul who needs to be wept with (Rom. 12) and loved (1 Cor. 12) on a regular basis:

Be devoted to one another in brotherly love. Honor one another above yourselves. Never be lacking in zeal, but keep your spiritual fervor, serving the Lord. Be joyful in hope, patient in affliction, faithful in prayer. Share with God's people who are in need. Practice hospitality.  (...) Rejoice with those who rejoice; mourn with those who mourn. Live in harmony with one another. Do not be proud, but be willing to associate with people of low position. - Romans 12:10-13, 15-16

But God has combined the members of the body and has given greater honor to the parts that lacked it, so that there should be no division in the body, but that its parts should have equal concern for each other. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it. - 1 Corinthians 12:24b-26

Click the link below to read the entire article:

http://www.ladolceliving.com/medical-conditions/assisting-the-person-with-dementia-in-planning-for-the-future.html

Come visit us at www.ladolceliving.com for more senior care tips, articles, online community and senior housing options.

Senior Care made Simple and Sweet!

Feel free to ask any questions or if I dont cover a topic that is of interest , feel free to ask.

Sheran Cohen

Senior Care Services Consultant

Marketing Director for American All Care Services

EMT Paramedic and California Licensed Pharmacy Technician

Support Group Facilitator, Los Angeles, Alzheimers Association

With over 30 years in the medical field with various positions from working in private physicians offices, a local hospital Emergency Room

and a career path transition that has proven to be the most challenging yet rewarding in 2000, Directing Special Care units in the local SFV for seniors

with Alzheimer’s and dementia.  Now Sheran provides families options for care as the intake coordinator for a local caregiver agency .

Let’s take a brief walk thru what is considered normal forgetfulness, the different types of dementias, their causes, general symptoms, current medication treatments,

Explore community resources and last but not least tips to build and maintain a healthy brain .

I did leave my heart in the Northern San Francisco Bay Area.

Oh.........one year ago. What happened then? How did it happen? Where did it happen? Why did it happen? I can answer all but the WHY did it happen. I was diagnosed with Lewy Body Dementia (LBD) What the heck is that? I read about one line on this type of dementia way back in medical school and then again in my residency in psychiatry.  Psychiatry is the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders. Psychiatrists are physicians who prescribe appropriate medication and do therapy to treat of a variety of conditions, from depression to schizophrenia.  I was taught that "if you see this term on your medical licensure examination, make sure you know it is a type of dementia. Period, paragraph. That's what Drs. generally know about LBD. Pathetic. Especially when it is the 2nd largest group of dementias. Alzheimer's Disease is the most common of the dementias.

I can only concentrate for short periods of time. So enough for today.

Dr. David

The slide show can be found here: KQED Quest Dementia and Artistic Renaissance

From the slide show:
"Frontotemporal dementia (FTD) causes neurons in the frontal and temporal parts of the brain to atrophy, bringing about marked personality changes. Some patients lose the ability to empathize and to read other people's facial expressions. Others experience difficulties with language. In some FTD patients, the disease also brings a flowering of artistic interest and ability. In this slide show, Dr. Bruce Miller, director of the UCSF Memory and Aging Center, shows us some of the artwork he's collected from patients with FTD, and explains what it can tell us about the disease."

My grandmother has been dying since I can remember. When I was about six, they sent her home from the hospital to die, and she lived with us. I believe she has one kidney, missing lengths of intestine and lots of plastic parts. She has had a colostomy bag.

She is now 92. I am 38. She is still dying.

When I saw the movie The Hunger, people who were bitten by Catherine Deneuve, some sort of alien / vampire, didn't die...they wasted away, she stuck them in a box in the attic to while away eternity as the undead and then...well, that was that. It instantly made me think of my grandmother.

When I think of my grandmother when I was a child, what I knew of her was very little. She was cold, distant, dismissive. I didn't find out until I was older what experience my mother and her sister had with her. She was disapproving of her children and lived in her own dreamworld. She and my grandfather lived in a house, then two condos in succession. They'd had a few poodles, who died, and a few parakeets they'd let fly around their homes, pooping everywhere and ripping down the wallpaper. One flew into the toilet and drowned. One spoke a few words in my grandfather's voice, which was really creepy after my grandfather died. She kept a glass bottle on the coffee table that had a plug on top. As children, we would remove the plug and "let the genie out of the bottle". She read, knitted, crocheted, did needlework. She and my grandfather bowled and played golf.

I have a picture of my grandmother when she was 19. I look a lot like her.

She and I never talked much until I was out of college. We got along well, and I started to learn something of her disappointments in life. She'd been born out of my great grandparents' desire for a boy, and was treated as one. She enjoyed boxing and baseball, and my great grandfather used to take her to matches and games. She'd been at the edge of the ring, sprayed with blood and sweat. In the racist 30's, the people in the crowd would root for the white man, singing "bye, bye blackbird" when the black man would go down. She'd had an older sister who was teacher who died of pneumonia when she was only 19, and this put such pain through the family that my grandmother didn't grow in height until she was 18. She'd been a good writer and wanted to go to journalism college, but my great grandparents couldn't afford college so she went to secretarial school.

She never forgave them. My father used to refer to this as "That Snyder attitude...you OWE me."

 My grandfather was an accountant and she would help him with bookwork. Not a dumb woman, but very stifled. She married my grandfather late, at the age of 23 (!), and lived with her parents even after he returned from serving in the Navy in WWII. My great grandparents owned a Victorian house in New Britain, CT. My great grandfather could stand on his head until he was 80, tap danced and sang with a barbershop quartet. My great grandmother played the piano and was the president of the Catholic Women's Society. They had an aviary where they bred parakeets and canaries and the birds would fly around the room, sometimes interbreeding with unfortunate results. Some of the birds would become eggbound. My grandfather, who didn't drink, would give them gin and they'd either die or get better. I tried this once when a bird flew into my window, and I had to crack an expensive bottle of wine and sure enough, the bird got better and flew off.

Of course I drank the wine...

My great grandmother used to work in a shoe factory. The chemicals they used inthe factory were carcinogenic, although people were unaware of such things at the time. She had throat cancer, and would cough up so much blood that my mother used to say it looked like someone was murdered. My grandmother and her family were still living there at the time, and after a while my great grandmother was bedridden. My mother swears that she saw her grandmother standing at the end of her bed the day she died, saying goodbye, although the woman had been in bed for months.

My mother and aunt had very few nice things to say about my grandmother.

My aunt became pregnant at 17. When my grandparents found out, they took off and moved to South Carolina, leaving my aunt and her fiance no knowledge of where they were. They moved into my grandparents' beach house. The neighbors at the beach bought fuel for them and called up my grandparents in South Carolina to admonish them for what they'd done, just deserting my aunt and uncle with no money, no food, no heat.

Later, my grandparents moved back to Connecticut, not because the rest of the family were there, but because my grandfather had an affair, and my grandmother wanted to move away from the other woman.

My grandmother spoke lovingly of my father and my uncle. At first, she didn't approve of either of them. My uncle was 10 years my aunt's senior, a protestant, and got her pregnant. They will have been married 40 years. When my aunt and uncle had a fight one time, my aunt ran home to mother only to find my uncle had beat her there, and was sitting at the kitchen table eating a pie. "You ran home to MY mother!!!" My aunt wailed. My father was Italian and an orphan, though Catholic. Mom met him at the USO when he'd come back from Vietnam. I guess in my grandmother's time, the Irish looked down on the Italians the way the English looked down on the Irish. My dad was never one to let a person dislike him and eventually wore my grandmother down to a point where she loved him. Oddly enough, one day my mom visited her in the hospital, and out of the blue grandma announced she wasn't speaking to him anymore.

She was right. He died something like three days later.

My grandmother told me of the trips to the shore she'd take with my grandfather, my aunt and my mother. She said the kids would get carsick, then the dog, and every time she'd wind up hosing out the car when she got to Old Saybrook. One time my mom forgot her stuffed horse back home and made my grandfather drive all the way back to get it. My mom would hang her head out the back window, and my grandfather would ash his cigarette outside and inevitably it would land in her eyes.

My mom says my grandmother never loved her. Always said she did everything wrong. Ruined every Christmas. Never supported her in anything she did.

My grandmother spoke of my mother to me only with love. Credits her for saving her life. One time when I was 17 the doctor thought she was a goner and wanted to take her off life support. Mom wouldn't do it, and grandma lived.

I have been witness to my grandmother baiting my mother. I didn't want to go to CCD when I was 12 and my grandmother said, "if she doesn't want to go, don't make her go." My mother was furious, said she had a kidney infection and grandma forced her to go to church anyway and after the service she had to be taken out by ambulance.

My mother tells me that one of her trips to the hospital, my grandmother raved to everyone that her daughters were prostitutes who were trying to kill her, among other things. I blamed it on the medication, but it clearly rattled my mom.

We are not a family who is big on proclaiming our mental illness to the world.

My grandmother broke her hip roughtly 8 years ago. As a result (although I don't agree with the WHY) my grandmother has been diagnosed with vascular dementia. She was in assisted living for a while, and then started to claim that people were watching her...through the TV, drilling holes in the door. So she came to live with my mom and dad. My dad would leave for work and my grandmother would follow my mother around asking where he was, looking for him under the couch and in closets.

They put her in the nuthouse. I visited her there once. Everyone else was way crazier than she was. The staff talked about her to me as if she were a potted plant. People were violent or inconsolable. They couldn't even put news on the TV because they were afraid of the reactions of the patients to real world news. Some had to be strapped into their beds.

Thank God she was moved.

Now she is in a long term care facility where she talks to dead people. I believe she does, as no one told her my dad died and she knew, among other things. Sometimes she is quite lucid; other times she believes her cousin lives down the hall and her parents are still alive. She thinks my son is a little girl named Angela, although now he is clearly a boy and the last time I brough him in she assumed I'd brought my nephew.

I think she was always crazy.

My brother is currently AWOL. He is a gonzo alcoholic, with delusions of grandeur and self destructive to the point of grandiose demonstrations of attempted suicide. He was diagnosed with borderline personality disorder. I thought perhaps he was bipolar, as he'd go through heavy mood swings, but looking back through the etiology of the disorder, I wonder about my grandmother. One of the features of BPD is often going to the doctor and confounding them with symptoms, so that they dig at you until they get a diagnosis from what ails you. My grandmother, whenever someone did something to anger her, headed for the hospital. My aunt, mother and uncle would assume one of the others had angered her and that she wasn't really sick. I'm sure the doctors made her sicker. But BPDs often delight in fooling doctors, or others they feel are above them. Sort of Munchausen-like. Prolonging the attention.

My mother told me that my grandmother fell this past Tuesday night and broke her hip. She has to go through surgery next week. There is a part of me that hopes she passes away peacefully. She can't see, can barely hear, all of her friends are dead, and she lays all day in bed, staring at the TV. She sleeps a lot. She "travels" to see loved ones (although not my mother...she says mom is "boring", and somehow mom is insulted by this). It really can't be much of a life. She doesn't even know what day it is, sometimes. I have some knowledge of her regrets, her pains. She told me once that her parents raised puppies, and one day one of them followed her to school and she was unaware. She turned to see the puppy just as it was killed by a passing car. And it still made her sad because the puppy had loved her so much that it followed her and somehow this got it killed. I can't imagine what she hadn't told me.

But we're waiting. I once told her a psychic had said I'd live to be 120. She patted my arm and said, "don't worry. I'll take care of you."

I don't worry.