1. Rating: +2

    Positive Negative

    Hi! I was wondering if you could give us your opinion. We are considering converting a bathtub to a shower so our 86 year old (feeble) Mom can gain access. It is my sister's thinking that the warm shower will help sooth aches and pains as well as the obvious shower advantage. The other alternative would be to take the money spent on doing the tub to shower conversion and just have a CNA come in twice a week to give her a bath. Mom is quite feeble, so we realize that additional assistance will be needed eventually. I live here with my Mom right now and give her sponge baths and she takes care of keeping her personal hygiene maintained. She has major problems with incontinence and has to change her pull ups a couple of times per day. At this point, what do you think is the best idea...investing in shower or using that money to have someone come in and help her with total bath. I'm just thinking what's best as we move forward. Thanks for your feedback! Pam B

    Hi Pam,

    Thank you for your question.

    There are a number of things to consider when contemplating a bathroom remodel, the first, of course, being cost vs benefit. Will rerouting of the current plumbing be necessary? (Sometimes the drains from a bathtub will not match up to where the drain from a shower will need to be placed). Space is also a consideration. Is there enough space for a conversion? Additionally, will the remodel increase or decrease the resale value of the home?

    From what I am reading, I am thinking that the bath tub that your Mom is using right now does not have a shower attachment above the tub. If you are simply wanting to add the shower component, I think that it would be a worthwhile investment. Be sure that the shower attachement is one that is convertible and can be used like a wand.

    You also mentioned ease of access which leads me to believe that you'd prefer something other than JUST the addition of a shower attachment.

    Ease of access is a big consideration with elders, espcially with women who are more prone to osteoporosis and possible hip fractures. (Treatment and recovery of one hip fracture would be almost the same cost of a small bathroom conversion.) Of course, it is also generally easier for caregivers to assist with bathing a care recipient in a shower than in a bath tub.

    There are actually 4 types of conversions that you could consider.

    The first one is the handicap-accessible shower which features a slightly slanted floor and allows for a wheelchair or rolling shower chair to be placed directly into the shower. It's probably not the best option for you.

    The second option is the walk-in bath tub/shower combination which can also be purchased with massage therapy jets. These are also expensive (about $9,000 - $13,000 after installation), are definitely not for persons who have dementia and will not add resale value to your home (unless, of course, the person buying your home has an aging loved one). (I will tell you that this is the option that I chose for my father and I regretted that decision.)

    The third option is also a version of a walk-in bath tub. A piece of the bath tub is taken out and fitted with a small door. The piece is saved and can be used to convert the tub back to a regular bath tub at a later date. A shower attachment can be added above. The cost of this conversion can be $4000 - $9000 depending upon your plumbing needs.

    Lastly, a conversion from a bath tub to a walk-in shower may be possible, depending upon space and current plumbing. I can't give you an estimate on the costs for this as I don't know your current set-up. Real estate agents used to say that having just a shower without a bath was not considered a "full bath" and thus decreased the value of the home, but with more people "aging in place" and boomers becoming older themselves, they are seeing the advantages of stand alone showers.

    So those are your options. My personal opinion is that seniors ought not be having to step over bath tub siding in order to bathe. It is difficult and dangerous for both them and the caregiver who is trying to help them (even if that's the hired CNA). When elders are nervous about getting hurt while bathing, they are less likely to want to take their baths which can lead to additional complications.

    Also, remember that whatever option you choose, safety grab bars, a bath chair, anti-slip flooring and good lighting should be available.

    Best wishes. If you have any further questions, don't hesitate to ask.


  2. Rating: +3

    Positive Negative

    Challenge: Dementia "Sundowner" syndrome - becoming delusional, agitated, and combative at sundown and through the night. We don't know how to deal with my 82-year-old Dad in this regard. He's fighting his caregivers, won't take meds, is suspicious of them, and calls us kids all hours of the night telling they're trying to put one over on him, etc. He sits up most the night and is angry if they try to talk to him or help him. Help!! Thanks so much. Nancy

    Hi Nancy,

    Thank you for your question and thank you for your patience as we worked out some bugs in this section of our web site.

    As you know, "sundowning" refers to a state of confusion or agitation that often occurs in dementia patients at the end of the day. There can be anxiety, pacing, suspiciousness and sometimes hearing or seeing things that aren't there. It is also a time when many of them "want to go home". It is not a condition, but an occurence and can be quite daunting for caregivers, their families and certainly not a pleasant experience for the loved-one either.

    While there is no one explanation for sundowning, many experts suggest that it is caused by the decreasing of light, the increasing of shadows and the fatique of the loved one, so many of the strategies that are used to decrease these activities revolve around this theory.

    One strategy is to plan all activities early in the morning so that the afternoon remains peaceful. The activity might even be followed by a mid-morning nap. Is there a way that your father can take his "evening meds" earlier in the day or must they be taken at an exact time?

    You mentioned his caregivers.........are these caregivers in his home or at a facility? If they are in his home, do they stay all night?

    If they are in his home, they can do much to influence the environment and redirect his actions. In the afternoon, the TV should not be constantly in the "ON" position; music should be soft and lighting should be adjusted to appropriate soft levels as the sun sets (a dimmer works well for this; as the sun goes down, the dimmer goes up). Leave the lights on low at night. The goal of lighting is to mimic daylight, and too many light bulbs on can cause shadows. There are now bulbs that you can buy called "day glow" or "vita light" or "pink light" that help to eliminate shadows.

    Redirection is also important. I know of one person who redirected her agitated "patient" by "accidentally" dropping an entire deck of cards and asked for help in picking them up. Other activities that can help redirect a person are drying silverware and sweeping the floor, although these two tasks work better for women. My father was always calmed by looking at (and describing) a favorite book of photographs that we prepared for him.

    Caffeine and sugar should be decreased or withdrawn in the afternoon.

    A caregiver should always remain calm because their mood will affect his. Conversations should be kept simple without a lot of questions - they can cause confusion and agitation. Sitting quietly with him is perfectly fine - they are there to monitor his safety, not to entertain him.

    Other than removing the telephone completely (or making it "broken") redirection by the caregiver is probably the only way that your father will stop calling you during the night. Would turning off your own phone be out of the question for you?

    Patients with dementia WILL have problems sleeping at night, so perhaps a television at the bedside might be helpful if he is still able to enjoy that.

    If all else fails, there are anti-anxiety medications that can be of some help in decreasing sundowning symptomology. It may require a trial of several different medications in order to find one that works well.

    Best of luck to you and your family as you struggle through this difficult disease.


  3. Rating: +0

    Positive Negative

    Hi Shelley, Great site and a wonderful resource. I found you through Sandra M's newsletter. My mom has dementia and parkinson's. She spends most of her day questioning my dad about the same things or wanting to go over the same things. They are preparing to move to my city so it is a confusing time for both of them. Her anxiety seems to be at a very high level and takes some med. for it. How do we cope with all the questions from my mom and keep our sanity? I want to be respectful and polite and help her keep her dignity. I'm worried my dad is going to loose his patience. He won't accept respite care and we visit as often as possible. (us kids are helping with the move since they are in their early 80's). Thank you! Jill

    Hi Jill,
    Regretfully, there is not a lot that you can do to prevent persons with dementia from asking the same questions repeatedly. They don't know that they have already asked them and they also don't know that they have already been answered. A lot of patience is required. When you cannot answer the same question ONE MORE TIME, change the subject. Ask her something about her childhood or a relative she would have known long ago.
    Your Mom's anxiety over the move will cause her to go over and over the same material in order to calm her nerves. Her anxiety will also increase her dementia and Parkinson's symptoms to increase, as well. She may improve once she is settled again.
    A couple of things that your Dad and you might try: anticipate her questions and provide information to her. She might process this information a little differently than she would if it had come in response to one of her questions. Also, if there is something in her line of vision that seems to be inciting these questions, move it. Let me explain. My father and I were playing cards one night and I had a new photo of my daughter and her boyfriend on the table. My father asked about the young man, asked what he did for a living, exclaimed that he was handsome and went back to his hand of cards. He then asked the same questions again. This went on for four more times and I finally got up and removed the photo from the table. That was the end of that.
    Regarding the respite care: that's a fairly common reaction, especially from men. On my site, you can find an article titled "Sneaky Ways to Make Respite Care Accepted". It has some thoughtful ideas with which others have had some success. When you visit, you might also try having 2 people visit your parents' home at a time and have one stay with Mom and the other one take Dad out "to run errands" and then stop off for lunch or a snack.
    Hopefully this will give you a couple of ideas to try.
    Best wishes and don't hesitate to follow up with any further questions.

  4. Rating: +0

    Positive Negative

    My Mom has been diagnoised with Cancer. She is 86 & we have done all the tests & she is able to have surgery to remove the tumor(Kidney). I felt she could have handled surgery but now I am not sure? At her age all the risks involved are so many but living out her life with cancer is scary. She is unsure of what to do & I am not sure how to help her through such a hard decision. Any advice please share or even a book to help would be appreciated. Thanks Laur

    Hi Laur,
    Although your Mom is 86 and that may seem too old to undergo such a big surgery, her physician would not have advised her that it was safe to go ahead with it if it was not. You may want to speak with him personally (with your Mom's permission).
    You did not mention whether the tumor that is in the kidney would be removed or the whole kidney would be removed along with the tumor or whether or not the cancer is just inside the kidney at this point. Will she have chemotherapy or any type of radiation pre or post surgery - as I understand it, those 2 treatments aren't often recommended with kidney cancer.
    The most important thing about her being able to handle the surgery is her attitude towards it. As a nurse, I have seen countless times that people who go into a surgery with a postive attitude will come out of the surgery much better. So she needs to be certain about her decision and if she decides she is going to go through with the surgery, everyone around her must show her positive feelings.
    One book I often recommend is "You Can Heal Your Life" by Louise Hay. This is a book my former husband read when he had cancer and both of us found it to be wonderful. (He has been cancer free for almost 15 years now.)
    Your Mom may still have many good years ahead of her. If kidney cancer is left untreated, it will surely spread.
    If by chance she smokes, please advise her that it would be good to stop.
    Best wishes to you and your Mom and we will keep you both in our prayers. Feel free to follow up with any other questions you might have.

  5. Rating: +1

    Positive Negative

    I have two questions, actually. 1. My husband has been diagnosed with MCI. He has been on Lovastatin for a few years. Recently he has also been have unexplained muscle pain. He'd like to stop the Lovastatin for a month or so and see if his symptoms improve. What do you think? 2. Would an MRI or PET Scan necessarily show if someone had a TIA in the past? Thank you!

    Regarding your first question: You mention MCI and by that I believe that you mean mild cognitive impairment. You also mention Lovastatin and I'm hoping you understand that Lovastatin is a medication that would be prescribed for controlling cholesterol, not for the cognitive impairment. Lovastatin has been known to cause myopathy which CAN manifest as muscle pain. I would advise you and your husband speak to his physician about this rather than just stopping it for a month.

    TIAs (transient ischemic attacks for those who might not be familiar with the term) can be seen with a special type of MRI called a diffusion MRI but not all hospitals have this available. TIAs also generally resolve quickly while stroke symptoms do not -a TIA MAY lead to a stroke though. The Lovastatin that your husband is taking is a med that might have been prescribed in order to help prevent a stroke from occuring, so you would want to be very careful about that as well.

    I Hope that helps. Please let me know if you have any further questions.

    Blessings, Shelley