One of the most disturbing symptoms of dementia is: the person suffering from dementia repeats the same questions over and over. I will present you 6 ways that will help you maintain your peace in your communication with the patient. In addition, dementia patients will be helped to regulate stress and anxiety.
Why do dementia patients ask repetitive questions?
Most often, the dementia patient repeats the same questions, for two main reasons: a. He just forgot what he asked before. B. He feels anxiety, insecurity and tension which make him ask the same questions to calm the anxiety he is in.
For example: the day before Mom’s doctor’s appointment, Mom asked several times – whose appointment is and when is the appointment? On the day of the appointment itself, she asked the same repeated questions every 20 minutes. Also, a few hours before the actual appointment, she asked every 5 minutes, the same questions over and over again. This is because she became more nervous as the doctor’s appointment approached.
6 tips on how to deal with a dementia patient who repeats the same questions?
1. Live their current reality-
A very common and completely natural mistake is to correct the dementia patient. Also, to remind him that the reality that he forms as correct, is actually not correct.
Below is an example case: Shoshana (pseudonym), lived with her family in Haifa, in 2012, when her room was in the attic. Today, in 2019, her family moved to Nahariya, in an apartment without an attic. Shoshana, now with advanced dementia and asks repeated questions every day about the time when she still lived with her family in an apartment with an attic in Haifa, in 2012.
For example, questions like: “When will Bugs the dog come downstairs to my room?” or “When will you fix the banister on the stairs to my room?”
In the above case, Shoshana got stuck on certain significant events from her past, which causes her to remember them over and over again and therefore she repeats and asks about the same events over and over again.
The response that can be more helpful is to participate in her experience, for example: when she asks questions of the above type, you should respond as if we were still living in 2012 in an apartment with an attic in Haifa.
For example: “The dog is currently on a walk outside with one of the children.” Or one of the children will bring the dog to the attic, to keep you company.”
There can be situations in which the person with dementia will recognize where he is and what year he is living in, and there will be situations where he will not.
Below are interesting books on the subject of dementia:
2. Use white “lies”-
It is recommended to use them, especially in cases where the dementia patients wish to perform tasks that may endanger their lives. For example – let’s take the same lady Shoshana, if she insists on driving a car, because she is sure that she drives well. It is absolutely permissible, in order not to hurt her feelings, to tell her that the vehicle is now in the garage and cannot be used. It is better to give space to their feelings, than to try to explain things to them that they will not understand or remember anyway.
Another reason why you should use a white lie is to prevent them from pain or grief. For example: explaining to Shoshana that her sister has passed away may cause her pain and sadness, which the family members taking care of her will have to deal with. Instead, it’s better to tell her that her sister is out shopping now. Which will cause Shoshana, most likely about 20 minutes later, to forget that this fact has already been told to her and she will ask the same question again.
Using white lies, for the demented person, is a better way than telling him the truth that could hurt him and make him in a bad mood. Especially, when there is a reasonable chance that that person will forget the truth that was told to them about 20 minutes later.
You are invited to join our WhatsApp group – on old age diseases:
3. Distract them-
Dementia patients sometimes have a question stuck in their head and they can’t find ways to get rid of it. The way of action that helps them in these situations is to distract them with an action or a task that needs to be done. For example, let’s take Shoshana’s family, if Shoshana asks the same question over and over again, it is very useful to distract her with a sentence like: “Let’s make the sandwich together”. Or “come fold the clothes with me now” etc.
4. Prepare a white memory board for them –
It is very advisable to prepare a small white board for them, on which they will have a list of what tasks they need to perform during the day. When the tasks are written on the board, the demented person does not need to ask the same questions over and over again, because everything is written in front of his eyes. Even if he asks the same question again, just show him the white board with his tasks for the day and it can calm him down for the next few minutes.
The onset of dementia is not the same in all patients, nevertheless, doctors have managed to divide the typical course of the disease into seven main stages. The duration of the disease ranges from 3-20 years, with the average period of time being 4-6 years from the diagnosis of Alzheimer’s (dementia)Alzheimer’s (dementia) until the patient’s death.
In the first stages, it is very difficult to notice the existence of dementia. After that, the patient begins to forget small things, such as people’s names, the location of objects that have always been placed in a fixed place. After that, he forgets what he wants to say. Reads a story chapter and forgets that he read the chapter at all. Later, he forgets what he ate for breakfast. Begins to lose interest in hobbies that he used to engage in enthusiastically. Also, also loses interest in the environment in general. Does not recognize people in his immediate vicinity and from here the situation only gets worse.
In this article, the 7 stages of dementia will be detailed for you, so that you can identify which stage of the disease your family member/patient is in. This is in order to make a diagnosis and start treatment on time and also to know how to prepare for each stage.
Sad dementia patient.
Stage 1 of dementia – before the disease –
At this stage, there are no noticeable symptoms of the disease. The patient looks and sounds perfectly healthy. The disease cannot yet be diagnosed at this stage. After that, small symptoms, begin to give their signals. However, these symptoms still seem relatively normal and cannot be associated with dementia.
Also, some symptoms may develop gradually and go undetected for a long time.
Stage 2 – mild forgetfulness that is still associated with age and not dementia.
A slight forgetfulness begins, which does not yet cause the environment to suspect that it is dementia. The patient forgets things such as: forgetting where objects are, locking the door. At this point, it is still difficult for a geriatrician to diagnose dementia.
Stage 3 – mild cognitive impairment that begins to hint at dementia.
The environment begins to notice that a mild cognitive disorder begins, the cases of forgetfulness become more frequent. For example: forgetting where the keys are, finding them and after a few minutes forgetting where they are again. Placing objects in inappropriate places. For example, putting a garment in the kitchen cupboard. The patient tends to forget names, fails to learn new names, has difficulty functioning in society or at work, has difficulty reading and generally has difficulty organizing and planning in advance. This stage lasts between two and seven years.
Stage 4 of the dementia disease – stage of moderate dementia –
A stage where the patient begins to lose orientation in time and space. This is the stage where the geriatrician must give a diagnosis, because the symptoms start to become clear to the environment. Examples of this stage: forgetting what the patient saw and heard on the news. Forgetting what he ate for breakfast that day. Inability to concentrate on one thing for a long time. Losing interest in activities that the patient previously liked to do.
Damage to the ability to think abstractly in complex tasks, damage to the ability to plan activities or perform complex cognitive operations (such as managing a bank account). Also, difficulty remembering personal events from the past, and physical weakness.
Stage 5 of dementia – noticeable cognitive decline that requires getting help.
At this stage the patient suffers from a noticeable cognitive decline, which requires getting help. For example: forget what the address is. Forgetting exactly where the patient is and whether it is morning, noon or evening.
The patient is confused, his ability to perform complex actions deteriorates. In addition, his ability to decide and adapt his behaviour to social norms and rules is impaired.
Nearly 50 million people were diagnosed with dementia in 2017, worldwide. Most of them live in developing countries. The number is expected to double in 20 years.
Stage 6 of dementia – severe cognitive decline.
This is a stage where it is already very difficult for the patient’s family to take care of the sick person alone and in need of help. The signs are: forgetting the identity of his relatives and the people closest to him. Completely forget how to perform daily activities.
At this stage, the patient has difficulty sleeping, begins to lose control over the sphincters, becomes more suspicious, suffers from false thoughts, hallucinations and compulsive behaviors. Also, at this stage, many of the patients tend to go wandering, when they very quickly forget the purpose of going out and may get lost and endanger themselves.
Stage 7 of dementia – most severe cognitive decline –
The patient at this stage loses his ability to communicate and speak. He needs daily help with very simple tasks. He needs help with everything because his muscles and reflexes become inflexible – he cannot get to the bathroom in time, has difficulty walking, sitting and even holding his head and swallowing. This condition usually lasts a few months, but sometimes also long years of inability to function and the need for constant nursing.
In conclusion-
There is an estimate that 75 million people may suffer from dementia by 2030 and 131.5 million in 2050. In any case, only 20-50% of cases in developed countries are identified in statistics. In developing countries the situation is much worse, with the majority of the population remaining undiagnosed during their lifetime. Spreading awareness of the disease and its various stages can significantly reduce the pain and costs required to treat the disease. It’s all up to you, share the important information in the article and spread awareness of the disease today!
Following on from the article on guardianship, should you be appointed and what are the roles of the guardian over body and property? Below is information on what needs to be done to start the guardianship process.
In order to be appointed as a guardian for a body and/or property in Israel, the following procedures are required:
A conversation to coordinate expectations before the start of the guardianship process-
1.A meeting should be held as early as possible with the person for whom you intend to be appointed guardians. As much as possible, talk to him in a language he understands, and according to his ability to understand. Explain to him what your role as guardians is, try to understand what his needs and desires are, and “coordinate expectations” regarding the period of guardianship. This conversation is very important, even if you are the person’s relatives. During the conversation, you may discover that your loved one has desires and needs that you were not aware of. If you are unable to find out with the person what his needs and desires are, find out what his wishes are as expressed in the past, taking into account his worldview and lifestyle. An application for the appointment of a guardian for a person, as well as an application for a replacement of a guardian, must be submitted to the family court in the jurisdiction where the person who needs the appointment resides (among the Muslim population – The application can also be submitted to the Sharia Court.
Filling out forms for the Family Court –
Attached is a link to the website of the judicial authority, where you can find forms and an explanation for submitting an application for the appointment of a guardian for the body (=personal and medical matters), for property or for a general appointment (for the body and property) as well as, an application for the appointment of a guardian for urgent medical intervention. These forms must be printed, filled out, signed by the family members who agree to the appointment or alternatively, the family members who oppose the appointment must be registered. Information recorded in these forms must be signed by the person who wishes to be appointed as a guardian in front of a lawyer. A lawyer’s signature can be done at any court for only NIS 50-60. You must bring IDs with you for the purpose of verifying the signature. The information recorded in the forms can be of great help to the welfare officer who is later supposed to write a report to the court and submit it with her recommendation as to who can act as guardian for the person who needs a guardian.
Contacting a geriatrician to perform a diagnosis…
A geriatrician or psychogeriatrician should be contacted in order to write a medical certificate – the doctor should provide a geriatric diagnosis, which will determine what the cognitive level of the elderly person is and whether he is incapable of making decisions in terms of his level of judgment. He was also given a mental test by an occupational clinic. If the elderly person lives in institutional housing, a geriatrician should definitely be consulted at the institution where the elderly person lives, as above regarding the occupational clinic. If the elderly lives at home, it is necessary to contact a geriatrician at the health fund or privately. If the elderly is hospitalized, a geriatrician and an occupational clinic at the hospital where the elderly is hospitalized should be contacted, for the purpose of the cognitive diagnosis. When the doctor’s certificate is written, it is necessary to submit it together with the application forms for the appointment of guardians at the family court in your area of residence.
Application to the court to start the guardianship process –
Applying to the Family Court and paying a court fee to open a case. A person interested in being appointed as a guardian must pay a court fee to open a guardianship case, the fee is usually between NIS 400 and 600. In addition, it is necessary to have a lawyer sign the affidavit from the guardianship case opening forms In court. The candidate for guardianship should submit all the required documents to the court and wait for the process to be carried out.
During the process, the welfare official should come to the elderly’s home and interview him, as well as interview the candidate for guardianship of the elderly. In fact, it collects information about the elderly and his environment and submits a review with a recommendation as to who is the most suitable person/organization to act as guardian of the elderly’s body and/or property.
The court’s decision – after all the documents required for the process are submitted to the court, a hearing will be held in court, usually it is behind closed doors and the candidate interested in being appointed as a guardian is not invited to the hearing. About the elderly, for how long and for what matters – body and property, or one of them. There can be up to 2 guardians for one person.
How do you appoint a guardian for an unmarried person (a person without children)?
The process on an unmarried person is carried out according to the following circumstances:
Where to start the guardianship process if the person lives at home?
If the person for whom a guardian is appointed lives in his home in the community, then a person from his immediate environment who wishes to be appointed as his guardian, should start the guardianship process through the social services bureau closest to the area of residence of the adulterous person for whom a guardian is appointed.
Where to start the process if the person is hospitalized?
If the adulterous person is hospitalized in a hospital, contact the hospital’s ward clerk, in order for her to submit a social report to the relief officer from the Bureau of Social Services in the residential area where the adulterant person lives. The report explains about the psychosocial condition of the arbitrator and a recommendation for the appointment of a guardian for him.
Where to start the process if the person is hospitalized in a geriatric/rehabilitation institution?
If the adulterous person is hospitalized in a geriatric/rehabilitation institution, he must contact the social worker who takes care of him in the institution. The social worker who takes care of him must submit a social report to a welfare officer from the Bureau of Social Services in the residential area where the person lives.
In the event that person needs funding from the Ministry of Health/Welfare at the institution. She must submit a copy of the report to the sponsoring office, so that when the petitioning candidate receives the guardianship appointment, his guardian will submit the guardianship order to the sponsoring office, and the sponsoring office will be able to begin financing the petitioner’s stay at the institution.
If there is no person who is interested or able to be appointed as a permanent guardian of the body and/or property for that minor person, the attorney or the relief official, will appoint an association for guardian services, the most prominent of which are: ‘The Foundation for the Care of the Confidential’, ‘Gag Lahusa’ and more. Associations It is their job to take care of all his needs and visit often.
Article: Irit Rabinowitz, attorney with a master’s degree in health and rehabilitation, interested in advice and guidance on appointing a guardian? Contact me – 0547758564.
Let’s start with an example from the field: on the subject of a guardian and his duties –
A client, who is not sure if it is worth starting a guardianship process for a mother suffering from moderate dementia, came to consult a social worker. The client told her that her mother is still able to recognize people but sometimes forgets what day it is. Also, her mother began to suffer from delusions as well. The client was sure that her mother was still sane and able to make decisions for herself. Despite the fact that it was explained to her that the disease is progressing quickly and may later impair her mother’s judgment. The daughter nevertheless refused to start the guardianship process.
One day, the mother fell and needed surgery on her broken leg, at the same time, the daughter discovered that her mother was in a much worse cognitive state than she thought. The doctors were not ready to perform an operation without the consent of the mother, since the doctors noticed that the elderly woman was not capable of this, it was decided to perform a mental test for her. The mother got a low score on the test. As a result, the hospital’s attorney-in-fact made temporary guardianship of the mother’s body only.
The process took several days until a guardianship order was received by the attorney general and during this time until the surgery, the mother suffered severe pain in her leg. The mother had to take painkillers to deal with the pain. Such a case could have been avoided if the daughter had started the guardianship process before the fall.
Why even start a guardianship process?
As people age, many of them suffer from dementia. As the dementia process worsens, the person suffering from the disease needs more help during the day. Elderly people with dementia are at physical and financial risk as a result of their vulnerability to physical, emotional, financial abuse and decisions without judgment.
These patients need more protection. For example, an elderly person who refuses to let a foreign caregiver enter his home, or refuses to enter a nursing home, may endanger himself and his surroundings, if the same elderly person has had a stroke, can no longer communicate and needs help 24 hours a day, he can no longer satisfy his opinion on the matter The help he gets. These are the reasons why he needs guardianship.
What exactly is guardianship?
A guardian is a person chosen to make personal decisions for another person. The other person is unable to make important decisions for himself such as: where will he live and what treatment will he receive? An elderly person can have more than one person as a guardian for him. It may be that he will receive a guardian for his body and property separately. There may also be a situation where there will be more than one guardian who is responsible for body and property together and each one separately. It means that if one is not available to come and sign consent for the surgery, the other will come in his place and vice versa.
Are you suitable to be a guardian?
If you take on the role of guardian, you must once every six months, update the general guardian on behalf of the court about the material condition of the elderly. You need to make sure with yourself if you really understand the role you want to take on before you become a legal guardian for the elderly.
If becoming a guardian for an elderly person is too heavy a responsibility for you, there are other alternatives that you can think of such as:
power of attorney in the bank.
Preliminary instructions.
decision supporter.
Lasting medical power of attorney.
*Details of which will be written later, it should be noted that the above options can be done as long as the elderly person still has sound judgment, that is, there can be a cognitive decline, but the judgment is still considered sound. In order to check the mental state, you must consult a geriatrician or psychogeriatrician.
In the case of an emergency, for example, of an urgent operation, if the elderly is unable to make a decision, his judgment is not correct, there is a possibility to make a temporary guardian for him for the required medical operation. The validity of the aforementioned temporary guardianship expires, when the aforementioned medical procedure ends.
The decision whether to perform guardianship over the elderly dear to you?
The family court needs proof that the elderly is indeed not legally competent to make decisions. It is necessary to prove that that elderly person is unable to make basic decisions for himself such as: where to live, unable to provide himself with food, clothing, take care of himself physically or make financial decisions for himself.
In what cases will it not be possible to be appointed as a guardian for the elderly?
Lack of experience in financial matters mainly.
Conflicts and interests.
low education.
minor.
Lack of legal capacity of the person who wants to be a guardian.
Advanced age (over 75).
The guardian has a number of obligations including:
Body guardianship versus property guardianship – are you interested in performing a body or property guardianship or perhaps even both?
When you ask to be appointed as a guardian for body and property, you are actually asking to be responsible in all respects for the elderly. Being a guardian of property means that you have to take care of that person’s property and assets in a way that best serves their interests.
“The court decides who to appoint as a guardian, while maximally protecting the interests of the person to whom a guardian is appointed, when several guardians can be appointed for the same person.” Taken from Reut – a caring family.
Evaluate confidential records and present them when necessary.
agree or disagree with certain medical treatments.
Agree or disagree with travel plans that the confidential, is interested in taking.
Choose a suitable place of residence for the confidential.
To provide personal needs and clothing needs.
Ensure that a doctor sees the insured once a year and provides a letter describing the insured’s health status.
to make sure that the confidential receives a response to his personal needs.
To take care of the rights of the confidential.
9. Forms that must be filled out for the purpose of follow-up by the general guardian-
Within 60 days from the date of appointment, a report must be submitted to the general guardian detailing the person’s assets and liabilities, known as a “statement”. The statement will detail all of the person’s assets, rights, and obligations. The information included in the statement must be updated and correct as of the day of appointment. The statement will be prepared on the attached form and must be Be verified by an affidavit. The affidavit can be verified before any lawyer. In any court this service is provided with a symbolic title.
A “living basket” form is also attached to these instructions. This form is intended for determining the person’s monthly spending budget and must be submitted for the supervisor’s approval. Determining a living basket will help you in budget planning and may make dealing with the bank easier. In the “living basket” form, you must fill in current monthly income and expenses that characterize one normal month, and submit it, as much as possible, within 90 days of the appointment.
For information on the execution of the guardianship process, see an article explaining the guardianship process in Israel.
Written by: Irit Rabinowitz, attorney M.A in social work, in the field of health and rehabilitation.
A reverse mortgage is the encumbrance of an existing apartment for the purpose of receiving money from the bank. The mortgage is intended for retirees aged 60+, who need a large sum of money for various needs: helping children, traveling abroad or financing life in old age. With a normal mortgage, people borrow money from the bank for the purpose of purchasing an apartment and must repay the mortgage in monthly interest-bearing payments.
Pensioners at retirement age will have difficulty obtaining a large amount of money in a normal way, therefore they can convert their apartment by working for a bank or other financial body, and receive a large amount of money in return.
Advantages of the reverse mortgage-
A reverse mortgage is a loan for any purpose, which is not limited in time.
There is no need to pay it back in regular monthly repayments.
There is no need to take out life insurance as with a normal mortgage.
Income tests are not done (because without regular refunds, there is no interest in regular income).
You can pay off the reverse mortgage at any point in time and without penalty.
A reverse mortgage helps to finance the needs of the borrowers at the expense of the property.
It is better for retirees who need money to take a reverse mortgage and not sell the house, instead of taking a normal interest-bearing loan and deferring the repayments.
The borrowers continue to own the house and are allowed to live in it.
For him, the bank is calm, because he has a lien on the house. The bank’s profit is from the interest that is accrued and recorded in the bank’s books, but is paid only at the end of the mortgage period.
When the borrower decides to sell the apartment or passes away, the proceeds from the sale of the apartment will cover the loan amount plus the accrued interest.
Helping children-
In light of the high cost of living in Israel and the growing dependence of young people on their parents, the need and desire of parents to help through greater funding has increased and they are working to realize a reverse mortgage. The expectation is that the process of using a reverse mortgage will expand. Many parents want to help their children later in life, than to help through the inheritance, because the children need help now.
Financing the old age-
A reverse mortgage is an effective way for retirees to get a large sum of money that will allow them to finance the rest of their lives after they stop working. Sometimes family members are unable to help their parents and this is the only way out. The amount of money that the pensioners can receive depends on the value of the apartment, the age of the borrower and it can reach half of the value of the apartment, therefore, this financial solution will significantly affect the quality of life of the pensioners and their families.
Who is eligible for a reverse mortgage?
60+ years old, who own a residential property without encumbrances, foreclosures or debts. Even those who have a low mortgage balance may replace a standard mortgage with a reverse mortgage.
The entities that give a reverse mortgage:
Banks and insurance companies.
The Actual Execution Process:
Submit an application to a body that finances a mortgage and receive a sum of money in exchange for pledging the property.
Returning the loan:
There is no need to return money immediately. The money will be returned to the lender through the sale of the property or the payment of the reverse mortgage. If there is a balance left when the property is sold, the surplus will go to the borrower or his heirs.
Due date:
It is possible to pay off the reverse mortgage at any time and without penalties (but it is advisable to verify this when signing the contract).
Restrictions on the use of money:
There are no limitations. The money given in exchange for a reverse mortgage can be designated for any purpose. T
he loan amount that can be received:
The amount depends on the age of the borrowers. It usually reaches up to half of the property’s value. As the age increases, the loan rate in relation to the value of the property increases.
Different routes to a reverse mortgage-
Old age financing – borrowers who want to continue living in their apartment and need money to live on, can request a reverse mortgage, which will be repaid at the end of their longevity or after leaving home.
Nursing home financing – borrowers who need money to move to a nursing home will receive the money until the end of their longevity or until they leave the nursing home.
Covering the debt of the regular mortgage – for those who still have a mortgage on the property, and wish to stop paying monthly payments, can cover the debt by taking out a reverse mortgage and leave more money to live on.
The interest rate used in a reverse mortgage-
The interest rate of a reverse mortgage is slightly higher than a standard mortgage (between 0.3% and 1.3% above standard mortgage interest). Reverse mortgage interest accrues over time.
Additional costs:
Fees for the lawyer, who signs the documents to open the case.
The cost of opening a mortgage portfolio – between 1% and 2% of the value of the property.
Fees for the appraiser, who determines the value of the property.
Insurance on the apartment.
Payment of service fees.
Reverse mortgage flexibility –
The borrower can repay the mortgage at a time that suits him. In addition, the procedure for taking out a reverse mortgage is relatively simple. In most cases, there is no need for guarantees or securities, because the property constitutes the security, therefore the conditions of the banks are more flexible.
Disadvantages of the reverse mortgage –
The interest on the mortgage increases over time. Additional related costs are: hiring an appraiser, paying a lawyer and paying management fees. Also, there is an influence here on inheritance. If there is no ability after the borrower’s death to return the loan money, the apartment will be sold and the inheritance will go down the drain.
Recommended if so:
Check in advance the positive and negative financial implications of taking out a reverse mortgage.
In conclusion-
A reverse mortgage is a safe and available financial solution for those who have difficulty raising money through a loan from the bank or other entities. It contains many advantages and solutions to difficulties, which without it would have been difficult to solve. The ability to raise a sum of money relatively easily can improve the quality of life of the elderly population and the life of the entire family in many respects.
Since it is a financial product with advantages and disadvantages, it is important to check the feasibility of the transaction, to examine the current and future financial situation of the borrowers and possibly also the heirs. For this purpose, it is recommended to contact a professional independent of the banks, and receive advice and a feasibility study.
Reporter: Maxim Weizman – economist, entrepreneur and real estate man, owner and founder of Weizman Consulting and Mortgages!
