Caregiving is defined as being responsible for someone else’s well-being. It usually relates to caring for a child, spouse, or other loved one. Not only is caring for one person daunting, but we are now seeing caregiver layering: a wife or husband may be caring for an ill spouse as well as a single-parent child and grandchildren. Anyway you look at it caregiving can be exhausting and overwhelming.

In my experience it is the everyday trials and tribulations that are so costly to a caregiver’s health and wellbeing. A professional healthcare provider can usually address the big issues, but the small ones become formidable obstacles. Who do you call to find out how to get your loved one to bathe without a battle? How can you get through the night with a loved one who wanders, rummages through closets, or is up at 2am? And what about the stress from siblings who rarely visit but are eager to give you advice about your caregiving duties?

I am here to listen to you. With more than 20 years in the geriatric healthcare field I hold the delusion that I have seen and heard it all. But, I have a feeling you will prove me wrong. I invite you to write or email your questions and concerns. You may not always agree with my responses but I will strive to be candid and honest. I will pull no punches nor skirt the issues, and I will encourage you to see the humor in a situation where it exists. Yes, caregiving can be an overwhelming experience but it can also be a pleasant one. Together we will try to find the answers and enjoy the journey.

Dear Mary,

My father is in his nineties and in pretty good health. However, I am concerned about his drinking and smoking. He has always liked his cigars and continuously chews on one even if not lit. He also has two beers every evening, one before and after dinner. These have been life long habits and he refuses to stop. I have talked to him about the health dangers but he tells me to leave him alone. His doctor is not much help. I love him and want him to be around a lot longer. How can I make him see that due to his age he is fragile and is shortening his life?

Get off his case. Be thankful that your father has lived for so long and has not had any negative effects from his habits. Yes, it is true that smoking and alcohol are risk factors for many health problems. However, your father seems to be one of the lucky few to live a long life without experiencing the ill effects. His doctor is not concerned, so neither should you be. Enjoy your time together and hope that you have inherited his genes!

Dear Mary,

My husband’s physician recently had “John’s” license revoked through the Motor Vehicle Administration. John has dementia and is no longer safe on the road. However, he still insists that he can drive and has a set of keys that he will not give up. Our son offered to disable the car, but John would find a way to fix it. I am at my wit’s end, what more can I do to prevent him from driving?

You would hope that revocation of his license would be enough to put an end to a dangerous situation. But as you have discovered, it is not. The ability drive is the ultimate in independence. It yells “freedom” and is deeply tied to a person’s identity. The loss can be devastating and not put to rest easily.

A tip I received from a caregiver suggested buying a battery intended to foil thieves. It is armed and disarmed by remote control: when armed, the car will not start. Sears makes one called the Security Die Hard battery.

Try to keep your husband busy to take his mind off driving and also to prevent isolation. Elicit the help of family and friends to include him when they run errands. Look into programs at the Senior Centers where transportation is provided. It is a difficult time for you and John but keep in mind this too will pass as all dementia related behaviors eventually do. Good luck.

Dear Mary,

What do you do about someone who is up several times at night to use the bathroom? My wife has early stage dementia but until recently slept from 11pm to 7am. Now she is up five or six times a night to urinate. Most of the time she just sits on the toilet, nothing comes out. I have also noticed that she is less cooperative and resists doing some of the things she enjoys. Is this a sign she is progressing to another stage of dementia? I’m not sure I’m ready for another stage so soon.

The speed of progression of dementia is different for everyone. However, since this is a new and sudden change, a medical evaluation is in order. A cardinal rule is to always investigate physical causes of behavioral change before blaming the dementia.

It sounds like your wife may have a urinary tract infection (UTI). The first sign of a UTI in a cognitively impaired person may be a behavioral change. Frequently the infection is not identified because the classic symptoms of pain and fever are absent. Without treatment the infection can become life threatening. Make an appointment with her physician as soon as possible.