Questions & Answers

So long as you are paying the appropriate taxes for the aide’s employment (either through an agency or directly as an employer by withholding for state, local, and federal taxes as well as for social security and Medicare), and so long as the aide is providing nursing care (such as those services associated with caring for your wife’s condition) then the cost of a home health aide is deductible. The aide does not have to be a qualified nurse, just so long as his or her services are consistent with such nursing care. For example, services such as giving medications, providing assistance with bathing, grooming or feeding, or changing dressings would qualify as nursing services. Housekeeping activities would not qualify. You should keep documentation on the nursing activities performed by the aide (such as types of activities performed and approximate amounts of time spent performing these activities) as well as any medically-necessary supplies required for care of your wife.

As for supplies, if you provide meals for the aide, his or her portion of the cost of the food is deductible. Other medical supplies such as prescribed medications, bandages or other wound dressings, wheelchairs necessary for disability, and some other medically-related supplies are deductible as well.

You should consult with a tax accountant for final verification of the information presented here as well as for more detailed instructions.

It is unusual for the director of a nursing facility to run out of her office and leave you alone without any explanation, but it could happen. Perhaps there was an emergency and she did not have time to explain. Regardless, try scheduling another appointment with the director to discuss your wife’s situation. You can inform the director that you were both confused and offended by her abrupt departure, and would greatly appreciate an explanation and an apology. Again state that you are having trouble dealing with the nursing home manager and are concerned for your wife’s well-being. I would strongly suggest that you bring along a trusted family member or close friend who is aware of the whole situation and who can act as your advocate (and witness) when you speak to the director. You can also try speaking to the staff in charge of your wife’s care. Perhaps they will have some insight on how to best relay your concerns to the director, or they may even be able to speak on your behalf. If your concerns continue to be disregarded by the facility, then you should consider looking for an alternative care facility for your wife.

Alzheimer’s disease (AD) is a progressive neurodegenerative disease, meaning that over time symptoms worsen and impairments increase. Your husband will probably have some good days and some bad days, but in general, his condition will unfortunately get worse over successive months and years.

Taking care of a loved one with AD can be challenging, so it is important that you find some support to help you get through the tough times. If you have not already done so, you may want to consider joining a caregiver support group. You can search for Alzheimer's disease caregiver and patient support groups in your area by visiting our Resources section, such as under the Caregiving and Caregiver Support heading in Helpful Organizations. Also, don’t be afraid to ask family and friends for help. Additionally, you may want to consider hiring a caregiver aide, even if it for only a few hours each week. Respite aide such as this can be invaluable because it will allow you to take short breaks from your caregiving responsibilities to rest and recharge. Respite care options can also be found in the Resources section, such as by searching in your local Area Agency on Aging (AAA) Eldercare Locator.

And as for all your husband’s behaviors in general, just remember that this is all common and a part of the disease. He does not do those things to annoy or upset you, he simply cannot help his behavior. Although it may be difficult at times, try to patient and stay positive.

With regard to communication, try to work out other non-verbal ways of communicating with your husband, such as by touch, written words, pictures or symbols, or hand gestures. You will have to learn to adapt to his ever changing needs in this respect, particularly as time progresses. When you talk to him, look at him directly and speak clearly and simply. For example, questions that require a yes or no answer (or a choice between two options) are usually better than opened ended questions if you want to figure out what he wants or needs.

Concerning eating, it is not uncommon for AD patients to completely forget that they have eaten (or forget to eat entirely). Here, a visual reminder such as a large schedule posted next to a clock might be helpful. On it you can list the entire day’s agenda: meals, activities, bathing or toileting times, rest times, appointments, bed time, etc. A regular schedule clearly visible to the patient can sometimes help to decrease anxiety and frustration, because the patient knows what to expect at any given time throughout the day.

And as for clothing, your husband may be overwhelmed by clothing choices in the closet and therefore cannot differentiate between his clothes and yours. Keep his choices simple by laying out an outfit for him to wear each day. It may be more work for you up front, but will probably save you aggravation later on. When you lay out clothes for him to dress, try arranging them on the bed in a logical order just as they would be worn on your body (for example, sweater above pants, with socks down by the ankles of the pants, etc.) You may still have to provide some assistance when he dresses, but let him do as much as he is capable of doing on his own.

It is not uncommon for an Alzheimer's disease patient to repeatedly ask the same question or repeat the same phrase over and over. The repetition is a function of the disease; your mother is not purposely trying to annoy you. Alzheimer's disease impairs a patient's short-term memory, so a patient effectively forgets that the same question or request has already been asked and answered. Just remember that your mother's forgetfulness is just as confusing and frustrating to her as it is to you.

In some cases, a patient may be physically bothered by something but cannot properly communicate what is wrong. Try first to rule out all the obvious culprits: she may be too hot or too cold, she may have a wound or sore or be sitting on something uncomfortable, she may have an ache or pain that is not outwardly noticeable (a toothache, joint ache, urinary tract infection, etc.), she may have to use the toilet or have indigestion, or she may simply be hungry, thirsty or bored. Talk to her primary care physician about this. If she has not had a physical in a while, you may want to consider scheduling an exam so that physical ailments can be ruled out.

In most cases, however, repetitive requests usually stem from a particular fear or anxiety. For example, if the patient repeatedly asks you when a doctor's appointment is scheduled, it may be because she is anxious about going to see the doctor. So when you talk to her, try to address the underlying emotion in the question ("I'll be right there with you the whole time at the doctor's office.") Since your mother repeatedly requests that you help her, it may be because she feels insecure or scared, that she cannot understand what is going on and is afraid of what is happening to her. She may literally feel helpless in a sense, and does not know how else to express herself.

In this case, all you can do is reassure her that you are helping her and then try to shift her attention to a new subject or activity. When possible, try having her “help” you with some activity (naming long lost relatives in old photo albums, folding clothes, mixing dough, sorting items into piles, etc.) This can provide her with a sense of self-worth and may even reduce some of her anxiety. Because of the nature of Alzheimer's disease, your mother will require continual calm reassurance that everything is fine, that you love her, and that you will continue to care for her.

Anything you can do to help reduce your mother’s anxiety and uncertainty may also help to reduce the repetitive requests. For example, you can use notes, signs, or even a written daily schedule on a wall chart to help remind her when it is time for meals, bathing, activities, bedtime, and so on. And if you are trying to get her to do something and she becomes agitated, be patient and explain what you want her to do with simple, straightforward instructions.

There are no studies in the scientific literature or in medical reports indicating that hearing loss contributes to the development of Alzheimer's disease. In fact, in a recent study conducted in China comparing the hearing capabilities of Alzheimer's disease patients and age-matched control subjects, no correlation was found between hearing ability and mental status. It is not uncommon to find both conditions together, however, as both are more common in aged individuals. Nevertheless, hearing loss is not routinely associated with early symptoms of Alzheimer’s disease.

Although it can be disconcerting, we have all had what are sometimes called “senior moments” where we completely forget what it is that we are doing or saying. Ask anyone if they’ve ever walked into another room and, once having arrived at their destination, completely forgetting why it is that they were going there or for what purpose. I would bet that most people will say this has happened to them more than once (myself included).

Daily stress can often interfere with memory. As a mother, you probably have to remember many things throughout the day (shopping lists, items for your child’s school or daycare, errands to run, household agendas, work agendas, etc.) It can be very overwhelming sometimes! Dietary and hormonal imbalances, depression, stress, as well as some viral infections can all cause memory disturbances and disorientation. In other words, there are a number of conditions besides Alzheimer's disease that could have caused the confusion you experienced, most of which are treatable.

So talk to your doctor and explain your concerns. If you haven’t had a routine physical in a while, you may want to consider scheduling one with your primary care physician. Your doctor may, for example, want to check for vitamin B12 levels and thyroid hormone levels in your blood; insufficient amounts of either of these can sometimes cause confusion and memory problems. Fortunately, imbalances such as these are treatable, as are a number of other conditions that can cause memory disturbances.

Oleocanthal is a compound found naturally in extra-virgin olive oil. Researchers at Northwestern University recently discovered that oleocanthal can change the structure of the toxic proteins (known as ADDLs) that are found in the amyloid deposits in the brains of Alzheimer's disease patients. Olecanthal was also found to inhibit the ability of ADDLs to bind to nerve synapses (the junctions between nerve cells) and disrupt neuronal functioning. Additionally, the researchers unexpected discovered that olecanthal can enhance the ability of antibodies to bind to ADDLs, which could lead to the development of a better immunotherapeutic approach against Alzheimer's disease. It is important to note, however, that all of these studies were performed in cell cultures, and additional research is therefore necessary to determine if these laboratory findings can translate into effective clinical therapeutic results in humans.

Based upon very loose estimates, it does not appear that the incidence of Alzheimer's disease in Italy is much different from that of other western European countries (or of the US or Canada).

Italy, Greece, Spain and other Mediterranean cultures are all known to predominantly use olive oil in their cuisines. One early study reported that a Mediterranean-style diet (in which olive oil figures largely) was linked to a lower incidence of dementia and cognitive decline, but subsequent studies have failed to replicate this positive correlation. Regardless, a Mediterranean diet that is rich in fruits, vegetables, nuts, whole grains, legumes and fish and low in saturated fats (such as from red meat and processed foods) has been associated with a lowered incidence of cardiovascular disease and diabetes. Coincidentally, vascular disease is associated with Alzheimer's disease and dementia. Some researchers therefore believe that lowering your risk of cardiovascular disease may also help to lower your associated risk of dementia. So olive oil, when used in moderation in a healthy diet, may someday be found to be beneficial on more than one level.

Taking care of a loved one with Alzheimer's disease can definitely try your patience at times. As you have said, you need to keep in mind that your husband cannot always control his behavior and remind yourself that what he does is not purposely meant to annoy you. Most likely, he follows you because he is confused and feels very insecure—he may feel anxious and vulnerable when he cannot see you. Patients with Alzheimer's disease often live in the now. They sometimes cannot remember what happened only moments earlier (such as where they were or what they were doing), and this is can be a source of great confusion and anxiety. Therefore, your husband’s behavior may simply be an attempt to provide a bit of continuity in his life, a sort of visual anchor. He knows you, he trusts you, and you make him feel safe. So if you start feeling annoyed again, try to remember that by letting him follow you around, you may very well be providing him with a source of comfort.