Delirium and the Elderly

It is fairly common for elderly people to be affected by delirium and/or hallucinations. There may be an altered level of consciousness, inattention or disorganized thinking.

Two of the things you will notice if your elderly parent is suffering from delirium are sudden changes in behavior and their mental state. They may be hyper-alert, startle more easily or be overly sensitive to their surroundings. They can also become quite agitated or may wish to sleep for longer periods of time. They may be unable to follow a conversation or stay focused. Or their conversation may become incoherent. They may also have a decreased appetite or become incontinent. Becoming lost in places they know well is not unusual in this situation. They can experience disturbances in perception such as not understanding what is happening around them. They may not recognize familiar people. There may at times be paranoia or unrealistic fears and possibly emotional outbursts.

My mother, in her last couple of years, had several episodes of delirium and hallucinations. This is very frightening for the person experiencing them and it was also frightening for her family members, especially before we understood the reasons for them. There were several times where she saw people that were not there and carried on conversations with them. She would be adamant that the person existed and became very angry and disoriented when we tried to explain to her what was happening.

Some of the causes of delirium and/or hallucinations are:

- side effects and possible interactions of some medications;
pain;
- infections or severe illness (with my mother it always happened when she had a bladder infection which is extremely common with elderly women);
- oxygen levels;
- lack of sleep;
- effects from anesthetics;
- poor nutrition and/or lack of hydration.

If this should happen to your loved one, it is important that they receive medical treatment as soon as possible. These changes in the person are sudden and are not connected with dementia.

The following are some of the things you can do:

- call the person by name to get their response. Remind them of the day, time and where they are;
- keep sentences short and simple;
- let them know that they are being looked after and are safe;
- if the person wears glasses, make sure they are clean and being worn. This includes their hearing aides as well. These things help them to become orientated;
- try to control excessive noise and over-stimulation. This cannot always be the case, particularly if they are in a hospital environment;
- ensure that dentures are in and that they eat regularly and drink fluids frequently;
- ensure that treatment for the cause of delirium is being treated and followed up on.

Recovery time may vary from days to several weeks or longer depending on the cause of the delirium. Comfort measures are important for the patient as well as having the support of family and friends nearby.

Adult Stepchildren - What is Within Our Control and What Isn't in a Step Family Relationship?

There are many situations in families that will make a difference in our ability to be a successful step parent - ones that we have no control over. But there are also things we can do to improve our step parent relationships.

The following is a list of things that will make a difference in a step family situation that have nothing to do with the new step parent but will have an affect on his or her ability to successfully be a step parent:

- How did the biological parent get along with his/her children before you came on the scene?
If there was not a close family relationship before you, it will not improve by adding a new person to the mix. If the children already feel their parent did not spend enough time with them or was not interested in them to the extent they wanted, there may be resentment that his/her time will now be reduced by the time he/she spends with a new husband or wife. In this case, it will be important to encourage your spouse to spend sufficient time with his children to hopefully avoid any resentment in this respect.
- How long has he or she been divorced or widowed?
If it is recent, there very likely will be resentment because of loyalty to the other parent. And no matter what you may do to try and win their approval, it will be an uphill battle and one you will not likely win without a lot of patience. It may be necessary to delay marriage to give the children time to adjust to having a new person in their lives.
- Are you the new stepmother or step-father?
This will make a difference as step-fathers are more readily accepted than stepmothers. Although this can also depend upon the gender of the children and how closely that child related to their same sex parent, i.e.: a son may not be as accepting of a step-father if he has a close relationship with his own father. The same is true of a daughter if she has a close relationship with her own mother.
- What is the relationship between the two biological parents? Is it an amicable one or rife with tension?
If the two parents don't get along, the feelings of friction can be passed on to the children which will affect their relationship with a step parent. It is pretty hard for a step parent to counteract effects of negativity. It will be important to not appear to take sides - remain neutral and do not take it personal.
- How dependent both financially and emotionally are the stepchildren on their biological parent?
Adult children may see the new person in their parent's life as a threat to their emotional well-being and a possible end to their financial stability. Both losses can create resentment of the new person in adult stepchildren. In this situation, the biological parent should have a talk with the children before a remarriage to allay their fears.
- Has the biological parent included his adult children in his plans to remarry and assured them of his/her continued love?
If this has not been done and a new person is thrown into their life without any prior warning or previous meetings and a getting-to-know period, it will be difficult for the step parent as there is sure to be some resentment. Try to get to know the children beforehand, if possible at fun events.
- How far removed from the parental home are the adult children, i.e.: are they living away, going to college, married with children or still living at home?
For those living at home it will be a different situation than those living away. Those who are married may be more established in their own lives so what happens in mom or dad's life might not have quite the same impact on their lives. Communication will be the key.
- Are they a normally healthy and well-functioning family?
This is important. If the family never did function well together, there will be difficulties. Adding an extra, unknown person to a family already having problems will just add to the chaos. It is almost impossible to fix a dysfunctional family as the step parent. It is probably a situation best avoided.
- Are there grandchildren involved? Are you a much younger wife with young children of your own?
If you are, there may likely be resentment from the adult children if they perceive that their parent is giving your children more attention than they feel should be warranted if the grandchildren are being deprived of their grandparent's affection. This will be especially true if more attention had been paid to the grandchildren before your arrival on the scene than after? If this is the case, encourage your partner to spend time with the grandchildren or include them in your own family outings.

All of the above examples will have a big bearing on how the step family will function as a unit before you even begin to try to establish relationships with the adult stepchildren. The best strategy is to attempt to have positive interaction with the adult stepchildren, don't take on the role of stepparent, be friendly, open and definitely do not be pushy. Let them determine the level of involvement they wish to have until they get to know you. If friendship with an adult stepchild can be established, it is a big step towards a cohesive step family situation.

How to Cope With Grief

Grief is a reaction to loss, an emotional response. There are many different forms of grief. Some responses may even include laughter and celebration as well as sadness.

Crying and talking abut a loss are healthy responses. However, lack of crying does not indicate there is no grief. It can indicate resilience where a relatively stable demeanor is maintained with healthy level of positive emotions. This does not indicate that this person feels their loss any less, only that they have a different method of coping.

When grief responses have been more in evidence, possibly following a temporary period of depression, in most cases recovery will gradually return to previous levels. Chronic dysfunction is a prolonged inability to function and sometimes delayed grief symptoms can appear months after an apparently normal adjustment to a loss.

The five stages of grief as described by Elisabeth Kubler-Ross are denial, anger, bargaining, depression and acceptance. But each person will respond differently to grief depending upon the situation. Some may not experience the five stages and may only feel initial denial and perhaps extreme fatigue until there is acceptance. There may also be feelings of injustice and anger that life around you continues to go on when you have suffered such a devastating loss.

What can be done to help cope with feelings of the loss of a loved one? The following are some ideas:

- spend time with caring people;
- express your feelings;
- accept that there will be changes;
- take care of your health;
- return to previous interests;
- postpone making any major life changes, possibly waiting a year or so;
- if necessary contact a community organization for help;
- acknowledge the pain of your loss, don't shove it to the back of your mind and ignore its existence;
- let yourself cry;
- talk about the loss of your loved one even if you get emotional;
- exercise – physical activity is a good way to release tension;
- have a hot bath, read a good book, eat your favorite foods, get a massage, have a nap or go to a movie with a friend;
- do something to honor the memory of your loved one – perhaps plant a tree in his or her honor or place a bench in their favorite area;
- join a support group;
- avoid excessive alcohol – it can be a depressant;
- don't blame yourself for things you think you should have done or said and didn't.

Depression is often part of the grieving process. However lingering depression is not considered normal. If it continues or affects daily life, consult your doctor because untreated depression can lead to other serious psychological disorders.

I have lost both of my parents. My father died when he was still relatively young. He was not ready to go and I was not ready to let him go. I found his loss very difficult to deal with. As such I was in denial for a very long time. I was unable to talk about him without crying so I didn't, shoving it to the back of my mind instead. It was a mistake because acceptance was a long time coming. Besides having four small children, the youngest two months old when he died, I also didn't have the maturity to cope with his loss.

My mother died recently at ninety years of age. She wanted to go, she had been unhappy with her poor health and her inability to do things for herself. And although I feel her loss very strongly and am unhappy that I no longer have my mother, I am happy for her because she no longer has to suffer. She has gone to join my father where she wants to be. I now have better coping skills than I had in my early twenties so I can accept her loss more easily than I could when I was less mature. And my mother had lived a good, full life.

But we are all different. We will look at things differently and have different perspectives depending on where we are in our own life cycle. In some cases losing a parent when we ourselves are getting older may force us to look at our own mortality. Or we can accept the fact that this is the cycle of life and nothing is going to change it.

What to Do as an Executor of a Will

When a loved one dies and you have been named Executor of the Will, there are many things to be considered. Duties of an Executor generally take about one year for a straight forward estate but if assets turn up even years later, the Executor is still responsible.

The following are some of the things you will need to know if you are an Executor of a Will:

- Is a handwritten Will valid?
Some provinces in Canada allow a handwritten Will even if it has not been witnessed.
- What is a Probate?
A Probate is a legal court procedure to determine the Will's validity and to confirm an Executor's appointment as well as assess assets of an estate.
- Do all Wills have to be probated?
Probate will depend on the amount and nature of the assets, the number and nature of beneficiaries and the agencies or financial institutions that hold the assets. An asset that doesn't have to go through probate is land owned in joint tenancy with another person. (If this is the case an application will have to be filed in Land Titles along with a death certificate). Probate isn't required for joint bank accounts or vehicles owned jointly either. A death certificate is required however to transfer ownership to the surviving joint owner. Also RRSP's or insurance policies with a named beneficiary don't require probate. However, usually stocks and bonds will need to go through probate.
- Are there Probate fees?
An example of probate fees are: an estate valued at under $10,000.00 will cost about $25.00; for an estate over $25,000.00 but not more than $125,000.00, the cost will be about $200.00.
- What are death benefits?
It is money due beneficiaries from such plans as in Canada the federal Canada Pension Plan or Old Age Security, private company pension plans, unions and organizations such as the Masons. There may be more plans where there could be death benefits and it would be the Executor's responsibility to find them.
- What about the deceased person's income tax?
All income tax requirements must be filed and paid before disbursements of assets can be made.

The following are some of the duties of an Executor:

- to make funeral arrangements;
- cancel all charge cards, notify banks and contact all pension plans;
- to gather up and prepare a detailed inventory of all assets, i.e.: cash, securities, jewelery, real estate and contents of a safety deposit box;
- to determine debts owed and pay them;
- prepare and submit any necessary probate documents to the court;
- contact all beneficiaries then distribute assets between them after debts and probate costs have been dealt with. It will be necessary to obtain releases from each beneficiary.

Being an Executor to a Will is a responsibility that cannot be taken lightly. Those chosen to act in the capacity of Executor must be honest, impartial and scrupulous. And the deceased person probably chose you knowing that you could look after their interests on their behalf.

Writing a Eulogy for Your Loved One

Speaking about a loved one at a funeral or a Celebration of Life is one of the most difficult things many of us will face. Our emotions are already shredded with the loss of someone close to us to the point where we can hardly think. How can we write a Eulogy too?

I recently wrote a eulogy when my mother died although I initially had no idea where to begin. The best thing to do is speak from your heart. Eulogies are about the memories of that person and your shared personal experiences. It is an opportunity to reminisce and say why this special person was well-loved and will be missed by you and others.

A eulogy can be serious but including some humorous anecdotes will lighten an otherwise solemn occasion. It is okay if those gathered smile, or if they cry and it's natural if you do too. No one will hold it against you.

The following are some ideas to help you write a eulogy for your loved one:

- develop a theme, perhaps talk about one aspect of your loved one's life, i.e.: the good times you shared;
- mention a particular situation;
- mention something that he or she was passionate about;
- try to make it inspiring, praise him/her;
- include quotes and memories from his/her closest friends and relatives;
- mention memorable events and share a story;
- say why you will miss him/her and what you will never forget;
- suitable quotations, poems or bible readings can be included;
- mention how he/she affected others;
- talk about his/her interests and achievements;
- write your eulogy in chronological order.

Paint a picture of words of your loved one so that those present will feel his or her presence. At the reception following the service a friend of mine said she could almost feel my mother's presence. I told her she probably was there and reminded her that even at ninety my mother hated to miss a party.

At the end of your eulogy try to end it with something thoughtful and heartfelt. I ended my eulogy with, 'Thank you to all of you who had been her friend. She was my mother but she had also been my friend and I will miss her too.' A friend added at the end of her eulogy, 'An old Indian legend says that 'no one ever dies as long as one person is left to speak his/her name.' You will continue to live through your family and friends.'

And a quote from Dr. Seuss, 'Don't cry because it's over. Smile because it happened.'

Funeral Services and Celebrations of Life

There are many ways of having a service following the loss of a loved one. They can be small Celebrations of Life held in a family member's home, a quiet memorial or a more formal funeral service held in a chapel.

The Celebrations of Life and the quiet memorials usually follow a cremation. When there is an interment, there is usually more formality. Fifteen years before my mother passed, she had made arrangements, including what she wanted written on her tombstone, and including paying for a large portion of her service. This made the decisions that I had to make, as her Executor, much easier. She had even decided on the funeral home where she wanted her service held.

By going the route we did, they took care of everything with the only decision to be made was relating to the food at the reception following and procuring and meeting with a Pastor for the service. He did a wonderful job of making what could have been a very solemn and mournful occasion into one we know our mother would have wanted. He allowed us to have songs from the Sound of Music movie played instead of the usual music that usually completely undoes most people.

For some, this may be a difficult area depending on the religious level of the family but particularly on the religious or non-religious beliefs of the deceased. We are a spiritual family but not regular church-goers so we asked for a service that was not heavy on religion. The Pastor struck a wonderful happy medium. His meditation was A Life Worth Remembering, Proverbs 31:10-31 and the two hymns were I Come to the Garden Alone and Amazing Grace as well as my mother's favorite music. And a couple of Eulogies were given to honor her followed by a reception and a graveside service attended by the family.

This type of service was my mother's choice but for many it will not be an option. There is a huge cost both emotionally and financially in going this route. A quiet memorial held in someone's home is gaining in popularity following a cremation. There is often some speeches and a lot of reminiscing about the departed person. The cost is not exorbitant and emotional strings are not being pulled when decisions are required to be made and guilt placed on the family members to have a nice service for their lost loved one. Fortunately this was not the case with my mother but in most cases, this is not so.

A Celebration of Life is not for mourning a death, it is to happily remember that person. It is a good opportunity to make suggestions of how to keep the memory of your loved one alive. In our family, we have decided that every year we will continue to have a birthday celebration on our mother's birthday. Each year her birthday celebration was a day she eagerly looked forward to more than any other day of the year. We will continue to honor this for her.

Although most of the decisions had been made by our mother, the ones we had to make were made with the knowledge of what we knew she would have wished. It was the last thing we could do for our mother as we said goodbye to her for the last time.

The Loss of a Parent is One of Life's Great Tragedies

The loss of a parent is traumatic. It is the end of a large segment of ones life. It means that the one person we can count on to love us without judgment or reservation is no longer there.

Losing a parent is a blow to the psyche. There is no longer a parent to go home to especially if we have lost both of our parents. There is no one to ask, 'What was I like when I was six years old? Does my son/daughter look like me at this age? What were you like when you were my age?” There are so many questions to ask and no one to answer them. And when we lose both parents,the generation that came before us is no longer living and we become the oldest. We are then expected to be wise and to make good decisions. We are forced then to contemplate our own mortality.

When our parents die, it is inevitable that there will be devastation. This bond, which is one of the strongest there is, has been severed by death. They are gone forever and there is no return. No matter our age, even if we're older when we lose our parent/parents, our grief will not be diminished by our age. I know this to be true because I have recently lost my mother.

Losing a loved one can take an emotional as well as a physical toll. It will be important to lighten your workload, get a lot of rest, eat adequately and take care of yourself. As I sat by the bedside of my mother in her final days, and following her loss, I felt completely drained. As her executor, I handled all the necessary details. But because I have always had an abundance of energy, I was surprised at my extreme feelings of exhaustion during all of this. I realized following the loss of my mother that I was not only losing my parent but my friend and adviser as well.

When we lose a parent, we may feel shock, anger, guilt or denial. When I lost my father many years ago, he was a relatively young man so I had feelings of anger because I felt it was unfair that he would die when he still had so much to live for. I felt guilt because I didn't feel that I had told him that I loved him often enough. And after he died I felt denial and was unable to talk about my loss for years without crying. Acceptance was difficult to achieve for a very long time where my father was concerned.

When my mother died two weeks ago, she was almost ninety-one years old. She had many years to do the things she wanted to do and she was ready to go. Because of that I felt no anger, nor guilt. I'd had many years to show her how I felt about her. I did however feel shock at the sudden failure of her health but at this age it should not have been completely unexpected.

I realize now when I think about how I have handled the loss of each of my parents that coping with grief depends somewhat on your personality, your coping abilities, life experiences and, I believe, particularly on your maturity.

But tears do not mean you are not handling your loss well. As the Pastor who looked after my mother's service said as I tried to control my tears, 'There is nothing wrong with crying. Tears help to wash the grief away.' And with that will come acceptance.