Tag - problem-solving - Fading from Memory

Tag - problem-solving

Monday 1 January 2007

Problem	Solution	Notes
Food
1. Eating cat food	Put all dry cat food in a dispenser. Buy single-serving cans of cat food.	Adoption of the dry food dispenser is a struggle. Since other members of the family are not filling the dispenser when they buy dry cat food, the full or half-full cartons remain in the cupboard and are available for mum and dad to eat from.
2. Not finishing Meals on Wheels meals	1) MOW to supervise mum and dad’s eating, and if not this then 2) put food out on plates, and if not this then 3) leave the meals unsealed and take lids away with them.	MOW are a little haphazard in their implementation of this. Dad tells them it is not necessary to put the food out, and they go along with him. I’ve asked specific volunteers to stick to the instructions, but have not asked the service to reitierate the message to all volunteers.
3. Not eating fresh fruit and vegetables	Provide fresh fruit and vegetables at weekends and on Wednesday. Social services visit on Monday and Friday afternoons to provide food for mum and dad, first feeding the cats.	Greg and Regan generally do not provide fresh food at weekends. Rachel has not yet established a routine for visiting and providing meals on Wednesdays. The fresh food emphasis of the evening meals on Mondays and Fridays is not strong. The meals are also rather small.
4. Eating food past its use-by date	Regularly clear out the cupboards.	It would be better if old opened packages of food were either used up or cleared out before new purchases were added to the cupboards.
5. Very poor evening meals	same as 3.	same as 3.
Medical
6. Not taking medicine	The nurses adminster medicine at about 1:30 pm, take no for an answer, and avoid trouble when it flares. They do not visit on Wednesdays. Dad gives it most days to mum.	The nurses’ visits are still being made in the morning, when mum is either asleep or cranky. We ought to switch to the evening round.
7. Missing doctors' appointments	Manage appointments for them.

Problem	Solution	Notes
Cleaning
8. Not cleaning cutlery and crockery	On Wednesdays, when dad is at day care, Rachel gives mum an outing. During this time social services clean the house.	So far I, not Rachel, have organised this. Last week there was a communication breakdown and Alison was sent home by dad. Alison normally arrives at 12:30 and works until 2:30. I leave notes for what I’d like her to do each week. The washing machine needs fixing or replacing. We need a reliable supply of pegs if washing is to be put out on the line.
9. Not dusting
10. Not washing clothes, bedding, or towels
11. Not cleaning the floors or toilet
Psychological
12. Boredom	Dad goes to the Day Care centre on Mondays and Wednesdays. Rachel takes mum out on Wednesdays.	Dad is still not used to the idea of going on Monday (partly because of the Christmas and New Year disruption to the routine) and has even suggested that visits on Mondays are not necessary. Rachel has not yet begun the outings for mum.
13. Confusion	‘Distraction and subtraction’ (reduce clutter in the house). Provide a large calendar with each day crossed out as time progresses. The nurses will cross out the days for mum and dad. Social services have provided a combination mini-safe to contain housekeys for fixing to the outside of the house – so that if the house is locked up we can always gain access. Change the locks so that they cannot be deadlocked from inside.	We have done nothing to reduce the clutter in the house. The calendar idea was unpopular and ineffective and so has been stopped. We have not changed the locks or provided a means of access through the screen door.
14. Mum stealing the mail	A secure mail box.	The new secure mailbox is a failure because postmen leave the letters hanging out of the slot and mail is therefore easily removed. A different design is required.

Problem	Solution	Notes
Hygiene
15. Not showering or bathing	A shower stool and a handheld showerspray have been installed. All soap in the house has been replaced with sorbolene (because it doesn’t matter if it is left on the skin and not rinsed off). Deodorant and wet baby wipes have been supplied for Rachel to try out on mum. Wine has been supplied to relax mum and make her more pliable. Dad says he showers before going to Day Care and church.	Mum does not wash either herself or her clothes and her room now stinks. Rachel should continue to persuade mum to take a bath or a shower or even just a wash, and try various incentives.
Safety
16. Vulnerability to robbery and violence	Real valuables are in the safe. The amount of money in the house is limited to a maximum of $200. An online webcam has been installed.	Police have not yet been asked to keep a closer watch on the house. Rachel reports freezing of the video stream when watching the webcam from home, but the webcam server software appears to be serving images correctly.
17. Uncertainty on the outside steps	White lines have been painted on them.	At first dad considered these lines confusing but now says he has got the hang of them.
18. Mum's attacks on dad	Counselling dad and possibly mum when it happens.	Mum’s attacks are worse than before: more frequent and more easily triggered. Counselling mum and dad is useless.

A good day

By MM on Monday 4 December 2006, 23:19 - Journal

Just like Friday, everything has gone according to plan today. The new careworker, Jenny slipped into the role as effortlessly as Carol, and was welcomed, just as we'd hoped, as a long-lost friend. She prepared sandwiches for mum and dad, washed down by tea and fruit juices. I slipped away before she did.

Later in the evening I returned to the house and found mum and dad happily watching TV. They both seemed in very good spirits. This echoes Rachel's observation, made earlier in the day, that mum seemed quite happy having spent the day at home while dad was away at day care.

The visit to day care seemed to go OK for dad. There was no outing, and the format was slightly different to what he has grown accustomed to on Wednesdays. I am sure he'll settle in just as well.

I also managed to solve a couple of computer problems; one for dad, one for myself. The problem dad had is indicative of his waning skills and comprehension. His diagnosis of the problem, given to me over the phone, was that he 'couldn't do a thing' with the computer. It sounded to me as if it had locked up or crashed into some non-Windows state. No. What he showed me was that one of the fields in his Calendar program was full of the character C, like this:

CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC

He couldn't understand what was wrong. Furthermore, he couldn't understand that the solution to the problem was to click on the field and hold down the DEL key. He no longer remembers the DEL key!

My problem was that I could not get all the machines I visit during my rounds (home, office, friend's offices, Greg's place) to access the WebCam in dad's room. The solution to this has been to set up the server to work with Java clients rather than Javascript clients. Now all machines appear to work properly.

That's all for today.

one comment

Monday 27 November 2006

Causes, effects, preventions, cures

By MM on Monday 27 November 2006, 19:04 - Reference

problem-solving

It seems a few people have been surprised at our analytical approach to mum and dad's Alzheimer's. I am surprised at their surprise - I don't see how else we might have handled it. Well, maybe that's not quite true. I've seen so many examples of groups behaving bizarrely in the face of problems that I ought not to minimise our achievements, no matter how modest. For example, here's a few common approaches to how not to solve problems:

Pretend the problem is not there
Run away
Rearrange a few deckchairs
Blame someone else
Give up

There are multitudinous variations on each of these. No 1 for example, has a variant which says 'all problems are opportunities'. Sounds good, helps little.

Here's a more effective strategy, which first looks at what feasibly can be done before looking into how to do it:

Prevention
Cure
Treating symptoms
Adapting to symptoms

When we apply this to Alzheimer's, particularly in mum and dad's case, we get the following:

Prevention
We missed the boat on this one. Whatever measures can be taken to prevent Alzheimer's disease, we are far too late.

In any event, no-one claims that there is any way to prevent the disease. The best that can be suggested at this stage is to minimise the probability of getting it. The suggestions amount to maintaining a healthy life, both physical and mental: consume vegetables, not nicotine; watch your weight, not your television. But, again, too late for mum and dad.

Cure
Depending on whether your definition of 'cure' means a return to how things were before the disease struck or stopping it in its tracks, there are two different observations to be made. Reversing Alzheimer's is a notion that has been given some credence recently by science, However, this is at the stage of 'We've got some promising results with white mice, let's issue a media release and see if we can improve our grant-attracting powers' rather than the 'We've just rolled the government into subsidising the huge prices we are charging for a medicine we started developing ten years ago' stage. Mum and dad's Alzheimer's will therefore not be reversed unless they manage to hang around for at least another decade.

Equally, there are no treatments for actually halting the development of the disease, as opposed to merely resisting the worsening of its symptoms.

Treating the symptoms
The symptoms of Alzheimer's, including loss of memory, anxiety, aggression, are amenable to treatment, but all the treatments are symptom-reducing rather than disease-abating. In the long run, only lowering the gradient of decline is possible, and the results are still disputed: in some cases there is nothing to say the medicines are effective in any positive way. However, as far as memory is concerned, our family may be getting a small benefit. In mum's case the Aricept may be responsible for helping her to be a little less confused. Since her dosage went to 10 mg she has been able to lay the table properly once more. Before, she would get, say, a knife and three forks out of the cutlery drawer and simply stand there dithering about what to do with them. In dad's case he sounds much more articulate since starting on Aricept though, from the examples of his speech that I have reported verbatim, it is clear that he would not cut the mustard at Toastmasters. We have not sought to treat anxiety or aggression. My main concern here is that treatments for these symptoms often worsen the patient's confusion.

Adapting to symptoms
This is where we are operating with mum and dad. We acknowledge that they are increasingly forgetful, confused, anxious, and in mum's case, aggressive. We respond by adjusting their surroundings so that there is, correspondingly, less to remember, less complication, less to worry about, and less aggravation. Where this is not enough, as in the areas of nutrition and hygiene, we have stepped in and sought outside help. Some of these interventions have worked, others haven't. Experimentation and variation is necessarily continuous. However, being specific about which aspect of their life we are trying to fix has been essential. Simply trying to maintain respectable middle-class habits and appearances, which is what we may have tried to do at first, just doesn't make any crucial difference. Building a pyramid of support for mum and dad's happiness is the only important goal. This means keeping the cats (though they are a source of problems), staying at home (though this is also a source of problems), giving dad a day out (though this either causes mum anxiety or aggression, depending on whether she has company during this time), giving them cash (though they appear to lose it frequently), and compromising between foods they like and what's good for them, and cleanliness on the one hand and not bullying them into cleaning on the other. There are simply so many small elements to these imperfect aspects of their lives that not to keep a table of them would leave the rest of us equally confused and anxious.

2 comments

Sunday 26 November 2006

Camerama

By MM on Sunday 26 November 2006, 21:43 - Journal

I am sitting at my desk at home, surrounded by cameras, cables and compact discs. But things just ain't working.

I've experimented with three different webcam server packages: Biromsoft's Webcam, YawCam and TinCam. I've tried three different cameras: Nogatech, Kritter, and Kensington. I've also explored the use of a Belkin video-USB adaptor that in theory allows me to attach any video camera.

The Nogatech is a really great little camera, well made, good quality picture, and both small and easily mounted on walls or other surfaces. The problem seems to be that this very good camera is paired with a very bad camera driver. When I use it my whole system often crashes.

When I tried other cameras I couldn't get either Webcam or YawCam to recognise them. Only TinCam seemed able to detect them. Unfortunately TinCam has the disadvantage that it requires Microsoft Media Player to run on the client's computer. I'd rather not have to impose this requirement on those who want to use my home-made surveillance system.

It is not the first time I have been thwarted by less than perfect digital camera driver software. My solution in the past was to use the Belkin video-USB device, which requires only one driver (a reliable one too, as it happens) and allows one to connect any number of different cameras to its video input. Unfortunately, it is again only the TinCam software that recognises it.

So, I am at something of an impasse, as shown below:

	Biromsoft Webcam	YawCam	TinCam*
Nogatech	crashes	crashes	crashes
Kritter	can’t find camera	can’t find camera	OK
Kensington	can’t find camera	can’t find camera	OK
Belkin Video-USB	can’t find camera	can’t find camera	OK

* Requires that the client installs Microsoft Media Player.

The other side of the system, Internet streaming, appears to be quite straightforward. Both YawCam and Webcam work well. I have not fully tested video streaming with TinCam but other methods of putting video on the net appear to work fine.

So much for the technicalities. Now for the social and ethical aspects.

Derek and I think there are sufficient reasons for installing a not-too-intrusive monitoring system for mum and dad. Others who have given me an opinion agree with us. What Rachel, Greg and Regan think, I still don't know.

Whether, once installed, the system will be invulnerable to tampering is something I think I can ensure. Dad might be inclined to dismantle the system, but I doubt it. He probably won't even notice it. His eyesight is really quite poor, and I shall install the camera or cameras in unobtrusive places, above or below eye level. And these days dad generally calls Greg or I if he thinks there is anything wrong with equipment. Previous experience tells me that nobody will ever notice the cameras.

It is probably illegal to make video recordings of people without their knowledge. The social services and others who come to the house may have objections, both personal and supported by legislation. I am simply choosing to disregard such rights, if they exist, for the greater good of mum and dad's well-being. If, in order to be legally unimpeachable, I have to erect signs saying 'This area is under constant video surveillance' I can guarantee endless questions and confusion on mum and dad's part. It would probably be the end of the whole enterprise.

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