An early diagnosis of Alzheimer’s disease is not a death sentence.
Those afflicted can function a long time requiring minimum assistance. They may initially require monitoring for medication, reminders and accompaniment to appointments. Eventually, though, they progress from displaying inconsistent symptoms to consistently displaying memory loss, language impairment, the inability to plan, decide, or calculate. Although physically present, they are progressively disappearing psychologically to the point of becoming fully dependent on others for their activities of daily living such as bathing, dressing and toileting. More often than not, it falls upon the family members to take on the caregiving role while witnessing the slow decline which has been referred to as the ‘ongoing funeral’, losing those closest to them right in front of their eyes. It is sad and contributes to the strain that can lead to caregivers burning out.
There is so much emphasis put on the strain family members experience in meeting the high care demands as the disease progresses. Consequently, the sadness and grief symptoms family caregivers experience stemming from slowly losing a family member to Alzheimer’s disease gets buried under the care demands. What we often do not hear about is help in processing the series of losses and grief that family caregivers experience as the disease progresses from the early to late stages. There is good reason to come to terms with the caregiver grief since research findings show grief to be a major barrier that family caregivers face.
It would be helpful to have a tool that uncovers the buried grief that family caregivers are experiencing – the sadness, frustration, guilt, anger, distress and so on. Fortunately, such a tool exists in the 3-A Approach. To fill a gap in clinical practice, I devised the 3-A Approach to raise grief awareness and provide a tool that helps in processing and moving forward in resolving the grief. Processing and resolving the grief from the situational losses assessed and acknowledged assists family members to carry out the care duties with less angst and with enhanced resiliency.
“Situational Loss is the loss of a person, thing or quality resulting from alteration of a life situation including changes related to – in addition to death – illness, body image and environment.”
– Mosby’s Medical Dictionary 8th Ed., 2009
The 3-A Approach initiates action by using the key words: Acknowledge, Assess, Assist for self-awareness and as a self-monitoring tool. The words initiate processing the situational losses experienced. Although ‘acknowledge’ is positioned first in sequence, it is not to be considered the first step or phase or stage of the 3-A Approach. These action words can be used alone or interdependently. For self-care, family caregivers can assist themselves by acknowledging their losses and assessing for themselves how the reaction to the losses is manifesting. A healthcare professional may assess the losses a family caregiver is experiencing and assist by informing the family caregiver so that the losses are acknowledged. Acknowledgement, on its own, can bring relief similar to the relief of receiving a diagnosis for puzzling symptoms.
It is not enough to generally acknowledge loss but rather to specifically acknowledge what the losses are. For instance, a husband who is losing his wife to Alzheimer’s is also losing what his wife represented to him. He could be losing her companionship, her role as cook, her social directing and so on. Also, as the disease progresses, there may be more losses due to further loss of health such as incontinence or wandering which means loss of freedom for the husband being unable to leave his wife alone and more time required attending to care duties.
It is not enough to generally acknowledge loss but rather to specifically acknowledge what the losses are.
The emotional impact of the losses are assessed to determine the effects. The impact – grief reaction – is unique to the individual and circumstance. The emotions can be overwhelming including sadness, anger, fear, loneliness, guilt and so on. There is a tendency for emotions to get clumped together, assessed and acknowledged as depression or stress without considering assessing them as grief resulting from loss. The benefit of assessing grief is that it emphasizes the experiential, linking the impacting emotions to a context of situational loss. Just as the losses acknowledged need to be specific so do the emotions need to be specific making it easier to assist. It is beneficial to acknowledge the prominent emotional impact. Are we dealing predominantly with guilt? with anger? with fear?
Assisting is easier when we can acknowledge and assess exactly what we are assisting. In addressing the situational losses, there are grief strategies that can be utilized such as journaling, rituals and letting go. We often hear people say in everyday conversation ‘let it go’ or ‘move on’ with reference to handling difficult, disturbing circumstances. For family caregivers, it is challenging to ‘let go’ when being faced with their situational losses on a day to day basis, especially if they are living with the person with the disease. For this reason, it is required in these circumstances to use the 3-A Approach, to acknowledge, assess, assist over and over, again and again.
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