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Best to be blunt: Of course it's awkward and embarrassing to discuss a loved one's incontinence with him or her, let alone to have to change adult diapers (a.k.a. adult briefs these days). Private matters turned team project usually are.

Unfortunately, the net effect of nobody wanting to talk about his or her adult diaper stories is stressful caregiver isolation. A new survey on dealing with incontinence by Caring.com and SCA, makers of Tena incontinence products, finds that one in three caregivers avoids discussing the subject with a loved one altogether because it's too "embarrassing and difficult." (Most of the 500-plus respondents, all caregivers with incontinence-care experience, were boomer-age women.) And 42 percent say they get depressed about dealing with a loved one's incontinence.

That's a disheartening conspiracy of silence. It's also a silence that prevents worn-down caregivers, as well as those struggling with incontinence, from getting the help they need...  Read more

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Caregiver stress has no shortage of causes. But sometimes you hit a tipping point: On top of everything else, you get swine flu. You get into an argument with a sibling or an insurance company rep. Or there's a new diagnosis (on top of the two or three other chronic conditions you're helping a loved one manage). And there you are, seriously wondering if it's possible for a human head to explode.

Rest assured, it can't! Try these seven ways to buy yourself time to regain a little sanity:

1. Inhale. Exhale. Repeat.

"Keep breathing," a yoga therapist friend always urges me when I get to that mush-on-the-floor point. The slower and deeper the breaths, the better.

Tracy Gaudet, the physician who directs Duke Integrative Medicine, taught me a handy force-yourself-to-slow-down breathing pattern that she learned from her former mentor Andrew Weil:

4/7/8 Breathing (Paced Breathing)

• Rest the tip of your tongue on the ridge behind your front teeth throughout the exercise...  Read more

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Let me say straightaway that Alzheimer's isn't funny. And yet… there sure are plenty of moments that make you want to laugh. Or me, anyway.

No doubt dementia is a horrible affliction, in the progressive way it erodes the memories and connectedness of someone you love. But it's exactly that long slow progressiveness, the years of everyday living situations, that present so many opportunities for absurdity and comedy —as well as so much need for stress release. And laughter (even cracking a smile) really is a proven stress reliever with healing benefits.

Many people cringe at the idea of finding anything remotely lighthearted about their dementia stories, and I respect that. Humor is a pretty individual taste, too. The black humor batted heartily around in some families (mine) is seen as distastefully verboten in others.

Before you strafe me with indignant comments over daring to suggest...  Read more

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As caregivers, we're often hardest on ourselves, trying to live up to impossible standards of "doing it all," "doing it right," and so on. But sometimes we inadvertently make the load even more strenuous -- by doing or saying things we believe to be correct in the moment, but which we wind up regretting. And that regret, in turn, adds to our caregiver guilt and caregiver stress load.

I know: It's almost impossible to guess when regret will come back to bite you. In the moment, a choice may seem so reasonable. But since preventing bad moves is one of the best ways to avoid regret over them, I asked around to see what others would think twice about if given the chance. Four main categories of caregiver regrets came up – or at least, four so far!

• Making promises you can't deliver.

"I'll never put you in a nursing home" is Numero Uno.

• Making choices not rooted in reality.

I thought...  Read more

What could be more elementally human than recognizing people -- the loved ones who feature in all your family memories, the friends you wave to on the street, the special face you wake up to every morning? I can't imagine what it must it feel like when Alzheimer's or another dementia turns those once-familiar faces into blanks.

But I well know about being on the receiving end of a blank stare. I've experienced the strange sensation of not being recognized by your own parent.

Intellectually, you understand the day might come. You know it's not unusual that recognizing people will become a challenge for someone with later-stage dementia. But the first time you're called by another name, it jolts. The gulf between you seems to widen.

The first time Dad introduced me as his "sister," my heart sank. It was a confirmation of what I'd long suspected, that he only vaguely got who I was. He seems to register me as family (as opposed to a total stranger), but can't quite place me...  Read more

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Compassion fatigue -- a.k.a. caregiver burnout -- is what happens when a well-intentioned caregiver crosses a hard-to-see line from One-Who-Helps to One-Who-Needs-Help. And it can happen to anyone. It happens precisely because you care so much.

Are you at risk of caring "too much"? Here are ten warning signs:

1. You use words like "always" and "never" with regard to caregiving.

Beware falling into absolutes: "I promised Mom we'd never put her in a nursing home." "I'm sorry I can't go to lunch because I always feed Sam by myself."

Being overly rigid can put you at risk for burnout.

2. Your friends seem to have stopped calling.

You may be feeling isolated or annoyed that your old circle no longer seems to check up on you and how you're faring...  Read more

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Sometimes it's the little things that get you with Alzheimer's. Phone challenges, for example. Difficulty using the telephone is an early sign of Alzheimer's disease. But even once you already know someone has dementia, phone issues can be an ongoing source of trouble.

Any of the following "ring a bell" in your house?

• Not recognizing the voice on the other end.

Before she died at 99, my grandmother's deafness had made our weekly phone calls harder as the years went on. But between my shouting and repeating, we somehow managed to have a talk that made us both feel good. Then sometime in her early 90s, Alzheimer's disease made her less likely to answer a ringing telephone, and when she did, she didn't always understand who I was. Eventually it got too hard, and looking back, was sadly the factor that changed our relationship most.

• Not recognizing the phone.

Another personal story: My siblings and I began to expect the same drill every time we called home...  Read more

Here's an unexpected cure for caregiver stress: Complain about it. Yes, go ahead and dwell. Vent. Gripe. Grouse. What drives you crazy? Make a list of your top 10 pet peeves and see if it doesn't give a twinge of satisfaction to get them out and corral 'em in one place.

The most common pet peeves about eldercare (and the stress of eldercare!) probably look a little different for every caregiver. What's important: Giving yourself permission to have such a list in the first place!

"It's the little things that get to me," one stressed-out caregiver admitted to me recently (thus inspiring this list). Like, of all surprising things, not being able to cook the way she used to. Since her dad moved in, she's had to simplify recipes (he doesn't like mushrooms, onions, green peppers, most other vegetables, fish, pasta, or salads). She must season less (he can't have salt and doesn't like spices)...  Read more

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Say you notice signs of dementia in a loved one who doesn't live with you. What's the best way to get a fix on what's really going on?

"Only her hairdresser knows for sure" is the punchline of an old hair-dye commercial. It may also be a clue to deciding how your relative with suspected Alzheimer's or another dementia is truly faring.

A new study showing hairstylists are often privy to older clients' health issues reminded me of a heated family debate I once witnessed among long-distance family members over what was really going on with their mom. Alost 90, she'd been showing signs of dementia or some other cognitive trouble:

• One faction was in flat-out denial. Nothing was wrong with Mom! She still went swimming, bought groceries, made it to church most Sundays, and most importantly, assured everyone she was "fine."

• One faction relied on firsthand observations. Trouble is, no one was able to visit terribly often...  Read more

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Stress and isolation are risks for all caregivers, but those who are caring for a spouse can be especially vulnerable. Factors unique to being a spousal caregiver raise the odds that someone in this situation will miss out on helpful resources –- and in turn raise his or her own risk for depression, disease, and even death.

(Though research shows that risks vary by age, gender, and the spouse's condition, they exist whether the spouse is caring for a husband or wife with dementia, cancer, heart disease, stroke, or other illnesses and disabilities.)

Obviously not everything about caring for a husband or wife who's ill is grim. But the grim parts can be as dangerous as they are often overlooked.

If you're a spousal caregiver, please consider the following factors that point to a need for giving in to more help, not less...  Read more

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Caregivers rightly have an aversion to treating older adults like children, even when the effects of dementia render them child-like. But here's a wonderful exception that Alzheimer's patients enjoy: Try giving a woman in the later stages of dementia a baby doll.

Surprisingly, an "Alzheimer's baby" helps someone with dementia feel like a functional adult (not a patronized child). And that brings feelings of satisfaction, pleasure, calm, and accomplishment. Cuddling a doll soothes and entertains, reducing aggression. Pretty good, as dementia activities go.

I'll never forget bringing my daughter Page, then about 15 months old, to her older sister's Brownie troop outing at a local nursing home. Page was in a huge baby phase – she gravitated toward babies, whether real, toy, or pictured in board books. So of course she quickly noticed the elderly resident sitting in a corner with a baby y doll in her arms...  Read more

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Hospice may be the best-kept secret of the American healthcare system. Although you hear the word more than you did a generation ago thanks to a growing hospice movement, myths and misconceptions abound about this form of end-of-life care. Even health-savvy, well-educated people are confused.

I know this firsthand. Because of a strange coincidence, I've been having endless conversations about hospice lately. There I was, interviewing hospice nurses, palliative care doctors, and grieving survivors for a work project, when the topic suddenly became personal for me this week –- again.

Two years ago my mom ran out of treatment options just a week after being diagnosed with cancer. When she was referred to hospice, someone in our numbstruck family asked, "What is hospice anyway? Is it in the hospital?" We became grateful fans of this compassionate care approach when Mom spent the last two weeks of her life as a hospice patient in the comfort of her own home...  Read more

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Sexual urges don't stop just because Alzheimer's or another dementing illness invades the brain. Sometimes this is a blessing; some long-married couples say that the mind and body long remember the behaviors of sexual intimacy, even when short-term memory is on the fritz, which helps reinforce their closeness despite the disease-related adversity. Sometimes, on the other hand, sexuality coupled with dementia can cause big problems.

Few of us care to think about our parents having sex at any age or in any circumstances. But when the circumstances include dementia, certain issues might sidle up to a caregiver anyway. Reading this terrific legal overview in the Washington Post about an Alzheimer's rape case is a great reminder to family caregivers that sex is a fact of life (sometimes a thorny fact of life) all through life.

What are the most common minefields?

• A consenting couple, in which one party has Alzheimer's, but both enjoy the sexual relationship...  Read more

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My mom didn't know she had compassion fatigue, since nobody named for her this extreme caregiving stress back when she was looking after her mother, who was in her 90s and had Alzheimer's disease. By the end, Mom was dutifully visiting the nursing home day after day for hours, where she'd not only quietly tend my grandmother but also became such a familiar face that she also felt she had to stop and greet half the other residents, visit Gram's barely-verbal roommate, bring treats to the nursing staff, and so on.

It was compassionate. But it was also taxing. And it added up to compassion fatigue. Compassion fatigue is a recognized stress disorder that often affects people in healthcare. But family caregivers are just as vulnerable. "Grieving by inches" is how compassion fatigue expert Sherri Showalter, a social worker in Tarpon Springs, Florida, describes it.

My mom didn't stop making the...  Read more

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On World Alzheimer's Day, Monday, September 21, most people with Alzheimer's disease won't be able to participate in an Alzheimer's Association Memory Walk. But they directly benefit from events like these being held around the world.

That's because World Alzheimer's Day events are meant not only to raise funds for research but to raise awareness about Alzheimer's and people with Alzheimer's disease. That makes this World Alzheimer's Day an opportunity for each of us to think about what messages we'd like to give to those who aren't yet affected by this living tragedy called Alzheimer's.

So here are three facts about Alzheimer's that I want the whole world to know:

1. Alzheimer's is not an inevitable effect of aging.

Senility doesn't strike everyone; it's a terrible disease. In a generation, much has been done to change this old public misperception. The fitting theme of World Alzheimer's Day this year is "See it Sooner...  Read more