Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota      

Many people with Alzheimer’s disease suffer from significant depression.  Fortunately, there are many effective non-drug and drug therapies available.  Treatment of depression in Alzheimer’s disease can improve a person’s sense of well-being, quality of life, and individual function.

 Symptoms of Depression

Men and women with Alzheimer’s experience depression with about equal frequency.  Identifying depression in someone with Alzheimer’s can be difficult.  There is no single test or questionnaire to detect the condition, and diagnosis requires careful evaluation of a variety of symptoms.  Dementia itself can lead to certain symptoms commonly associated with depression, including:

• apathy
• loss of interest in activities and hobbies
• social withdrawal
• isolation

The cognitive impairment experienced by people with Alzheimer’s often makes it difficult for them to articulate their sadness, hopelessness, guilt, and other feelings associated with depression.

Depression in Alzheimer’s does not always look like depression in people without the disorder. For example, depression in Alzheimer’s is sometimes less severe and may not last as long or recur as often.  Also, people with Alzheimer’s and depression may be less likely to talk openly about wanting to hurt themselves, and they are less likely to attempt suicide than depressed individuals without dementia.  What is more, depressive symptoms in Alzheimer’s may come and go, in contrast to memory and thinking problems that worsen steadily over time.

 Diagnosing Depression in Alzheimer’s Disease

The first step in diagnosis is a thorough professional evaluation.  Side effects of medications or an unrecognized medical condition can sometimes produce symptoms of depression.  Key elements of the evaluation will include:

• A review of the person’s medical history
• A physical and mental examinations
• Interviews with family members who know the person well

To facilitate diagnosis and treatment of depression in people with Alzheimer’s, the National Institute of Mental Health established a formal set of guidelines for diagnosing the condition. Although the criteria are similar to general diagnostic standards for major depression, they reduce emphasis on verbal expression and include irritability and social isolation.  For a person to be diagnosed with depression in Alzheimer’s, he or she must have either depressed mood (sad, hopeless, discouraged, or tearful) or decreased pleasure in usual activities, along with two or more of the following symptoms over a two-week period:

• Social isolation or withdrawal
• Disruption in appetite that is not related to another medical condition
• Disruption in sleep
• Agitation or slowed behavior
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
• Recurrent thoughts of death, suicide plans or a suicide attempt

Treating Depression

Because of the complexities involved in diagnosing depression in someone with Alzheimer’s, it may be helpful to consult a geriatric psychiatrist who specializes in recognizing and treating depression in older adults.

The most common treatment for depression in Alzheimer’s involves a combination of medicine, support and gradual reconnection to activities and people the person finds pleasurable.  Simply telling the person with Alzheimer’s to “cheer up,” “snap out of it,” or “try harder” is seldom helpful.  Depressed people with or without Alzheimer’s are rarely able to make themselves better by sheer will, or without lots of support, reassurance, and professional help.

 Non-drug Approaches

• Schedule a predictable daily routine, taking advantage of the person’s best time of day to undertake difficult tasks, such as bathing.
• Make a list of activities, people, or places that the person enjoys now and schedule these things more frequently.
• Help the person exercise regularly, particularly in the morning.
• Acknowledge the person’s frustration or sadness, while continuing to express hope that he or she will feel better soon.
• Celebrate small successes and occasions.
• Find ways that the person can contribute to family life and be sure to recognize his or her contributions.
• Provide reassurance that the person is loved, respected, and appreciated as part of the family, and not just for what she or he can do now.
• Nurture the person with offers of favorite foods or soothing or inspirational activities
• Reassure the person that he or she will not be abandoned.
• Consider supportive psychotherapy and/or a support group, especially an early-stage group for people with Alzheimer’s who are aware of their diagnosis and prefer to take an active role in seeking help or helping others.

If you would like more information on “Depression and Alzheimer’s Disease” feel free to contact Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Emeritus University of Minnesota at waldn001@umn.edu.  Be sure to watch for more Family Living Focus information in next week’s paper.

 Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota       

Everyone has stress in their lives regardless of their age, occupation, or lifestyle.  It is important to find ways to reduce your stress before it has a negative affect on you.  Following are some quick tips that you might find helpful to reduce your stress.

 Meditation
If you have ten free minutes a day, you can reduce stress, improve insomnia, lessen anxiety and depression, and decrease your chances of developing cardiovascular disease. Sound too good to be true?  In fact, the meditative technique known as the “relaxation response” has been scientifically proven not only to reduce stress and anxiety but also to improve symptoms of cancer and other conditions.

Just what is the relaxation response?  Simply put, it is the opposite of the “adrenaline rush” we associate with stress and anxiety.  Physiologically, our bodies respond to perceived threatening situations with an increased release of the hormones epinephrine and norepinephrine, leading to increased heart rate, increased blood pressure, accelerated breathing rate and increased blood flow to the muscles.  Because these reactions prepare our bodies to flee the situation or to fight, this reaction has been termed the “fight-or-flight” response.  The relaxation response is a state in which our bodies undergo an opposite reaction which leads to decreased breathing rate, heart rate, blood pressure, and metabolism.

Almost anyone can learn to elicit the relaxation response, and no special equipment is necessary.  The relaxation response technique consists of the repetition of a word, sound, phrase, etc. while sitting quietly with eyes closed.  Intruding thoughts are dismissed by passively returning to the repetition.  This should be practiced for 10-20 minutes a day in a quiet environment, free of distractions.

A seated position is recommended to avoid falling asleep, and you may open your eyes to check the time but do not set an alarm. Don’t feel discouraged in the beginning if it is difficult to banish intruding thoughts or worries; this technique requires practice.  With consistency and time, the relaxation response will occur effortlessly and smoothly.

For maximum benefits you should schedule time to practice the relaxation response into your daily routine.  Many people find it helpful to practice this technique at approximately the same time each day.  For example, upon returning home after a busy workday it may ease your transition to a relaxed and enjoyable evening.

Another technique is practicing what the Buddhists call “mindfulness.”   At various times of the day try to focus on your breathing.  Notice how the air feels cool when you inhale, and then feels warm when you exhale.

You can do this while you are doing the washing up, making the beds, waiting at a red light, or even standing in a post office queue, etc.  The instant benefit from this is that it brings you immediately to the present moment.  It is also very effective if done during or before an important meeting, an exam, or even while sitting in the dentist’s chair.  As you breathe out, you will start to feel your body relax, and your mind will become more focused.  Each time you feel yourself getting stressed or find that you have unexpected time on your hands, do a quick 60 second meditation.

 Tai Chi
Tai Chi Ch’aun is a centuries old Chinese system of physical exercise based on the principles of effortless breathing.  It can be practiced by an individual, alone, and in a limited space.  It requires no equipment, except a loose-fitting garment that permits continuous rhythmic body movements.  It can be learned by anyone regardless of age, sex, or athletic ability.  Tai Chi emphasizes relaxation, receptivity, and inner calm rather than strength.  The flowing stretching movements make the body limber, tone up muscles, and help release muscle tension.  This is accomplished by practicing movements slowly and evenly in circular patterns.  Many people also report it is an excellent and effortless way to lose weight.  Check YouTube for tutorials to practice this technique.

 Yoga
Yoga is a wonderful way to release stress.  Meditation, breathing exercises, and sustained poses help you focus on relaxing your mind and body.  Once having learned the techniques in a class, it can be done at home.  Yoga also helps you develop greater control over your thoughts and worries.

 Acupuncture
Acupuncture can treat a wide spectrum of ailments since it approaches injury and disease by looking at the underlying cause as well as the symptoms.  Since acupuncture treats the root of the problem, it is favored over traditional therapy because with acupuncture symptoms rarely return.  Although acupuncture is renowned for its effectiveness in the treatment of pain, such as back pain, frozen shoulders, and migraines it is also effective for many other problems such as stress and anxiety.

 Massage therapy
Massage therapy works to improve an individual’s health and well-being through the hands-on manipulation of muscles and other soft tissues of the body.  Massage therapy is designed to stretch and loosen muscles, improve blood flow and the movement of lymph throughout the body.  It facilitates the removal of metabolic wastes resulting from exercise or inactivity and increases the flow of oxygen and nutrients to cells and tissue. In addition, massage stimulates the release of endorphins which are the body’s natural feel-good chemicals into the brain and nervous system.  It provides a relaxed state of alertness, reduces mental stress, and enhances capacity for calm thinking and creativity.  Massage also satisfies the need for caring and nurturing touch, creates a feeling of well-being, and reduces anxiety levels.

 Aromatherapy
Aromatherapy is the art and science of using essential oils, extracted from plants, for therapeutic benefit including stress management.  Because aromatherapy can be done as a self-help technique, its use can be very beneficial as a stress reducer while you work. Most of the workplace applications are available in hand lotions for easy use in the office. Bergamot and lavender work well for stress and anxiety reduction.  Pendants are also an excellent way to utilize aromatherapy oils in public.  Nebulizers and misters are used at home.  There are hundreds of unique oils and scents, and each has its own medicinal or therapeutic value.  Here are some common oils: Anise, Sweet Basil, Bergamot, Cedarwood, Atlas, Blue Chamomile, Cinnamon, Clary Sage, Clove, Cypress, Eucalyptus, Sweet Fennel, Geranium, Grapefruit, Juniperberry, Lavender, Lemon, Sweet Marjoram, Nutmeg, Sweet Orange, Palmerosa, Patchouli, Black Pepper, Peppermint, Pine Needle, Rosemary, Sandalwood, Tea Tree, Vetiver, Yarrow, Helichrysum, Neroli, Grapeseed oil and Ylang Ylang.

 Relaxing personal retreats
Take a relaxing, scented bath with candles.  Every woman knows this is a sure-fire way to relax, but how many of you take time to do it?  For the guys, stay thirty minutes in a hot shower, soak in a hot tub or go to the local sauna.  Take a weekend break to a spa, even the guys.  Get a facial.  Take a weekend trip with your partner or with friends.  There are many activities you can do to remove yourself from the daily grind, have fun and just relax.

If you would like more information on “Helpful Tips to Reduce Your Stress” feel free to contact Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Emeritus University of Minnesota at waldn001@umn.edu.  Be sure to watch for more Family Living Focus information in next week’s paper.

 Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota   

FACT:  The majority of older adults are quite satisfied with their lives and cope with loss, change or a chronic medical condition without becoming depressed but depression affects one in every six seniors living in the community.

FACT:  Older adults are twice as likely to suffer from depression as the general population, and women are more likely to be depressed than men.

FACT:  Scientists think that depression is caused by an imbalance of brain chemicals called neurotransmitters.  It can be triggered by stressful situations, death, a chronic illness, recent surgery, or caring for a very ill family member.  It can run in families.

FACT:  Depression can be triggered by other chronic illnesses common in later life such as diabetes, stroke, heart disease, cancer, chronic lung disease, Alzheimer’s disease, Parkinson’s disease, and arthritis.

FACT:  Depression is NOT a normal part of aging, but many older adults and their caregivers believe it is.  Consequently, depression in older adults often goes overlooked and untreated.  The symptoms of depression are often missed when they coincide with other chronic illnesses.

FACT:  Depression often goes undetected because patients do not report their symptoms, and when they do, they are often misinterpreted as symptoms of a medical illness.

FACT:  Older adults may be reluctant to seek help for depression because they think it comes with age, is a sign of weakness, or believe that they can pull themselves out of it.   Depression is a treatable medical illness like diabetes or heart disease.  At least 80% of people can be treated effectively and their symptoms relieved within a few weeks.

FACT:  Older adults are considered the group most “at risk” for suicide.  The suicide rate in older adults is more than 50 percent higher than young people or the nation as a whole.  White men over age 80 are six times more likely to commit suicide than any other age group.  If someone you know is in crisis or an emergency call your local law enforcement or hospital emergency room.

 Common Attitudes of Older Adults Towards Depression

Sixty-eight percent of Americans ages 65 and older know little or almost nothing about depression.  Only 38 percent of Americans ages 65 and older believe that depression is a “health” problem.  If suffering from depression, older adults are more likely than any other group to “handle it themselves.”  Only 42 percent would seek help from a health professional.

Learn to Recognize the Symptoms of Clinical Depression

No two people experience clinical depression in the same manner.  Symptoms will vary in severity and duration among different people.  See your doctor if you experience the first two symptoms listed.  Along with four or more other symptoms, for at least two weeks and generally daily:

• Feeling sad or irritable throughout the day
• Loss of interest or pleasure in activities once enjoyed
• Changes in weight or appetite
• Changes in normal sleep patterns (difficulty falling asleep, interrupted sleep, early morning awakening, or increase in sleep)
• Fatigue or loss of energy
• Feeling worthless, hopeless, or unreasonably guilty
• Inability to concentrate, remember things, or make decisions
• Restlessness or decreased activity
• Complaints of physical aches and pains for which no medical causes can be found
• Recurrent thoughts of suicide or death (not just fear of dying)

As a first step, a thorough physical examination may be recommended to rule out other illnesses that may be causing these symptoms.

As I write this column, I know I am challenged to find an interesting way to talk about City finances. I may not have the most interesting angle on its finances, but I’m pleased to share the numbers with you and am convinced that our City is in a good financial position.

First, here is some of today’s news. The City Council did pass a tentative 2025 budget at the September Council meeting. The budget will be finalized at the December Council meeting so I say “tentative” because state law allows the budget to go down between now and December, but not to go up. That budget reflects a 9.17% increase over 2024. I talked about inflation taking a bite out of our budget, and much the same as you’re experiencing at home, everything the City buys has gone up in price too. The Council really struggled putting this budget together because no one wanted that kind of an increase. But their only choice to take proper care of matters was to pass this budget or to “kick the can down the road” and that simply puts the expense off until next year or later. The Council’s decision to take care of things now rather than to putting them off is the most responsible.

At this Council meeting the Council also decided to purchase a used snow plow truck (2004 Sterling) and to replace the boat dock at the lake with a heavier duty model. They also gave permission to erect a large flag pole and U.S. flag on the east end of town along Highway 14 paid for by the Legion and other generous donors.

Then, as promised, here is a quick snapshot of financial considerations during the time I served as Mayor beginning in 2016. Each year since that time the City has balanced its budget. That year (2016) the total levy to taxpayers was $1,152,110. The total in 2023 was $1,643,010. During that time, the City’s General Fund Expenses went from $4,100,460 to $4,589,460 in 2023. On average during that eight year period of time those expenses increased by a little over 1% per year. And as you know, the City did not stand still during this time.

Then too, I want to give you a brief look at the City’s financial positions. In 2017, the City’s financial holdings were $7,310,374 and at the end of 2023, it was $11,567,718. In 2017 the PUC’s holdings were $3,596,429 and at the end of 2023, our holdings were $4,761,361. These numbers do not include special road and sewer funds, hospital funds, and other smaller designated holdings which increases the City’s total holdings significantly.

Finally, let’s take a look at the City’s debt. In 2016, the City paid a debt levy of $679,260. In 2023, our debt levy was $767,850. Those levies are factored into the City’s budget each year and reflect total debt of $15,458,000. Those levies are paying for various street and infrastructure improvement projects and our aquatic center.

We’ve been blessed and are fortunate to have done as well during these eight years. COVID actually helped our financial position. And keep in mind that during this time the City built and paid for the Event Center.

Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota

How to Help Yourself if You are Depressed:

Depressive disorders make one feel exhausted, worthless, helpless, and hopeless.  Such negative thoughts and feelings make some people feel like giving up.  It is important to realize that these negative views are part of the depression and typically do not accurately reflect the actual circumstances.  Negative thinking fades as treatment begins to take effect.  In the meantime:

• Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
• Break large tasks into small ones, set some priorities, and do what you can as you can.
• Try to be with other people and to confide in someone; it is usually better than being alone and secretive.
• Participate in activities that may make you feel better.
• Mild exercise, going to a movie, a ballgame, or participating in religious, social, or other activities may help.
• Expect your mood to improve gradually, not immediately.
• Feeling better takes time.
• It is advisable to postpone important decisions until the depression has lifted.  Before deciding to make a significant transition such as changing jobs, getting married or divorced discuss it with others who know you well and have a more objective view of your situation.
• People rarely “snap out of” a depression but they can feel a little better day-by-day.
• Remember, positive thinking will replace the negative thinking that is part of the depression and will disappear as your depression responds to treatment.
• Let your family and friends help you.

 How Family and Friends Can Help a Depressed Person:

The most important thing anyone can do for the depressed person is to help him or her get an appropriate diagnosis and treatment.  This may involve encouraging the individual to stay with treatment until symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs.  On occasion, it may require making an appointment and accompanying the depressed person to the doctor.  It may also mean monitoring whether the depressed person is taking medication.  The depressed person should be encouraged to obey the doctor’s orders about the use of alcoholic products while on medication.

The second most important thing is to offer emotional support.  This involves understanding, patience, affection, and encouragement.  Engage the depressed person in conversation and listen carefully.  Do not disparage feelings expressed but point out realities and offer hope.  Do not ignore remarks about suicide.  Report them to the depressed person’s therapist.  Invite the depressed person for walks, outings, to the movies, and other activities.  Be gently insistent if your invitation is refused.  Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon.  The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness or expect him or her “to snap out of it.”  Eventually, with treatment, most people do get better.  Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Where to Get Help:

If unsure where to go for help, check the Yellow Pages under “mental health,” “health,” “social services,” “suicide prevention,” “crisis intervention services,” “hotlines,” “hospitals,” or “physicians” for phone numbers and addresses or Google resources.  In times of crisis, the emergency room doctor at a hospital may be able to provide temporary help for an emotional problem and will be able to tell you where and how to get further help.

Listed below are the types of people and places that will make a referral to, or provide, diagnostic and treatment services.

• Family doctors
• Mental health specialists, such as psychiatrists, psychologists, social workers, or mental health counselors
• Health maintenance organizations (HMOs)
• Community mental health centers
• Hospital psychiatry departments and outpatient clinics
• University or medical school-affiliated programs
• State hospital outpatient clinics
• Family service, social agencies, or clergy
• Private clinics and facilities
• Employee assistance programs
• Local medical or psychiatric societies

Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Professor Emeritus, University of Minnesota   

 Get the jump on seasonal cleaning!  Summer officially ends in September.  Consider marking the seasonal transition with a bout of fall cleaning.  While that may sound like a contradiction in terms, stop and think about it.  Warm summer months means vacations away from home and more time spent outdoors.  While you were out enjoying yourself, dirt and grime did not take a vacation.  They sat around the house, accumulating and multiplying.  Now with the fall months followed by winter and the holiday seasons rushing in upon us, it is an ideal time to get a thorough house cleaning under way!

Take Stock

Before you begin, take inventory of your cleaning supplies.  Make sure you have the products you need for the surfaces you plan on cleaning.  Review the information on the product labels to make sure you are using them properly.  As you clean, pay attention to where your products are stored.  You may decide that future cleaning will be more

efficient if you keep sets of supplies in different areas of the house.  For example, keep one set on each floor, or an extra set in the master bedroom suite or in the laundry room. Be sure you store your items where children and pets cannot get to them.  Also consider adding a small hand-held vacuum in various locations so it is easy to scoop crumbs off the kitchen floor, hair from the bathroom countertop, and dust from the family room.

Expand Your Reach

Go beyond the usual vacuuming, mopping, and dusting.  Look up and get rid of the cobwebs that have accumulated in the corners and around the light fixtures and ceiling fans.  If necessary, invest in a telescoping extension pole so you can adjust it to the length you need for dusting those high-up places.  Move the furniture and send those dust bunnies scurrying. Wipe down the baseboards.

Tackle the Refrigerator

Check its contents for expiration dates.  Discard anything that has overstayed its welcome.  Then remove and clean each shelf.  Work one shelf at a time so that food will not have to stand out at room temperature.  Once the inside is clean, take a look at the outside.  Dust and lint buildup can reduce the cooling performance of your refrigerator. Remove the grille and vacuum the coils or clean them with a long-handled brush.  If it is not a built-in model, pull it away from the wall and vacuum or sweep behind it.

Launder Lavishly

Launder all washable comforters, mattress covers, pillows, bed skirts, curtains, blankets, throws and slipcovers.  Turn mattresses and vacuum them thoroughly.

Refurbish the Furniture and Care for the Carpet

Take a close look at your upholstery.  Remove the cushions and vacuum thoroughly, using the crevice tool to get into those hard-to-reach places.  Check the carpet for spots and stains.  This may be the time for deep cleaning all these surfaces.

If you would like more information on “Fall Cleaning Tips” contact Gail Gilman, Family Life Consultant, M.Ed., C.F.C.S. and Emeritus University of Minnesota at waldn001@umn.edu.  Be sure to watch for more Family Living Focus™ information in next week’s paper.              

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