Monday, November 9, 2015

Assisted Living Costs and Vets

This seems an appropriate time of the year to mention that veterans may be eligible for senior care benefits. Contact the Veterans Administration to determine eligibility at the VA's Health Benefits Service Center: (877) 222-VETS
I was a caregiver for my mother and one of her most vivid memories was the end of the Great War, which, of course, was what they called World War I. The war ended with an armistice that was to take effect at the 11th hour on the 11th day of the 11th month in 1918. 
Mother was 7 years old and attending public school in Chicago. The boys wore paper hats to be soldiers. The girls wore white rags made from an old bed sheet tied around their foreheads. A red cross in the center of the headbands, made with iodine, completed their nurse costumes. The children all paraded around the flagpole in the playground that morning of November 11, 1918. Armistice Day, or as we call it, Veterans Day.

Monday, August 17, 2015

Asia: Does an Adult Child Have a Legal Obligation to Parents?


I read an interesting article about filial piety throughout Asia explaining that although this respect for elders is an integral part of the culture of many Asian countries, financial realities are causing major changes.

For example, as young people from China's interior move to coastal areas for jobs, the elderly are being abandoned. And, because China has had a one-child rule since 1979, an adult child has to care for both parents alone.

China now has laws delineating the actions adult children should take. Chinese companies are supposed to provide vacation time so employees can visit their parents. These laws, however, do not provide punishment for failure to obey, unlike Indian law, which provides for the imprisonment of children who fail to care for their parents.

Singapore law has provided parents with legal recourse to sue their children for money and caregiving since 1999.

This thought provoking article, When Filial Piety is a Legal Obligation, was written by Winnie Chwang, a Senior Research Analyst with Matthews Asia, an investment company, for the week of August 16, 2013. The full article can be seen here:



Tuesday, August 4, 2015

TOO OLD OR TOO ILL TO DRIVE?


I felt it was time for my dad to give up driving. He was in his late 80's but not senile. His eyesight was good but he was becoming quite deaf even with a hearing aid. I wasn't concerned about his ability to operate the car but rather how he could cope with traffic and with the crazy drivers that are sometimes out there.

It also happened to be the time for him to renew his license. I took him to the facility to take the road test.

The examiner rode with Dad and then came back to me and said hesitantly, "I don't feel comfortable passing him." 

"Then don't!" I replied.

He looked relieved. I was relieved. 

The first thing Dad had done in the test was to try to start the car -- even though the engine was already running. He couldn't hear it.

Dad was okay with not being able to drive anymore; at least he acted as if he were okay about it.

The Alzheimer's Association has resources to assist caregivers in initiating a conversation about giving up driving. http://www.alz.org/care/alzheimers-dementia-and-driving.asp


A postscript to Dad's story:

A few months after giving up driving, Dad and I went to a nearby strip mall. When we came out of the store, I found that someone had parked illegally and had our car boxed in. I tried to maneuver the car out of the space but I wasn't getting anywhere.

Dad suggested we trade places. He got behind the wheel and quickly and deftly pulled the car out of the space. Then we traded back…and I humbly drove home. 


Wednesday, July 29, 2015

HOT COCOA FOR A BETTER MEMORY?


A study of 60 seniors showed a relationship between drinking hot cocoa and improved memory.

Those participants whose memories improved had low blood flow prior to the study. Drinking two cups of cocoa per day improved blood flow and memory.

Scientists are not recommending anyone drink cocoa, however. Only 18 of those studied had low blood flow and those participants who had normal blood flow did not improve. Scientists worry about the side effects of drinking cocoa, which has fat and sugar.

See the article here: http://bit.ly/1fzyFKm


Monday, July 20, 2015

Leeza Gibbons and Caregivers Part II

Now, as promised, I'm continuing with Leeza Gibbons' commandments for caregivers-- in my last post I explained her first commandment was "Take Your Oxygen First":

Commandment 2:  "NEVER ASSUME" -- anything about a loved one without having all the necessary information.  Making assumptions about each other can lead to anger and resentment.

Commandment 3:  "HAVE ONGOING FAMILY CONFERENCES" --  about the roles and responsibilities of everyone involved.

Commandment 4:  "DO NOT ISOLATE" – yourself if you are a caregiver.  A caregiver support group can help you to cope with the stresses.

Commandment 5: "DO NOT TAKE ANYTHING PERSONALLY" – because it isn't about you.

Commandment 6: "PLAN AHEAD/HAVE CONTINGENCY PLANS" – in my book I call this a willingness to be creative and flexible!

Commandment 7: "DO NOT FALL PREY TO SHAME & STIGMA" – if you are a caregiver and are becoming depressed, or have other issues, don't let shame or stigma keep you from getting the help you need.

Commandment 8:  "USE COMMUNITY RESOURCES" – available  in your area and online.  Both the caregiver and the loved one can benefit from the many programs offered.

Commandment 9:  "HONOR SACRED MEMORIES" – the whole family should be involved in preserving family stories.


Commandment 10:  "FIND HUMOR IN MANY PLACES" – sometimes you have to laugh so you don't cry, but any laughter is good for caregivers -- and their loved ones.

for more information visit http://www.leezascareconnection.org/

Tuesday, June 16, 2015

Leeza Gibbons and Caregivers

American talk show host Leeza Gibbons has a personal interest in Alzheimer's disease and caregiving.   Her mother was diagnosed with the disease – and Ms. Gibbons  promised her that she would "tell her story and make it count."

To make good on that promise she established the Leeza Gibbons Memory Foundation in 2002.  The main program of the foundation is Leeza's Place (http://www.leezascareconnection.org or check it out on Facebook) which has facilities across the country.  

The mission of the organization is to support caregivers so they may have positive experiences with their caregiving.  To that end, Leeza's Place offers the Ten Commandments for Caregivers.

The first commandment is "Take Your Oxygen First."  We are all told on airplanes that we must secure our own oxygen masks before helping our children.  If we don't help ourselves first, we won't be able to help them.   Caregiving  can be enormously demanding and a caregiver who experiences burnout can't assist anyone else.  Caregivers (I wish I had a synonym for this term) must learn to care for themselves – body, mind, and soul.  I have to admit I didn’t follow this rule when being the caregiver for my parents, and I regret that.

It's such an important concept that, Ms. Gibbons uses this first commandment as the title for her book about caregiving.  Co-written with a psychologist/social worker and a physician,  Take Your Oxygen First: Protecting Your Health and Happiness While Caring for a Loved One with Memory Loss, was published last year. 

More on the Ten Commandments for Caregivers next time.


Thursday, June 11, 2015

Caregiving and Dementia

You become the parent – and your parent becomes the child:  that happens when you realize your parent's mental ability is slipping to the point that your roles have begun to change.  It need not be your parent; of course, it could be a friend, sibling, spouse, or other relative.
The first hurdle is determining when that day of role reversal has come.  The realization may come suddenly with obvious signs of mental deterioration; or you may experience a slowly building awareness that something is wrong.  Some people rush the day.  The first "senior moment" or mistake is, to some, a sign that the senior is incapable of caring for herself.  Sometimes it is done maliciously -- the adult child who wants the parent out of his life or to obtain control of any assets. 
Some forgetfulness occurs at any time in life – the misplaced homework of a child or the misplaced key of a young adult.  Then suddenly is misplacing an item evidence of aging?  Not necessarily, without a pattern of problems.
The more common issue is not recognizing that the day has come.  One may be in denial simply because one doesn't want it to be true and doesn't want to face the future without that person as a fully functioning member of one's life. 
Distance can be a factor in realizing that a problem exists.  A friend of mine spoke with her elderly parents often by phone and thought they sounded fine.  They reassured her they WERE fine.  When she finally came to visit them, she was stunned to find her normally tidy parents living in absolute squalor.  They were unable to cope with daily living.
            I recommend this You Tube video to learn more about dementia.  It's about 90 seconds.  http://www.youtube.com/watch?v=DQx6Ku390YU

Monday, June 8, 2015

Caregiving and Elderly Couples

 
Many elderly couples have to deal with heartbreaking dementia.  During the time I was the caregiver for my parents, I had the privilege of watching how my father coped with my mother.  She suffered from senile dementia; his faculties never declined.  

I'm sure the dedication, love, and valor my father displayed was not unique.

This is from one of those emails that are always circulating, author unknown.  I don't know if it's true, but I do know that the essence is true.

"It was a busy morning, about 8:30, when an elderly gentleman in his 80s arrived
to have stitches removed from his thumb.

He said he was in a hurry as he had an appointment at 9:00 am. 
 
I took his vital signs and had him take a seat, since I was not busy with another patient, I would evaluate his wound.

It was well healed, so I got the needed supplies to remove his sutures and redress his wound.  While taking care of his wound, I asked him if he had another doctor's appointment this morning, as he was in such a hurry.

The gentleman told me no, that he needed to go to the nursing home to eat breakfast with his wife.  I inquired as to her health.

 He told me that she had been there for a while and that she was a victim of Alzheimer's disease.

As we talked, I asked if she would be upset if he was a bit late.

He replied that she no longer knew who he was, that she had not recognized him in five years now.

I was surprised, and asked him,
 'And you still go every morning, even though she doesn't know who you are?'
 
He smiled as he patted my hand and said,
'She doesn't know me, but I still know who she is.'
  "




Thursday, June 4, 2015

Caregiving Books

When I began as a caregiver for my parents, only a few books dealt with the issues I was facing.  Many books have been published on the topic since then. 

I'm disappointed with some of these books.  I lived with my parents for the 23 years that I cared for them, and, except for occasional forays into the real world, my caregiving was 24/7.  The books that are written by heath care professionals are undoubtedly correct from a medical point of view.  What they generally cannot tell you is how to deal with the responsibility of DAILY caregiving. 

A physician typically sees the patient for a few minute and usually doesn't understand what it's like to live with the patient.

One book that I do highly recommend, written by Dr. Dennis McCullough, is
My Mother, Your Mother: Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones.

Dr. McCullough appears on PBS in this one-minute video: 


Dr. McCullough's book deals with aging in general, not just dementia patients.  

Perhaps the most famous book dealing with the elderly and memory loss is The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life, by Nancy L Mace and Peter V. Rabins.  First published in 1981, it is currently in its 4th edition.




Tuesday, June 2, 2015

Caregiving Introduction

When I was in law school, I had a professor who told about his senile father.  The man often wandered away from home and when my professor found him, the father refused to return home with him.  A police officer had to tell the father to go home with this 'nice young man' for him to cooperate. 

The professor explained that one in four people would develop dementia so chances were 50/50 that we would have a parent with Alzheimer's disease or senile dementia.  (I don't know if his statistics were correct.)  I paid little attention to his stories, but within a year, I realized Mom was showing signs of dementia, too.

I was busy finishing law school and only vaguely aware of the changes in Mom's behavior.  At first little things happened that only someone close to her would realize were "off."  The odd conduct occurred more and more frequently.

When I graduated, hiring freezes made it impossible to seek employment with the federal government as I had planned.  I began caring for Mom while looking for work.  Her needs increased and I cared for her until her death in 1997; I cared for Dad until his passing in 2001. 


Although I worked some part time and temporary jobs, my career was essentially on hold from my graduation in 1980 until 2001.  I certainly do not recommend that for anyone!  After caregiving for 23 years, I have definite ideas on what to do – and what not to do.  More resources are available to the caregiver and the elderly than ever before.  In subsequent posts, I will share some of the resources I found most valuable.

Friday, May 22, 2015

The Longest Day - A Day of Hope

On June 21, 2015, the Longest Day of the year (the Summer Solstice), the Alzheimer's Association invites volunteers to help raise funds to find a cure for Alzheimer's.

Five million Americans and 35 million people worldwide suffer from dementia.

To learn more or join a fundraising team, please visit



Sunday, May 17, 2015

Alzheimer’s Disease More Common in Women than Men

According to the Alzheimer’s Association 1 in 6 women will develop the disease compared with only 1 in 11 men. Approximately 500,000 people die from Alzheimer's every year.

The Alzheimer's Association report is here: 

The ABC News report is here: http://abcn.ws/1psM5yb

Saturday, May 9, 2015

Caregiving Diversions

Caregiving Diversions

My caregiving often kept me housebound which meant a lot of listening to music, watching TV, and reading.

When asked about my ONE FAVORITE, book, movie, song; or even my top 10 books, movies, songs, I'm stuck. Do people have absolute favorites? How do you compare fiction with nonfiction, or comedy with drama?  So if I do answer the question, it is only true for that brief moment in time because my choices keep changing.

Here is my list of favorite, but maybe not-so-well known-rock-'n-roll-non-instrumental-and-including-some-other-genres songs, in no particular order. At least, they are my favorites at this moment….

 1 Rock Around the Clock, Bill Haley and His Comets [the one that started it all for me]

2 California Sun, the Riveras [especially important to listen to in Chicago during a February blizzard]

3 I've Got a Line on You, Spirit [not copyright infringed by Led Zeppelin]

4 Season of the Witch, Stills & Kooper, Super Session album [best album ever]

5 I'm Your Witch Doctor, John Mayall and the Blues Breakers (Clapton) [do I detect a witchy theme?]

6 (Don't Fear) The Reaper, Blue Oyster Cult [good advice]

7 The Voice,  Moody Blues [even more haunting than their ambitious concept album Days of Future Passed]

8 For What It's Worth, Buffalo Springfield, written by Stills [sums up my experiences during college]

9 Cocaine, Eric Clapton [If that's too offensive we'll go with his I Shot the Sheriff]

10 Battle of New Orleans, Johnny Horton [hey, I'm a history major]

11  House of the Rising Sun, the Animals [Eric, my man, you are still rockin' it!]

12  Quick Joey Small (Run Joey Run), Kasenetz-Katz Singing Orchestral Circus [even with a fair amount of airtime in '68 I was the only person I know who actually heard it.]


Friday, May 1, 2015

ALZ.ORG

How can the Alzheimer's Association (Alz.Org) help you as a caregiver?

Alzheimer’s Association’s essentiALZ™ (http://www.alz.org/essentiALZ/#jump1) --

an individual training and certification program that allows for the caregivers of dementia patients. The training is online and pricing starts at $24.95 per person.


1.800.272.3900 is staffed by clinicians who can help with issues related to Alzheimer’s disease. Call for information about local community programs, services, and for support.

Alzheimer’s Association Virtual Green-Field Library (http://www.alz.org/library/about.asp)

Receive answers to your dementia questions, find statistics, and research related topics, by phone, email, mail, and in person.

Nationwide chapter network (http://www.alz.org/apps/findus.asp)


More than 250 chapters provide local programs and services including support groups and educational workshops. 

Friday, April 24, 2015

Connection between Down Syndrome and Alzheimer's

Scientists are attempting to learn more about Alzheimer's by studying and testing patients with Down syndrome.

The genetic disorder, Down syndrome, is related genetically with Alzheimer's.  Persons with Down syndrome have an extra chromosome 21.

Chromosome 21 contains the gene that is responsible for the "sticky plaques" found in Alzheimer's patients.

Read the NPR report here:  http://n.pr/1DZgrxi


Thursday, April 16, 2015

Inside The Brain: An Interactive Tour


Go to alz.org/alzheimers_disease_4719.asp?esrc=10242011 for a brief but comprehensive tour of the human brain provided by the Alzheimer's Association.

Sixteen illustrations show us things like tangles and the differences between healthy and unhealthy brains.

Interesting facts are sprinkled throughout the tour. How much does YOUR brain weigh?

Thursday, April 9, 2015

A SECOND LANGUAGE DELAYS DEMENTIA

A recent study shows that persons who know a second language have significantly later onset of dementia than those who speak only one language.

Previous research had suggested that a person's level of education directly correlated with the age that dementia began, with the most highly educated individuals having later onset dementia. However, this study included geriatric patients who were illiterate, eliminating formal education as a factor, and putting the focus on second language skills.

In the test group of approximately 650 patients, knowing a second language delayed the start of dementia by an average of 6 years.

The patients studied suffered from various forms of dementia including Alzheimer's disease.

The study, reported in Neurology, can be accessed here:



Wednesday, April 1, 2015

A Frightening 4th - When I Was 6

I was sick on the 4th of July when I was 6 years old. Dad promised, though, that I could use my sparklers when I was well. I was visiting my aunts and grandma at their house a few days later and excitedly told them that I was going to use my sparklers that night. Grandma called an aunt over and asked if it was the 4th of July.

I was terrified at Grandma's question! At the age of 6, I was absolutely certain that adults knew everything. Yet here was my Grandma not knowing if it was the 4th of July! Unthinkable. I didn't tell anyone that I was frightened and no one realized that I was upset about something. I kept trying to puzzle out what was happening. I can still feel how scary it was to realize that an adult might not even know what day it was!

And so all these years later I have written the story of Johnny, a little boy who thinks his grandmother doesn't love him anymore because she is acting differently. Mommy explains about grandmother's illness in a way that makes Johnny happy.

Unlike me, Johnny is sad rather than afraid. Also unlike my true-life experience, Johnny's mom realizes something has upset him and helps him.

I wrote the story to help families cope with a difficult problem that occurs so often: a child dealing with the decline of a loved one. I hope my story is of help to you.Special Secret Hearts: a Child's Introduction to Dementia  http://amzn.to/KhvXA8



Wednesday, March 25, 2015

Handicapped Inaccessible Again

From July 2013

I told in my previous post about my sister and her foot injury that required the use of a wheelchair. 

She is now allowed to walk, but not more than about 50 feet. She has to work her way up to normal walking.

So I took her out to run (roll?) a few errands. She could get out of the car and take the necessary couple of steps to get into the wheelchair. Then I pushed her wherever she wanted to go.

I was surprised at one office building that was very unfriendly to the wheelchair. She had to reach out and hold the door open while I pushed her through. That was bad enough but getting over the high threshold was very difficult. If she had been frail, it would have been almost impossible without another person to help.

What sort of building is so inhospitable to wheelchairs, you may ask? 

It was, wait for it…, a medical building. 

As I said, we still have a long, bumpy road before we attain full access.



Saturday, March 21, 2015

Just when I thought I knew a lot about caregiving, I was humbled. Again.


From July 2013
I took care of my parents for twenty-some years and helped here and there with other family members. My dad had nasty arthritis in his knees so in his last few years when we were out and about, I pushed him in a wheelchair to spare him some pain. Clearly, I know a lot about caregiving, I even handled someone in a wheelchair. Not really. We were lucky. At the time Chicago had curbs at each intersection. We'd get to a curb, Dad would hop out of the wheelchair, I'd push it into the street, he'd step off the curb and into the chair. Reversed the process at the other side of the street. As I said, we were lucky because Dad COULD walk. Not far, not comfortably, but that was still light years ahead of anyone who cannot stand at all.

Fast-forward 13 years. My sister injures her foot and has to be in a wheelchair. Bad, but not THAT big of a deal to get around because now Chicago has extensive wheelchair access. No problem with curbs because sidewalks have small ramps at every crosswalk in our neighborhood.

Pushing her wheelchair from the car to the 4th of July picnic WAS easy when it came to crossing the streets. But every crack in the sidewalk (both the normal expansion breaks installed every 8-10 feet and the unintended fractures) and every tiny hole or depression in the street jerked the wheelchair. Fortunately, my sister was strong and had the use of one foot so she was in no danger of being thrown from the chair.  We finally made it to the park and then had to cross what appeared to be a vast prairie but was just a mown grass barrier between us and a shady spot next to our neighbors.

Still, it was rough going over that lawn and if my sister had been frail, I don't think we would have made it; at least not without a lot of help.

Interesting to me was that a few days later we went to a suburban park and could get to the softball field across prairie, er, grass OR on a series of small paved paths that wound throughout the park. Wheelchair access led to almost every field, play lot, pavilion, and flowerbed. These paths had neither cracks nor holes that jarred the chair.

I humbly learned that although wheelchair access is getting better, we still have a long, bumpy road before we truly attain full access.



Monday, March 16, 2015

Link between Not Brushing Teeth and Dementia

The Journal of the American Geriatrics Society reports that an unexpected benefit of good oral health may be the reduced likelihood of developing dementia.  More than 5,000 people participated in the study which was conducted from 1992 to 2010. Those who brushed less than daily had a 65% increased risk of developing dementia.

More information is available here:


Thursday, March 12, 2015

Men Caregivers

I was the caregiver for both my mom and my dad. Many people seem to think that most caregivers are women. Since I've been writing about caregiving, I've been speaking with many caregivers -- and I've met more men who are caregivers than women.

Some of the men have taken care of their wives. More of the men, however, were, or are, caregivers for their mothers, fathers, or both. I don't have any statistics, just my own observations. Many of these men sacrificed a great deal to care for parents. A surprising number -- at least it surprises me -- never married and never had children primarily because of their caregiving responsibilities. A Chicago Tribune article from Valentine's Day 2012 explored the topic of men caregivers:



Sunday, March 8, 2015

Still Alice the Novel

Still Alice by Lisa Genova is a novel written from the point of view of a 50-year-old woman who is in the beginning stages of Alzheimer's. It is well written and gives what I feel is an insightful look into the thought process as a mind is ravaged by dementia. However, Alice is such an unlikeable person that I cannot have any compassion for her. It's as if a robot's memory chip corrodes. Although, if Alice were a more sympathetic character, perhaps the story would be too hard to bear. I recommend the book, just don't expect to feel like shedding a tear over Alice.

I'm biased, of course, by my own experiences. I lived with my mother as she struggled with senile dementia. Unlike the rapid decline of Alzheimer's, it was a long process spanning 20 years. Mom's experience was completely unlike Alice's. Mom was surrounded by loved ones, had little awareness of what was happening to her, and experienced very little fear. As the ability to deal with the mundane world was taken away from her, Mom seemed to become a more authentic human being.

The Alice of Still Alice is a neuro [psychology professor] something or other, I find myself not caring, at Harvard, and her husband is a scientist and professor at Harvard who has to deal with lab research.

The story begins with Alice editing a peer-reviewed article. She hears her husband racing around the house and she cannot concentrate. She knows he has misplaced something and so sits back in her chair and waits for the inevitable call. How helpful of your, Alice. He does call her because he cannot find his glasses and he is late. Possibly. Alice's alarm clock shows it's about 7:30 but she believes it to be about 10 minutes fast. The clock downstairs by her husband indicates 8 AM. She strolls into the kitchen and immediately spots the glasses and notes that it is only 6:52 according to the microwave.

So two presumably intelligent people have no idea what time it is nor how to set clocks, electronic or otherwise, to the correct time?

Rather than handing hubby the glasses, she stands there with them in her hand until he notices her, and she manages to insert a snide comment. She muses that she and her husband have not been close for quite a long time -- she dashes around the country lecturing and he has irregular hours caused by responsibilities such as checking lab experiments in the night.

The purpose, apparently, of both being employed by Harvard had been so they could work closely together and "commute" by walking together. In the beginning of their marriage, walking together arm in arm. Now they are different schedules.

As the husband, who probably has a name, dashes off, he asks Alice not to argue with their youngest daughter.

As for the peer reviewed article, she does not have time to deal with it so merely stuffs it in an envelope and mails it off, implying, if not lying, that she had reviewed it. So much for professionalism. Well, she had to. She's a very busy Important Person, you know.

As the story unfolds, we learn that Alice and her husband have three children, a doctor, a lawyer, and the baby of the family. The "baby" was, Alice admits, ignored by her busy parents primarily because she was smarter than her two older siblings were and thus needed no guidance. This baby, now a young woman, chose to pursue acting rather than a college degree. Alice refuses to accept the choice because the only reason one could possibly decide not to go to college is to spite Alice and her husband and rebel against their lifestyle.

Alice tends to be all over the place with advice. The youngest daughter is warned that she is running out of time to make a proper life for herself. The older daughter is told not to try to become pregnant with her husband because, at 28, she has all the time in the world.

Alice is also an annoying lecturer. She loves it because no matter how challenging the audiences are, she has never forgotten one fact, nor groped for the proper word. She can recite the author, journal, and year of countless articles in her field. Goody for her. Too bad she doesn't bother to use that  ability to, oh, I don't know, review articles. I've never met such a person -- the more brilliant, the more forgetful, in my world.

Then begin the symptoms of the memory loss to come:  during a lecture, she forgets a word. And never having had to deal with such a problem, she is ill equipped to handle it now. 

Her memory worsens, and she seems compelled to make poor choices. As she cooks Christmas dinner with her family around her, calling her for help, she decides to test her ability to remember words she has randomly selected from the dictionary. Since she is rarely with her family, one might think she would take the opportunity to enjoy them. But alas, it is not to be.

During a frantic moment in the kitchen, Alice cannot remember one of her words -- and gracefully handles it by yelling at her loved ones. Not confiding in them about her doctors' visits and her concerns -- just snapping at them. Perhaps they are not loved ones at all.

Alice doesn't appear to have any sort of emotional life. Does she realize that when Alzheimer's ravages her once brilliant mind, she will have nothing?