California Mom Joins Sandwich Generation

At 34, Cathy Thompson is in the middle of a role she loves -- mother to 6 year-old Caitlin and 2 year-old Nicholas. But her already full life is complicated by another traditional role most women don't face until they are much older: Thompson's parents, Mary and Herb, are beginning their final years, years in which Thompson will become their caregiver as well as her children's.

Cathy was born when her mother was 46, the only daughter of a lifelong career woman who married late and didn't plan on any children. Now her duties as daughter and mother have moved together in time and overlapped.

Herb has a severe heart condition and has suffered two heart attacks. The next one could be fatal. But she worries most about her mother, whose recent open-heart surgery has hastened the beginning of Alzheimer's Disease.

Many people confuse the terms 'dementia' and 'Alzheimer's'. The second is a disease. The first is a symptom.

Mary is experiencing dementia but no one can say whether she will develop full-blown Alzheimer's. It cannot be diagnosed while the patient is still alive; only through a brain autopsy after death.

The disease is caused by abnormal clumping and irregular knots in the brain cell pattern. In addition, there is no definitive test for Alzheimer's; diagnosis depends on physicians trained and experienced in dementia symptoms.

Listening to a telephone conversation between Cathy and Mary, the observer doesn't need to hear the other end in order to understand what is happening. Cathy patiently repeats an explanation three times before she begins to show frustration.

But she keeps it from erupting until she has finished the conversation. She knows it isn't Mary's fault that she can't remember what Cathy told her yesterday. Alzheimer's is the most common form of dementia in the United States, with more than 4 million people affected. This could increase to as many as 14 million in the next 20 years, as the largest generation in history enters its' golden years.

What is difficult for both patients and caregivers is that during the early and even middle stages of the disease, the patient is aware something has gone terribly wrong with their cognitive functions. According to Alzheimers.com, the most important caregiving needs during this time are mental and emotional support, and a support system consisting of a doctor, social worker and possibly a psychological counselor.

Cathy is looking for a house large enough to accommodate her family and her parents. Not an easy task in Northern California, where prices have soared into the stratosphere, but unlike it is for many caregivers, money isn't an issue. Mary and Herb are retired hospital administrators, with excellent pension and retirement benefits and are both members of Kaiser Permanente, a California-based HMO. According to Cathy, all her family has received excellent care from Kaiser.

Presently, however, the Thompsons are still living in their house in San Francisco. Their desire to retain their independence as long as possible isn't unusual, but it presents difficulties for a young mother with two small children.

"Right now I'm going down to the city three times a week, but just after mom's operation I was there every day," Cathy said. "I'll usually pick Caitlin up after school at 12 and go down then. I'm hoping that once we're in the new house, they'll be ready to move up here.

"Money isn't a concern with my parents, with makes them lucky, but they are clinging fiercely to the lifestyle they've always had," she added. "I know they'll have to relinquish it soon, and every day it becomes more difficult for them to manage daily living. I'm ready for them. They're just not ready for me, yet."

According to the American Alzheimer's Association, there are 10 warning signs that indicate the beginnings of Alzheimer's.

The most obvious is recent memory loss. Usually the long-term memory remains excellent and can even improve, while things that happened yesterday are completely forgotten. This is what is happening to Cathy's mother. This is usually accompanied by language problems (i.e. trying to find the right word to express something and being unable to remember it.) Dates are difficult to remember; the day, month or even year can be forgotten. Working with numbers can become impossible; small tasks such as checking a bill or balancing a checkbook become frustrating.

Placing items in inappropriate places, like clothes in the freezer or gardening tools in the bathtub, are signs that the cognitive functions are beginning to fail.

Mood, behavior and personality changes, or a loss of judgement, can be more than simple aging. Alzheimer's makes people paranoid and frightened of those who love and care for them.

Loss of initiative beyond the simple trials of aging.

Mary has already experienced a few of these symptoms and because Alzheimer's cannot be reversed at this time, her symptoms will slowly increase. Once Cathy has her parents living with her, she is planning to hire a nurse during the afternoons, so she can return to university and take a Master's degree in Psychology.

Cathy's parents are lucky. They have a daughter willing to be their primary caregiver, and plenty of money to cushion their last years. For those who don't, the oncoming effects of Alzheimer's can be even more challenging.