The cup is always full

While there is no cure for Alzheimer’s disease, David Troxel ’78 is offering hope and much-needed relief to Alzheimer’s patients and those who care for them.

David Troxel ’78 and co-author Virginia Bell have released “A Dignified Life: The Best Friends™ Approach to Alzheimer’s Care.” According to their website, the newly revised and expanded book “offers hope and help for the millions of family care partners who are affected by a loved one’s diagnosis.The first edition of “A Dignified Life” changed the way the caregiving community approached Alzheimer’s disease by showing care partners how to act as a Best Friend to the person, finding positive ways to interact even as mental abilities declined. Embraced by professional and family care partners throughout the United States, Europe, Asia, the Middle East and South America, the Best Friends™ Approach succeeds because it sustains people’s connection to their world, their loved ones and themselves.”

Most people would say they’ll have achieved ultimate success in their careers when they’re wealthy.

For David Troxel ’78, his ultimate success would be unemployment.

“I will definitely celebrate the day I’m unemployed,” he said, “I’m a big coffee person, so I’ll go work at Starbucks and be a barista.”

Troxel is a dementia and Alzheimer’s disease consultant and co-author of “A Dignified Life: The Best Friends Approach to Alzheimer’s Care,” which has changed the way caregivers and family members help those who suffer from progressive memory loss.

Alzheimer’s disease, a form of dementia, is a progressive terminal illness. Eventually, for a person with the disease, the brain-body connection begins failing. One in four families will be hit by the disease.

“It is a major public health crisis,” he said. “Alzheimer’s is the sixth leading cause of death and the only one with no truly effective treatment, no prevention and no cure. Every seven seconds, someone is diagnosed.”

Yet despite the sobering statistics, Troxel said, caregivers and family members can take a positive approach and help their patients and loved ones live life to the fullest.

“It’s really all about happiness,” he said. “It’s the relationship with a family member or staff member that’s most important. If you can develop empathy and understanding and treat them like a best friend, so to speak, that’s one way to travel this journey.”

He said there is always something a caregiver or a family member can share with someone suffering from dementia or Alzheimer’s, even when that person loses the ability to understand words and language. He said song lyrics and music last longer in the brain than words and language. So a caregiver or family member can play an old song, and the person may recall all the lyrics.

“It’s basically trying your best to determine, ‘How can I set the environment up for someone to have more success and happiness?’ If your mother says, ‘President Eisenhower is doing a great job,’ you say, ‘I like Ike, too.’ Instead of saying, ‘Mom, what’s wrong with you? He’s not the president.’ They’re not going to change – they have a progressive illness. So we have to change our tactics.”

For more information go to bestfriendsapproach.com.

Troxel has worked in the field since the 1980s, back when practically no one had heard of Alzheimer’s disease or dementia.

“You’d say you worked at the Alzheimer’s center, and people would say, ‘What’s that?’ Now, of course, the numbers are staggering – 15 million Americans will have the disease by 2050. When I graduated from Whitman maybe 500,000 had it.”

Troxel majored in politics at Whitman. After earning his master’s in public health from Rutgers Medical School, he spent thousands of hours with people affected by progressive memory loss while working with co-author and colleague Virginia Bell at one of the nation’s first dementia-specific adult day programs.

“At Whitman, I certainly didn’t study Alzheimer’s disease, because it wasn’t widely known,” he said. “I received a job offer from the University of Kentucky Alzheimer’s Research Center. And they hired me, though I really knew nothing about Alzheimer’s. The director at that time said, ‘Sometimes, knowing nothing is a good thing.’ I think my Whitman experience helped me look at a problem like Alzheimer’s, which back then we had no idea about, and think out of the box.”

At first, he thought the purpose of the research center’s day program was to give caregivers a break. The families of many of the people they worked with had labeled their loved ones as “combative, impossible and difficult.”

“One expert from New York suggested that Virginia and I and the volunteers take self-defense lessons,” Troxel said.

He and Bell took a more positive route and built time for those enrolled in their day program to take part in music, exercise, discussion and fun activities.

“They came to the center and thrived!” Troxel said. “They responded to socialization and activity, cooperated, laughed and sang songs. That was an early ‘ah-ha’ moment where we thought, ‘Hmm, environment does matter and approach does matter.’”

From there, Troxel and Bell came up with their Best Friends™ Approach and wrote the book about what they had learned.

“We actually thought that when we published our first book that we would be laughed at and ridiculed throughout the field,” Troxel said. “I said to Virginia, ‘Well our careers will either do well or go off the deep end.’ The book was an immediate success, and it was embraced all over the world.”

In 2004, Troxel’s mother was diagnosed with Alzheimer’s. In order to make time to deal with her illness, he left his job at the Santa Barbara Alzheimer’s Center and started consulting, writing, teaching, designing programs for care centers and educating families.

The approach to the disease that he preaches came in handy for a nurse caring for his mother.

“Knowing 100 things about each person is my mantra,” he said. His Canadian mother liked Earl Grey tea, so when she’d get upset, the nurse would brew her a cup, and she’d calm down and feel as if her caregivers knew her traditions and preferences. When caregivers know the life stories of people with dementia or Alzheimer’s, they can more easily redirect situations toward positive outcomes.

“Socialization is the best treatment for dementia,” Troxel said. “I’m really against use of psychotropic drugs. You wouldn’t take an antibiotic that only works 20 percent of the time, and that’s the rate of effectiveness for these psychotropic drugs. Meaningful activity, meaningful engagement, good health care, good exercise – these kinds of approaches never make it worse, and we find so often they make it better.”

Through his many years of working with people who have progressive memory loss, Troxel’s view of those with illness has changed. He said he doesn’t see them as being as fragile as he once did. “Life is a journey, and people with dementia are sometimes more willing to say ‘yes’ to things than even we are. Try to give the sense of normalcy in life whenever you can and adapt as you can. It’s not only good for them, but good for you.”

Alzheimer’s disease diagnosis

Most of us have those "senior moments" when we forget a name, can’t find our car keys or even forget why we walked in a room. Troxel said that most of the time these are moments of normal forgetfulness, probably caused by the stress of modern life and our tendancy to multi-task.

If someone is worried about his or her thinking and memory, a medical evaluation done by a neurologist or capable physician leads to a diagnosis. The typical workup includes a brain scan to look for stroke or tumor, blood work to look for infection and neuropsychological tests (word recall, counting backwards by sevens or drawing hands on a clock face).

"The person with dementia can sometimes give an Academy Award-winning performance in that doctor’s office for five or six minutes," Troxel said. "That’s why it’s important to tell the family story, discuss unusual or worrisome behavior and find a doctor who will take some time to study the situation. We know enough about Alzheimer’s disease and other dementia to almost always come up with a diagnosis families can have confidence in."