Mom, what's wrong with Nana?

Alzheimer's can be baffling to anyone, but for young children and even teens it can be especially hard to grasp all that's happening to someone who has played a central role in their lives. But because Alzheimer's can have a profound impact on family life, it’s important to talk with your children about the disease as soon as possible and help them to understand how this disease will probably have to change the relationship they’ve previously shared with that loved one.
You should expect that your children will have a strong reaction to the news of their loved one's Alzheimer's diagnosis. "Both the five-year-old and the fifteen-year-old are going to be alarmed and stressed, and as grandpa or grandma drifts away they're going to face feelings of bereavement," says Richard Powers, MD, associate professor of neurology and pathology at the University of Alabama at Birmingham School of Medicine and spokesman for the Alzheimer's Foundation of America. "It's important to explain that while grandpa may not remember your name, he still loves you as much as the first day he laid eyes on you, and you need to reach out to the part of the person that's still intact."

To choose the right words to explain a loved one’s Alzheimer diagnosis to a child, first consider their age and modify the conversation to make it age-appropriate. The following tips can help you to do just that:

• Younger children - when talking to a younger child about a loved one's diagnosis, you won't necessarily want to use the term Alzheimer's disease. "I recommend parents say something like, 'Grandpa is having problems with his memory or he is unable to think as well as he used to think, so sometimes we'll have to help him with his thinking or his remembering,'" says Barry J. Jacobs, PsyD, a psychologist, faculty member of the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa., and author of The Emotional Survival Guide for Caregivers. You should mention that the person with Alzheimer’s will get sicker over time. Then, if your child seems to have a good grasp of what's already been explained, you could prepare him for some of the changes he will see in the person with Alzheimer's by going over symptoms and how to handle them appropriately.
• Teenagers - will be capable of understanding more than young children, so you should share details of both the progression of Alzheimer's disease and the treatment options available. "For teenagers, we developed a more sophisticated program that actually gets into the brain pathology," says Dr. Powers. "Often, teenagers will end up playing a role in caring for grandpa or grandma, so it is important for them to know as much as possible up front."

Reassure children that Alzheimer's disease is not infectious as you answer their questions and acknowledge their feelings. Make sure they understand that the dementia patient still loves them and wants to see them, but don't force them to visit if they are very resistant or uncomfortable with the situation.

There are a number of emotions children and teens might experience after hearing of their loved one's Alzheimer's diagnosis, including:

• Sadness and a sense of loss
• Confusion or fear about behavioral changes
• Worry that Alzheimer's is contagious, or that their parents might develop the disease
• Anger or frustration because they have to repeat questions when interacting with the dementia patient or help with caregiving tasks
• Remorse over their anger or frustration
• Embarrassment and not wanting to have friends over if the Alzheimer’s patient lives at home with them

These emotions can also be expressed in ways that are less obvious. The child or teenager might act out by:

• Complaining of vague physical discomfort, like a stomachache
• Performing poorly at school
• Spending more time away from home
• Refusing to invite friends over

Parents should respond with unconditional love and support, allowing their children to work through their feelings and answering all of their questions as honestly as possible. Family-related activities like sorting through old photographs or making a family tree also might help by reinforcing the child's connection to their loved one.

Above all, don't force kids to do things they are not comfortable doing. This could include being present for medical exams, participating in daily care (like toileting), or making visits to a nursing home rather than visiting the person with Alzheimer's at a more neutral or familiar location.
Hearing of a loved one's Alzheimer's diagnosis is tough. Explaining it to kids can be challenging for you as well. But following these tips, and customizing them to your specific situation, can be a great step in the right direction. Opening the lines of communication will ease the transition for everyone, no matter