Embarrassing, Uncontrollable, But Common: A Side Effect From Stroke That Leaves You Laughing Or Crying

Mention stroke and you might think of physical side effects like paralysis or muscle weakness. Or there are cognitive issues that make it difficult to speak. There are other side effects—cognitive in particular—that are possible, too.

A common cognitive post-stroke side effect is called pseudobulbar affect, or PBA for short. It’s a brain disorder that causes uncontrollable crying or laughing. These unintended emotional outbursts can be extremely embarrassing for everyone involved. Here’s what you should know.

Totally Unintentional

Often people who observe stroke victims with PBA think that there’s some exaggeration going on. The responses seem inappropriate. One thing’s for sure: the response does not represent this person’s true feelings.

Unfortunately, someone with PBA might cry when hearing good news. Or they may suddenly burst into a sobbing fit while they are laughing. Something only mildly sad can cause them to become hysterical.

Even more alarming, someone with PBA can have these spontaneous emotional outbursts without any trigger at all. And perhaps most troubling of all is that these episodes can happen up to 100 or so times daily.

Not Well Known

The unpredictable nature of PBA can be embarrassing for those who have the condition, as well as those who care for them. Many older adults experiencing PBA simply become unwilling to be around other people.

Although more than half of all stroke survivors report having PBA symptoms, less than 20% of them know the cause. In most cases, they’ve never even heard of the condition. Life for them becomes frustrating and sometimes devastating because they have no idea why this behavior is happening to them.

What Causes BPA?

The condition occurs when a stroke damages areas of the brain controlling how emotion is expressed. The damage short circuits brain signals, causing involuntary episodes of laughing or crying. And, since it’s a short signal, the laughing or crying is usually highly exaggerated.

Although stroke is the likely cause of PBA, it’s also a side effect caused by other neurological disorders—including dementia, and Parkinson’s disease.

PBA causes uncontrollable crying, so it’s often mistaken for depression—and this is a condition that many seniors experience. As a result, PBA might be misdiagnosed. Both PBA and depression are conditions that can last for extended periods of time, so it’s important to make sure a correct diagnosis is determined.

There are specific medications to treat PBA, but a medical professional also may prescribe an anti-depressant. Both can help to suppress the involuntary emotional outbursts, but it may not be possible to stop them completely.

How to Help Prevent Elder Fraud

What is elder fraud? It’s when unscrupulous people take advantage of senior citizens. It affects nearly 40% of those of us over the age of 65, and the loss is over $36 billion annually.

How does it occur? Some of it is going on right under your nose. It includes things that don’t necessarily have to be confusing for seniors, such as misleading financial advice, hidden fees or subscriptions, or even fake dietary products. Here are a few things you need to know.

The 3 Main Types of Elder Fraud

  1. The largest type of fraud is financial exploitation. It’s the cause of nearly $17 billion in annual losses to seniors. Much of this comes as junk mail or unsolicited telemarketing. Scammers defraud seniors by getting consent to take their money.
  2. Seniors lose another $13 billion because of criminal fraud. At the top of the list is identity theft.
  3. Tragically, caregiver abuse contributes another $7 billion in annual losses to seniors. This is not physical abuse. It’s when a trusted person uses their relationship with a senior to inappropriately use finances or even outright steal money.

Who’s Most at Risk?

You might think that seniors with memory issues are the biggest victims of elder fraud. Statistics may surprise you.

  • Studies have shown that thrifty seniors are 5 times more likely to be at risk because they’re attracted by the bargains that get pitched to them by scammers.
  • Ironically, extremely friendly and sociable seniors are 4 times more likely to be defrauded. Experts believe this is because they’re more approachable and tend to give strangers the benefit of a doubt.
  • Even financially sophisticated seniors are at risk. Experts have discovered these seniors tend to lose more due to fraud because they’re comfortable with larger amounts of money.
  • Seniors who receive one or more telemarketing phone calls a day are 3 times more likely to experience a financial loss due to fraud than someone who only gets an occasional telemarketing phone call.

Prevention

The easiest way to keep elder fraud at bay is to check on a senior’s financial situation regularly. There are enough scams to worry about already, but it’ll be in your best interests to start paying attention to those that are particularly aimed at seniors.

You can cut down on telemarketing and potential scams by helping seniors sign up for the National Do Not Call registry. It’s a free service provided by the Federal Trade Commission. You can register online or call 888-382-1222.

FAST: The Acronym Every Senior and Everyone Who Is Around Seniors Should Know

According to the Centers for Disease Control and Prevention, a stroke happens every 40 seconds. They take the lives of over 140,000 Americans every year—at the pace of 1 person every 4 minutes.

Seniors are more prone to strokes, and quick medical treatment is absolutely necessary to increase survival. What does FAST have to do with strokes? Here’s what you need to know.

Early Action

The chances that you will survive a stroke increase when you receive emergency treatment as soon as possible. The Centers for Disease Control and Prevention (CDC) report that people who get treatment within 3 hours of the first symptoms of a stroke experience less disability than those who receive delayed care.

The CDC also reports that nearly 75% of all strokes occur in people over the age of 65, making it the 5th leading cause of death in our country. The American Heart Association reports that while the percentage of strokes has increased as a result of heart disease, the actual number of stroke deaths has declined. This is largely due to FAST.

What is a Stroke?

Strokes occur when the blood flow to a certain area of the brain gets cut off. The cells in this area of the brain begin to die because they are starved of oxygen. The resulting damage causes loss of muscle control or memory. Serious strokes are fatal.

Here’s the thing about a stroke: they may not be obvious. Television and movies may be entertaining, but they aren’t always realistic. Transient ischemic attacks—also known as mini strokes—have symptoms that are short-lived or may even spontaneously resolve.

FAST

There are 4 common signs of a stroke, and that’s where FAST comes in. These symptoms often appear suddenly, so if you see them in a senior—or someone of any age—it’s important to get immediate medical help.

  • Face: Ask them to smile. Does it appear uneven?
  • Arms: Ask them to raise both arms and hold them level to the floor. Does one arm drift downwards?
  • Speech: Ask them to repeat a simple phrase, like “Let’s have tacos for lunch today.” Do they slur their words, or maybe even miss a few?
  • Time: This isn’t a symptom—it’s a reminder of what to do. Fast medical treatment is crucial. It’s time to call for emergency medical help.

Make a note of the time if you should happen to notice any of the FAST symptoms. This piece of information is important to medical professionals. Clot-busting drugs called tissue plasminogen activators reduce long-term disability for certain kinds of strokes. This type of medication, however, is approved for stroke treatment only if given within 3 hours of the onset of symptoms.

Take As Prescribed: Why Seniors Fail To Follow Medication Schedules

It’s not just seniors. The New York Times reports that at least half of the medications for chronic diseases simply aren’t taken as prescribed. That’s a serious issue for a person of any age, but it can have even worse consequences for seniors. It’s estimated that 10% of hospitalizations for seniors happen annually because of missing medication doses.

Here are the three main reasons why seniors decide not to take medication prescribed to them, and suggestions on what to do about it.

1. They have difficulty understanding the cost

Not all prescription medications are expensive, but much of it is. Many seniors know that they are on a fixed and limited income, and sometimes they decide it’s a better idea to take less than what has been prescribed.

While it may make the prescription last longer, it can make the benefits of the medicine far less effective—or even totally ineffective. If it’s possible, find out whether this is why a senior is skipping taking their medications. It may be necessary to have a frank discussion with them, reminding them that they’re really not saving money. It will cost far more in hospital or medical bills if their condition is not kept in check.

2. They don’t believe there’s any benefit

Serious health conditions like a heart attack or kidney failure often have a long recovery period. During that time, it may not seem as if the daily medications prescribed are doing anything at all. Seniors may start to lose faith that they indeed will get better. Even worse, taking regular medications is a daily reminder that they are not well.

Keep an ongoing dialog with seniors about the medications they’re taking. Remind them that the medicine works best with a healthy diet and lifestyle changes. Point out improvements you see, which they may not. This can help to associate taking the medication with gradual health improvements.

3. They think there’s no longer any reason to take it

Sometimes it seems like a waste of time—and money—to take a medication if you’re feeling better. That’s always a decision best left to a health professional. Often, medications must continue to be taken even after a senior recovers from a health crisis.

No one is likely to appreciate hearing that they’ll have to take a daily medication for the rest of their lives. Seniors may exercise curiosity and decide to stop taking a medication to see if it changes the way they’re feeling. And, they probably will continue to feel fine for the short term.

The problem with this false sense of wellbeing is that they won’t really be able to determine whether drugs that treat conditions like heart disease or high blood pressure are working or not. Many health conditions in the elderly have few or no noticeable symptoms.

The most important thing to remember as a caregiver is that most seniors do not purposely skip medications with the intention of harming themselves. Many times, they simply need a reminder or reassurance that it the medication really is good for them, regardless of what they can or can’t feel.

Balance Exercises for Seniors

More than 2 million older Americans end up at the emergency room because of fall-related injuries every year. There are many related causes, but the majority is because seniors just don’t get enough exercise.

Regular exercise is a crucial part of maintaining health and mobility for older adults—especially those who are in memory care homes. Balance exercises are especially important because they can help to prevent falls. Here are two exercises that caregivers can help seniors perform. They’re simple, and they require no complicated or expensive equipment.

1. Standing on One Foot

Either you or a sturdy chair that’s not on wheels will be the only assistance required for this exercise. Have the person stand behind the chair, or extend your arm and tell them to hold on to it.

Then, have them raise one of their legs off the ground. The easiest way is to ask them to bend their knee, so that their foot comes up behind them. It only has to be a few inches off the ground. The objective is to have them standing only on one foot.

Ask them to hold this position for 10 seconds. Tell them it’s fine if they want to rest their hand on the hip of the raised leg. This might assist in their feeling of a comfortable balance. Be sure to watch for their stability, and be ready to assist them if they start to fall. Ask them to repeat this motion 10 times, and then switch to the other leg.

It might seem as if this isn’t even really an exercise. It’s helping the participant to utilize the muscles in their standing leg and back. They’ll be focused on keeping their balance, and that’s what you want to help them retain.

2. Heel-to-Toe Walk

Your exercise partner might not even believe that this is an exercise—and that’s one of the benefits. Have them do this exercise near a wall, or assure them that you’ll be right next to them to offer a steady arm.

Have them position the heel of one foot directly in front of the toes of the other foot. This will work best if they actually have the heel of the front foot touching the toes of the trailing foot. Then tell them to take the back foot and place it in front of the front foot. Make sure they’re not looking down at their feet. Ask them to focus on a spot directly in front of them.

Speed isn’t what you’re after here. You want to help your exercise partner maintain a slow and steady movement as they concentrate on placing one foot in front of the other, taking about 20 or so steps. The exercise helps them think about foot placement and balance.

These two exercises help seniors to maintain—or even regain—their sense of balance. It allows them to feel surer of themselves as they move about. A better sense of balance can help to prevent fall-related injuries by building strength, flexibility, and endurance. Best of all, they don’t even really seem like exercises!

Understanding Sundowning

It’s not depression. It’s not a disease, either. Sundowning is actually a group of symptoms. In combination, they often mimic depression—and it’s also easy to think of it as a manifestation of dementia. Especially when studies report that 1 in 5 seniors with Alzheimer’s disease experience increased depression, agitation, and confusion toward the end of the day.

More study is needed. The exact cause of sundowning still isn’t known—but there are factors which contribute to it that can be controlled.

Reduced Light

Vision becomes even more challenging for the elderly as the sun’s natural light fades. Many are already challenged with impaired vision. Shadows and decreased lighting can cause confusion and fear in seniors with dementia.

Gerontologists also postulate that dementia alters the part of the brain that controls the need for sleep. The reduced light may also cause unintended disturbances to their biological clock, making difficult to separate dreams from reality, as they’re no longer sure when to sleep or be awake.

Fatigue

The setting sun often coincides with a culmination of physical and mental exhaustion for a senior. The rapid mood changes and uncooperativeness some seniors express may actually be frustrated reactions to the wear and tear of the day—which is also something that caregivers are feeling.

This last point is worth examining further. Sundowning often happens during a point of increased activity in a senior living facility. It’s usually when there’s a shift change. The increased activity and pace of people coming and going may be unsettling for some seniors.

Ways to Lessen the Potential Causes

If you’re aware of the possible triggers of sundowning, you can help to lessen its impact. Routine and activities have been shown to help. Keep seniors who show signs of sundowning on a consistent schedule of sleeping and eating. Plan regular activities for them throughout the day—especially things that get them outside and into the sunlight.

Remove stimulants from their diet if possible. Move caffeine and sugar intake to the start of the day so it won’t amplify the things that contribute to sundowning later in the day. Stimulation isn’t always a bad thing. Use it to build familiarity. Music often helps when seniors show signs of sundowning.

Finally, pay close attention to lighting. The objective isn’t to keep the night at bay. Poor lighting, however makes environments feel unfamiliar. That can be extremely stressful. It’s also important to remember that a senior exhibiting the symptoms of sundowning has not willfully chosen to act that way. Your actions often will determine their reactions.