Hello, my dad was diagnosed with PSP yesterday, a friend went with him as I was unable to attend (I have a young baby) He was sent home with a print out about his condition (which he is unable to read) My dad really doesn’t understand what he was diagnosed with and seems very indifferent. Does anyone have any tips in which I can break this to him in a way he can understand? Should I mention it has no cure? He’s been unwell for quite a number of years and only now, finally, he has been diagnosed. He seems quite advanced already and can barely eat meals anymore (he can’t cut up food or chew it) resulting in weight loss. He actually almost choked to death a year ago and was rushed to hospital. I feel frustrated as he won’t listen to advice and is refusing to eat easier foods / have his food chopped up and he won’t accept any carers into his home. He can barely walk and was stranded in the bath for a whole day recently. I’m so worried but I have a young baby, work and I can’t drive. I feel devastated and he seems completely unaware of the severity of his condition. Thanks for any advice.
Advice on breaking PSP to my father in a w... - PSP Association
Advice on breaking PSP to my father in a way he can understand.
Some people deal with PSP by not dealing with it. You could sit with him and tell him what he has. He may choose to ignore the information.
The day the neurologist told Larry and I what he had and his life expectancy I could see Larry shutting down. He wasn’t going to deal with it then. Some time later talking to his cousin Diane she told me that he had said I would tell him what he needed to know. As he declined it got easier to tell him as his limitation slowly increased.
Your father seems like he may be mid stage where he can still functioning well enough. It would help if he let a caregiver into the house to do some things for him. Maybe present it as your needing it for your peace of mind. He would be doing you a favor.
Thank you, Jeff. I’m sorry to hear about Larry.
Yes, I’m not sure if my dad even properly listened to the doctor when he was told? He was told that he didn’t have glaucoma after all and didn’t need to take his drops- so he just seemed happy he didn’t have to apply those (as he never remembered anyway) I’ll try and broach the subject as gently as I can with him and hope he listens (even if he does choose to block It out at first) I fear he’s declining fast as he can’t stand up without assistance and can’t really walk anymore. His vision in the last few weeks has really deteriorated and he can’t see to read anymore.
It’s such a strange disease as no two people have the same course. If you feel he is closer to the end then he probably is. However PSP people are full of surprises.
Yes, I’m just beginning to get my head around it all- it’s all so new. He’s been having symptoms for about five years now, rapidly worsening in the last year and it feels like the puzzle pieces have come together now that he has a diagnosis. I’m hoping he’s not as advanced as I fear!
There is an aggressive form of the disease that only takes about five years from onset to death. He made or may not have that form. All you can do is wait and see if he plateaus.
Fingers crossed he doesn’t. His symptoms have deteriorated rapidly recently but hopefully he stabilises and can gain some quality of life back.
I am the mother of a son who at barely 55 years of age died of PSP, 2017. He chose to NOT being fed about 5-6 weeks after having a PEG installed. The PEG was installed, with my son's permission, because he had gone thro a hospitalization of 8 days with his 2nd bout of aspiration pneumonia. My son was highly formally educated (Law degree from UC Berkeley, Boalt Hall, passing both the CAlif Bar and the Calif CPA). His death came at about 3 years and 3 months after his first symptoms appeared.....Double vision, slurred speech, and heavy fatigue. He went on to have a seizure, to losing all his bodily functions, to being UNable to swallow healthily (hence the PEG), to no longer being able to walk without assistance. He chose that end of life route while under Hospice from his health insurance program.
You do not mention your dad's age, but I deduce old enough to make his own decisions... IF he still has his cognitive faculties. PSP, as you mentioned, is terminal and the medications only help make the symptoms more bearable....not to slow down the progress and sometimes does nothing to help the symptoms.
Prior, did you ever have any discussions with your father about his end of life wishes? If not, based on past conversations, can you deduce what might have been his philosophy/wishes?
What are your expectations, your hopes, for your dad if you he was made more aware of his condition? How are you able to assist? Can you make phone calls? If you get him help do you think he will ALLOW that help in the house? You state he WON'T ACCEPT CARERS IN THE HOUSE.
You mentioned his "indifference". Many of us familiar with PSP recognize that APATHY presents itself as a symptom. Sometimes this disappears, but sometimes not.
You do not mention where you live. IF YOU LIVE IN A COUNTRY WITH UNIVERSAL HEALTH CARE, SUCH AS THE UK, there is MUCH HELP AVAILABLE TO HIM. IF SO I WOULD GET ON THE PHONE AND FIND THE HELP. There is a SEARCH BAR on the top right......write in CHC. If he resides in the USA, not so much medical help unless one can pay OUT OF POCKET or limited assets.
With more time, others will come on this site and give you their counsel and suggestions.
Prayers.............
Los Angeles, CA, USA
Thank you for your reply and all your information. I am so sorry to hear about your son. He was so young. It seems to be such a cruel and unrelenting disease.
My dad i has just turned 70 and we live in the U.K. fortunately. His decision making is dubious as he seems to be showing signs of a form of dementia. He is very confused and struggles with understanding /remembering, hence why I don’t think he understands the condition he has been diagnosed with (which is perhaps where the ‘indifference’ comes from maybe?) He doesn’t even remember what the disease is called (he told me it was called BPC!) he cannot read the handouts he has been given due to his eyesight. His eyesight is very bad now. It’s sad as my dad loved to read and do crosswords etc.
My father has not expressed any end of life wishes. I think I’d have to broach the subject once I feel he understands his situation. I know he would want to stay in his home but we would need to look into care options, as he is alone and I have a young baby (and no other siblings capable of helping to care for him) He would have to accept outside help. Before now, he wouldn’t even let a cleaner into his house (he has been unable to clean for a few years after an accident where he damaged his leg). Before I had my baby I would go and clean his house for him.
I just fear he will never fully understand. His mood has been so down and his lack of mobility has rendered him mostly housebound. I fear he’ll fully give up on life and not even try and make the most of the time he’s got left. I’ll try and help him in any way I can! I’ll do some further research at your suggestion. Thank you again for your advice x
I agree with everyone who has answered you .I would think Dad is blessed to have you help him . you need to make the decision for him. you will have to be strong and tell him that he needs to give in too having carers to assist caring for him .
Since he can't eat he needs to decide on if he wants s feeding tube or not . Talk to him and even if you don't agree with his decision get it in writing .Those of us with PSP are very stubborn.
You are in my prayers. go on line to cure PSP and send for the material on PSP . You are lucky that you live in the UK
You have more options then we do in the USA .Good luck we are all here for you and your dad .
Maria Elena
Thank you for your advice, Maria. I am so sorry to hear your diagnosis from PSP and that you have less options living in the U.S. I am now reading up on all the information I can find. To think I was not aware of this condition until yesterday! More definitely needs to be done to shed light on this disease and to find treatments / cures.
Yes, hopefully if I can get him to understand what he has he will be more receptive to bringing care in. Up until now he has been told he is okay- just has glaucoma and all other symptoms have been attributed to his bad leg. I knew something was wrong and I had to fight them to look into it more.
My dad is stubborn by nature, even before this, so I’m guessing he won’t want a tube. Food was one of his biggest passions, which you would not think now, with all the weight he’s lost.
Thanks again x
Oh dear, so sorry to hear your news but at least you now know what it is.
As you're in the UK you potentially will have a lot of support. GP, District Nurse, OT, Physio, SLT are all there to help you with your Dad's journey.
If you can get an advanced directive from your medical team and work through it so that as and when medical emergencies happen, you ALL know what's what. It will mean that if you aren't there the emergency team will know his wishes. Another important document, if your Dad still has mental capacity, is a Lasting Power of Attorney for Health and Welfare. This will give you power to make decisions for him when he is no longer able to do so. There is also one for financial matters.
I know this is all very daunting but with help and advice from the medical team, it will all fall into place. Equipment will be supplied as needed and removed when superfluous. The NHS gets so much bad press, but my experience is that they are there for us and the support I have had for my darling husband has been invaluable.
So my dear, keep on keeping on,
Hugs
Anne
Thank you Anne. I’m glad that your husband is getting well looked after. I feel that after years of not knowing what what wrong with him (we assumed it was maybe onset of Alzheimer’s) that at least hopefully he will be offered help with living (which he will accept!) although such a bleak diagnosis is still hard to digest. I shall have to look into getting power of attorney and advanced directive ASAP as his mind is really starting to decline.
Thank you for all the advice. I really appreciate your help xx
Apathy is part of PSP
Although my husband changed from a very energetic and enthusiastic man into an apathetic and often confused one he was sweet natured and was very definitely the same man inside. He was aware of what was going on and remembered all the family news.
Your father needs the GP to organise support. You haven't mentioned falls. My husband needed me around.
Good luck. I remember the shock of diagnosis. All the symptoms clicked into place but it was worse than I imagined.
You will need this site.
Love Jean xx
Yes, I feel that my dads personality has completely changed. He’s not like my dad anymore, but in a strange way he is actually more kind now. He used to be quite judgemental and harsh and now he seems to have softened (although extremely stubborn and prone to getting very angry / emotional)
It is strange how everything that has been happening all seems to click into place isn’t it. When I read about the condition I was floored, as I imagine you were too.
Yes, my dad has fallen so much over the last few years- repeatedly cut his head open doing so but everyone assumed it was his sore ankle making him fall- I knew there was more to it so it’s taken two years of me chasing his GP and the hospital to investigate further. I fear and worry constantly for him as he lives alone. My husband and I go around as much as we can but it’s hard with the baby. I’ve possible had a baby at the very worst time.
I’m so sorry to hear about your husband, Jean. Thank you for your help and kind words. I feel like this forum has already helped give me a bit more confidence to take control and help him through this x
Such a difficult time for you all. My husband was diagnosed way before the symptoms your dad is experiencing became apparent and he was in denial for the first year but eventually had to accept the truth and that enabled me to ask the tricky questions about his wishes. He didn't want tube feeding (PEG) had a DNR put in place and with the help of hospice staff had his wishes recorded and his GP was made aware. He chose to refuse hospitalisation and intravenous antibiotic for life threatening illnesses brought about by the condition. In the final year of his life (3yrs after diagnosis) he lost a lot of weight and had to eat puréed food, having carers in was essential even though I was at home looking after him. I think that your dad will eventually realise he needs help and once he gets over the fact he will soon become used to regular visits which will ensure he is being looked after properly and he will build relationships with his carers. Ben was horrified at the thought of being cared for as he was a stoic and indepentant man, I thought he would be a difficult man to care for but it turned out that it was fine as he was very good natured and compliant with any professionals he came into contact with as well as myself. I hope you soon find a way to get to ask the questions and get Power of Attourney to deal with his affairs, both financial and health wise.
Fingers crossed for you
Love Kate xx
I’m so sorry to hear about your husband, Katie. What an awful time you’ve had! I’m hoping that my dad has the ability to think about this clearly when I speak to him. He said he couldn’t remember what the doctor said when I asked and then told me ‘In one ear, out the other!’ Will the doctor look into carers or will I need to do this? I’m hoping he may come around to the idea of having people care for him, as I recently had his home renovated for him as he didn’t want to move (I’ve arranged his house to be more suitable for living downstairs, as he can’t climb the stairs anymore- and we put in a wet room for him) and he loved having the builders in to talk to / send on errands! They are family friends.
Gosh, there is so much to think about. My head is scrambled! I wish I had a sibling to help but my brother is very severely autistic and requires 24/7 care himself.
Thanks for the advice xxx
Pleased you have the living arrangements sorted as that's one of the big obstacles dealt with. Bens care was put in place after he fell and broke his hip so didn't go through the usual channels. I suggest you speak to his GP who can get the ball rolling also ask for referral to the local hospice who can send someone to assess your dad and get outside agencies involved e.g. Occupational Therapist, physiotherapist, Speech Therapist etc. They can also help approach the sensitive subjects such as Advance Care Plan. Your Dad is probably entitled to various allowances and eventually should receive Continuous Health Care but again you will need advice and guidance on this. Ben also had support from the Parkinson's Nurse who also have knowledge of PSP /CBD. The sooner you get the ball rolling the better as your dad will need all the support and help out there. He may also enjoy time at the Hospice Daycar Centre, Ben was horrified when this was first mentioned but he got to really enjoy his day a week there and they were lovely with him. Hope that helps
Love Kate xx.
Yes, because his mobility has been bad for a good few years and he’s had some nasty falls we decided to sort his house out. Thank god, now we know what is wrong with him. I’ll speak to the GP tomorrow so we can get him some help. Will they come to his house? He can’t travel well now and gets very anxious. Yes, I don’t know if I can approach the subject of advanced care with him myself- it would be good if someone else can touch on those for or with me. Gosh, so much to think about. I hope that I can make it all happen for him. I’ll have to see about him going to the daycare place, my dad sounds like Ben in that respect, although, I think me dad would like it too if he gave it a go- as he gets lonely at home. Thanks Kate, you’ve been such a massive help! Xxx
I also found the day centre at the hospice good. They are so caring. Then they provided his palliative care and they knew him well - that helped a lot.
Jean xx
Speak to his GP,s surgery and explain your Dad's predicament, the GP may not have heard of PSP and the PSPA provide booklets for GP,s which you can hand to them. Ben had GP visits in the last yeat of his life but your dad is on his own so probably would be entitled to visits. The Hospice will arrange an introductory visit to assess your dad and then visit on a regular basis and are always at the end of the telephone. He may need a coded key safe so that professionals can get into the property, social services provided ours along with all equipment that will be needed along the way. Once he is on the radar there will be many professionals visiting which is a pain at first but then becomes part of everyday life. If he is entitled to CHC it could fund full time carers living in the house or eventually nursing home costs so something you may need to investigate. Wishing you well and fingers crossed things start to get put in place very soon.
Love Kate xx
Hi Kellsbelles. I see you mentioned it seems he has a form of dementia with dubious decision making. Many patients, like myself, have dementia affecting Executive Functions. This includes planning, organizing and decision making. For the most part we still have our intellect and our memories but a few do have some losses in that department. It's not unheard of to have more than one disorder at the same time, with Fronto Temporal Dementia (FTD) being a prominent one. As well as Apathy, we also have Impulsivity. So you may need to be on guard for him doing things you repeatedly tell him not to do. Please show immense patience at that time as it would be the disease doing it. His brain is dying and he is losing control of all functions. Most of us are being progressively locked in our bodies with minds slowed down but intact and, though we are not children, requiring the physical care like one.
What I experience could be viewed as a brain slowdown. I can still think and process but on a much slowed down time scale. As an example, I used to be a certified project manager among other things. I have a son that is taking additional courses to become certified as a project manager. When he has questions about real life application of what he is learning he asks me and, though finding the information in my head and communicating it is slowed down, I am still able to help him out. Good luck with the carer situation. We have lived our lives independently for so long that its hard to accept that we need the help without feeling a failure. I still find it hard to accept my own wife assuming a caregiver role for me. So I understand his thoughts on the matter completely.
Tony
Ahhh Tony, your response made me cry. Thank you for taking the time to reply. I feel so sad that this illness makes you so aware of what is happening to you. I don’t know what it worse- being so painfully aware or not having a clue. My dad too is very intelligent and was working up until a four years ago when I suspect the early days of this disease stole him of the ability to work / drive. I know he is devastated he can no longer read and use his computer / phone as this was a great passion of his. He used to laugh at me for my lack of tech knowledge despite being so young and now he can’t even use them for their basic functions.
My dad is very impulsive and doesn’t listen to reason willingly! I do try to be patient with him- my only frustrations are at actions that cause him to injure himself- but I now understand better the reasons behind this. I wish I could keep an eye on him all the time really but sadly that is not an option.
You are lucky to have your wife and family supporting you through this, Tony and they are lucky to have you too- supporting your son in his career is amazing! I could only dream of that type of support!
Thanks again for all of the advice! x
So sorry to hear about your dad. My mum has PSP and lives in Sussex. She is very weak now she lost her eyesight totally in January and cannot even move without help which has come on very suddenly but my dad is amazing and she is my hero as she is so brave. As you are in the Uk I would recommend going through your dads doctors and see if they can put you in touch with your local hospice. They are amazing and maybe your dad could go to day care but not sure his mobility. If not they can provide advice and help at home. My mum has her dr , but the hospice lady comes in also and they can discuss various decisions to make I. E do not resuscitate request and PEG decisions as and when required. My mum is trying to fight a uti and they have sent nurses in to check on her. They can also provide equipment to so please contact them
Ahead of purchasing any aids. I have a young son and live 2 hours away so I can feel for you with a young baby. Sending you all my best wishes xx
Thank you mav46 I’m so sorry to hear about your mum- I hope she fights off that UTI very soon.
I will be contacting my dads doctor on Monday. So scary to have to discuss all of this stuff isn’t it. Im in over my head tbh as I suffer from quite severe anxiety so this is pushing me right out of my comfort zone. Obviously, I would do anything for my dad so I just have to focus.
I’m not sure my dad will be handle it as well, as being alone he is already very down about life. I feel so bad that I can’t help him more. I wished I could have known sooner to put off having a baby. X
It’s so hard and to have a little baby is exhausting enough but you need to instigate help there’s plenty out there. This site is fantastic for advice. It’s so hard if your dads alone but if you can get a hospice involved they are literally like angels. Take each day as it comes my friend and just take care. Where in the UK are you ? Also make sure you get in touch with PSPA uk they hold regular meetings and another lifeline if you need advice. Big hugs everyone on this site are so supportive xx
Hi Kellsbelles. I'm in the UK (Hampshire) and caring for my mother who almost certainly has CBD which is like PSP. I've had to make the diagnosis myself as we've had a nightmare of wrong referrals. If you apply for attendance allowance he should get the higher rate. It's not loads but I've used it to persuade my mum that it can pay for a few hours. In her case I waited until she described something that she couldn't do any more that she wanted to -having a shower - and said she could pay for someone to come in the morning, bring in the milk and help her get dressed. They start next week! When my mum has problems I just say that her brain has stopped talking to her legs/ arm etc properly. I also keep reminding myself when I get annoyed about something that her appropriateness filter doesn't work anymore (others will have different behaviours). It definitely helps me to think in terms of parts of her brain not working properly or working slowly. Keep following this group. They are massively helpful!
Oh gosh, it’s so frustrating fighting for a diagnosis isn’t it. I didn’t know what my dad had but for the last few years i knew there wasn’t something right with him and his brain. Took a lot of harassing doctors to get someone to take notice. I’m glad your mum finally has some help now! It’s a wake up call knowing what’s wrong and how to approach it. You sound like you are very clued up and understanding of your mum’s condition. She is lucky to have you x
I just wanted to say hello and give you a solidarity wave. I’m my dads only child, he has been divorced from my mum since I was young and I too have a young child and don’t drive.
We are reaching the end of Dad’s journey, but it has been 12 long years since a fairly early diagnosis. He went from living independently, to having carers come in four times daily at home, then to a warden-assisted flat, then a residential, then nursing home. Even if he is resistant to doing what needs to be done you MUST make sure that he does what is recommended to keep him safe and keep your peace of mind. Before my dad went into care he was having multiple falls and I was always worried, I paid his bills, did all his life admin and ordered his shopping online. After he was somewhere safe it was a huge weight off my mind.
Feel free to message me if you want, I may not have the answers, but I’ve been there and can offer my sympathy.
Hello Mikocat. Thank you for reaching out. I appreciate it. Your life seems to parallel mine in many ways- from the admin / shopping to the not driving!
I am so sorry to hear about your dad. 12 years is such a long time compared to the prognosis. Wow. I doubt my dad will reach that but I can hope. We looked at moving my dad into a flat / somewhere smaller but he took equity out on his home which made it financially impossible. He chose to change his house so he could live downstairs which we are still doing. He was only diagnosed a couple of days ago. I do worry about him alone all the time- I can’t call him to check as he can’t answer his phone now- maybe he needs a special phone? I’m going to push for some care to be provided to him and go from there I guess. I’m seeing him tomorrow to tell him about what he has properly and so he understands. I feel so nervous and sick about it. I wonder if the doctor he saw even knew my dad wasn’t fully comprehending him? My dad told me all he remembers is that they made him take his clothes off so they could take pictures of him!
Thanks again x
Hi, I am very sorry. We did not tell my aunt what she had. She did know she wouldn’t be able to walk or eat at some point . Her level of understanding was low due to cognitive impairment from the disease. Not certain there was any benefit telling her she would die soon. She prob had an idea she would. It’s a tough call and personal one.
Yes, I’ve just been to see him today and I just couldn’t bare to tell him. I was honest and said there was no cure and it was progressive but I avoided the full bleak prognosis. I’m not sure how much went in though. We shall see. Thanks for answering x
I feel badly .. my aunt passed away 4 months ago.. towards the end she couldn’t see , couldn’t swallow and couldn’t walk. Over time cognition declined terribly. I did talk to her, all the time, as if she could understand up until the end. I reassured her I loved her all the time. I spoke often of the old times and I would talk about current stuff happening. I have to believe she knew she was dieing. There were times when she tried to communicate but it was too difficult to understand . I did ask her if she was getting tired and giving up.. I also told her we would keep her comfortable in regards to pain. Even before she got real bad , I don’t think she understood what the doctors told her about PSP. They did tell her she wouldn’t walk and swallow. That’s how I left it. She never asked about it . I just didn’t see benefit telling her she would die. Reassuring her of love and reassuring her she wouldn’t be alone were more important . She passed away about 4 years after diagnosis . Although symptoms were seen about 3-4 years previous to diagnosis.
If he wanted to know more he would ask. I don't know what benefit there is for him. We have the right to deal with things in our own way. I have to know and so Chris heard me asking all the details. He didn't talk about PSP with me but we discussed his wishes for end of life care - organised by the hospice. That included DNR and where he preferred to die.
Remember denial is a legitimate way of coping.
Love Jean xx
Hi Kellsbelles, welcome to the club! After the initial relief of having a diagnosis, the reality kicks in I'm sorry to say. Like you, I was surprised Mum didn't want to know too much after her diagnosis given that in the past she would want to know every last detail about things.
If you haven't already done so, please speak to the PSPA helpline, they've been really lovely and helpful. Not just in explaining more about the disease but really practical too. They were able to liaise really quickly with the DWP so someone went to interview Mum about Attendance Allowance. pspassociation.org.uk
Has your Dad's GP referred a Parkinson's nurse for him yet? Although Mum had to wait a few months before she saw one, the speed which the nurse them was able to liaise with OT, SLT, physio and hospice nurse was quite amazing. They were also well aware that she lives on her own (I'm 4 hrs away) in a totally unsuitable cottage and adjusted her needs accordingly. As others have said, now is the time to sort out Lasting Powers of Attorney, the government website is simple and clear to use gov.uk/power-of-attorney
Good luck!
Thank you for the advice! I need to speak to his GP but she is away this week. I’ve asked someone else to phone me back today. His doctors surgery doesn’t seem the best / proactive so I’m thinking I’ll have to do a bit of chasing up!
My dad asked a few questions but he didn’t ask about the full prognosis. He was more concerned with knowing he didn’t have glaucoma! Still thinking he doesn’t realise how serious it is, but at least I’ve made sure he’s a bit more aware of his condition.
Wow- you have already gotten so many caring and thoughtful responses! So sorry you and your dad are now in this unfortunate club. My mom and I are in Utah (USA) and she is now in an assisted living facility, minimally mobile and quite limited as far as what she can do (the TV remote is a challenge). She can talk, with difficulty.
I have a couple of practical suggestions. My mom also did not really “get” the diagnosis at first and seemed apathetic (like with most things now). But she would periodically ask about it and I would always remind her that like the doctor said, the first “P” stands for progressive, which means things will not get better, they will get worse. My brother started talking about this as a journey, and we use that analogy quite a lot. “Looks like needing to be in the wheelchair whenever you leave the room is the next step in this journey”, etc. It’s been very helpful.
The other thing I can suggest is trying some sort of “Alexa” device to replace the phone. My mom hasn’t been able to use her phone for a year or so, and so we placed a “dot” near where she typically sits. From my “Alexa” device or my phone I can “drop in” on her and we can talk. Her weak voice/poor articulation at the is point make it impossible for her to make an outgoing call, but it does let us communicate.
Hang in there. It’s not an easy journey, but you will get good advice here.
I know all the responses have been amazing. I feel a bit more confident about handling things now.
Yes, without scaring my dad I want him to know that things won’t get better, just so that it may encourage him to be a bit more receptive to outside help, as I don’t want to feel like I’m forcing it on him!
I was actually thinking of getting him an Alexa device. I’ll need to wait till I’ve started back at work (I’m on maternity so I have no cash) but I think that would help him greatly! Glad it has benefited your mom.
Thank you 💜
Wow 👍🏼about the some sort of "drop in" device. My husband has so much trouble with the phone😬Every second I need to get it back to where we started . I need to find out what a 'dot' is😄Thx
A "dot" is another name for the Alexa device. If you say it's name it starts listening and talking to you. So, you say "dot" when talking about it but don't want it to activate.
You can also connect it by Wi-Fi to many smart devices like lights, thermostat, garage door, electric outlets, TV's, microwaves, small appliances and even a refrigerator that can order food for you!
I also was asked by Amazon to be part of testing for one in the car! However, my voice is becoming softer and more slurred/garbled all the time and sometimes the Alexa devices do not hear me call them. That can be frustrating.
On a daily or regular basis I have it tell me the current weather and forecast, tell me the date and time, read a book, read the news, play verbal games like 20 questions, set alarms, list and remind me of upcoming appointments, tell me of expected package deliveries, tell me a joke, play bible readings, recite the rosary, tell me "good morning" and "good night", and ask how my day went. I'm becoming more housebound and finding many more uses for it.