Recognizing Dementia When it Strikes!
Carole Larkin - December 10, 2012 08:55 AM
This past week a friend of my business partner called and asked for my help. She had been given my card two years ago. Her 80 year old mother Brenda (all names have been changed for privacy purposes) lives alone in a northern suburb of Dallas. Her daughter, (I’ll call her Niki) travels most of the time for her job. Currently she is on a one year assignment on the east coast. Her brother lives on the west coast. Niki knew that Brenda had a “few memory problems” but until she went on a cruise with her this spring, did not know how extensive Brenda’s problems were. Now she was worried about mom and wanted us to assess her situation and to work to have Brenda safe and cared for. She told us that she and her mom have had a rough relationship for years and years, and that her brother was the favored one. Her brother claims Niki’s fears are overblown and nothing is wrong.
I went to do the assessment and found signs of dementia everywhere. There were bills on the kitchen table that were paid twice or not paid at all. On a number of the envelopes Brenda wrote “I don’t understand”... I found papers scattered around the house from the time of her husband’s death in 1991 in plastic bags sitting on the floor. We found a check for $16,000 in one of those piles of papers.
She complained of people calling her all day long and bothering her, especially the phone company, and she didn’t understand why the phone company would call her three times a day and ask her to call them back and pay them money. We found her latest water bill, over $800. It showed a previous balance not paid. What was Brenda’s reaction to the bill? She looked all around the outside of her house for leaks and didn’t see any, and was upset that her water bill was so high.
She said that she stopped cooking and that she drives to her favorite restaurant a few times a week to eat a nice big lunch of meat and vegetables so she has nutritious meals. However she’s lost 12 lbs in the last 3 months. She knows that she needs to drink fluids, but admits that she rarely does. (Dallas has had a streak of forty continuous days of temperatures over one hundred degrees.)
Brenda says that she’s worried about her competency driving, so she only drives around her neighborhood (one to two miles, mostly of four to six lane roads). “By the way, “she says, “could you help me find my driver’s license? I’ve lost it. And I’ve lost my health care insurance card too. And while you are here, can you look at the TV? It hasn’t been working” (the power switch was off).
She doesn’t like to take medicine so she quit taking it. She feels fine though. I found a copy of her latest visit to her primary care physician. (8/1/11). Diagnosis’s included anemia from post gastrointestinal hemorrhaging, history of breast cancer (within the past three years), abnormal electrocardiogram, depression, elevated cholesterol, osteoporosis, and more. I did not find the second sheet.
Have I given you a good enough picture of her state of cognition? Oh, yes, I also gave her a dementia screening test. It showed deficiencies in attention, visio-spacial attributes, working memory and delayed recall. Not horrendous, but it showed clear deficiencies.
She was lonely she said. Her friends have abandoned her. But while I was there she turned down an invitation to play bridge and asked the person who called her to call her bridge partner and tell her that (Brenda) wasn’t going. Brenda had lost her bridge partner’s telephone number.
For the following two days she called me and asked me to come over to her house as she had a major problem to discuss with me. I ended up buying her chicken rice soup and crackers one day and helping her pay a bill the next day. She was happy to see me. Did I mention that she was lonely?
I made an appointment for her at her primary care physician’s and wrote him a letter explaining that we needed either a preliminary diagnosis of a dementia and referral to a neurologist , or if he wished to do it himself, a “fully baked” diagnosis. I was to take her. We discussed lightening her stress by having someone do her bill paying for her, under her supervision of course. She agreed to that. Once we figured out what her income and assets were, (as she had no idea what either of them currently are); we were then planning to either hire a home care companion to monitor her taking of her medicine, cook for her, encourage her to drink fluids and provide companionship for her or find an appropriate assisted living community for her.
However, this morning she decided that she didn’t want to see me ever again and “fired” me. Her daughter said that there was nothing she could do about that, and her son was happy. I’m sad for Brenda and her family. There was a chance of less stressful, calmer days ahead for all of them; now that’s gone. A crisis will occur and I’m afraid the outcome will be the one that no one wanted. Brenda may just spend the rest of her days in a nursing home. I think it’s such a shame.
I think procrastination and denial when it comes to these diseases is not a useful coping strategy.
Update: One year later. The daughter started having a caregiver come into the home 4 hours a day for a couple of days a week a couple of months ago, and now is preparing to move her mother to an assisted living near her on the east coast.
The daughter was lucky nothing major happened in between.
Click here to read Carole Larkin’s article, “Why Does Grandma Wander? : Understanding Coping Mechanisms of Seniors with Dementia.”
Carole Larkin MA, CMC, CAEd, QDCS, EICS is a geriatric care manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. Her company, ThirdAge Services LLC, is located in Dallas, TX.
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