DEMENTIA STAGES – TIME LINE

While every person with dementia has a different experience and progression. For dementia symptoms that follow the decline due to Alzheimer’s disease, these changes can be tracked in the following way.

Mild Cognitive Impairment: Very early changes noted in areas of forgetfulness, problems in locating lost/misplaced objects and loss of words. Changes cause concern yet mild cognitive impairment does not always progress to dementia. Many elderly people never experience an increase in this level of confusion. (this lose can occur very gradually over up to 10 years)

Very Early Dementia: No longer able to be gainfully employed, may becoming lost in familiar community, experiences anxiety due to having trouble always understanding environment.   Very important at this time to have hearing and vision checked to support the elder in understanding the environment. (2 years)

Early Dementia: Now diagnosed with dementia, possibly of the Alzheimer’s type, no longer able to handle finances, trouble identifying money, no longer able to do meal planning, no longer driving, unable to live independently, flattening of expression  (most noticeable in family group photos), emotional problems, withdrawn, tearfulness and sometimes anger. Starting to have problems with appropriate clothing choices and hygiene. (2 years)

Mid-Dementia Stage: Now need caregiver support for hands on assistance in hygiene, bathing, dressing, toileting, brushing teeth, significant problems with communication uses few words, is now incontinent of urine and beginning to be incontinent of bowel as well. Continues to be able to eat independently but totally dependent in all other areas of eating even cutting food and pouring beverages. (2 years)

Late Stage Dementia: Total care in all areas of life, need to be physically fed all foods, non-verbal, few people can walk at this point,  and requiring to be re-positioned when in bed, no longer moves independently.

Dementia stages vary depending on the disease causing the dementia, most notably in dementia caused by delirium or early onset dementia. The person with early onset dementia who is diagnosed at a young age goes through the dementia stages at a much faster pace.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

 

HOW TO CHOOSE A NURSING HOME FOR A PERSON WITH DEMENTIA Part I

Choosing a nursing home for the person with dementia, is about where the person is in their disease process, as well as what their finances are and will be. The competition is currently very high for nursing homes caring for persons with Alzheimer’s disease.  This climate has brought forward many, very innovative programs. Programs that include plants, animals, special menus and dining options, activity programs for special interests, art, music, and the list goes on.  When a person is in the early stage of Alzheimer’s disease, they are more able to make use of special programs. Later in the disease process the person will have less interest or ability to participate in such programs.

Because many of the high end programs are usually found in private pay facilities, when assessing the elder’s finances, it makes good sense to use those resources when the elder can most enjoy them. Knowing that there is a progression to this disease, and that there is a slow decline, helps in planning. In the early stage of the disease, more funds should be available not only for the nursing facility but also for community events.  Going on outings, shopping, to a movie, out to lunch, to the zoo, etc., these opportunities need to be available.

When visiting a nursing home ask to see the activity calendar. Look for not only internal opportunities but for those outside events. Ask how they are funded, does facility have their own van, do nursing assistants accompany the elders as well as activity staff.

I well remember a nursing home that sponsored an outing to the zoo for its patients. The patients who participated were in early stage of Alzheimer’s disease.  Everything was going fine until the first patient went to sit down on a park bench and missed the bench falling to the ground. About 30 minutes later a second patient did the same thing. (both without injury)  The nursing home administrator decided it was time for this group to return to the facility. Thereafter a group never went out without a member of the nursing department, trained in Alzheimer’s care, in attendance.

Ask if there is a special memory loss unit? Is there a director of that unit? Interview the director and inquire not only about their program but also how they assess their patients for activities. The director should use terms like “person centered care” as well as vocalize an interest in your loved one’s history and “favorites.” Favorite foods, beverages, sports, music, any art interests, and more questions that would help the facility to design a program for your loved one.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

MILD COGNITIVE IMPAIRMENT – NOT ALWAYS EARLY DEMENTIA

“I think mom might have early Alzheimer’s disease” says the worried son. “I saw the other day that she had left the burner on the stove on, and walked into another room.” I wouldn’t worry too much about one incident the dementia specialist said, “sometimes I do things like that myself.”

The dementia specialist is over sixty-five herself, and knows she has a problem with distraction. As a person ages they begin to become more easily distracted. The classic story is always about walking into a room and forgetting what you are there for. If someone talked to you while you were going to get something, or you answered the phone on the way, you became distracted. I frequently remind people of times they might have forgotten where their car was parked.

The concerned son should keep his eyes open for other changes. How is his mom doing cooking? If she always was a great cook and made many things from memory, and still does, nothing to worry about there. If on the other hand she now has problems with things like measuring, getting confused with familiar recipes or putting together a meal, these could indicate a problem.

If his mom always followed the news, and now seems to be having trouble remembering news and recent events, this would indicate a problem. The problem comes when there is a change. If the person never was interested in the news, this is just in line with their personality.

If mom never was much for handling finances, then her lack of money sense is just her. However if mom always knew the price of everything on her shopping list, and now shows problems with handling money, it is time to take a close look.

If mom knows what day it is, doesn’t get lost in familiar places and recognizes people around her, and there are no other noticeable changes, then the stove incident was a simple lapse. Yes, a potentially safety issue, and mom should be as concerned as everyone else that she had this lapse. She should vocalize, that she will make an effort to focus more on what she is doing. But if there are indications in the kitchen that there have been other safety events. Such as burned cutting boards, charred pots, pans, cooking utensils, or possibly missing items because they were discarded after an incident. It is now time to closely monitor mom.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing