TALKING TO YOUR DOCTOR ABOUT DEMENTIA

Talking to your doctor about dementia requires thought and much planning. Making vague statements like “I seem to be having trouble with my memory,” or “I don’t remember things the way I used to,” will only bring a response of, “what do you expect at your age,” or “we all have those moments when we forget as we age.” When you talk to your doctor about dementia, you need to keep in mind that this is the first conversation.

Doctors today are working under a very tight schedule. A recent analysis of office visits found that patients when first speaking their concerns, only speak for 12 seconds before being interrupted by the doctor.  The doctor must now account for every question and answer in their electronic record which is then tracked by national organizations.

If you have been seeing this doctor for high blood pressure, he will have to ask you if you have been taking your medication, monitoring your blood pressure, any symptoms, etc.  All the while you sense the time slipping away, while you haven’t talked about what you came for, your worries concerning dementia.

To stay on track with your concerns you must:

  • Come prepared – you need to have a written account of what you have been experiencing. The book The End of Alzheimer’s is a very good resource for creating this account. In reading the many case studies, you can make your own notes on your experiences. A woman in the book, Eleanor, describes how she first noticed “facial blindness,” where she no longer recognized faces, she lost her mental clarity later in the day, she was having more difficulty following complex conversations and movie plots, she had problems remembering words, etc. Reading other people’s accounts of their loses, can lead you to write a very specific account of your own memory loses.
  • Bring someone with you – someone who you have confidence in, who will speak up and be able to clearly state that they have witnessed these changes in you as well.
  • Come with a plan – if you have been reading The End of Alzheimer’s you can begin by stating what you have already done on your own. Give a written account of the steps you have taken to; change your diet, reduce your stress, ensure quality and adequate quantity of sleep, and removed toxins from your environment. Sharing the steps you have already taken demonstrates to the doctor how serious you are about your mental health.
  • Know that you will have to have follow up appointments, unless the doctor is totally un-receptive to your goal of fighting dementia. In that case you will have to find another healthcare practitioner to help you. A doctor who is open to the idea that dementia isn’t going to be cured by a magic pill – someday.

Virginia Garberding RN

Certified in Restorative Nursing and Gerontology 

SUDDEN INCREASED DEMENTIA CAUSED BY INFECTION

Her mom was diagnosed with mild dementia, but now she has significantly increased dementia. And it has happened so suddenly. From being able to walk independently around her neighborhood, handling her own finances and even helping with her granddaughter. To suddenly not only was all of that gone, but now she is unable to speak, only babbling incoherent sentences. Mom is now total care with all of her needs from dressing to toileting and eating.

The first sentence she wrote me said it all, Mom is 88 years old and has had a urinary infection. At her advanced age, and with already a diagnosis of mild dementia, it is no surprise that she has had an increase in her dementia since being sick. The urinary tract infection was resistant to several antibiotics and after the 5th try her blood still shows a low grade infection.

Once the elderly person has a decline in cognitive function due to infection, the person even after the infection is resolved never returns to their previous level of function. And this mom just hasn’t recovered from the infection.

Preventing a infection is the only sure defense against this type of sudden increase in dementia. Taking advantage of the things we know that prevent infection. Taking a oral probiotic daily, especially something fermented such as sauerkraut. Taking a vitamin D supplement as well as an Oregano capsule. We have all now seen the chicken commercials from Perdue where they tell how they have moved away from antibiotics in their chickens water by the addition of Oregano.  So the elderly can also benefit not only from a little chicken soup but the Oregano that is keeping the chickens healthy.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

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ALZHEIMER’S DISEASE OR LEWY BODY DEMENTIA

Alzheimer’s disease and Lewy Body dementia are similar and yet significantly different.  Those differences are the hall marks of Lewy Body dementia. Because Alzheimer’s disease represents  the largest amount of people identified as having dementia, it may be assumed early on that this is the disease process the elder has. However once the elder begins to exhibit the classic signs of Lewy Body dementia, it becomes easier to diagnose.

Lewy Body dementia can have fluctuating attention and alertness. Person’s with Alzheimer’s disease have a ongoing progression of the disease without fluctuation. Clara was assumed to have Alzheimer’s disease, when one day when entering her room in the nursing home, Clara clearly asked “Where am I?” The nursing assistant then had a nice conversation with Clara, (who before this had only spoken in non-sensical word salad) while we called her daughter, telling her to come now to visit Clara. Clara maintained this higher level of function for the rest of that day.

Persons with Lewy Body dementia will often have visual hallucinations. While the person with Alzheimer’s disease can have hallucinations they are the result of other disease processes. The person with Lewy Body dementia may or may not be disturbed by these hallucinations. Sometimes the hallucination presents in a similar way to the child who has an imaginary friend, not in any way causing alarm.

The person might also appear to  have hallucinations during sleep. However these night terrors are usually identified as a REM sleep behavior disorder. The person may start to yell, scream, punch, fight, thrash, kick, get up and pace or even run around, and at times fall out of bed all the while appearing to be asleep. This is a very difficult part of the disease process for the caregiver to still manage at home.

Lewy Body dementia will resemble Parkinson’s disease with movement problems; stiffness, slowness, rigidity and difficulty walking. A rule of thumb has always been that a person with Parkinson’s disease might not have Lewy Body dementia, but person’s with Lewy body dementia will have Parkinson symptoms.

There is a saying in healthcare when working with a patient with Lewy Body dementia to “go with the flow.” Every day might be different and it is the caregiver who needs to adjust, the patient can’t.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

 

 

6 WAYS TO MANAGE ANGRY OUTBURSTS BY THE ELDER WITH DEMENTIA

Mike was visiting his daughter Marge and her family for the 4th of July holiday. Mike had called ahead and insisted he was bringing all the food. He arrived during a heavy downpour, and Marge standing on her porch urged him to stay in the car till the rain stopped. Mike proceeded by demonstrating an inability to reason on something so simple as staying out of the rain, and then immediately becoming angry, thus began the unhappy holiday.

Mike stated “No one was going to tell him what to do.” And he proceeded to get out of his car, struggling with his walker as he tried to carry his groceries to the porch. Mike not only wasn’t going to be told what to do, but he very much wanted to direct his daughter. When Marge said she would be waiting for the rain to stop before moving groceries, Mike went right into his now frequent response of “just do what I tell you!”

Starting the visit all wet did nothing to improve Mike’s mood. From this unfortunate beginning, Mike proceeded to engage his teenage grandchildren in conversation regarding the dishonesty of the healthcare industry.  Saying everyone in healthcare is crooked and only in it for the money. Mike’s son-in-law a dentist, quickly became frustrated with Mike’s outrageous behavior and soon was asking Mike to leave.

6 Ways to manage angry outbursts by the elder with dementia:

  • realize that this is an episode of agitated behavior and that in order to manage this well you need to be in control of your own emotions
  • take care of yourself first – whether it is with taking some deep breaths or whatever you normally do that helps you to remain calm
  • be aware that arguing or trying to reason with the unreasonable person with dementia is not possible
  • remove the “audience” it is harder for Mike to back down from outrageous things he says if the whole family is there, and seeing himself as the father figure, he wants to save face
  • instead of several family members entering into this argument making Mike think everyone is against him, only one person should engage in de-escalating the situation
  • be respectful and avoid becoming defensive, the angry words even if directed at you are not about you

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DELUSIONAL NEIGHBOR – EARLY DEMENTIA

Bob considers himself a lover of animals, he feels all the little animals in his community need him. Bob would be amazed to know he is considered a “delusional neighbor.” Bob is well known in his condo community as the owner who is bringing an unwanted amount of small critters to the property. Bob throws peanuts and bread out his 4th floor windows into trees below and onto neighbor’s patios morning. noon and night to feed his friends. Bob extends his feeding to the parking lot, putting food out every evening next to his car, resulting in bringing skunks to the property.

As neighbors try to reason with Bob, pointing out the heavily treed grounds with many walnut trees for the squirrels and natural sources of food for all, Bob continues to throw out food. And that is the problem, you cannot reason away a delusion. A delusion is a fixed false belief that isn’t able to be changed by presenting facts or explanations.

Bob has lived in this condo, with these neighbors for 18 years. To all outward appearances Bob hasn’t changed much over these years. He has always lived alone here in his condo. Bob drives a car, maintains his property, even investing in upgrades as needed. Bob always appears clean and well groomed, wearing clean clothes. Bob does his own grocery shopping and prepares his own food.

However for the last year Bob has been so sure that the animals need him and need food, that he has gone against all the established rules of the condo association. He argues with his neighbors and although he has been fined multiple times for feeding the animals he has vowed not to stop.

Recently Bob has solved his own problem by deciding to move. He is relocating about 15 miles away from the condo and interestingly from his beloved critters. I can only wonder if he will leave this delusion behind and in the new and strange environment develop a new delusion. Suspicions and delusions are common in people with early memory loss. When the memory loss makes the person feel like something is wrong, but they cannot identify what the problem is, they will create a new explanation that, for them fits the facts.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part III

As stated in Part I of this series on Sudden Dementia, the key here is to have the diagnosis, of delirium. Once the patient has the diagnosis, the nursing home is mandated by Medicare to investigate all of the previously mentioned  probable causes. The nurse or nursing assistant may be very concerned, and listen to the story of how rapid this change came over this patient, but there will be little follow though with this information. Only physicians, and nurse practitioners are able to write a diagnosis,and the delirium diagnosis is what drives the investigation.

As well as the previously mentioned possible causes in part I and part II, there will be attention given to the circulatory system, the respiratory system and metabolism. Circulatory – did the patient possibly have a stroke, are they in congestive heart failure, have they had a heart attack, or are they possibly suffering from severe anemia?  Respiratory – does the patient have asthma, emphysema, or is in respiratory failure? Lack of oxygen to the brain caused by a circulatory or respiratory condition can cause confusion.

Does the patient have a metabolic problem – diabetes, or thyroid disease? Anyone familiar with and experiencing these disease processes knows how they can impact so many other areas of the patient’s health. Ruling out these very significant  disease states is extremely important.

The center for Medicare Services has created this special focus for delirium showing how seriously this condition is viewed. When a patient in a nursing home, covered by Medicare, the patient’s power of attorney for healthcare is able to ask to see the patient’s diagnosis. Reviewing the diagnoses and making sure that someone who doesn’t know the patient’s history has called this sudden confusion, Alzheimer’s disease, is very important. Once the patient has the diagnosis of Alzheimer’s , the healthcare community finds no need to look any further.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing 

REASONS FOR SUDDEN DEMENTIA – DELIRIUM AND DEMENTIA Part II

The Center for Medicare requires healthcare professionals to investigate causes and reasons for sudden dementia including these changes:

SIGNS OF POSSIBLE DEHYDRATION

  • recent decrease in volume of urine, more concentrated urine or a darker color
  • recent decrease in eating habits, skipping meals, leaving food uneaten, weight loss
  • nausea, vomiting, diarrhea, or blood loss
  • receiving IV drugs
  • receiving diuretics or drugs that might cause electrolyte imbalance

FUNCTIONAL DECLINE

  • falls or increased risk for falls
  • recent decline in the ability for self-care in hygiene, dressing, walking, eating, etc.

MEDICATION REVIEW

This area requires the services of the pharmacist. A medication review would first focus on new or recent medications and possible interactions with other medications the patient is taking. All narcotics need to be investigated, the elderly may become unreasonable, angry, or argumentative on narcotic medications. All behaviors that are different for the patient since beginning a new medication must be explored. Especially so for any drugs used to change or modify  behaviors such as anti-anxiety, antidepressants, sleep medications and of course anti-psychotic medications.

SOCIAL CHANGES

  • social withdrawal – recent loss of a family member or friend
  • recent changes in mood – crying or anxious\
  • a recent move – out of state or from home to facility

UNUSUAL BEHAVIORS

  • recent change in sleep habits, sleeplessness at night and sleeping during the day – nightmares
  • unusual, inappropriate or unsafe movements
  • hyper-active or hypo-active, a recent change to the extreme in a person’s level of activity

 

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

DEMENTIA FROM ALCOHOL AND THE FAMILY IN DENIAL

Long before experiencing dementia from alcohol, the alcoholic has spent a life time trying to hide his alcoholism from family, friends and even medical professionals. So when the illness progresses to the dementing stage the  family who is in denial, now takes over not only the feelings of guilt and shame the alcoholic experienced. But also the active role of concealing the real cause of the dementia.  Dementia from alcohol doesn’t come on rapidly, but after a long time of alcohol abuse.

During those years of alcohol abuse the family maintains a code of secrecy, looking away and in so doing gives the abuser little reason to seek help. Family and friends are referred to as “co-alcoholics” due to their role in maintaining the alcoholic’s excuses, thereby promoting continued abuse.

Enabling, references the families efforts to protect the alcoholic from the consequences of their drinking. Supporting statements of needing “something to unwind,” ignoring odd or inappropriate behavior, and not identifying times when the alcoholic is not physically or emotionally available, are ways in which families protect the drinker. By not addressing the abuse the family gives the alcoholic little reason to seek help.

The alcoholic most likely, because he is enabled, will not seek help until he hits rock bottom. However more often than not, the abuser experiences dementia from alcohol and long term placement becomes necessary before he has the opportunity to make that choice. Once in long term placement the family and friends then continue the charade by finding a diagnosis of Alzheimer’s disease more acceptable than dementia from alcohol abuse.

The true numbers of persons with dementia from alcohol will most likely never be know because of the family continuing their role of “co-alcoholics.”  While healthcare professionals avoid questions about alcohol consumption so they are not seen as being “intrusive.”

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

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 

 

WHAT DOES THE PERSON WITH DEMENTIA NEED?

The person with dementia needs to feel safe, but not in a way that they feel restricted. The person with dementia has a need to understand. The person with dementia has a need to be understood. The person with dementia has a need to be healthy and physically fit. The person with dementia has a need to be spoken to like an adult.

The need to feel safe, means feeling comfortable and accepted. Many times when a person with dementia moves into a nursing home, they will talk about “going home.” Home is where you are comfortable, accepted and you will not be forced into doing something. In the nursing home setting it takes about a month for many to no longer ask to go home. It is not that they are now resigned to being in the nursing home. It is that they finally feel that acceptance and feel at home.

The need to understand, and be understood. Persons with dementia have lost their normal forms of communication. They no longer can communicate verbally or non-verbally their needs. Even the person who still has words has trouble expressing their thoughts and feelings. Misinterpretation of their environment causes more misunderstanding and results in fear.

The person with dementia has a need for nutritious food and exercise.  Nutritious meals, no junk food, supplement with B vitamins for stress and brain health, fresh air and exercise results in better sleep. (B vitamins should only be taken in the morning so they do not disrupt sleep)

The person with dementia needs to be included in conversations. They need to be addressed by their preferred name or title.

The person with dementia struggles all day long to understand their world and make their needs known.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing