EARLY STAGE DEMENTIA – SYMPTOMS OF EARLY CONFUSION

Harry has currently un-diagnosed early stage dementia. How can he be so happy and content, seemingly unfazed by his confusion. All due to his wife Ann’s attention.

Harry’s wife of over 45 years was at his side while he greeted friends outside of church. Harry loves to talk and has many friends. These friends don’t seem to notice that Harry is having memory retrieval problems.  And that is all due to the wife at his side who is seamlessly providing words and cues to Harry. Harry never seems to be stumbling in his conversation or  searching for words. Ann knows Harry so well that she just fills in for him with the right word at the right time and he accepts her help.

At this point in time Harry might not even be aware of his memory loss, his wife makes no effort to point it out to him. Harry drives the couple around but you know it is Ann who is navigating because Harry would be disoriented without her.

This partner in life, is now the decision maker, for today deciding where the couple will go for lunch. Because of their warm trusting relationship, Harry trusts Ann to now manage their finances.  When shopping he might just joke that the “little lady takes care of all of those money things.” This saves Harry the stress of trying to pay bills, balance the checkbook, and make poor financial decisions, all signs of early stage dementia.

Emotional outbursts and anger directed at others and situations come from anger at oneself. The person who has early stage dementia and rejects any help or assistance from others may be a risk to himself and others. The inability to change a bad behavior is a symptom of early stage dementia.

For Harry, the frustration that accompanies trying to understand where he is, what is going on, and what might be expected of him is all reduced because of his partner, and yes now his caregiver, Ann.

Virginia Garberding

Certified in Gerontology and Restorative Nursing  

HOLIDAYS A GOOD TIME TO HAVE THAT FAMILY TALK ABOUT GRANDPA’S DEMENTIA

Grandpa still lives alone in the family home and his daughters keep in constant communication with him by phone. Getting ready for the family holiday get together, required several phone calls to Grandpa to remind him of where and when they were meeting. After the big event , the daughters used their time with Grandpa to compare notes on how well their Dad is still able to function.

What they found:

  • Dad needed those frequent phone reminders – he had a 15 minute chat with the oldest daughter and the next day didn’t remember she had called
  • Dad had been mentioning that neither of his 2 hearing aids still worked, yet he was wearing both
  • Dad was now making strange and inappropriate comments to strangers, he asked a man in a restaurant if the design on his shirt was Nazi swastikas
  • Dad’s personal hygiene was in question, even though the holiday event was for an entire weekend at a hotel, Dad was wearing exactly the same clothes every day and on arrival it was apparent that Dad hadn’t bathed for some time
  • When asked what he has been eating, even though the daughters kept him well supplied with grocery delivery, he was choosing to eat all of his meals at the local fast food carry out
  • Dad had been asked to bring his latest report from his physician, after reviewing the doctor’s findings and recommendations, it was clear that Dad not only had no intention of following the doctor’s advise but didn’t understand most recommendations
  • Dad asked one of his daughters for a type of first alert button – in case he was taken to a hospital he could push the button and an ambulance or “someone” would come and take him out of the hospital

On the positive side, all of the daughters are on the same page, that Dad has dementia and needs their monitoring any changes. It is terribly hurtful and lonely to be the  only member of a family seeing signs of dementia. When even some of the family members are in denial of signs of confusion, it delays solutions. These daughters are realistic and pro-active trying to get ahead of future problems and support for their Dad.

Now after this holiday, they know that Dad might be needing some house help if the reason he doesn’t make meals is that he no longer can put a meal together. Some home help might be also needed for hygiene. One of the daughters needs to get involved in going with Dad to have his hearing aids taken care of as well as accompany him to his physician.  Dad probably would benefit by having a calendar to write down appointments and events. This way the daughters could check, just by calling and asking Dad what he has written down for a certain date.

The daughters know that as Dad continues to decline, (and they realize he will) he will be a candidate for an assistive living facility. When that day comes they will have to be united, it really helps to start now.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing

 

EARLY STAGE ALZHEIMER’S DISEASE AND CAREGIVING

Caregiving for the person in early stage of Alzheimer’s disease, is in some ways very different from the mid-stage and late stage caregiver role.

The early stage caregiver is in many ways a companion. A very alert and involved companion. A person who is proactive in preventing accidents. Looking at the confused person’s environment, while not changing the environment, (which would increase confusion) but modifying as needed for safety. Knowing the confused elder may no longer be that aware of tripping hazards, the danger of walking in busy parking lots, or handling hot food. So many areas in our, day to day lives, where our own personal safety awareness and good judgement keep us safe.

Helping the confused elder with communication difficulties. Giving the person that extra time they now need to get their thoughts in order. Not rushing the person as they are searching for words, and when providing those words, doing it in a way that is supportive not critical.

By offering frequent reminders of where the person is and what is going on. When the person has a concerned puzzled look on her face, the caregiver gently reminds her that she is at the mall, close to her home. Providing information to the date, time of year, temperature and most of all who people are in relation to the confused elder.

Keeping to a routine and familiar places gives the mildly confused person a sense of security. When that is not possible, as in the case of a change in residence. The caregiver needs to use less verbal directions and more walking a person through the new environment. Accessing that body memory through repetition, by doing something over and over, can re-create that routine and familiarity. Routine and familiarity bring comfort.

Taking time, while stepping back and trying to see what might increase confusion, and what the caregiver can provide to decrease that confusion.

The need that remains is always the same throughout the disease process, is for the the caregiver to be so very kind and understanding. Understanding of the struggles the person is facing to still be here. Support to still maintain their independence as much and as long as possible.

Virginia Garberding RN

Certified in Gerontology and Restorative Nursing