Wednesday, September 24, 2008

What's Happening to Mom? - Taking the First Step

Carrie has a full-time job and two kids still at home. When her dad became ill and passed away unexpectedly, Carrie spent a lot of time with her mother, talking to her about what she would be doing with her life now.

Carrie worried about depression becoming a problem for her mom, and her mother being alone, but what she discovered was that her mother seemed unable to manage even the simplest daily tasks. Cooking seemed to be completely beyond her; even daily dressing, bathing and grooming tasks seemed overwhelming.

In just a few days, Carrie began to suspect that her mother had been experiencing a decline in mental functioning for a long time – her father had been “filling in the blanks,” and no one in the family had even noticed her mother’s failing. Carrie needs to figure out what to do to be the most helpful to her mother right now – at the same time she’s coping with the loss of her father, as well as her own full-time work and family demands.

Figuring out how to face this challenge in addition to your own life demands is the first step you’ll need to take. Learning to cope with your loved one’s needs without losing your mind is your biggest challenge, however!

The First Step

Get a diagnosis. This is the first step you need to take, and the sooner you take it the better. You may wish to go directly to a research center that specializes in Alzheimer’s disease (most university hospitals have these kinds of programs). Or, you may need to start with a family doctor, and go from there for further tests, if necessary.

A visit to the doctor for a thorough check-up is the first important step.

You may hear, “There’s nothing wrong with me – I’m not going to the doctor.” Right off the mark, you need to learn some new skills.

Start with this one: Reassurance. “Dad, I’ll go with you, and I’ll stay with you the whole time – it’s no big deal.”

If that doesn’t work, try bargaining. “Mom, if you’ll just do this for me, we can go to lunch together afterward and have a nice, long chat at your favorite restaurant.”

If that still doesn’t work, try diversion: “Honey, I need you to go to the doctor so the kids will stop nagging me. I’m getting sick and tired of the nagging – it’s up to you to get those kids off my back.”

These are skills you’ll develop and learn to use like a pro over time. You’ll find that you need a whole new set of skills to be most helpful to your loved one, and keep your own sanity intact.

The least useful approach both now and in the future is argument. You might also call this debate, persuasion, or explanation. Whatever you call it, it won’t work! When the brain functioning is impaired, even slightly, a factual presentation is likely to be futile. Logic is frequently one of the first brain functions to diminish, so no matter how grounded in facts your arguments may be, you just won’t win. Try some of the other “tools” for accomplishing necessary goals.

Janice had tried every logical approach she could think of to get her husband Mac to agree to go to the doctor for testing. Each time she brought it up, Mac simply refused to go. “I’m perfectly fine,” he’d say.

Finally, at her wits end, Janice said, “I promised the kids that we’d both get to the doctor for a check-up. I’ll go first if you’ll go after me.” Reluctantly, Mac agreed to go. Janice got a same day appointment, and took Mac in before he was able to change his mind and refuse again.

Once you get an agreement to go to the doctor, you’ll want to consider the following things:
  • Accompany your loved one to the doctor – all the way in. Don’t send him or her into the examining room alone.
  • Make notes about what you’ve observed – details and facts, suspicions and observations. Take your notes with you, and don’t hesitate to read them to the doctor, or simply give them to the doctor. Can you do this in front of your loved one? Try it – you may be surprised how accepting your loved one is with the facts you present, especially if you word them as facts. For example, “Dad got lost coming home from the store last week. It was kind of scary for us both.” If you just can’t read your notes in front of your loved one, simply hand them to the doctor or nurse to read. Be prepared for your loved one to become suspicious about what you might have to say “behind my back,” and make an effort to include your loved one in your discussions with the doctor if at all possible. Most individuals with early stage memory loss are keenly aware of what they are losing, and this is distressing to them as well. Talking about it openly can actually be very freeing for both of you. Whispering about things tends to reinforce our society’s stigmatizing of diseases causing dementia. Choosing to openly discuss all of the facets of memory loss and dementia can help both you and your loved one face this disease rather than feel that it needs to stay “hidden.”
  • Ask for tests. If your loved one has just suffered a significant loss – from a spouse to a beloved pet – be aware that depression could be the problem. Untreated, lingering depression can cause a person to act like they have dementia or another brain impairment. With appropriate medication and perhaps a “friendly visitor” program or brief talking therapy, your loved one may be able to work through the depression and re-gain complete mental functioning. Other physical problems like bladder infections, pneumonia, or vision or hearing losses can look on the surface like Alzheimer’s disease. These problems are generally completely treatable, and what looks like dementia can be totally reversed if the underlying health problems are addressed. Be aware that simple things like drug interactions, dehydration and malnutrition – fairly common problems for the elderly person living home alone – can cause the appearance of dementia. Ask the doctor to test for these and similar treatable physical ailments before you both assume that your loved one has dementia.
  • Expect your loved one to be much more lucid at the doctor’s office than what you’ve observed. This can drive you nuts, especially if the doctor is not experienced in diagnosing dementia, and looks at you like you’re the one with the problem! This is so common that, fortunately, the medical community is beginning to catch on, and educate doctors to look beyond the “perfectly normal” presentation in the office. Be prepared that your loved one may even be able to ace the “mental status exam” that a physician can complete in 2 minutes during an office visit. If this happens, ask for a referral to a neurologist, or seek out an Alzheimer’s diagnostic center at a nearby University or teaching hospital. Don’t let this distress you. Take a deep breath, and know that what you’re going through is very common and normal. Keep at it until you find a doctor who is really able to see what you’ve been seeing, and help you find an appropriate treatment plan.
  • Ask about medications. Once the physician has ruled out treatable problems, and has determined that your loved one likely has a disease like Alzheimer’s, ask about medications. The drugs currently available to “treat” Alzheimer’s disease and other dementias work best during the earliest stages of the disease. During this time, medications can be truly helpful, and can help your loved one regain some functioning, and, barring that, can delay significantly the progression of the disease. Imagine giving your loved one a year or two of extra independence, and what a difference that can make to him or her, both personally and financially. Ask about those medications!

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