My mother, age 92, who has always had a loving and sweet disposition, has turned into a rude and abusive woman. She shows early signs of dementia, but she is in relatively good health. She won’t leave the house and though she complains about being lonely at night she threatens to call the police if we suggest a nighttime companion. Her behavior is irrational and I don’t know what to do to help her. She refuses to see a geriatric psychiatrist and her physician is concerned that a calming medication could contribute to a fall. Can you give us any advice?
— Michael B., Miami, FL
This is indeed a very difficult and stressful situation for you but unfortunately, it is not uncommon, according to Dr. Leslie Kernisan, a board-certified geriatrician and a clinical instructor at the University of California, San Francisco, whom I contacted for some expert advice on your situation. Here is what she advised in an email to me;
“First, I would find a way to obtain a preliminary medical assessment for dementia possibly handled by his mother’s primary care provider,” Dr. Kernisan wrote. “She’ll be checked for other health problems that might cause personality or thinking changes. It’s possible that the changes her son is observing are not due to dementia, which can be exacerbated by additional problems such as electrolyte imbalances, medication side-effects, untreated pain or even constipation.
“I suggest that the son familiarize himself with how dementia is diagnosed and then accompany his mother to the exam prepared with good information regarding her abilities and challenges. Also, bear in mind that HIPAA does not prevent you from contacting her doctor ahead of time and relaying your concerns and your observations. I generally think it’s good to do this in writing, as it can be put in her chart.
“If a diagnosis of dementia is confirmed, her son will want that information to be in her medical charts with all of her physicians since it has implications for how to manage the care of any other health problems she has.”
Finally, Dr. Kernisan wisely pointed out that a diagnosis would also make it easier for you to get help as a family caregiver with coaching in dementia behavior management and caregiving coping strategies. “Learning better ways to handle your mother’s behaviors can have a big effect on her well being and on yours,” she explained.
A diagnosis will also help you plan ahead for when her cognitive abilities and independence are further impeded and she requires more support and oversight. While these situations are always emotionally and financially challenging, I have observed that families who plan ahead tend to use support services more wisely, and as a result, they experience less stress.
For help coping with the experience — whether it’s how to get your mom in to see the doctor, how to deal with the doctors, how to cope with your stress, how to manage her outbursts, and how to plan ahead — Dr. Kernisan recommends the following resources.
— Visit online support forums, such as these very active forums at aging care (www.agingcare.com) and Caregiving.com (www.caregiving.com) of people caring for aging parents.
— Read a few good books, as it’s hard to learn a lot by skimming web pages. For dementia, the “The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss” (Mass Market Paperback) by Nancy L. Mace (Author), Peter V. Rabins (Author) is well respected, as well as “Surviving Alzheimer’s: Practical tips and soul-saving wisdom for caregivers” by Paula Spencer Scott.
I also highly recommend visiting Dr. Kernisan's blog, "Better Health While Aging," www.betterhealthwhileaging.net, which offers practical ways to improve health and wellbeing in aging. She is a leader in the field of geriatrics and I have found her writing to be instructive.
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ABOUT THE WRITER:
Nancy Stein, Ph.D., is the founder of Seniority Matters (www.senioritymatters.com), a caregiver advisory and referral service in South Florida for seniors and their families. You can contact her at nancy@senioritymatters.com.
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