Saturday

Never Underestimate a Person With Dementia


Around and around she went!  When she first was admitted to the dementia unite at the nursing home, Abbie was able to walk. In fact, she could hardly sit still. She was like a jack in the box at mealtime. She rarely slept through the night. She was on a mission, going to Who Knows Where. She did not seem particularly disturbed by her own wanderings even though there never seemed to be an end to her journey.

Her only child, daughter Karen, visited her each and every day. It was clear to everyone that Abbie did not even recognize Karen, yet Karen remained steadfast. "I'm giving her back the loyalty and care that she provided me when I was a child." she said.

Days and years passed. Abbie eventually started falling so she was given a wheelchair. People of any age can have a hard time learning how to maneuver a wheelchair, but Abbie had determination and she figured it out. She started wandering about on two wheels. Shuffling her feet as she propelled herself forward, she would wheel herself around the facility in what seemed to be a surprisingly consistent pattern.

I was Director of Social Services at the time, and I could tell time by her. Abbie would wheel herself to my doorway, speaking to me in a language that I could not understand; the language of Alzheimer's Dementia. Inevitably she appeared at my office each day promptly at 11:55 a.m. and then again at the change of shift at 3 p.m. Every day without fail Abbie was right on time, although she did not wear a watch and was assumed to be totally confused and disoriented.

One day we received the tragic news that her daughter had died in her sleep. She never had a chance to say goodbye to her mother.

All of a sudden Abbie changed her route. She started showing up at all different times in different places. She was unpredictable. She now mumbled constantly. Her words were not intelligible, but she was clearly repeating the same thing over and over again. One day I sat with her and I finally grasped what she was saying. I was amazed. 6-7-3-4-2-4-6.... 6-7-3-4-2-4-6... ad infinitum. I went to her medical record and, sure enough, she was repeating her daughter's phone number over and over again.

Everyone had just assumed that her daughter would pass from her life and she would never know the difference. Abbie taught us otherwise. We ultimately offered her comfort in her grief and could only assume that she might have been able to understand and receive it.

If you know someone with Alzheimer's Disease, the best thing you can do is to treat them with respect and dignity. They are trapped inside a body that seems to not understand because it can't communicate whether it does or not. Assume the best. After all, if you were that person, isn't that how you would want -- and need -- to be treated?

Friday

Care Manager Reverses Dementia Diagnosis


My client, we'll call him Walter, sat through an intensive three hour interview with his new doctor. I was impressed with how thorough the session was. After all, this was one of the reasons I referred Walter to this particular physician.  

Walter, at 90, holds a PhD in Electrical Engineering. His mind is beyond active! He has worked all over the world during three different wartimes. Top secret research has been his specialty. When he moved to Arizona he brought over 400 boxes of books with him. He believes in God and the angels and extraterrestrials. He forgets all about himself while making his mission his obsessive center of focus. He doesn't care what anybody thinks of him. The clock is ticking and he needs to complete his mission before he leaves This Place.

Before I meet with new clients and their families, I ask them to sketch out some basic goals to get a head start in preparing a customized plan of care. At our initial meeting, Walter was prepared. He had typed up five pages of goals!  

Most people want help preparing meals, cleaning the house or getting to church. Some need help getting out of bed in the morning... or need inspiration to face each day. Walter had five pages of goals related to complex and continuing research with his ultimate goal: To find a way to save human civilization. He had already met with the nearby Hopi Elders to learn their thoughts about how they have survived since the Dawn of Time. 

Sounds far out, yes. Walter was far out. But he was clear as a bell. He was brilliant beyond brilliant. Some people are so intelligent that they just don't handle the mundane things very well. 



When the doctor created Walter's initial file, the diagnosis of COPD was first and "Dementia: Probable Alzheimer's Type" was secondary. I was floored. Granted, the interview was all over the place because Walter was trying to teach the good doctor about what was important in his Great Scheme of Things. I could see where the doctor was coming from. The doctor remained firm in his opinion that Walter was fighting severe dementia.  

This is where a Geriatric Care Manager can come in very handy as an advocate. I took Walter back home that day and, with his eager cooperation, we completed a Mini Mental Assessment to determine the level of his "dementia". The tool assessed him in 30 different areas of cognition. His final score on the test: 29 out of 30. Early in the process I asked him to remember three things -- Pencil, Shoe, Watch. At the end of the test, when I asked him to recall the three, he missed the shoe. That was the one and only point Walter missed. 

On our next appointment we presented the doctor with the test results and he agreed that it was appropriate to remove the dementia diagnosis from Walter's chart. 



Click here for the Folstein 30 question MMSE assessment.  This 10 question format, a much simpler assessment, is available for people who have higher degrees of dementia.

Wednesday


Some Things Never Change

This is an article that was published in the Syracuse Business Journal over a decade ago.  
Care managers have increased their rates and costs of assessment since the time this was written 
and costs vary by location.