If you suspect a loved one has a dementia, a progressive deterioration of memory and other cognitive skills, please consider these recommendations.
The primary consideration in all such circumstances is the safety of the loved one. There may be months of time between calling a specialist and receiving an appointment; perhaps longer before a meaningful diagnosis is achieved and treatment is initiated. As I have pointed out many times, there is no guarantee of treatment effectiveness. Even after treatment, your loved one may still suffer with the same symptoms, or worse, the initial treatment appears to cause a decline in the patient’s condition. It is this last group that calls my office in the most desperate fashion. Typically, the decline is not from practitioner incompetence, but poor standardized treatment protocols for victims of senile dementia. The focus is almost exclusively on medications for memory, and these come with a host of side-effects that may be worse than the symptoms for which you sought treatment. Unfortunately, in the last twenty years of assessing victims of senile dementia, I have not witnessed an institutionalized patient regain functionality through the use of memory boosting medications. As a caregiver of a dementia victim, do not believe that memory medications will slow or halt the progression of Alzheimer’s Disease.
Knowing that it may be months until meaningful help arrives, consider a few simple steps to make your loved one safer in their home. The risk of fires and falls are preeminent. I strongly suggest unplugging stoves anytime someone is inattentive or actually confused. This includes barbecues and working fireplaces. Microwave ovens are generally safer, since they will usually blow a fuse before starting a fire, but you may want to observe the loved one’s actual use of the device before making that determination. Smoking in bed is almost a cliche, but it is a very real danger, and all confused people should be supervised while smoking. Matches or lighters should never be in their possession.
Falls are the bane of every caregiver, and the source of most nursing home admissions. Kitchens and bathrooms are the big culprits, with sharp corners and hard surfaces everywhere. A consult with a physical therapist is an excellent early intervention to determine your loved one’s ability to safely ambulate. As with all behavior, past behavior is the greatest predictor of future behavior. If your mother has fallen twice in their home, it is likely that a third will occur. The interval between falls is very important. If you as a caregiver notice a doubling or trebling of fall occurrences, than consider rapid follow-up with a physician to rule out common causes of weakness and imbalance. Here again, consulting with a physical therapist is very important. The use of an assistive device for ambulation is not always straight forward. Consider the charitable act of giving the demented person a walker for balance. Unless trained on how to use the walker over a number of sessions, the walker may increase the number of falls. Negotiating transitions between floor surfaces and maintaining a forward upward gaze is critical to the use of a walker, and it is not always self-evident.
What if your loved one’s ambulation is so good they are wandering away from home? This is an intolerable situation from a safety standpoint. If the person is confused, simply putting curtains over the door will decrease exit seeking, but not entirely prevent the same. Installing double dead bolts will keep the person inside, but may seal their fate if a fire is started. The best solution, and most expensive, is to purchase an alarm placed on the patient’s body and corresponding sensors placed on every door. Please keep in mind that this only is effective if someone is able to respond to the alarm in under five minutes, or the patient is unaware how to remove the bodily alarm. Even in the nonverbal seventh stage of a senile dementia, I have witnessed these poor people remove alarm bracelets from arms and ankles, as they have no idea as to the purpose of the alarm. The only iron-clad way to keep a demented person safe from exit seeking is to have eyes on them 24 hours a day-7 days a week.
There is no realistic method to keep a demented person completely safe. Even in facilities dedicated to the treatment and maintenance of the terminally demented, falls and exit seeking are a fact of everyday life. All a caregiver can do is try their best. Please avoid trying so hard that sheer exhaustion nullifies your effectiveness as a caregiver. Comments are always welcome in the space provided below.