I just came across a great article in the Journal of Family Practice (January 2015) by Marisa Mendola PhD and Barry D. Weiss, MD, called “Addressing Alzheimers: A pragmatic approach.” JFP_06401_Article1 The article is, of course, addressed to physicians who may be noticing signs of cognitive impairment in their patients or who have been alerted that “there seems to be something going on,” “something’s changing,” “he is getting confused.”The article has lots of practical advice that can be useful for non-physicians as well.
I have observed over the years in my clients that the progression of the disease may be slow at first and can then periodically seem to speed up. A person with Alzheimer’s (called “AD” in the article) may withdraw or may make jokes in ways that could seem to mask the deeper degree of genuine confusion that is present. They may remain capable in certain simple domains of daily living but become unable to make decisions when faced with multiple choices, or may become unable to remember new information. Along with getting a good assessment of what may be going on, the caring family members need to start dealing with the impact of this disease on the person’s ability to safely manage their daily life.
The broad issues can be sorted into medical, legal, residential and social. From the legal standpoint, once it is apparent that dementia is developing, it is crucial to make sure that the patient appoints a health care representative (called a “proxy” or “agent”) before it’s too late. The “proxy” will be authorized to make the medical decisions when the person is no longer capable. Similarly, it is crucial that there be a financial surrogate, whether that be an agent under power of attorney, or the trustee of a revocable living trust. This person would manage the assets, sign contracts, pay the bills, file the tax returns, pursue any necessary lawsuits, hire and fire caregivers, and so on. See my previous posts about these planning arrangements. If there’s no Will, the patient needs to meet with his or her attorney and get one in place, again before it’s too late to make the decisions and understand what they are signing. I have had so many clients with early stage dementia who told me that now they felt more secure, knowing they had put a plan in place.
On the home front, once a diagnosis of dementia or Alzheimer’s has been made, it will probably be necessary to increase the frequency of visits by family members in order to really stay aware of how things are changing and make sure the home is cared for. Is the mail piling up? Is the checkbook being overdrawn? Is the laundry being done? Is the house clean? Is spoiled food being thrown out? Is mom eating regularly? Family meetings may be needed. The person with dementia may be losing their ability to cope with pain or recognize symptoms of a medical problem. There may be disagreements among the family members about the scope of the problem. But safety first has to be the prime consideration.
You need to look at the home from the vantage point of whether a person with some confusion will be at risk of falls. Injury caused by falling is one of the major causes of people having to leave the comfort of their homes before they want to.You may need to get a companion in the home at a time that your loved one feels they need no help. These are delicate issues, but I like to say that we respect our elders by arranging for their care and safety. Keeping out of the way so that your loved one with dementia can “stay independent” for the sake of independence can result in compromised safety or even financial loss. A person with dementia can easily be preyed on and send money to strangers without understanding why. As these problems start to develop, a person with dementia needs their family to step up to the plate and do what’s needed to preserve their safety and quality of life.
When I needed to step in to help my mother overcome her own reluctance to accept the need for home care, and to stop driving, and to have someone go with her to every doctor’s appointment, and someone to oversee all of her medication, she was very mad at me. “Linda, I feel that I am being managed,” she said. To which I replied, “You are, Mom, because I worry about you and I love you and you raised me to be here.” She was still mad, but she did get over it.
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