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Old 07-16-2009, 10:22 PM   #1
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Another assessment

The Nursing Home and doctor are sending mom for another assessment. She already had an assessment a few months ago? I am told this is for a mental assessment? I have to wonder if there is a difference? Don't know where this is going, but mom hasn't been herself especially in the last couple of weeks. She is very angry, very obsessive, and paranoid and feels imprisoned in the NH and says if she doesn't get out of there, she is going to go coo coo. God if I were in her shoes, I might feel that way too. It seems so unfair. Last night she was saying that she was scared the nurses were going to kill her, scared that they were going to do something to her. Today she accused them of avoiding her and refusing to give her her hearing Aids.. She hides her stuff, and accuses staff, residents and even family of taking it. She told me that she doesn't trust anyone, not even family members. She is telling each of us that the other is avoiding her, including me which is simply not true.
They put her on a drug for her paranoia but it's only been a couple of days so it hasn't started to work just yet, it seems that her behavior has been even worse since she started on this med.

I'm really worried about her.

 
Old 07-17-2009, 11:02 AM   #2
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Re: Another assessment

Dorri... I can so relate to what you are typing here because it is the story of my Mom. I will tell you that the psych evaluation was the best thing I did for my Mom. Make sure it is a geriatric psych eval. There are some subtle differences in the way they treat the elderly dementia patient.

Mom did the same thing your Mom did. Her paranoid, delusions, and angst elevated to the level of hysteria. She thought people were trying to kill her, steal from her, and didn't like her. She had wild tales of what other were doing to her. She hated where she was and swore it was the reason for all of her confusion. That place was driving her crazy. She packed up, moved out, was combative, and either cried or was angry all the time. Then the psych eval and the new medication. She still has her paranoia and delusions but she's in a much better place. The hysteria and angst along with the combativeness and aggression is gone. She is on four medications to control her psychosis.

We had done hit and miss medications before. Several things I have learned. It takes up to 6 weeks to see the true effect of a psychotic medication. Sometimes it does seem worse befoe it gets better but you have to wait to truly know how they will respond. Many don't have the patience to wait and you need to. Mom was in Behavioral Senior Med the first of May. When she came out she seemed over drugged. The psychiatrist told me to be patient. At the end of 6 weeks she was back to most of her previous level of function.... minus the bad behavior.

One of the areas of the brain that can be affected by ALZ will bring on these kinds of symptoms. They are part and parcel of the disease. Just know that you can't change her location and make it better. Mom was at home and in two facilities after this behavior started and it made no difference. What our Moms want to escape is the confusion that is in their mind, created by the disease, and there is no way to escape that. I was opposed to excessive medication until I talked to the psychiatrist. He ask me if my Mom had a tooth ache would I refuse to let the dentist pull her tooth... well of course not. If my Mom was in physical pain would I refuse her pain meds... well of course not. Well my Mom is in emotional pain because of a disease that is taking over her mind. Do I want to refuse her medication that will relieve her pain? OF COURSE NOT! This disease does cause emotional pain for our loved ones and it is something that we can not fix or make go away in any other way than medication. We can not talk them out of it because they don't comprehend and they can't remember. It is their reality. So we do what we have to do.

Hope some of this helps. Know I will keep you and your Mom in my thoughts and prayers I do feel your pain.

Love, deb

 
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Old 07-17-2009, 11:08 AM   #3
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Re: Another assessment

dorri,

Based on what you've said about your mom's unusual mental state, it seems like a mental assessment is a good idea. If they can determine the cause, perhaps it's treatable. The assessment she had a few months ago might have been a general physical. If she appeared to be of sound mind at that time, they wouldn't have had any reason to go beyond a regular physical. Now there appears to be a reason according to the doctor and the NH. All you can do is trust them to do the right thing and see how it works out.

About the paranoia drug: If she has some form of dementia like Alzheimer's it's quite likely that the wrong medication could make it worse. Perhaps you could request that they either give her less or stop it completely.

How old is your mom? At a certain age (about 85), one out two has dementia and more often than not it's Alzheimer's. I know it's difficult to watch a loved one go down-hill like that. My father was the same. After an operation, he thought the nursing home was holding him prisoner and he wanted me to help him escape. He was about 78 at the time.

P.S. About medications: At one point the nursing home clearly had him overmedicated. They had him so medicated, he was like a zombie. We got him out of there and off the meds and he was much improved without any medication.

Last edited by JohnR41; 07-17-2009 at 11:19 AM.

 
Old 07-17-2009, 02:21 PM   #4
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Re: Another assessment

Deb, thank you for sharing about your mom. Yes, your mom's symptoms sound the same as my mom. Mom is blaming all her problems on the Nursing Home and her family saying we are ignoring her, and avoiding her and this is making her crazy. It's so untrue, but she must lose track of time between one conversation to the next. She's even told my sister that I'm avoiding her yet I am the one who is picking up her every phone call or more to reassure her. At first I was down right hurt about her accussations and untruths, but as I'm getting use to her and understanding her strange behavior I can tolerate it more. My poor sister is still coming to terms with this and finding out for herself bit by bit..

Deb, you mention that your mom was moving out? I take it at the time your mom wasn't in a locked facility? Is the NH she is in now a locked facility or can she go as she pleases? They have an unlocked Ward at mom's NH as well, but they have codes to get in and out of the ward as simple as 1 2 3, but it is doubtful mom will connect to press those buttons but who knows she can dial my long distance number without a problem?

John, mom is 77 years old. several months ago, mom went thru every test imaginable including a lot of heart tests etc...she went through an geriatric assessment at that time for cognitive function etc...the Geriatric and Heart Specialist's final prognosis is:
probable vascular dementia with a component of Alzheimers. I like how they say probable vascular dementia, (aren't they sure) like is it or isn't it but I take it he's sure about the Alzheimers or is he?. Having said that, is it because there are no official or clear cut diagnostics for dementia. As far as I understand the diagnosis of dementia is given when all other possibilities and diseases are ruled out, like, for all they know, mom can have mad cow's disease?

My mom never took well to any medication and was vigilant about the side effects of all drugs prescribed for her. A few months ago, she was over medicated and because she wasn't with it, it seemed she could care less, so I don't want to see her that way again...like your dad she was in a zombie state, no personality, no motivation, and no energy to even get up.

The drug they put mom on now isn't putting her to sleep nor taking away her energy. I think it's an anti psychotic drug. It has yet to work.

Last edited by dorri; 07-17-2009 at 02:25 PM.

 
Old 07-17-2009, 11:56 PM   #5
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Re: Another assessment

Mom was not moving out in reality.... just in her mind. She is absolutely in a locked facility. The only doors out are all coded with a special code that changes monthly. But.... She would pack up her stuff and move it from place to place. She would move furniture out into the hall. Pack all the smaller items including clothes in boxes, baskets, trash cans , or whatever was available. She moved clothes from Dad's chest and hers to the chest in the entrance way because she wanted to take that one. She took pictures off the wall. She would carry load after load up to the office, out to the porch, or throw it over the fence. She couldn't get out but she got some of her stuff outside the fence!! While she was out of the room they would lock her door so she could not get back in to pack up and she would become hysterical. She still does that some but needless to say I have brought most of it home with me and only left the bare essential.

Dorri you have to remember that your Mom doesn't remember who calls her when. If she doesn't remember talking to you, then you are ignoring her. Mom made the comment recently that she had not seen any of her extended family in over a year. She had no memory of her niece and great nephew coming to see her just a couple of weeks ago. She doesn't know if I come one a week or every day. Sister 3 had just been there the weekend before and she had the staff call her because she had not seen her in months and thought she was dead. It has absolutely nothing with what you do... it has everything to do with what Mom remembers...... and recent memory is the first that goes with dementia!!! In her reality, your Mom has not heard from you because she can't remember talking to you. You remember, but she does NOT!!

Doctor's put all kinds of probables and maybes on cognitive diagnosis. Cognitive testing can tell you if your Mom has cognitive dysfunction but it can not tell you the cause. Yes, they rule out all other causes and then label it dementia. The only way they have right now of giving a definitive diagnosis of Alzheimer's is to do an autopsy on the brain. Only they can they identify the tangles and plaques that are characteristic of ALZ. In the later stages of some dementia, if they have previous scans to compare with, they can see brain shrinkage which is characteristic of some dementias. So they do the best they can.

Mom went to a research service that specializes in diagnosis of ALZ. She had extensive cognitive testing that lasted for almost 7 hours. They compared that to previous history and current behavior. They also did a complete physical with extensive blood work and a brain scan. Then they went over every med she was taking to rule out any other causes. What I got back was Moderate to Sever Dementia consistent with ALZ. Many doctor's leave the door open for other possibilities because there is always that slim possibility..... but in time you just know. I knew before I ever took her. My grandmother, several of my great aunts, and several aunts, had already died from this disease. I knew.

You also need to know that the psychotic meds are not going to bring back your Mom as she was before. My Mom doesn't sleep excessively. She is up and walking. But, she has difficulty expressing herself, is sometimes incontinent, and she wanders aimlessly. She is not her previous happy go lucky self. She still doesn't understand what is happening to her and she still wants to go somewhere else where her brain is not fuzzy. But she doesn't have the hysteria, angst, anger, paranoia, or combativeness she had before. She still says hurtful things when she can get them out. She still has delusions and her reality is severely skewed. But she is easily distracted without getting excessively upset. She still cries occasionally. She is not the Mom of old. She is the Mom that she is now without the psychosis attached to what she is. Mom is not "with it" but that is not a side effect of the medication.... it is because of the disease and where she has progressed to in that disease.

Love, deb

 
Old 07-18-2009, 08:05 AM   #6
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Re: Another assessment

Deb thanks for taking so much of your time trying to help me to understand all this. Mom hasn't been relocating (moving) in her mind just yet, but she has been talking that she has to get out of there many a time. She says all her stuff is missing but it's all carefully wrapped in her clothing so who knows maybe she was packing too, either that or hiding it from thieves? When she was in the hospital a few months ago she tried to escape with her walker behind a visitor that was leaving...she got caught and was escorted back so then they had to close the Ward doors and put a bright yellow vest on her. It's so sad for both and all our parents who suffer this?

Guess what, my sister is making a trip out here for a week's holiday so is bringing mom with her with the approval of the Nursing Home of course. Sis no 2 will have her for 3 days and I will have her for 4. I will be happy to spend the time with her, but I'm a little bit worried but decided unlike the last time that I will be taking her out a lot to distract her if she is up to it. Too I will make up a bunch of meals and put them in the freezer so not too much time will be consumed preparing them so I can give her my full attention, but still I'm worried if I can find the strength to give her the best of my patience and love?

 
Old 07-18-2009, 09:50 AM   #7
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Re: Another assessment

Dorri,

You mentioned your doubts about Alzheimer's. My father was diagnosed with Alzheimer's disease. Some months after the diagnosis I read that those who suffer from Alzheimer's usually lose their sense of smell. Then I thought: "well, that explains the fact that he had no sense of smell many years before he had any other symptoms." He couldn't smell cookies baking in the oven, couldn't smell leaves burning in the yard and we didn't know what to make of it. It was an early warning that we didn't recognize.

That part of the brain that registers smell was the first to go. I don't know if that will be the case with your mom but you might give her a "smell test". For example, you might hand her a bottle of perfume and ask her if she likes the way it smells, or a bar of soap with fragrance. You don't have to tell her it's a test.

 
Old 07-18-2009, 10:24 AM   #8
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Re: Another assessment

Thanks John, you know I never really noticed a loss in her sense of smell but thanks, when she'll be with me for the 4 days in the following week I will definitely have an opportunity to test it, without telling her of course. She use to hate my perfume, it was too sweet for her. I will try that on her and will also ask her if she smells the coffee, she loves her coffee.

 
Old 07-22-2009, 04:30 PM   #9
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Re: Another assessment

The assessment is complete. she doesn't need to be in a locked ward, so will be put on a waiting list for an open ward in the NH. We are thinking of moving her to another Nursing Home because the one she is in isn't providing half of what they were supposed to, plus they are short staffed so the residents don't get full care. I have communication with my sister but forgot to ask her just how free will she be in an unlocked ward? There must be some monitoring of a person's coming and going while in there? Atleast I hope so? I do have some concerns and hope that the NH will judge her freedom fairly and if she does need to be put back into a locked ward at a later date, then may they do so for her own safety?

 
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