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Old 10-08-2012, 02:40 PM   #1
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Question about Alzeiheimer's/Dementia and Sundowning... please help if you're able

Hello. So I have a 96 year old grandmother, who is in okay health. About a year ago, she fell and went to the hospital because she broke her pelvic bone. While there, we were told she was "sundowning." She acted totally different, was violent, angry, and miserable.

All in all, she is very positive. She lives alone, and my mom helps her by bringing her food, and cleaning. She is a Christian, and watches church programs on t.v. and reads the Bible. She also does light cleaning.

She had melanoma about three years ago. They didn't get it all, and she now has keyloid scars, and other problems in her leg that cause her pain and swelling. She uses a walker now. She fell two weeks ago, hit her head, and didn't tell anyone until a couple of days later, but was okay. She said that it was like someone pushed her down.

Anyway, she is VERY happy, outgoing, positive, etc.

Well, lately, she has been a bit off. Last night, I talked to her at 8 p.m. when I usually talk to her at 7 p.m., and she was really mean to me. She told me that she wanted to tell the doctor (she has an appt. soon) that he has to fix her leg. I told her that we've all told her over and over again that there is nothing they can do about her leg. She started yelling at me, saying, "WHY are you telling me this at night? I want to go to heaven now," over and over again. She was really mad. Honestly, it was like it wasn't even her...not even her voice. It was very upsetting.

So I talked to her at 9 a.m. this morning and apologized for upsetting her last night, and she didn't remember the ENTIRE conversation.

Also, yesterday she was looking for her walker while her hands were ON her walker.

It's really interesting (sad I mean) that when she's forgetting something, she is really good at changing the subject, or pretending that she remembers by saying "yeah, yeah." She won't admit to forgetting things, if that makes sense.

I really hope that someone here can help me.
My questions are:

1. Does this sound like Dementia?
2. How long will this take to progress to episodes during the day?
3. Is she still okay to live alone?

Thank you. I really appreciate any help/input.

 
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Old 10-08-2012, 03:08 PM   #2
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Re: Question about Alzeiheimer's/Dementia and Sundowning...please help if you're able

Quote:
Originally Posted by lovetoread12345 View Post
Hello. So I have a 96 year old grandmother, who is in okay health. About a year ago, she fell and went to the hospital because she broke her pelvic bone. While there, we were told she was "sundowning." She acted totally different, was violent, angry, and miserable.

I really hope that someone here can help me.
My questions are:

1. Does this sound like Dementia?
2. How long will this take to progress to episodes during the day?
3. Is she still okay to live alone?

Thank you. I really appreciate any help/input.
First of all, she is 96 so definitely she should not be home alone given such old age.
Second, did the hospital actually diagnose her with dementia? Sundowning comes with dementia. It depends. Sounds like she has dementia as she is very forgetful when she talked to you.
I am not sure what you mean by progressing to episodes during the day. Basically sundowning is only about sunset and afterwards until daylight.
It is usually a time to feel depressed and she would be afraid of the dark. Close the curtains at night and leave a night lamp for sleeping.
It is just the time when she is down. She may just forget about it the next morning!
Dementia is progressive so she may get sicker later on and needs help all the time. Also major surgery and hospitalization can make her dementia decline further.

Amazing that she is still home alone at the age of 96. Since she probably has dementia, she needs to have a caregiver with her full-time or even 24/7.
She could even live with your parents or go to a memory unit/NH for her safety.

Take care,
Nina

Last edited by ninamarc; 10-08-2012 at 03:10 PM.

 
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Old 10-08-2012, 03:26 PM   #3
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Thank you for your help. She has been fine living alone at 96. Except for the recent fall, she cooks, does light cleaning, and takes walks in the hallway to see her friends (she lives in an apartment). So that's not really what I'm worried about right now.

I guess that I was wondering how long it takes to go from sundowning to having symptoms during the day. She's lucid during the day, and I haven't noticed any issues in the evening either except for last night. I mentioned a few things that she's been forgetting, but everything I said was it.

Thanks again

 
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Old 10-08-2012, 03:28 PM   #4
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Also, I'm not sure if the hospital diagnosed her.

I want to add, that her doctors all know that she lives alone, and they all believe that she is capable of living alone at this point. I will tell my mom to let them know what happened last night though. My mom is there three/four times a day to check on her, and I talk to her at least 8 times a day to chat/check to see how she is.

 
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Old 10-08-2012, 08:06 PM   #5
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Love, first of all there is something call Hospital Delirium that occurs when a patients, usually older patient, is confined to the hospital. It is very disorienting to them but it is not dementia. Also anesthesia can cause confusion that may take weeks to clear up. This is very possibly the cause of your grandmother's difficulties in the hospital, especially since it has been so long ago that she was having these difficulties.

Next, Sundowning is a symptomatic part of dementia that occurs in the evening.. It is not an evening thing that later develops to a day light thing. Dementia is there or it is not. Yes, they do function better in the early part of the day when they are more rested. As the day wears on and frustrations build along with tiredness they do get more confused. But they are just as likely to be irritated in the morning and not function well at that time.

Yes, they are very adapt at changing the subject or giving you answers that cover their inabilities. If they don't remember, and you insist it is so, then they just agree.... much like we do with persistent people in our lives when we don't have a clue what they are talking about. It's a technique we all use to get past a difficult moment. Especially in the early and mid stages the loved one with dementia does have a thought process. Their input and ability to retain memories may be deficient but they can and do respond to what they perceive. Their judgement may be off and their social filters may be missing... but if they are challenged they get angry, defensive, or dismissive just as we do. When she ask about her leg she truly didn't remember what the doctor had said. All she knew was that it was bothering her and she wanted it fixed. You told her there was nothing that could be done and that made her angry. I am sure it makes you angry too but you know how to suppress that anger.... she doesn't and didn't. At the end of a long tiring day of trying to function alone, you gave her exactly what she didn't want to hear, and she responded honestly.

As for her living alone.... The doctor's may know she is living alone but you need to be very aware of what is going on in her apartment when nobody is there. I do hope the doctor's have given your grandmother a MMSE (Mini Mental Status Exam) which is a 30 question test to determine her cognitive abilities. If she makes less than 30 (1 point for each correct answer) then she needs to be referred for further cognitive testing to determine if dementia is a problem. A word on doctor's (especially family physicians).. many do not have a clue about dementia. I repeatedly hear, the doctor said it was ok, when in fact it is not. My Mom's doctor said that to me as well when I knew Mom was beyond living at home.

You need to check her apartment. You say she cooks... are there burned pots or spoiled foods? Is she cooking or just finding cereal type foods to eat? Is her apartment being kept neat. Is she putting items where they belong or are they in strange places? Is she losing things and has no idea where she has put them? If the smoke alarm came on would she know to get out of the apartment and call 911? Does she have trouble with the TV remote or the phone? Does she repeat herself telling the same stories over and over? Is she still taking a shower daily and wearing clean clothes? Is she still visiting and socializing on a daily basis? Just look for anything out of her normal.

You may want to talk to her doctor about the MMSE. You also might want to look into a Life Alert necklace that she can push if she falls. You can also install a nanny cam in her apartment so that you or your Mom can watch and see what is going on. That is the best way to know for sure if she is safe alone. But, in my opinion, what you are describing, is some level of dementia. It is best to have her checked out by a specialist and be sure. Then you can make a decision concerning her living situation based on what you find out.

You are a great granddaughter to be so concerned about your grandmother Hope something here has helped and hope to hear back from you soon.

Love, deb

 
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Old 10-09-2012, 03:21 AM   #6
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Wow. Thank you SO much, Deb, for that well thought out, caring, kind, helpful reply! Now that you mentioned "Hospital Delirium," I remember a nurse telling me that she was sundowning, but that it was only because she was in the hospital. Hmmmm...but the nurse still used the term sundowning. That's very interesting, and I had no idea that didn't mean that she has dementia.

Okay...so to answer some questions:

--she's not putting things in the wrong place
--she is keeping herself very clean
--her apartment is very clean (pretty spotless)
--she doesn't lose things
--when she cooks, she always cleans up afterwards perfectly

I'm SO thankful that you mentioned the smoke alarm. I'm going to talk to her about that today, and ask what she would do if it went off. I think she knows, because sometime the apartment building's alarm goes off, and she knows to go into the hallway with her friends. Oh, her second language is English, so I like to really make sure she understands things.

I'm going to talk to my mom about asking her doctor to do the MMSE. Thank you so much for all of your help. I feel like I kind of have a place to start (by asking about that exam, and looking into a necklace). I just feel like something is definitely off with her personality.

Oh...one more thing. Do you know if she has dementia how long it would take to get worse? Like...would it be weeks or months? I'm pregnant, and want so badly for her to meet my daughter, and know who she is. Thanks again.

 
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Old 10-09-2012, 04:06 AM   #7
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Just to add two things to consider: when a person falls and hits I their head, they can suffer a subdural hematoma, a I
Blood clot that slowly develops between the brain and skull. This manifests in unusual behavior, confusion and altered mental status, and usually becomes noticeable 2-3 weeks after the fall so if she is truly different in these last two weeks than what she was like before the fall, she should have a CT scan. The other consideration is that the melanoma they couldn't get all of out will spread and it can spread to the brain causing similar symptoms. So a CT scan could be helpful in ruling out metastatic melanoma in the brain. Of course, this might just be dementia, but those other two possibilities are valid considerations to think about, especially if she is going downhill quickly.

 
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Old 10-09-2012, 08:46 AM   #8
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

Love, behavior is one of the first changes you may notice if someone is developing dementia. They are losing their short term memory which makes life confusing but they are also losing their ability to make good judgements, handle the confusing situations, and explain themselves. This causes agitation and/or anger. Not every episode of strange behavior by a senior means dementia but if it become a pattern of change you need to take notice. There can be other causes for the behavior changes. You do need to mention behavioral changes to her doctor because there can be so many other causes. It might be time for blood work, medication review, and even a CT.

Rather than asking about the smoke alarm it would be better if you could make it go off and watch her reaction. I thought Mom and Dad got it.... but when Dad plugged the vacuum into the batter back up for the computer and overloaded it causing a small fire rather than leaving the house which was filling with smoke they stayed in the house looking for the problem and did not call 911. They actually argued with the neighbor who tried to get them out of the house. It is what happens in those moment of chaos that are critical in a crisis situation. The out of the ordinary is where those with dementia have a difficult time. By creating chaos (turning on the smoke alarm) and watching her reaction, is the best way to know how she would react.

Congratulations on your new daughter that is on the way Know that dementia develops over years not weeks. I know you want your grandmother to understand and know. I can't promise but I bet you she will be there and be thrilled

Ladybud does have a point. If she did hit her head in a fall, and the strange behavior continues, you will want to ask the doctor for a CT scan or MRI.... just to be safe. A Subdural Hemotoma (brain bleed) is possible. Some are slow bleeding and will correct themselves in time but some are life threatening. Yes, the Melatoma could be back and in the brain. It would be worth checking out with a CT if you notice other episodes.

You might also want to check out the side effects of the medications she is on. As her pharmacist for a list of side effects for the medications she takes. Many medications have side effects that can cause behavioral and cognitive changes. Has she changed any of her medications recently?

As far as the nurse calling grandmother's episodes "sundowning" but only in the hospital.... I am not surprised at the confusions in terminology. It is amazing how little understanding there is in the general medical professionals concerning dementia. In the 14 years that I have been dealing with my parents dementia... I have found very few medical professionals that "get it". In a hospital setting... that percentage has been almost zero! The few I have found... had somebody in their family with dementia rather than learning it in medical training. Sad, but that is the way it is at this time.

Funny story... Dad had taken a fall. He did not hit his head but was complaining of pain in his back/hip area so we needed a hip x-ray to rule out a broken hip. The doctor walked in and I told him immediately that Dad had advanced Vascular Dementia. The doctor insisted on talking to Dad. OK! After a short, nonproductive, confused conversation the doctor came back to me and said Dad needed a CT scan! WHY??? To quote the doctor, "Your Dad is very confused!" DUH.... I actually laughed and then ask him what part of Vascular DEMENTIA did he not understand? I requested that the doctor go back and look up Dad's last CT (just a few weeks before). After looking at that scan, if he thought we still needed a new CT to come back. I never saw that little fellow again We got our negative hip x-ray and went home.

I wish you well for you and your daughter. What a thrilling time for you all. I also wish you well with your grandmother and hopefully it was just a single episode of annoyance. It is good to be armed with knowledge about the possibilities and aware of changes. Good for you for taking action to find out what those possibilities might be

Love, deb

 
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Old 10-09-2012, 11:55 AM   #9
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Re: Question about Alzeiheimer's/Dementia and Sundowning... please help if you're abl

To be honest, a doctor is not a caregiver strictly speaking. He doesn't see the patient everyday so it is not really up to him to say if she can be alone. Yes, the doctor could say there is nothing wrong so she can stay home. This is just his theory. It doesn't replace the true caregiving your Mom is doing. No one can be there overnight. Often, the elderly falls overnight and does not know what to do. Given such old age, someone nearby is to make sure it is safe even if she is sound and can call 911. What if she faints and etc.
I know a former neighbor who is in the early 90s. She moved out to an AL when she felt she was not safe if she was dizzy. She is doing fine and has no dementia.

Since there is no formal diagnosis, it is hard to say. It may not be dementia itself. It could be some brain issue. No one knows how long the demented person can last. She seems pretty good so she will have a long time to go. One only knows more about the death when it comes to severe stage and she is not there yet.

Hugs,
Nina

Last edited by ninamarc; 10-09-2012 at 11:57 AM.

 
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