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  • Dementia, drama and reality -- crisis moment!

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    Old 05-16-2013, 03:29 PM   #1
    TerryJ2
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    Exclamation Dementia, drama and reality -- crisis moment!

    I moved my elderly cousin here from NYC 3 yrs ago. She was an actress, and suffers from major depressive illness, anxiety, ADHD, and dementia/Alzheimer's. She had fallen 3X and broken her hip and tailbone and refused PT, and became addicted to oxycodone. When she weighed about 90 lbs, and the svc I hired in NY got her file mixed up w/someone else's, I moved her to VA, taking her by ambulet immediately to a convalescent center. Within 9 mo's, she had "graduated" to assisted living (amazing, because I seriously thought she was going to die).
    She's been in her apt at asstd living for 2 yrs. I have told her several times, amidst much drama, that I had signed away her rent-controlled apartment
    and she was here to stay. Crying, drama, hysterics, anger, blame, you name it.
    We even went to therapy together but the therapist basically kicked her out after 6 mo's because she refused to use her walker and admit she needed help. (The therapist surely didn't want the liability, either. My cousin is a huge fall risk.)

    Today, a former employee/so-called friend called from NY to say hi, and I have asked her to not say anything about the apartment to my cousin. Today, the superintendent was there, and wanted to talk to her, so this person put him on the phone. Immediately my cousin said she was coming up to her apt to visit, and he said, "No, you can't do that, it was sold a year ago and has been converted into a condo."
    She went hysterical. Just when the Visiting Angels person (a true angel) got her calmed down, the do-gooder called back and it started all over.
    She gets Ativan at 8 p.m. tonight but I know that won't keep her until morning.
    I called the head nurse and gave her a heads-up, and suggested that she unplug the phone. This isn't about my cousin's wellbeing, it's about the woman who called to begin with and called back and made it worse.
    I will probably have to see her in person tomorrow and go through everything all over again.
    What do I say? Do I guide her back to la-la land or tell her this is the way it is and that's it? I've gone both directions and it is a circular route. I hate being the bad guy.
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    Married 31 yrs, 18-yr-old NT daug in coll, 13-yr-old Aspie, adopted 2 days old. Poss mood dis. LD but only 1 gr behind; priv school; wheat/gluten-free, milk-free diet; Adderall, Imiprimine, Clonidine.

     
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    Old 05-16-2013, 06:01 PM   #2
    Gabriel
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    Re: Dementia, drama and reality--crisis moment!

    Oh Terry... wouldn't you just love to strangle the lady that called and called again. Does Mom have a phone in her room or is she using the facility phone? If she is using the facility phone you can ask them to screen her calls and not let her talk to this lady. I would absolutely call this lady and let her know what her phone call did.

    As for your cousin, you know which works best for her... and many times neither does. Mom wanted to go home until she could not say it any more because she had lost her speech communication abilities. I told her every story in the book and then a few. In the beginning, she wanted to go home so I took her for a visit. The first time she didn't seem to recognize the house. Walked in and then said she was ready to go. Next time she didn't have a clue where she was and never went in. The third time we had lunch with friends (who she didn't recognize) and when I ask her if she wanted to go by the house she looked at me with a blank stare so we didn't even go by. That was the last time. Yet when we arrive back at her AL... she wanted to go HOME! I finally understood that she wanted to go somewhere that she was safe, secure, and not confused. It's not a place they are looking for but a feeling. I just told Mom constantly that she was "where she needed to be". She was with Dad, and close to the "girls". I also told her that the doctor said she needed to be there for whatever reason I came up with in the moment. It all depends on how in touch with reality your cousin is. She may not even remember the conversation tomorrow. If that is the case, don't bring it up! She may remember that something has upset her but not remember what. If you ask what is wrong and she can't tell you, then just assure her that you are going to find out what happened and take care of it. Do not elaborate. Just assure her that you will take care of it! If she remembers enough to know what happened and details of the conversation then you can tell her that she almost died there and you love her too much to let that happen. Tell her she needs to get stronger before the doctor will consider any changes. If she is like Mom... her ability to determine time is limited. I could tell Mom we would do something next week... over and over and over. Next week is too long away for them to know when it is time. Again, this depends on the cognitive abilities of your cousin. So do not bring it up, play it by ear after you know what she remembers, and at most reassure her that you understand and you are "working" on it.

    I found the mid stages of dementia to be the most trying because they have some sense of reality but it is warped. Their judgement and ability to reason is severely limited but they think they are "fine". For them, it is you that is out of it!

    I did shake my head. Therapy usually does not work in even early dementia. As I said before their judgement, reasoning, and grasp on reality puts them in a place that they can not benefit. They have limited short term memory as well which hampers the benefits. They also have lost their ability to follow complicated directions and come across as uncooperative. A good therapist should know this. I went through the same thing with Mom after her diagnosis. We were told that Mom did not need to be living alone and were trying to get her out of the house. I fired the therapist after she told Mom that she just needed to be more assertive and tell us girls... who were trying to help... to go home and leave her alone!

    So know you are doing the best you can in a difficult situation. Follow your gut feeling and don't look back. If approach one doesn't work... go home and try again the next day

    Love, deb

     
    Old 05-16-2013, 07:36 PM   #3
    TerryJ2
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    Re: Dementia, drama and reality--crisis moment!

    Thank you so much, Deb. I really appreciate your response.
    I really like this: "is where she needed to be".
    My cousin has her own phone. When the nurses check on her (or, considering that it's 10:30, when she went in) she was going to unplug the phone. That will keep the woman in NY from getting through again, and it will prevent my cousin from calling me.
    If something terrible happens, that staff will call me. That's why my cousin is there.
    I left a msg for a supervisor at our local NAMI chapter and she called back. She thinks I should tell my cousin the truth if she remembers the conversation. It all depends upon how lucid my cousin in in the morning.
    In the meantime, I escaped having to call her back tonight. So far ...
    Thank you so much for responding.
    __________________
    Married 31 yrs, 18-yr-old NT daug in coll, 13-yr-old Aspie, adopted 2 days old. Poss mood dis. LD but only 1 gr behind; priv school; wheat/gluten-free, milk-free diet; Adderall, Imiprimine, Clonidine.

     
    Old 05-16-2013, 08:48 PM   #4
    Gabriel
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    Re: Dementia, drama and reality--crisis moment!

    And I agree with NAMI Supervisor. If your cousin remembers the conversation in the morning and is still upset by what this person told her then tell her but please do not go on and on about it. Reassure her that you are love her, are helping her, and that she is where she needs to be. Acknowledge that your cousin is upset and that you are there to help her. But I still say... let your cousin guide what you say. If she's fine and doesn't bring it up then let it go.

    Over all my years I learned that I was the one that was bothered more than anybody by what happened yesterday. Mom, Dad... they forgot. They lived in the moment. I had to learn to do the same. It was a great lesson and has served me well There are blessings in this disease!

    Love, deb

     
    Old 05-16-2013, 09:04 PM   #5
    TerryJ2
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    Re: Dementia, drama and reality -- crisis moment!

    Well, she's a drama queen and can s*ck the life right out of you, so I can only let her lead the conversation for a little bit.
    Yes, these middle stages of dementia are so hard. My dad died from Alzheimer's last June and he didn't get violent until about a month before he died. We were very lucky ... he was generally very happy.
    My cousin is a complainer (and she's the first to say she's not a complainer) and she can be very funny when she is the center of attention. But mostly she's irrational and dramatic.
    __________________
    Married 31 yrs, 18-yr-old NT daug in coll, 13-yr-old Aspie, adopted 2 days old. Poss mood dis. LD but only 1 gr behind; priv school; wheat/gluten-free, milk-free diet; Adderall, Imiprimine, Clonidine.

     
    Old 05-16-2013, 09:52 PM   #6
    Gabriel
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    Re: Dementia, drama and reality -- crisis moment!

    My Mom was the one for the drama. She did not go lightly into her dementia but fought every step of the way.... Usually ME! Mom's complaining evolved into more than complaining. She became combative and aggressive. But after a 10 day trip to a great Geriatric Behavioral Med Unit.. she spent the last few years very content. We were able to find the right combination of medication to give her the best quality of life possible. The only problem I had with Dad, was when he got upset because Mom was not happy. For the most part, he was very content. Just proof that each is different and why you have to take advice and fit it to your situation.

    Your cousin will lead the conversation... and if she doesn't mention the house then let it go! Hang in there. This will pass and be replaced with something else!

    Love, deb

     
    Old 05-17-2013, 05:31 AM   #7
    Luau
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    Re: Dementia, drama and reality -- crisis moment!

    Quote:
    Originally Posted by Gabriel View Post
    My Mom was the one for the drama. She did not go lightly into her dementia but fought every step of the way.... Usually ME! Mom's complaining evolved into more than complaining. She became combative and aggressive. But after a 10 day trip to a great Geriatric Behavioral Med Unit.. she spent the last few years very content. We were able to find the right combination of medication to give her the best quality of life possible. The only problem I had with Dad, was when he got upset because Mom was not happy. For the most part, he was very content. Just proof that each is different and why you have to take advice and fit it to your situation.
    Deb, if you don't mind, please tell us more about what took place in those 10 days at that great Geriatric Behavioral unit?

    On an unrelated note, it seems folks in the early to early mid-stages of cognition decline seem to be hypercritical towards others in similar situation. My mother and my DW are like that. Each will go on and on and on complaining about the other's "condition". DW complains non-stop that Mother asks the same question 4 or 5 times in a conversation, and forgets. Mother continually complains that she can't talk to DW because DW screws up her facts and tells made-up stories. Good thing they live on opposite sides of the continent.

     
    Old 05-17-2013, 07:18 AM   #8
    Gabriel
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    Re: Dementia, drama and reality -- crisis moment!

    Luau, Mom was out of control. They started with a complete physical to make sure there was nothing else going on, UTI, pain, etc. Then they started test runs of medications. They are very trained in side effects vs benefit evaluation and after a few attempts settled on the right combination. Then she stayed a few days to make sure the combo they had chosen was what was going to work long term and tweak the dosage to the lowest possible dosage. Honestly, it was so finely tweaked that if her dosage was a couple hours late I knew it! What made it work was having a doctor (geriatric psychiatrist with had spent his career specializing in dementia behavior) and his staff who were experienced and trained in dementia behavior care. This is the ONLY thing this unit does and they have a great reputation. This is not a job for just any doctor and why I always say find a good geriatric psych unit that specializes (and has good results) in dementia behavior. Guess I was lucky to have this unit available!

    As for your side topic Luau!... YES YES YES. Try having two in the same house Mom was always irritated with Dad. He was lazy. He didn't do anything. He didn't understand. He wouldn't take her on vacation. On and on and on. Dad would get upset because Mom wasn't happy and try to fix it. Then he would get angry with her because she was unhappy. He would tell me she was just a demented old lady. She would tell me Dad was useless. This constant bickering with one another, which frequently became very verbal and occasionally even became physical, is one of the reasons they could not remain together at home.

    Lack of empathy is common in dementia. The part of the brain that lets you empathize and connect with other people is damaged. Dementia patients are typically self centered. It is all about how the world around them affects them and there is no consideration for others and how the world (or their actions) affects others. This is why they can say such hurtful things.... or not understand why people are doing what they are doing. Before dementia Mom would have understood (and did) why Dad did what he did or couldn't do what he could not do. With dementia... she just complained

    Love, deb

     
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