Making plans for dementia, just in case

When and how might we—or friends or family—know the time has come to get additional support if we should develop dementia? At what point would moving have been less traumatic for Traci? For Quinn? There are no easy answers, but some pondering and research have led me to these behavioral warning flags. I can communicate this list to my partner and friends in advance of dementia striking any one of us, and agree with them that repeated patterns of these behaviors will shout “Get Help!”:

  • Time disorientation, specifically regularly missing appointments, arriving on the wrong day or time routinely. My mother’s hairdresser dropped her as a client after too many missed appointments. A friend frequently misses lunch appointments. These are signals.
  • Space disorientation, being unable to find the way home, or to the restroom in a building they should know well. Arriving at a familiar intersection and having no idea which way to turn. Every one of the dementia victims I know suffers from this.
  • Short-term memory issues such as repeating the same question over and over, or constantly searching for lost dish/glasses/shoes. We all do this sometimes, but it is the frequency and persistence of this behavior which is the signal.
  • Problems with any of the Adult Daily Living functions (dressing, toileting, medication, eating).  20.7% of adults aged 85 or older needed help with ADLs

If any of those became routine behaviors in me or my spouse, I would seek a consultation with a physician and/or neurologist for diagnosis. Some dementia is the result of medications; geriatricians have a list of those. Some dementia symptoms are induced by anxiety. A physician or neurologist might seek additional assessment as part of the diagnosis.  Our community’s annual physical (and our entry physical exam) includes some mini-mental status questions. Data and diagnosis in hand, it would be time for decisions. Be at home as long as possible? Hire caregivers for at least part of the time? Or utilize that continuing care contract ASAP?

 In my case, I am aware that I am impatient, irritated and exhausted with the behaviors associated with dementia. I feel strongly that my loved ones should not be expected to endure such stress daily if I were the one to fall victim to dementia. I believe I would also be happier settling in earlier to a Health Center or other institutional environment, when I might still be able to understand and remember the love and care that my family exhibited in ensuring my care and theirs.  It sounds easy, and maybe it will be, but if I should be the victim of that dastardly dementia, I would want care which helps me remain safe and engaged with life, and able to be as independent as the disease would permit—in a Health Center setting. This  is why we live in a Continuing Care community, an economic luxury for which we are very, very grateful.

Moving my demented friend to fulltime care

Sharing my experience of moving my friend with dementia into our community’s Health Center where Assisted and Nursing Care are available as part of our contract.

My friend, Traci (not her real name of course) is 90, virtually devoid of short term memory and sometimes very anxious—a bad combination. When she gets anxious about the whereabouts of her husband (Quinn in my narrative), she might search the neighborhood for him. Neighbors have learned to gently guide her home if she is walking alone.

Sometimes, Traci is running away, because Quinn, 93, gets angry at her repetitive and constant questions “Would you like a cup of coffee?”   Some neighbors are convinced that her anxiety is causing her dementia and that Quinn is simply abusive while others have urged for many years that her dementia be handled professionally in our Health Center. Quinn has been unwilling to relinquish the full responsibility for care of his beloved wife of 70 years. Whenever he spoke of it to Traci, she cried or ran away. Traci is loving and attentive, tidying up tables and stacking plates as she did years ago in the restaurant they owned.  A meal with Traci may include 10 or more queries about refilling your coffee or tea.  She is normally calm, caring and kind.

Recently, Quinn fell and was hospitalized; as her friend, I was asked to stay with Traci who could not be left safely alone.  She had watched her husband leave in an ambulance but could not remember it and had no idea where he was. For hours, I sat with her, ate with her, kept her safe while repeatedly calming her with stories and tidbits of information. When it was clear that Quinn would remain overnight in the hospital, I led her to the Health Center, away from her home, her cat, and her possessions knowing she would never return. We took nothing with us. I walked with her to a room, explaining that she would wait there for her husband’s return the next day and left her to the care of the nursing staff.

Meanwhile, our Health Center staff had obtained permission from their son/Power of Attorney to move Traci to the Health Center during Quinn’s hospitalization. Their son had already slowly begun the process of permanently moving them both and he agreed to hasten that process.  By nightfall of the day Quinn had fallen, Traci was safely a resident in the Health Center. Quinn returned to the Health Center a few days later; he too would never again return to his former home. A week later, Quinn and Tracy were united in a new shared suite in the Health Center with furniture, possessions and cat.

Everyone who knows them celebrates that they are safe and together with 24/7 professional care. I am relieved, emotionally drained, physically exhausted, and deeply regretting that the move had not happened long ago. The “what-ifs” are haunting: What if their son had been unavailable? what if a transition hadn’t already been planned? what if they hadn’t had such strong community support? what if they didn’t live in a community with a Health Center contract?