Q. My 92-year-old mother has always had a loving and sweet disposition, until recently, when she has turned into a rude and abusive woman. She shows early signs of dementia, but she is in relatively good health. She won’t leave the house and though she complains about being lonely at night, she threatens to call the police if we suggest a nighttime companion. Her behavior is irrational and I don’t know what to do to help her. She refuses to see a geriatric psychiatrist and her physician is concerned that a calming medication could contribute to a fall. Can you give us any advice?
Michael B., Miami
This is indeed a very difficult and stressful situation for you but unfortunately, it is not uncommon, according to Dr. Leslie Kernisan, a board-certified geriatrician and a clinical instructor at the University of California, San Francisco.
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Here is what she advised in an email to me:
“First, I would find a way to obtain a preliminary medical assessment for dementia possibly handled by his mother’s primary care provider,” she wrote. “She’ll be checked for other health problems that might cause personality or thinking changes. It’s possible that the changes her son is observing are not due to dementia, which can be exacerbated by additional problems such as electrolyte imbalances, medication side-effects, untreated pain or even constipation.
“I suggest that the son familiarize himself with how dementia is diagnosed and then accompany his mother to the exam prepared with good information regarding her abilities and challenges. Also, bear in mind that HIPAA does not prevent you from contacting her doctor ahead of time and relaying your concerns and your observations.
“… If a diagnosis of dementia is confirmed, her son will want that information to be in her medical charts with all of her physicians since it has implications for how to manage the care of any other health problems she has.”
Finally, Kernisan wisely pointed out that a diagnosis would also make it easier for you to get help as a family caregiver with coaching in dementia behavior management and caregiving coping strategies. .
A diagnosis will also help you plan ahead for when her cognitive abilities and independence are further impeded and she requires more oversight. While these situations are always emotionally and financially challenging, I have observed that families who plan ahead tend to use support services more wisely, and as a result, they experience less stress.
For help coping with the experience – whether it’s how to get your mom in to see the doctor, how to deal with the doctors, how to cope with your stress, how to manage her outbursts and how to plan ahead – the doctor recommends the following resources.
▪ Read a few good books. For dementia, the 36 Hour is well respected, as well as Surviving Alzheimer’s.
I also highly recommend visiting Kernisan’s blog, “Better Health While Aging,“ (www.betterhealthwhileaging.net, which offers practical ways to improve health and well-being in aging.
Nancy Stein, Ph.D., is the founder of SeniorityMatters.com, a local caregiver advisory and referral service for South Florida seniors and their families. You can contact her at firstname.lastname@example.org.