WHAT SHOULD WE DO ABOUT MOM?
Since Dad died 2 years ago, Mom has been more forgetful and is missing important appointments despite having put them on the calendar. She just doesn't seem to be herself and lately, I've noticed that she's forgotten conversations with me about recent family events. She's had two fender-benders in the past year, the last one resulting in a nasty bump on her head. I don't think she's taking her medicines properly because I find pills lying around the house, but she resists my efforts to monitor them and tells me her doctor is keeping tabs on her. She's pretty adept at covering up her mistakes, but I sense she's worried too since I've heard her joke to her sister in Ohio that she thinks she's getting "Old Timer's Disease." My siblings live in different parts of the country, and none of us want to admit this is happening, but now I'm really concerned about her safety. We don't know what to do next.
This is a common scenario being played out in every city across the country. None of us want to think of the possibility of a devastating diagnosis like Alzheimer's or some other type of dementia, and how each family deals with the problems and questions that arise will be as diverse and individual as each family is unique.
Your objective will be to maintain Mom's dignity, health, happiness and safety, and she first needs to be thoroughly evaluated by her physician. A "dementia work-up" would include a history along with blood tests to rule out a problem that can mimic dementia. Depression, thyroid disorder, vitamin B12 deficiency, and medication reactions are just a few of the possibilities which can be treated successfully. Memory tests such as a mini-mental state exam, including a clock-drawing test are important and should be done for a baseline evaluation, as well as in follow-up to monitor memory status. PET and CT scans or an MRI can show abnormalities in the brain such as strokes, lesions or excess fluid, all of which could account for her symptoms. Someone should accompany her to these appointments, and her doctor should be informed about the family's concerns.
In any case, a durable healthcare power of attorney must be appointed in order to access medical information or make medical decisions for her, if needed.
Waiting for the crisis to happen before acting is being "reactive" where "proactive" would be finding some answers to try to prevent a crisis. Since people don't know what they don't know, accessing those professionals who can provide answers will give families some control over what may happen. It will never be easy or comfortable to find the answers, but meeting your objective may depend on what you do before the crisis. Future articles on this topic will address some of the specific challenges faced by families dealing with dementia.