Wandering: Ever Wonder Why He Just Wants To Be Where He Thinks He Wants To Be No Matter How

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Alzheimer's Care, Alzheimer's Disease, Alzheimer's Humor, Behavioral Problems in Alzheimer's, Behavioral Problems in Dementia, Dementia Care, Lack of Insight

(Photo Credit:rowanpeter.com)

Ever notice the inside pages of newspapers where there’s a row of missing persons lined up like a mug shot. Have you ever noticed that about three out of five of them would be older persons and about one of those three, a caption includes the fact about the patient having Alzheimer’s Disease?

That is because of wandering. They go about town aimlessly and then eventually would forget to find their way home.

This can be a worrisome problem which you may need to manage. The person with AD may wander around the home or leave the house and wander around the neighborhood. They may get lost. Safety is a primary concern when the person with AD is out in public alone.

Suggestions:

Make sure the person carries some form of identification (a Senior Citizen’s ID, a piece of paper that contains contact number, a dog tag, a baller ID etc)

Make sure your home is secure and that the person is safe and cannot leave without your knowing

(Some of family members of my patients have installed double locks or locks high enough that the patient cannot reach, locks on their gates etc)

When the person is found, avoid showing anger-speak calmly with acceptance and love

It is helpful to keep an up-to-date photograph in case the person gets lost and you seek the help of others

(That means, do not send to newspapers his graduation or her prom picture. There’s no chance  you’re gonna find your patient that way)

N.B. Pictures are for illustrative purposes only. In no way is this blog saying that the person depicted has Alzheimer’s Disease.

In Praise Of The Good Daughter-In-Law (All Over The World)

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Daughter In Law, Dementia Care, Elderly Care, Retirement

                 In a talk I was asked to give in an Asia-Pacific forum on experiential sharing of care giving practices for Older Persons  in the Philippines, I culled my data largely from my own clinical practice and loosely from the scarce literature I was able to scour from equally limited sparse library shelves .

                 Because of the diaspora of Filipinos  going out of the Philippines to work abroad, they leave behind their aging parents to the care of other  family members. The top primary caregiver would invariably be the spouse, who himself is an older person, himself,  most of the time, a patient. Then comes the unmarried daughter, be it the eldest or the youngest and other relations like a niece, a nephew or a cousin.

                 Sometimes, it would be the untrained household help or even the neighbor.

                 But neck to neck on top of the list along with the spouse is the daughter in law.

                In an interview with one who resigned from her work as a nurse to care of  her mother in law with Alzheimer’s disease, she reasoned that she was doing this – this superhuman act of caring for her mother in law was because the patient had been a most supportive and gentle person she knew. But above all,  out of her great love for her husband.

                 My own mother in law passed away in December last year. I never had the chance to care for her the way my patients had been cared for with all the genuine compassion, affection, infinite patience and love that I see among daughters in law that come to me. My own brothers in law and sisters in law, my husband included, have always been a most caring and loving nuclear family.

                 I am writing this post however in honor of daughters in law, here and those I met elsewhere – that to some degree, in my clinical practice,  you’re my ‘hero’.

                 As an aside, a lesson to be learned for future mothers in law is to be kind to the woman your son wants to spend the rest of his life with. For when the time when you get old, when you will have become a fallen tyrant,  it is your daughter in law who will likely take care of you.

Top Five Reasons Why Alzheimer’s Patients Are Not Brought Along To Parties Anymore (Family Says “I’ve Had It!)”

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Alzheimer's Care, Alzheimer's Humor, Behavioral Problems in Alzheimer's, Dementia Care, Ghost, Hallucinations, Macaroni, Mahjong, Psychosis, Social Disinhibition

1. They would pick the macaroni pasta by hand, piece by piece, from the salad bowl and arrange them like mahjong tiles. Then would ask the other guests to play mahjong with them.

2. They would take out their false teeth and leave them lying around anywhere. (Put them back where they should be Mom. They’re  e-x-p-e-n-s-i-v-e)

(Photo Credit: vintage.com)

3. They would insist in wearing the same dress they wore at another party two nights before – the same dress they wore to bed in the night before.

(Photo Credit: en.wikipedia)

4. They  can’t stop talking about the ghosts that they see in the lawn, behind the gate, by the banquet table, in the garage, on the stairs near the restroom, inside the restroom, behind one guest (what his name) etc that scares the wits out of the other guests

5.They can’t stop talking. (About the same thing over and over again). They just cant.

Testing Your Alzheimer’s Quotient

Tags

Aging, Alzheimer's Care, Alzheimer's Disease, Dementia Care

 

(Photo Credit:profimedia.si)

1.) Which of the following is not an indicator of Alzheimer’s?

• Getting lost in familiar places
• Forgetting the names of casual acquaintances
•  Having trouble balancing a checkbook
• Coping poorly with unexpected events

2)Which of the following may increase your risk of Alzheimer’s?

• Head injury
• History of depression
• Low level of education
• All of the above

 

(Photo Credit: bocahomecareservices.com)

3)No other age-related problem results in dementia.

• True
• False

4)Which of the following has been connected to Alzheimer’s disease?

• High blood pressure
• Low blood pressure
• Both

5)Family history plays no role in your risk of developing Alzheimer’s.

• True
• False

6)A simple blood test can confirm an Alzheimer’s diagnosis.

• True
• False

7)Besides Alzheimer’s, which of the following also can cause memory loss and confusion?

• Thyroid problems
• Drug intoxication
• Depression
• All of the above

8)Though a definite diagnosis of Alzheimer’s disease is possible only by autopsy, doctors can usually identify the disease by ruling out other causes of dementia.

• True
• False

9)Early diagnosis provides no benefit in Alzheimer’s disease.

• True
• False

10) And how did you do in the test?

•  Excellent
• Satisfactory
• Fair
• Poor

Top Five Jaw Dropping Lines Alzheimer’s Patients Have Told Me (Some Things Were Cute, By The Way)

Tags

Alzheimer's Care, Alzheimer's Humor, Behavioral Problems in Alzheimer's, Behavioral Problems in Dementia, Dementia Care, Elderly Care

1. On seeing a  framed oil on canvas painting of me examining an 80 year old candle vendor, weather-beaten creased face,  wrinkles and all

Patient: What a beautiful, beautiful lady.

Me: Well, thank you Sir.

Patient: I mean the old lady, not you.  (LOL)

(Photo Credit: ‘PAG-AARUGA’ oil on canvas, from this blogger’s collection, Rolly Yakit, artist)

 

2. On asking the patient how she was.

I am fine. It’s you. Wow, you put on so much weight!

(And she said this after I already lost  about 30 pounds from my all time heaviest at 154 pounds)

(Photo Credit: bigstockphoto.com)

3. On asking a patient to draw a clock (as a screening test for dementia)

What  for?  I have a Rolex

(And right she was. She had an authentic Rolex Oyster Perpetual Datejust)

(Photo Credit:coolspotters.com)

4. On telling a patient she has diabetes based on her HbA1c result

I don’t think so. I think I’m still two tablespoons of sugar away from diabetes.

(Photo Credit organicsoul.com)

5. On introducing myself  to the patient as Dr. Angel

                                          The patient called on his caregiver and asked ‘Am I in heaven? Why is there an angel?’

(Photo Credit:angelmovies.org)

Testing, Testing (Part I)

Tags

Aging, Alzheimer's Care, Alzheimer's Humor, Dementia Care, Elderly Care

(Photo Credit: mangomaven.com)

(Photo Credit: knowledgerush.com)

(Photo Credit: homedesigns.com)

One of the neuropsychological tests doctors conduct for screening (N.B.  Screening not Diagnosing) dementia is Folstein’s Mini Mental State Exam (MMSE) which uses the three objects for immediate and delayed recall.

This is how it normally goes:

Doctor: I’m going to say three words. After I say them, say them back to me

Mango  Paper  Table

Patient:  Mango Paper Table

Doctor: I’d like you to remember these three words because later I am going to ask  for them again

(After a brief distraction which may be the Serial Sevens, the doctor again asks the patient those three words)

Doctor: Do you remember the three words I asked you to remember.

It would be that the number of words a patient remembers  or the speed with which they remember them depends on the magnitude or degree of the impairment.

One particular patient has been having a hard time remembering any of the words and she appeared to be painfully sluggish. So that even if she would not be getting a point for this, I tried to give her a cue.

Doctor: Ma’am, do you remember any of the three words?

Patient: I don’t remember.

Doctor: OK, I’ll give you a clue. One of them is a fruit.

To this the patient seemed jolted from a trance and exclaimed ‘Did you just say fruit?’

Doctor: Yes Ma’am. A fruit.

Patient: (This time laughing)   ‘Ha ha ha. Ha ha ha ha. No, way. No way. No way will I remember that because I never liked fruits!’

LOL

An Alzheimer’s Patient’s Prayer

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Alzheimer's Care, Alzheimer's Humor, Alzhiemer's Disease, Behavioral Problems in Alzheimer's, Dementia Care, Elderly Care, Retirement

Lord, grant me the senility to forget the people I never liked anyway, the good fortune to run into the ones I do, and the eyesight to tell the difference.

Stages Of Alzheimer’s Disease (Quick Quirky Version)

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Alzheimer's Humor, Dementia Care, Elderly Care, Forgetfulness, Memory Loss, Stages of Alzheimer's Disease

1. First you forget to zipper down.

(Photo Credit: geekologie.com)

2. Second you forget to zipper up.

(Photo Credit: wolf-howl.com)

3. Third you forget to zipper up and see ‘that’ thing and forget what ‘it’ is for.

(Photo Credit blog.sellingtoconsumer)

Hoarding 101: A Sneak Peek Into What Alzheimer’s Patients Hoard In Their Bedrooms

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Alzheimer's Care, Alzheimer's Humor, Behavioral Problems in Alzheimer's, Dementia Care, Early Alzheimers, Hoarding, Paranoia, SM

Like it or not, they do hoard. One of the early signs of  dementia that I have seen in my practice is hoarding. They hoard a motley of things – from the priceless to worthless.

Shopping bags. Mostly SM’s. I saw a box of neatly folded blue ones and another boxful of yellow ones. Both boxes under the patient’s bed and well kept and away from the prying view of ‘thieving maids‘, by a bed skirt. It’s almost the same story everywhere – whether it’s a private home, a nursing home or a home for the aged – there’s always one or more who would hoard all this plastic.

One patient ordered her son to transfer the freezer inside her room because the maids were raiding her refrigerator especially when no one was looking at night. The next time the son visited, he would see five day to one week old worth of left over food inside the freezer.

A male patient, a former industrial arts teacher had his tool box, yes, the entire cabinet type tool box mounted and bolted into his room because again there might be ‘thieves’.

An old single lady, a patron of the arts and well-known in civic circles in the capital city was cared for by a care giver-niece. The niece came to the center because off the Aunt’s bizarre behavior. Every afternoon, she would be in the laundry room where the kasambahay would be folding her newly washed clothes. She would insist in personally putting all her underwear inside her drawers. There seemed nothing wrong with that except for the fact that she would have with her a logbook where she made an inventory, of all things, her old underwear. Yellow, check. Beige, check. White, check. You see the picture.

Hoarding cash may seem like prudence or foresight on the part of the patient but she withdrew them from the bank for fear that her children would put a fast one over her. She’s blessed to have had a ‘yaya’ who kept a careful accounting of her cash and persuaded her to deposit the money the following day. But in this day and time, she might have thought the bank secrecy law to be leaky she just might be next -  after CJ Corona. This time I’m just kidding!

Stop In The Name Of Love (Unpurposeful Behaviors That Drive The Family Nuts)

Tags

Aberrant Motor Behavior, Alzheimer's Care, Alzheimer's Humor, Behavioral Problems in Alzheimer's, Dementia Care, Unpurposeful Behavior

1. HAIR PULLING  to the point of going bald on a certain spot. Others have resorted to letting their patient wear a wig.  Playful daughters bought their Moms  purple wigs, blue wigs, red wigs on top of the generic short curly blond ones.

2A. PACKING THE  SUITCASE because they just had to go home (even if they are already home)! Believe it or not, they do this from a range of six to sixty times a day!

2B. UNPACKING THE SUITCASE because they are already home (even if they have not actually left)! Believe it or not, they do this from a range of six to sixty times a day!

3. HOLDING ON TO THE BAG NO MATTER WHAT because the ‘maids are out to steal her money, jewelry, make-up, bottled water  and, yes, bag.

4. GOING TO THE GROCERY AND BUYING MULTIPLES OF THE SAME ITEMS that fill the cart almost every day. One patient bought a grocery cartful of ketchup. The same patient, after filling her kitchen cabinet with bottles of ketchup shifted to buying  jars of mayonnaise. Another patient was reported to have bought a basket of peanut butter. Lycopene rich peanut butter-mayo sandwich anyone?

5. STOMPING THE FOOT whether sitting down to eat or to watch TV or bathing while seated on a plastic chair, with or without music, they simply couldn’t, wouldn’t stop stomping!

DISCLAIMER: The identities of the subjects in the vignettes and other stories on this blog are intended to be ‘anonymous’ to protect the patient and their families and keep the doctor-patient confidentiality or fiduciary relationship. The personas cited here are not meant to be blind items or fodder for gossip. My lips are zipped in that department. Some of their identities and circumstances have been altered but the nuances of their medical condition are fact and not hidden behind veiled medical-clinical fiction. Think Oliver Sack’s ‘The Man Who Mistook His Wife For A Hat’. Okay, it’s like comparing Roederer Cristal rose wine with vin d’ table but  I know you see the drift.