While I am trying to deal with the possibility of having to move her, I am more concerned at this time with her behavior. Since the move she has seemed different, sadder, more confused. It pains me to see her like this but I don't know what to do. Or, is there really anything I can do? I'm not sure how much she understands.
A: Yes, there are some things you can do to help your mom during this transition period.
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Most people who have dementia are unable to respond to conversations and questions in a normal manner. I believe that, for this reason, the rest of us assume that people with dementia cannot understand what we are saying.
When communicating with a person who has advanced cognitive decline, you can no longer rely on them to be able to provide you with the usual verbal responses. Instead, you have to watch their actions, or listen for word associations. The person may lapse into a story from their past (typically viewed as "confusion") when actually they may be telling you about an incident from their past that was upsetting to them, and it is their way now of communicating or expressing a current feeling or thought.
One incident I experienced, that I like to use as an example when educating caregivers on communication and working with cognitively impaired people, is a case I had that involved a very devoted husband and wife.
The husband had advanced Alzheimer's and was living in a skilled nursing facility where I was working. The wife would travel back and forth between the East Coast, where their children lived, and California. We (the wife and I) always made a point of telling the husband when the wife would be planning a trip, and I would remind him while she was away that she was visiting their children and would be back within a week. On one trip the wife became ill and ended up passing away. I met with the nursing staff and asked them not to tell the husband in order to allow the family to tell him when they arrived the following week. Well, the nurse went ahead and told the husband, stating, "he doesn't understand anyway." The husband died two days later.
While the exact cause of the husband's death was unknown, he had exhibited no changes in his health prior to his death. It was my opinion that he lost the will to live after being told of his wife's death by the nurse in the manner in which she did. This is a very important lesson for anyone who provides care to Alzheimer's or cognitively impaired individuals.
In the case of your mom, even if
you think that your mom won't understand, make sure any changes in her care or living arrangements are explained to her before hand. Provide reassurance through these periods, and always try to keep any changes to a minimum.
If it does come down to needing to move your mother, try and make this next move her last move, and prepare yourself for a possible decline in your mother's health and cognitive functioning. It's common for a person with dementia to experience a period of increased confusion, to become depressed, resistive to care, or experience a physical decline, when their normal routine or environment is altered. This decline can be temporary, or permanent.
A person's personality can also play a big part in how well they handle changes. If you know that your mom becomes anxious with changes, speak to her doctor about the temporary use of what is called "psychotropic medications" - these are a class of medications that include anti-depressants and anti-psychotics. Sometimes these types of medications can also help ease a person through a transition.
Jeannine Clark is a Pescadero resident, medical social worker and private geriatric care manager with Clark Consulting. She writes a regular column for the Review on topics relating to aging and transitions associated with aging. Send questions to Clark Consulting, P.O. Box 101, Pescadero, CA 94060, or email to: clark@southcoast.net.
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