Dementia is
often used as a diagnosis even though it is actually a set of symptoms that can
be attributed to specific disease processes.
These symptoms
can vary, even among individuals who have the same diagnosis. For example, one
individual with an Alzheimer’s diagnosis may be “pleasantly confused” and
readily cooperate with care provided by others; while another individual with
an Alzheimer’s diagnosis may be resistive and combative with attempts to
provide care. For those individuals who demonstrate resistive, combative and
agitated behaviors, finding appropriate treatment and care can be a nightmare.
An older couple
from Cumberland County recently discovered how difficult it is to obtain
desperately needed treatment and care in this situation. They have been living
in a 55+ community, and although her husband’s care needs increased over the
years, his wife delayed making a decision to move him to a facility because she
felt an obligation as his spouse to care for him. She also believed he would be
happier at home.
Several attempts
at home care were unsuccessful for various reasons. The responsibilities of
managing the home, all financial matters and her husband’s care fell squarely
on this 80-year-old woman’s shoulders.
When she finally
worked up the courage to move him to a facility, she was dismayed when, several
hours after moving him in, she received a telephone call that, due to
behavioral issues, he could not remain at the facility and she needed to pick
him up. This discouraging experience led to additional months of caregiving at
home before she could bring herself to begin to investigate other alternatives.
During these
additional months, the husband began to develop regular episodes of agitation.
The wife was creative in figuring out ways to diffuse this agitation, but the
effort was exhausting. Attempts to regulate her husband’s mood with medication
were difficult because he did not like to take medication and the list of
potential side effects of these medications made her uncomfortable.
One recent day,
his agitation reached the point where he lashed out and hit her. Fortunately,
she was not hurt. But due to his strength, size and ability to walk, she was
fearful of her safety. Police were called, and after initially raising a
threatening arm to the responding officers, the husband willingly climbed into
the ambulance for a trip to the local hospital emergency department.
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While it was
understood that a psychiatric hospital admission would be the most appropriate
type of treatment for this gentleman, the local emergency department seemed
like a logical place to start so that both he and his wife would be safe, and
professional referrals for additional treatment could be obtained.
Imagine the
shock when the emergency department physician insisted that he could not help
because “no psychiatric hospital unit will accept an older person with
dementia.”
The
physician recommended placement in a long-term dementia care facility, and was
unwilling to even attempt to locate inpatient hospital care first, in order to
help stabilize this gentleman’s behavior. The physician did not appear to
understand that no long-term care facility will admit an individual who is
demonstrating behaviors that pose a potential threat to the facility’s staff or
other residents.
Unable to provide the guidance and assistance this couple needed, the physician ran some blood tests, gave the husband a drug to sedate him and discharged him back to his home with no concrete plan to ensure his or his wife’s safety and well-being.
SOURCE: The Sentinel, Karen Kaslow
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