What should I know before meeting with geriatric psych about mom's dementia?
Mom has end stage renal disease, clinical depression, and dementia. The dementia is progressing at a rapidly accelerated rate due to her kidney disease and surrounding issues. She sleeps a lot, falls once or twice a week, can no longer walk more than a few steps (and usually needs assistance for that), has little to no appetite, and is very weak, depressed, confused, has short-term memory issues, and is sometimes pretty zoned out. At times, she's almost catatonic, even while sitting up (like, not even hearing directions even when I repeat them many times). Sometimes I need to walk her through very basic things, like every single step of getting from the car seat to the wheelchair ("Put this hand here, now move this leg here," etc.). She has also started to have mild delusions in the hours after dialysis, but they don't last too long, and she seems to find them more entertaining than troublesome.
Just as recently as last night, she had several tests and scans to rule out stroke, brain injury, dehydration, and infection.
The nurse on the renal ward told me yesterday there's nothing they can do to help beyond her renal care, and that I need to get a referral to geriatric psych from our GP, and then get mom some meds for her dementia.
I don't know anything about what to expect from geriatric psych. I gather they will do a cognitive assessment and probably prescribe some meds, but I don't know much about the meds. I don't want her to take something that will make her worse or harm her health! Can anyone tell me what I might expect, or what kind of meds are available and what the pros and cons are? (For example, I've heard that some meds only work for a limited period of time.)
I'd especially appreciate hearing about people's personal experiences with medicating their loved ones' dementia.
Mom is palliative - meaning the doctors think she has less than 6 months to live, but can continue treatment until she is ready for hospice care. She has been on a low dose of Zoloft for 20 years for her depression, but I think it stopped helping about 5 - 10 years ago. In her alert moments, she is very interested in something that would help her with her "confusion."
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He loves red, so I made a bouquet of red roses with small ivy vines and brought it to his room for him. That produced a smile. He also likes receiving cards, so I'm going through my stash and will create a group of them, with added comments. Some years ago a family member was ill, I was in a creative mood, so I used my massive collection of rubber stamps to create some humorous additions to land and sea animal cards. I'm going to do that for my father as well.
And I'm searching for the old portable CD player so I can bring some of his favorite CDs, polkas, mariachi bands, and of course Strauss waltzes.
I hope you find something that helps your mother, but it may just be that these end of life situations are depressing and unsettling and meds won't help....just my opinion though. I'm sure others who have more experience can offer better suggestions.
I'm going to go ahead with the geriatric psych meeting, as my mom is depressed and troubled by her confusion. So anything that might help ease her mental suffering would be beneficial. Even if it only has a placebo affect!
"The U.S. Food and Drug Administration (FDA) has approved two types of medications — cholinesterase inhibitors (Aricept, Exelon, Razadyne) and memantine (Namenda) — to treat the cognitive symptoms (memory loss, confusion, and problems with thinking and reasoning) of Alzheimer's disease. There is also a medication that combines one of the cholinesterase inhibitors (donepezil) with memantine called Namzaric."
source: www.alz.org/alzheimers_disease_standard_prescriptions.asp
I was hoping to glean info from people's personal experiences with some of these....like whether they actually work! (I remember reading somebody's comment that one of those meds made their LO's behaviour worse, but I can't find it now.)
If you think about it some take the drugs, they work or not. How do we really know it is the med that is causing any improvement or decline. If you feel anything new is helping mom, that is great! And definitely try whatever the doc thinks, if confusion gets worse, let doc know, it could be a reaction to the med.
Dori, I am so sorry you are going through this. There is nothing harder and the disease will continue to progress. How long ago was your mom diagnosed? I am wishing you the best and know you are providing mom excellent care and she is very happy you are with her, I am sure.
And one thing to remember, shoot, I forgot!
Now I remember. Many meds that are prescribed have a black box warning that the med may cause additional risk to the elderly for a variety of reasons. Many meds regardless of the carry the same warning. My mom took Seroquel, it carries black box warning, but it helped her tremendously. You need to weigh the benefit/risk for their well-being.
If I can't find the little portable CD player, I'll be looking for one as well. I'll let you know if I find anything.
I think I'll bring some more flowers to Dad's room as well. We may have a little garden in there by the time I'm through brightening the room.
As to Aricept, I recall asking one of my mother's internists about it. This was back in the late 90s or early 2000's. I'm not sure if it was before she broke her leg or afterwards. Mom was sundowning at that time and it was confusing her, and saddening us to see her in that situation. The doctor said he wouldn't consider using it b/c of the side effects.
GA - lovely ideas too brighten up your dad's room. I have the disadvantage of being at a distance, so flowers/arrangements have to be sent which is a different from bringing pots in. Now that the hearing aid problem is solved, I hope, I want to bring an old boom box that was my youngest son's and some cd's for mother. The nurses have said they will operate it. It is large enough it should stand up to wear and tear.
Relax Dori, I think they they know what they are doing, The geri psychs we had both were excellent, sensitive, caring...
GA - do you remember what kind of side effects? I don't think we'll ever have a living garden in mom's room because she never opens her curtains! Lol. I've just been buying a 4" pot of live flowers every week. But I might see if I can find some of the better-looking silk flowering plants....she's so sick, she might not know the difference. I think the hardest thing for mom about giving up the house was giving up her lovely garden. Even when I was young and we lived in an apartment, she filled the patio with overflowing pots and hanging baskets, every year without fail.
golden - (edited to add this because I missed your comment!) Part of the problem may be mom's dementia has never been narrowed down to a type. All that's ever been done is ruling out stroke, brain injury, etc. So I have no idea if it's Alz, vascular, or "metabolic derangement," which is a phrase the nephrologist used once!
My mom was prescribed Aricept (Donepezil) for Alzheimer's when she was in (I'm figuring) stage 3.
In 1-1/2 years she progressed to stage 5, when I had to have her reevaluated, decleared incompetent and later put in a Memory Care facility.
In my personal opinion, I don't believe the medication did anything. It didn't seem to lessen her confusion nor slow the progression of the dementia. (Progressing 2 levels in a year and a half does not indicate to ME that the medicine worked.)
In the past I have asked if another medication would work better and the answers were to just keep her on the Aricept. She is still taking it.
Mom had been on Ativan (anti-anxiety med) for many years. Recently the doc took her off it. When she lived with us, she was much more agitated than when she was at MC and we went through Seroquel and another med. Nothing seemed to work. Because we couldn't get her mentally stabilized, we had to send her back to MC. She's happier there. The doc now has her on
Remeron (antidepressant). She's more awake and has a better attitude.
At 95, she is at the end of stage 6 and has leveled off.
All you can do is give the psychiatrist her symptoms, s(he) will examine her and probably prescribe medication. Sometimes there are unwanted side effects. Sometimes the meds don't work and sometimes they do. It's a crap shoot. Usually you will have to go through a couple to find one that gives the desired effects.
I'm sorry you and your mom are having this trouble. Hang in there.
Remember, you don't have to have her take anything that has bad effects. You can refuse any treatment for her at any time. You can look up any medicine at Drugs.com. Good luck.
Also, it's interesting that you mentioned a pot. Back in 2003-2004 during a long hospitalization and rehab, one of the 5 different placements was at a long term care hospital in Ann Arbor, with the U of M teaching hospital, and a nonprofit hospital with very high standards.
I was advised not to bring in live plants b/c of the bacteria in soil. So now I just bring in clean artificial plants.
And how is your mother doing these days?
Dorianne, try the artificial plants; they don't require any work, especially watering, so there's no obligation for the staff to not want to care for them. And if they fall on the fall, just pick them up and dust them off!
I think just the splash of color might be noticeable by your mother. I've found the best selection of artificial flowers is at Michael's - a craft store here in Michigan. There's so much it's hard to choose, and the varieties seem to be wider every year.
Several years ago I also bought some polished glass pieces (probably manufactured and not water polished glass) that I use for the larger vases. The stones not only hold the flower stems in place, but they can glimmer in the light if placed in an area that gets sunshine.
As to the Aricept, as I recall the doctor didn't give any explanation as to the side effects he thought dangerous. He just said that he wouldn't prescribe it b/c of the side effects.
Mother is hanging in there - heart, lungs, kidneys, liver etc. are all doing well. Thanks for asking. She is declining cognitively, very slowly, but still recognizes us. She has good colour, can manage feeding herself a bit, but they help her every meal. Her muscles have to been weakening continually due to the VaD, but I don't see anything different from last year.
I have a few artificial white orchids in mother's room. Latterly they were her choice for plants. Two walls are a soft sage green so they go well. We put some of her "Haiti" paintings, and others, which are colourful, on the walls, so her room looks very nice. Thinking of sending an arrangement of fresh flowers for Easter. She loved the lacy hydrangeas.
My FIL’s Gerentology group has a policy to discuss (with patients and family) to let us know that anyone over the age of 75 has not been studied in drug trials. There is little to no data regarding drug interactions and side effects of any medications for what scientist call “the oldest old”.
Our group of doctors do not suggest Aricept and its cousins to anyone over 75 because the risks and side effects FAR outweigh any minor benefit that might be had.
I’m sorry to hear your mom is suffering so. I know there are often times that I wish, for my FIL’s sake, that he wasn’t still aware of all he has lost in the last year mentally and physically.
I hope you have a caring doctor who will be honest with you. I hope you get some answers and your Mom gets some relief.
Still does not excuse not enrolling those over 75 in clinical trials. Us olderster have just as much right to benefit whatever comes on the market.