VASCULAR DEMENTIA IN THE ELDERLY: GLOBAL DETERIORATION SCALE/PART 5/STAGE 6

This is the fifth in a series of six posts based on information from the Global Deterioration Scale adaptation by Dr. Doug Drummond from Reisberg, Barry et al. This scale is for the assessment of primary degenerative dementia and Dr. Drummond includes the "Usual Care Setting" for people in this phase, which is very helpful from a pragmatic point of view.

The information from the GDS will be italicized for clarity of origin.

 Stage 6         Moderately Severe Dementia

 May occasionally forget name of spouse
 Largely unaware of recent experiences and events in their lives
Will require assistance with basic ADLs.
May be incontinent of urine.
Behavioural and psychological symptoms of dementia (BPSD) are common e.g. delusions, repetitive behaviours, agitation

Usual Care Setting: Most often in Complex Care facility.

Several things had happened while our mother was still in her home that began to point to more serious dementia symptoms, but hard as it may be to believe, we were still able to convince ourselves, or let her convince us, that these new confusions were reality.   In fact, so determined was I to believe what she was telling me about seeing elephants at her neighbor's house at night, that I walked the 100 or so yards to the back dividing fence with her to see what might be over there.

The neighbors had Great Pyrenees dogs which have a very deep distinctive bark, so I decided that yes, she could be hearing the dogs, seeing lights there at night (they had spotlights shining into the woods) and maybe she had thought the shadows were elephants because of how the dogs sounded. By now, you are probably laughing. Now, I agree.

But you do not know how convincing our mother could be, even with advanced dementia symptoms.  In May, just after she turned 87, she had cataract surgery. The nurses came in, asked her which eye was to be repaired, and she told them the wrong eye. When I corrected the information, they looked at me, looked at her, and said they would look at the chart. I certainly thought that was a good idea.

Mother never backed off, insisting on the wrong eye, authoritatively.   Fortunately, they checked the chart. After that surgery, everyone pitched in. My brother went and put drops in her eye several times a day, and everyone made extra trips down to see about her.

But that marked a signal change. I hated to leave her several days post surgery, and it was patently clear that she could not stay there without more care and probably fulltime care. We all decided that we must act soon and decide on a plan.

No one wanted to go up against her will, not because she would really fight with us or even get mad, but it was just difficult because she continued to cling to her independence and we had not made the transition to being the "parents".

We made a one month plan, and as I've detailed in an earlier post, "Thank God for watermelon angels", we were lucky. On the day before my sisters went down to get her to take her to the doctor for evaluation, she made a last stand of independence that, but for the grace of God ,could have been her last stand.

She became less able leading up to this phase to remember names. And her memory as far as events was suspect and unreliable, though she told things with great authority. We realized at this juncture that she had to have pretty intense observation, so we made the decision for her to come and live in my home for a while, at least, until we figured out what to do.

Once she was here, we determined that we would not be comfortable leaving her alone for even an hour once she arrived. We arranged for caregivers. I'll do one more post on the last stage of the GDS and then I will move to a more detailed account of the approximately 1  1/2 years she was in my home and in Stage 6.


DEMENTIA HINT:  You will have to become as a parent to your parent.  This is more difficult for some people than others.  When the shift changes, the more quickly you acclimate the better, for there will be all sorts of decisions to make, and if you wait for your parent to make them, it will just never happen.


Installed