VASCULAR DEMENTIA IN THE ELDERLY: 7 STAGES OF THE GLOBAL DETERIORATION SCALE/PART 3/STAGE 4

This is the third 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.

Stage 4   Early dementia
               Clear-cut deficits on careful clinical interview
               Difficulty performing complex tasks e.g. handling finances, traveling
               Denial is common.  Withdrawal from challenging situations

               Usual care setting-might live independently-perhaps with assistance from       family or  caregivers

At this time our mother  turned her financial affairs over to my sister who began paying bills, doing her taxes, and tending to other financial matters.


I mentioned that she had stopped teaching her Sunday School class, which she had done for many years. toward the end of Stage 3.    In retrospect, I believe she knew she was unable to concentrate to study or that some other aspect of her cognitive skills were weakening and she knew it before we did.  As noted in the GDS, it appears that she withdrew from this challenging situation. 

I believe during this stage she stopped going to church regularly.  Friends offered to pick her up, but she always made an excuse.  This we could never figure out either, except that maybe she would forget when it was Sunday, forget to set the alarm, etc.  She did not want to bother anyone, so it was easier to stay home than try to remember.  This increased her social isolation because she lived out in the country and church activities had been her main social activity. 

To add to the severity of this change, she also apparently cut way back on driving and eventually stopped herself from driving, but "blamed" it on her adult children.  I'll do a post on that specific thing later.  It is actually one of the things that we still laugh about.  Her strong will still very intact, she would not accept that she really couldn't drive, but rather that we "meanies" made her quit.

So at the beginning of this phase, she was still driving,  still living independently with assistance and oversight from all four of her children, but it was getting harder for the adult children to forsee the needs and make sure all of her needs were met.  We knew that soon we would have to have more "boots on the ground" to keep her in her own home.

My brother visited her most days, we sisters brought food; in addition, my older sister shopped for her weekly and delivered food and supplies along with prepared food.  She could still take care of showering and washing her hair.  We had paid someone without her knowledge to deliver food three times a week, but that system had broken down.  We were at least five years into dementia proper, with the possibility that we had been dealing with it a few years prior but without objective symptoms.  Mother was 86.



DEMENTIA HINT:   It is less important to know why than to know what.  You may never be given a reason for the behavior.  Just observe it and figure out what to do to adjust the environment for the person to keep them safe. 

Installed