VASCULAR DEMENTIA IN THE ELDERLY: GLOBAL DETERIORATION SCALE/PART 4/STAGE 5

This is the fourth 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 5        Moderate Dementia

                  Can no longer survive without some assistance

                  Unable to recall major relevant aspects of their current lives, e.g. an address or telephone number of many years, names of grandchildren, etc. 

                 Some disorientation to date, day of week, season, or to place. 

                 They require no assistance with toileting, eating, or dressing, but may need help choosing appropriate clothing.

USUAL CARE SETTING-  At home with live-in family member.  In seniors' residence with home support.  Possibly in facility care, especially if behavioral problems or comorbid physical disabilities.

This was the stage, though we did not know she was in it per se, when things got really "dicey". 

She was on almost no medicine, or it would have gotten more complicated, and we likely would have had to have more care, sooner.

Our biggest problem continued to be food, or her lack of intake, which had to be addressed.  She began to be unable to operate the microwave, the can opener and we began to have concerns about the gas burners on the stove although she was still capable of this.

During this phase, we had our only gentle confrontation in which the three sisters and her met together and came to a meeting of three of the four  minds.  Hers did not meet at all, but a plan was introduced regarding a caregiver, and one was hired to go three days per week, more if needed.  This plan worked for about a year, and the social interaction was good for her.  She would say "I know you're trying to help me, but I don't need anyone." 

There were aspects of her "self" that were largely intact, including her judgment.  The problem continued to be her memory.  It was not that she would do something foolish, rather that she might forget she had done something.  Again, we balanced her need to be independent with her safety.

 And I do want to add here that I learned when she was in my home for a while that the elderly can fall, suddenly, with the caregiver present, and without your having any way of predicting or preventing it.  I became less critical after having her with me 24 hours a day, realizing that like a child, they can get hurt in spite of your best efforts.

I would suggest people should err on the side of caution, but the pros and cons must be weighed.

Here are just a few considerations: 1.  A person who has been in her/his own home may be more susceptible to contagious disease initially upon being placed in an institutional setting, so it isn't that everything is always better.  It's a tradeoff.
2.  Many families walk this fine line with an elderly parent and may delay putting them into the higher level of oversight for more time than someone else thinks they should
3.  The bottom line is the person's psychological wellbeing and their safety

Our mother still maintained a strong rationality about her even though her thoughts and memories were draining from her like honey dripping from the comb.  So it was during this phase or maybe a year prior that I felt like I started exerting my will on her. 

She liked to "burn brush" outside, and we had cut a lot of undergrowth from the yard one weekend and had to leave it stacked out by the pond (tank to all you Texans), so I knew she'd want to burn it.  I called and left a message on her recorder  "DO NOT BURN" and repeated it a number of times.  Then I called several times during the week to reinforce the message.

 I think my siblings heard the message and may have thought I was being rude, but I needed to make the idea stick.  And it did.  She never burned that pile of brush until someone offered to help her later.

She had begun to forget names of some of the extended relatives, but mostly knew her children, their spouses and others that she saw regularly. 

She used a calendar since about Stage 2 and kept it beside her telephone.  She noted when someone called or visited, and other important events.  During Stage 5, at some point, she stopped keeping the calendar. 

Still, as noted in the information set out by Drummond, she could still take care of all her personal needs with the exception of preparing her food.  And she could hop in and out of the bathtub like a teenager.  Her agility was amazing  for her age. 

As she progressed further into this stage, we increased the caregiving to five days per week,  and then her adult children checked on her on the weekend. 

My next post will deal more with all the changes that took place during this phase.



DEMENTIA HINT:   During this phase  is a good time for the caregivers to start keeping notes and informing the family about things that are changing because at the end of this phase, the family will likely be looking at how to provide 24 hour care, if they have not already. If you are a spouse or child caring for a parent without outside caregivers, the notes will still help you assess changes, although you may not have time to do them.






Installed