29 Mar 2009
Dear Mary,
I’m upset, scared, and hope you can help me. My eighty year old mother was hospitalized with pneumonia a few days ago. Until this illness she had been very healthy living independently, driving, and going to a senior center and on trips with friends. Two nights ago I got a call that she was confused and fell trying to get out of bed. She broke her hip and needed surgery. When I visited yesterday I was told she now has dementia and was put on Aricept and another medicine to keep her calm.
Mary, I read all your columns and know you say that dementia doesn’t come on fast. When I told this to the nurse she said she can only tell me what the doctor wrote. I see my mother drifting away before my eyes. What should I do?
Dear Reader,
I’m sorry to hear this story again. Besides bathing, this situation is the most often asked-for-advice I get.
It’s hard to diagnose dementia during a hospital stay - unless the person had a stroke, or other brain injury. It requires a thorough assessment including family input about past function and cognition, and observation over several days. With today’s standard of rapid discharge, the person just isn’t there long enough to do this.
Dementia comes on gradually and looking back you can remember times of “funny” behavior or memory impairment that you brushed off. You put the pieces together and say, “ah ha”, those must have been early signs.
Delirium, on the other hand, comes on suddenly and is commonly seen in hospitalized older adults. It’s usually due to medication side-effects, infection, or electrolyte imbalance. It has the same signs and symptoms of dementia, but goes away once the cause is resolved.
I went through a similar situation with my mother who was in a nursing home at the time. She suddenly started to hallucinate, was sent to the hospital, and returned hours later diagnosed with dementia! As you can guess, I was outraged. I called the ER doctor, informed him she did not have dementia yesterday, and asked if he had checked for a urinary tract infection. It turned out he hadn’t. When a urinalysis was finally done, it revealed she had a raging infection. Within twenty-four hours on an antibiotic her cognitive problems cleared up.
What I’m telling you is this: don’t take the diagnosis lying down. Speak with the doctor and tell him about her past cognitive history and then ask what he thinks caused her sudden dementia. I also recommend someone stay with her at night to keep her calm and minimize the use of psychotropic medication. Only when she’s discharged and back to her normal environment - and no longer taking pain medicine - will you see a measurable improvement in her cognitive functioning. Don’t be surprised if it takes longer than you expect or she doesn’t regain it fully. Trauma and anesthesia can have a permanent negative impact on cognition in older adults.
Dear Mary,
My mother is diagnosed with ARMD. I know it affects her vision but what exactly is it?
Dear Reader,
ARMD is Age Related Macular Degeneration. It is a condition that affects central vision and is the most common cause of blindness in the older adult population. I encourage you to contact the National Federation of the Blind at www.nfb.org for valuable information to help both you and your mother understand and cope with it.
| 
