Hello all. My name is Scott Morrow. I am a social worker with the Alzheimer's Association Greater Missouri Chapter. I work daily with care givers and people living with Alzheimer's and dementia to plan for the disease and overcome barriers to successful aging with dementia. I'm excited to answer your questions.
Unfortunately we do not know why "sundowning" occurs. Sundowning is a term used to describe behavior changes that happen after sunset. There are some things you can try to alleviate the symptoms of sundowning. Some people have tried closing curtains and turning lights on in the evening. I would recommend working with the person with dementia to stick to a schedule where they wake up around the same time each day and go to bed around the same time each night. Try to have meals at approximately the same time each day. Practice morning hygiene routines every day and routines prior to bedtime so that the behaviors become more automatic. Try to keep the person with dementia active during the day so that they are tired at night.
This is a tough situation to deal with. If someone is suspicious or paranoid and making false accusations, your instinct is most likely to correct them. If you are able to orient them to the reality of the situation and have success, then that is great. If that does not work, you might not want to push reality too hard as it could cause an argument or worse. You might consider seeing what happens if you agree with the accusations and apologize for the accusations to see if this alleviates the stress caused by the suspicion. If the paranoia is persistent in causing stress, I would recommend talking to the person with dementia's primary care physician to see if medication is appropriate.
It is hard to speculate how long the course of the disease will be. It often times depends on the individual. If you are interested in measuring the course of the disease, consider taking your grandmother to see a neurologist and ask about testing. There is a number of tests that can be given to people with dementia that can help to measure the rate in which it is progressing. Creating a baseline and following up with testing regularly will help to show the rate in which the disease is progressing.
When someone is experiencing symptoms of paranoia with dementia, I never say that it is normal, but it is not uncommon. If this is causing her stress, I would recommend consulting with her primary care physician about the paranoia. The doctor may refer your mother to a psychiatrist for intervention.
If you are comfortable with it, talk with your father about your thoughts and observations. If there is other family who spend a significant amount of time around your father, you might consider seeing if they have noticed any behavior that is consistent with Alzheimer's.
The Alzheimer's Association Greater Missouri Chapter does offer financial support for respite. The care giver has to be living in the home with the person with dementia. Typically the Alzheimer's Association offers 500 dollars in a year period for respite support. I will post a link to the website with more information.
The best way to get information about respite support from the Alzheimer's Association would be to call our 24 Hour Helpline at 800-272-3900 and ask about the respite program and they will begin the process of assisting you in obtaining financial support for respite.
Care giver stress very common among people caring for someone with dementia. People cope with the stress in different ways. If you know of someone who is caring for a person living with dementia, be proactive. Spending a little bit of time talking to them by phone, visiting with them in their home or going out with them can go a long way. Be proactive in reaching out. You don't have to make it about them being a care giver unless they want to talk about it. Be there to just to be there for what the care giver needs. If they do ask for help such as someone to run to the store for them, or to stay at home with the person with dementia so that they can leave the house for a bit is always helpful.
The Alzheimer's Association offers a number of services to help care givers. We offer care giver support groups across the metro area and throughout the state of Missouri. We have a number of social workers on staff that work with families in person or by telephone to address their specific needs through a service called a Care Consultation. Care Consultation's goals are to help care givers overcome current barriers they are facing and to plan for the future. We offer Living with Memory Loss, a 4 week course where both the care giver and person living with dementia attend the class to learn together about dementia. We have a number of classes on specific topics in the community. We offer message boards as a way for care givers to communicate with one another also. We offer a program called "Dementia Mentors" which connects a current care giver with someone who has been a care giver in the past to help mentor the care giver.
If you want more information about any of these programs you can call the Alzheimer's Association at 800-272-3900 or visit our website.
You might consider seeing a neurologist. We do suggest to speak with a primary care physician because it is important to rule out any medical issues that might look like memory loss before someone is diagnosed with dementia. If you do not like the services that your primary care giver is providing, you might consider getting a second opinion.
If someone is asking about going home, try to orient them to the current situation. Keep pictures on the walls and personal items nearby so that they can identify their home as their home. If that does not work, attempt to redirect them. If they are asking to go home, say something like, "We can go home later, but right now, lets make dinner here," and redirect them to an activity.
I apologize for the messy links.
Speak with your father's primary care physician about the situation. If he is not diagnosed with dementia, have the doctor examine him. If the PCP does not find anything medically significant that might cause the issues, you should take him to see a neurologist.
I talk with families about this quite a bit. When caring for someone with dementia you always have to consider treating someone with dignity, but also don't want them to be upset. If it causes sadness to tell her the truth, your friend might consider just making an excuse of where they are, such as the store. It might not feel great for the care giver, but it might be worth it to avoid the stress that it puts on the person living with dementia.
Yes. There are a number of things that can look a lot like memory loss and it is important to ensure that all of those things are addressed prior to a dementia diagnosis. Before a diagnosis you would want to rule out that the memory loss is not being caused by drugs (including unintended side effects of prescription medications), depression, sensory isolation (loss of sight or hearing), an infection (especially a UTI), Normal Pressure Hydrocephalus, a tumor, Vitimin B12 deficiency, or alcohol use. There might be more tests, and the primary care physician will be able to suggest those tests as necessary.
If handling money responsibly is an issue for your mother, you might consider taking control of her finances. Becoming the designated power of attorney of her finances can let you control her bank account so that she cannot mishandle her money. If she has the funds, you might consider letting her carry a small, inconsequential amount, and if it gets lost, it is not a big deal. However, for someone on a limited budget, losing money can have severe consequences and compromise their way of life. If it helps, consider going over bank statements with her and taking her to the bank to do her banking herself with safe oversight, as long as it does not cause her stress.
Thank you, Scott, for sharing your expertise with our readers!
It looks like I have answered everyone's questions. Thank you to everyone who submitted questions. I hope that you all were able to get something out of this. If you have any further questions, don't hesitate to reach out to the Alzheimer's Association for support. We have a free 24 Hour Helpline at 800-272-3900 and our website will be up and running shortly. Thank you.
Keep your eye on the Post-Dispatch for future installments of our "Stolen Future" series, and more chats with experts on dementia.