Dementia and the Family – Navigating the Turbulence
Mitchell L. Gelber, EdD, PC
Private Practice
In each of the scenarios, the identified person has been professionally diagnosed with Alzheimer’s’ dementia.
Scenario #1
1. What are the cognitive and behavioral changes notices in Tony that are influencing the family system?
2. What suggestions would you have regarding an action plan with family members, outside resources?
3. What are some specific ways to address the changes in Tony with Stockton and any mother grandchildren in the family?
4. What directions would you give to the parents when the anxiety or intolerance level rises in Tony?
Scenario #2
1. What are the cognitive and behavioral changes noticed in ‘Mom’ that are influencing the decision-making in her daughter?
2. What suggestions would you have regarding an action plan with family members, outside resources?
3. What would you expect ‘Dad’s’ response to be when you arrived at their home?
4. How would you initially address mom?
5. If there are other siblings, how would you address them?
6. What would you tell your children?
Scenario #2
Mom and dad live about 5 hours away and we get to see them about every three months. They are retired and have had active lives. Over the past year, our once weekly telephone conversations have gotten shorter and mom spends less time talking with our children. There are times when she does not talk to them at all. Over the past month, she has called several times asking who this is, not remembering she called or misdialing our number. After several ‘weird’ questions, she regains her composure and has a pleasant, although short, conversation. There have been several phone calls asking me question about what had happened to old papers and bankbooks from former accounts. Other times she has suggested that someone had been stealing and selling her jewelry and other personal items. Recently, while my dad was on the telephone talking to one of my children, I could hear her yelling in the background that he had stolen her diamond ring and probably gave it to another woman.
My father has downplayed her transitory behaviors although acknowledging that she is more moody, forgetful and less patient than in the past. We have suggested several times that they visit for a long weekend or we visit them but they have declined because of “other plans”. We are getting worried that there may be something medically wrong that they are not sharing. Last week, was my younger son’s 8th birthday. My mom has never failed to call on anyone’s birthday or special event regarding the children. After waiting two days, I called her and she stated that I was lying and that she had called and spoken to Billy (his name is Sean). When I disputed her recollection, she started yelling at me that I was just like my father and abruptly hung up the telephone. She refused to answer the phone on my “call-backs”. When I spoke to my dad later that evening, he stated that he did not know that I had called and said that my mom was having a bad day and not feeling well. I decided that I had to go visit and find out what was going on. I told my husband that I did not believe it was wise for the family to go at this time because of the odd manner of things. He agreed and I set off to visit my folks alone. I debated whether to call first, but ultimately decided that if something was wrong, this was the best way to discover the truth.
When I arrived at their home, I rang the doorbell, even though I had a key. My mom answered through the door. With the door closed, I told her who it was and she said, “my daughter does not live here and you should leave”. I tried to explain that I was her daughter but got vague indistinguishable responses. As I was about to use the key, I heard my father asking her what was going on and she said that someone was trying to break in. I called through the door and he eventually opened it to see it was me. My mom had left the area and gone to her room. When I came into the house, things were a mess, with clothes and clutter all around. The house smelled of spoiled food and dad looked ragged. After telling him why I was there, I could see tears in his eyes. There were also bruises up and down both of his arms.
Scenario #1
Tony lives with his son’s family. The built an extension to their house for his privacy, and since the loss of Marge, his wife, they thought it would be better o have him close to be with grandchildren. Stockton, his eight-year-old grandson has spent many afternoons with ‘poppie’. Sometimes they read, walk around the mall or go to the park. Tony has a history of major depression and attends outpatient physical therapy for recent left hip facture surgery. Since his surgery, Tony and Stockton have been spending less time together. When not in therapy, Tony spends increased time alone in his part o the house. When asked to participate in family activities, Tony attends but it as become quite difficult. The family notices that Tony has had difficulty remembering appointments and scheduled times to ‘watch’ Stockton when his parents are out of the house. One time, when they were planning to go out to dinner, the family waited fifteen minutes in the car for Tony when he said he “forgot my watch” on the dresser. Watching football on the television with his son and grandson is no longer the pleasure it was. In fact, Tony rarely makes it through an hour-long television program without getting up several times seemingly distracted or, he falls asleep.
Tony continues to read the newspaper and can discuss the newsworthy events of the day. He does forget names and occasionally uses the wrong word or will describe words instead of saying the word itself; “you know that thing you write with” rather than saying “pen”. Stockton and Tony laugh about those times. Tony says that he is trying to teach Stockton new words and practice his old ones. Sitting with Stockton when parents are out continues with parents coming home to Stockton still awake at midnight and the half-gallon of ice cream bought that afternoon, gone. Tony and Stockton love to build with Lego’s and blocks but recently, Toney seems to lose patience and appears unable to complete the projects with the enclosed diagrams. Putting together the Lego airplane is no longer possible.
Just the other day, Tony was helping to clean up the dinner dishes. He took a dish with corn in it and asked his daughter-in-law, Martha, where the “watchamacallit” goes. She was not looking at him and asked what he was referring to? He responded saying “you know this stuff in the dish. We didn’t finish it”. Stockton began to giggle. Tony was clearly frustrated with his word loss and Stockton’s giggling. Loudly, he said “the darn leftovers, for heaven’s sake. You know what I mean. You don’t have to make a deal over this”! Martha turned around stunned by his loud angry voice and Stockton had a frightened look and moved closer to his mom.