Apr 10, 2010

Sometimes We Have to Pick Our Battles – Dr. Brent Forester

More on Alzheimer's, repetitive behavior and shaving.....A geriatric psychiatrist's point of view.

By Max Wallack
Alzheimer's Reading Room

After reading Jocelyn’s question about the shaving problem, I recalled many incidents where Great Grams perseverated on a particular topic or a particular act. Great Grams’ favorite was her checkbook, which could literally occupy four or five hours a day, every day. It never, never occurred to us that we could simply remove the checkbook, and it would be out of our lives forever, forgotten. Then, one day, my Uncle visited and asked her for her checkbook. She handed it over, and she never mentioned it again. See Alzheimer’s and the Checkbook.

Many of you have also read my articles praising the great care Great Grams received at McLean Hospital. The care she received there from a brilliant and empathetic doctor, allowed us to keep Great Grams at home with us. Her doctor was Dr. Brent Forester, the Medical Director of the Geriatric Neuropsychiatry Unit at McLean Hospital in Belmont, Massachusetts.

Since Great Grams’ death I have met many wonderful Geriatric Psychiatrists whom I admire. Dr. Forester was my first role model and shining example of what I want to be professionally.

I ran the question that Jocelyn posed past Dr. Forester, and here is his response:

“As for the question posed regarding the man who wants to shave all the time. I have not seen this before, but repetitive behaviors are common with this disease. It could represent many things to this person.

Obviously, one way to reduce the behavior is to remove all shaving equipment from the home....no access to razors and shaving cream, no shaving. If the person truly has AD and is at least is the moderate stage,they may likely forget about the shaving and look to something else to fulfill whatever unmet need the shaving represented to the person.

Also, sometimes we have to pick our battles so to speak with the person who insists on certain behaviors. If they are benign and not dangerous then it is sometimes not worth interfering, though in this case removing all shaving equipment and getting them involved in other activities is my first idea.”

Sometimes, we look for complicated answers to simple questions. Maybe, if those razors and shaving cream disappeared, they might never be missed. It’s worth a try!

Dr. Brent Forester is the Medical Director at the Geriatric Neuropsychiatry Unit at McLean Hospital in Belmont, MA. Dr. Forester attended Dartmouth College and later went onto Dartmouth Medical School. In Boston, he completed an internship in medicine at Massachusetts General Hospital followed by three years of psychiatry at McLean Hospital in Belmont, MA. His fellowship in geriatric psychiatry was done at Dartmouth Hitchcock Medical Center.

Dr. Forester's clinical interests include: Geriatric Psychiatry: Late Life Depression, Alzheimer's Disease and related disorders, Geriatric Bipolar Disorder.

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