Dec 29, 2011

More Alzheimer's Questions and Answers

If the spouse can understand this concept they will not feel threatened. It takes an unusual person to adopt this mentality/understanding, but those people do exist. It’s just rare.

By Carole Larkin
Alzheimer's Reading Room

Carole Larkin More Alzheimer's Questions and Answers
In the event that a patient bonds and becomes romantically involved with a patient, what type of conversation might a caregiver have with the person’s spouse? How often does something like this actually occur? Is this more likely to happen with a mid-stage patient?

Never forget that you are talking about are people, just like you and me. They are people who have forgotten some of society’s codes, and along with other things they have forgotten about their lives (like sometimes their relationships to certain people, like a spouse).

They know that they like the person, that they are happy when the person is near, but have lost the concept of what relationships are. Given that loss of memory of the relationship they behave just like all people do.

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They see a person they like or are attracted to, they go for it; it’s a natural instinct to go for what is attractive to you.

Good facilities let the spouse know just what I’ve just written. They still love the spouse; they’ve just forgotten what the relationship means. They are just acting on basic human instinct in that moment, because all they have is that moment. The past is gone, the future is unknowable.

If the spouse can understand this concept they will not feel threatened. It takes an unusual person to adopt this mentality/understanding, but those people do exist. It’s just rare.

The other part of this is dealing with social norms. If two people are romantically involved and the families are OK with it, then propriety needs to be maintained in public. If they start getting amorous in public they should be directed to one of their rooms, and left alone. No Hanky Panky in public, so to speak. Other (ladies, usually) will become annoyed, angry or jealous.

It happens often enough to cause facilities to have to make a policy of how they will deal with it.

Clueless facilities forbid it automatically, and throw one of the two people out of the facility. Enlightened facilities take it on a case by case basis, and involve the families in education and decision making surrounding this.

I guess you could say that the likelihood of this happening is around mid-stage, as early stage people generally are still aware of what relationships mean, and very late stage people are so limited as to not be able to focus on much other than themselves for more than a miniscule period of time.

Additionally, very late stage people generally have lost the ability/energy to do anything about urges most of the time anyways.

Are phone conversations difficult for Alzheimer’s patients due to the absence of visual cues?
Because of this, are in-room telephones usually provided at managed care facilities?

Generally phone conversations become more difficult due to the fact that the person begins to not be able to formulate words or use the correct words to express what they are thinking and feeling.

Also, yes, they may misunderstand what the person on the other end of the line is saying because they no longer can associate words with the meaning of those words and cannot see body language to help them with that.

Those problems don’t usually happen until mid-stage or later in the disease. Generally phone lines are available to people in Assisted Living, but by the time the person is far enough along in the disease to require a secure Memory Care unit or community; telephones are not provided for the residents.

Usually they would have to ask staff to help them use the facility’s phone. By that time remembering and dialing a phone number is beyond their capability.

Also, even if they are capable of remembering or dialing a phone, they generally don’t remember if they have called the person before, that day. To save family members from receiving 20-30 or more calls a day from the resident; phones generally are not made readily available to the residents.

If a visitor were to have a medical crisis on the premises (fainting/dizzy spell, vomiting, etc.) would the facility be equipped to examine the patient and offer medical assistance?

Again, it depends on the individual community. Some assisted livings have nurses onsite or on call. Some don’t.

Nursing homes always have nurses 24 hours a day. Does that mean that a visitor would be looked at and given medical assistance from the staff? Not necessarily, due to legal liability issues.

Some nursing staff would go ahead and help, no matter what; damn the liability! Some wouldn’t dare. Some might call 911 for the visitor, some might not. I think of it just like the Good Samaritan issue after there’s been a car accident. Some people will help, some people won’t help.

Carole Larkin MA,CMC,CAEd,QDCS,EICS,
is a Geriatric Care Manager who specializes in helping families with Alzheimer’s and related dementias issues. She also trains caregivers in home care companies, assisted livings, memory care communities, and nursing homes in dementia specific techniques for best care of dementia sufferers. ThirdAge Services LLC, is located in Dallas, TX.

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