Fast progression?

ASJ

New here. My father (88) was diagnosed with Alzheimer's last November (2022). He had very mild signs ahead of this and was functioning well given his age - no other medical conditions except mild high blood pressure. But is September he fell down and hit his head pretty hard - was in hospital for a couple days. Even after coming home, was still his normal self for the most part - was able to take care of himself, eat, bathe etc. and slept OK at night. But in the subsequent weeks/months there has been a dramatic change - every day showing new signs - especially starting in mid-December. His memory and behavior suggest he is now about late stage 6.

My mom also had dementia which took a more "normal" course - diagnosed in 2012 and going through all the stages before passing in 2016. Seems my father is experiencing the stages in an accelerated manor which makes it harder to predict or prepare for what will happen next. Cannot tell if he will linger at his current state or if we're in for another dramatic change.

He is taking Zoloft to help with evening agitation and night sleeping - although doesn't help that much.

He barely talks and is very quiet when he does. Appetite has gone way down.

Right now I'm the only caregiver. He lives with me (and my family) and I've moved into his bedroom to help at night time.

Night time is the hardest as he is up every few hours and is wanting to walk around even though he finds it physically difficult to do - only uses walking aids if I insist. 

He's taken several falls in the past few weeks - nothing serious, usually when he is getting up from bed or chair. But due to illness, he keeps repeating behavior. Means I have to help him go the bathroom or get up from chairs.

He was the principal caregiver for my mom before we got an aid to help with daily tasks. She had mobility issues though, so wasn't insistent on walking around like he does.

A few noob questions:

When to make the switch to diapers - does an accident have to happen first? It would make it easier for me if he didn't need to get up and go to the bathroom at night. But if he would still insist on going to the bathroom despite wearing a diaper, then it doesn't help that much.

Any tips for helping with the night time need to walk around? Unless I physically lead him back to the bed, he will keep getting up several times. This eventually works i.e. after repeatedly getting up and laying him back down, he will go to sleep.

Rick4407

Hello ASJ.  With regard to incontinence, when my DW had an accident or two I threw away all of her underwear and just started using Depends.  There was never any discussion or notice of it.   A fresh pair at bed time and at 1-2 AM she gets a change as well.  If I miss the early AM change then its a sheets change in the AM.   Good luck, Rick

​fesk

Hi ASJ. If you haven't already, I would recommend having a doctor visit to discuss the fast decline. Have bloodwork done and have him checked for UTI to rule out any other causes. 

I would also make an appointment with a geriatric psychiatrist to be sure he is on the appropriate medicine for his behaviors. It may be there is something else he can take that will allow him to sleep better at night.

In the meantime, is it at all possible for you to get a caregiver that can stay overnight and take care of your father when he wakes at night? It does not seems safe and you also need to be able to sleep.

LaurenB

I switched my mom to depends after several minor leaking accidents in her underwear, followed by a major accident on the sofa. I personally would have switched her sooner, but my stepdad needs a higher level of proof.

CanyonGal

My mom had a nasty fall and hit her head pretty severely. Her dementia fast-tracked. But vascular dementia does that, it moves faster than Alzheimer's dementia. Sometimes she has a year before moving to the next stage, but with every illness (i.e. urosepsis), or surgery (AAA, cataract repair), she moved to the next stage within 6 months. We were at stage 5 (moderate) in the fall of 2021, and although I haven't had her tested, I see signs of stage 6 (severe decline).

The walking around at night could be the beginning of sundowning syndrome. 

My mother wore a light pad when she had minor leaking episodes and refused to wear depends-type underwear. After surgery, in rehab she had to wear them, and we just continued that practice.

There are some incontinence undergarments that actually work like a diaper and there are some that are more like underwear that are padded to absorb any accidents (Depend real fit).

abc123

Hi ASJ & Welcome.

I am at the start of this journey with my 86 year old dad. It all started when he slipped on ice and hit his head twice. A few months later he had another accident that involved hitting his head again.

If I were in your shoes, I'd make an appointment with his neurologist to discuss the rapid decline. Seeing a geriatric psychiatrist to discuss medications and the possibility of sun downing would be a huge help to you and your dad. They are the best for prescribing the correct meds. You can also ask them about what stage your dad is in. My mom had Alz and she died this past July. I did not care for her neurologist. I felt like he gave my dad a lot of misinformation about Alz. and he never wanted to talk about the stages. When dad fell we got a different neurologist, he was extremely up to date with dementia patients. I could tell that he actually cared about dad and what we were going through. Even though we are in another state now, I still call him when I have a question.

In my experience with having my mom staged, hospice was the easiest. I was overwhelmed and tired and needed someone's help and guidance so I called and set an appointment for an evaluation. They were kind and had answers for all my questions. Just because you reach out to hospice doesn't mean your giving up on your loved one or the end is near. I'm glad you found this group. There are many wise and caring people here who have years of experience with caregiving. We care about each other and we support each other. Please read as many post as you can. Knowledge is power. I've learned so much here! Feel free to ask any questions you may have. On rough days you can come here and rant, rave, get it out of your system. Good luck.

AWilder

Be it far from me to suggest anything but has his doctor re-imaged his head since the initial hospitalization from the fall? could he have a subdural hematoma or normal pressure hydrocephalus?