Boredom?

secondcor521

My 87yo Dad is in stage 5/stage 6 Alz/VD, living in a nice CCRC AL apartment.

He has started calling me in the mornings asking me what he is supposed to do.

I think this is a mixture of several factors all getting mixed together:

1. He is bored. This in turn is a consequence of many factors, including a lack of mobility (he is in a power chair 99% of the time) and a singular social focus on his girlfriend of six years so a paucity of friends.
2. There is an aspect sometimes of a bit of agitation and forgetfulness. He thinks he's supposed to be somewhere or do something but he can't remember what it is.
3. He's sort of lost the ability to problem solve, so it's hard for him to identify even that he's feeling bored and if so what to do about it.
4. I think he might be somewhat depressed. Depression is listed as a diagnosis in his medical history (we kids never knew, FWIW), Alz/VD is inherently depressing, and he has lost interest in nearly everything, including things he used to enjoy.

The CCRC has activities directors and daily activities both on the IL side and the AL side. He has adequate access to the activities bulletins.

When he calls, I reassure him that there is nothing that he is obligated to do (to try to address item #2 above). I'm talking with my siblings about maybe having him try an antidepressant (to try to address item #4 above).

Mostly he just likes to eat and hang out with his girlfriend and talk with her on the phone. (She's in the same CCRC but in IL.) But if he's already eaten and his girlfriend isn't available (she cares for my Dad but unlike him he is not her only friend or social outlet), then he's at a loss for what to do. So he calls me.

I usually suggest reviewing the activities lists from IL and AL. Usually there is only one thing going on at a time. Often it's an offsite event like going to lunch at a restaurant, or visiting a local attraction, which he isn't up to due to the power chair and lack of mobility. Sometimes it's something that is more simple and basic, which my Dad probably feels isn't interesting to him. The things that are closest to a hit are onsite music, or documentaries.

I also suggest he just go down to the lobby/common area to see if there's anyone to talk to there. I'm hoping he might make a friend. While he's friendly to everyone and most everyone there knows my Dad and likes him, he's not really friends with any of them. For whatever reason, he seems to be friends more with the staff than the other residents; I'm not really sure why.

I called my sister and asked her for advice. She suggested making a list of ideas for him to try (he already has lists for phone numbers and dining room hours, plus the activities schedules, all of which he seems to refer to), and asking the activities directors for ideas and help. She also suggested an Amazon Echo Dot or similar that could play music or tell jokes, which might work.

Also, I was sort of trying a strategy of letting it be his problem - figuring if he's bored, eventually going to more activities will sound better than sitting in his room looking at his clock and waiting for dinner. But with his Alz/VD my idea probably isn't a reasonable approach. It also doesn't really seem to be working - I've tried it for a short while and he's mostly choosing to stay in his room and watch the clock...I think, anyway; it's not always clear what he ends up doing after we finish our phone calls.

Any suggestions or insights for how to handle a bored person with dementia?

Thanks!

M1

I suspect you are overestimating his rational capacity and underestimating the impact of the dementia. He would probably fare better in a true memory care setting than a hospitality model AL, especially if he is stage 5-6 as you say. The dementia involves not only memory loss but apathy and loss of executive function, such that expecting him to make choices from lists is unrealistic, and it sounds like you've realized that. Certainly depression can play a role, but sounds like he's more or less telling you that he needs more help than he's getting. If making a move to memory care would mean losing the girlfriend i can see how that would be difficult, but you probably need to think about it.

solerdr

I agree with what M1 has said, especially the piece about expecting your father, who has ALZ to be able to problem solve. Not going to happen, and if it does, it will be fleeting and not be sustained.

A full-term Memory Care facility that focuses on those with memory issues is better equipped to manage individuals with ALZ.

My father liked to help; thus, the staff at the memory care facility used to ask him to help them with little things: setting tables for meals, watering flowers outside, helping pick-up things that were left out.

We left National Geographic magazines in my father's room (his favorite pre-ALZ), plus we also had a television in his room that was always tuned to the History Channel or National Geographic to keep my father occupied when there were no activities going on at the facility.

I wish you and your family the best.

May God's light guide your day, and His spirit bring you peace.

Damion

secondcor521

Thanks for the replies so far.

As far as what stage he's in, looking at the FAST scale he meets all of the stage 5 items except he knows where he is 99% of the time, and some portion of the ADL help needed is probably attributable to his other medical conditions. The only stage 6 item that I know for certain is some slight personality and emotional changes and maybe some anxiety. So I guess the most accurate way to describe him is on the border between stage 5 and stage 6, or maybe leaving stage 5 and entering stage 6. I assume it's all approximate anyway.

Also, it's hard to grasp that his cognitive capacity has declined to that great of a degree, even with evidence staring me in the face. He is a retired physician and was one of the smartest people I've ever met.

Memory care would be quite a change. He just moved from independent living to assisted living in February this year. Although that move was precipitated by a medical crisis and he probably should have moved to AL up to six months sooner than he did; in retrospect he would have fared better.

He is in a CCRC and they do have a memory care unit there. I don't know much about it other than it is very small (both in terms of room size and number of resident rooms) and I think that the residents are not free to come and go as they like. There are walls around the patios and doors with locks and so forth, which I think is standard fare for MC but I don't really know for certain. I'm sure his girlfriend could visit him in MC, but if he wouldn't be able to leave to go to watch movies, or have meals in the IL dining room, I think that would be a major lifestyle change and he wouldn't be happy about it.

My understanding is that MC is more for when dementia patients become combative, or hallucinate, or wander. None of which my Dad is at this point. But perhaps my understanding is inaccurate.

The other thing I'm starting to come to grips with is that my Dad's decline has been and continues to be relatively rapid, at least from my perspective and compared to my hopes. The loss of executive function and loss of orientation to time have come on only in the last week or two. I'm finding it hard to keep up with his decline - in the time it takes me to get used to him on one thing, something else happens. He was only officially diagnosed January 24th.

I don't want to, but I may need to start having some conversations with the IL activities director, my Dad's NP or PCP, my siblings, and the MC folks.

Thanks again. Additional comments welcome.