Out of psych hospital

livlea

After a suicidal attempt and a month journey in a psych hospital, she will be released tomorrow !

The AL is taking her back in a more secure wing
Don’t know what to expect .. she has been wanting to die for the last few months , begging , crying and when she finally met a doctor to discuss she just said it was no longer her wish ..

Wondering what stage she is in , in comparison with some of you , they just tell us she has declined.

The confusion is that she is in great health otherwise, she is completely mobile, walk in the hallway all day, able to eat , dress etc.

She still recognizes us , but forgets when, where and what , she is extremely agitated, crying and is completely disoriented , her stories don’t make sense anymore .

Quilting brings calm

The doctors don’t tell you what stage she is in. We have all typed stages of dementia in the internet search bar and made our best guesses.

Search for Tam Cummings or dementia care central stages or even alz.org. They all have descriptions of stages.

fmb

This is the staging tool that many of us use, Tam Cummings' DBAT:

https://us.v-cdn.net/6037576/uploads/M85FKA0SKDC0/dbat.pdf

SDianeL

so sorry. Is she on medication for depression? Does she have a Geriatric Psychiatrist managing her meds?

harshedbuzz

@livlea

I am so sorry, that sounds upsetting all around.

IME, a neurologist typically offers staging on a 3-stage model based on what medical intervention might be appropriate vs the 7-stage model others have mentioned. The DBAT and FAST, for example, are focused more on the progressive losses of IADLs, ADL and who they impact care approaches. Tam Cumming does touch on "catastrophic reactions" and mood changes which can happen at early stages. If she's able to dress appropriately independently, is still continent and manages her own hygiene, this sounds mid-stage to me.

I hope medication was able to provide relief.

HB

livlea

https://alzconnected.org/discussion/comment/229463#Comment_229463

I think she is late mid-stage maybe early late-stage …hard to say because she is very mobile.. she checks many boxes in Tam Cumming stage 6 but not many in stage 5 ..weird , everything about her is weird

She wears the same clothes every day , starting to be incontinent, and has help with bathing and hair washing..but yet she could walk in the hallways all day

livlea

https://alzconnected.org/discussion/comment/229407#Comment_229407

We use it also , but it seems like she has more of the symptoms in stage 6 then in stage 5

harshedbuzz

@livlea

How did the transfer back to the AL go for you both?

You said:

She wears the same clothes every day , starting to be incontinent, and has help with bathing and hair washing..but yet she could walk in the hallways all day

I agree with you that this sounds very Stage 6. Wearing the same clothes daily is not "appropriately dressed". Urinary incontinence is a stage 6 symptom; onset is often described as "occasionally at first, but increasing in frequency". It sounds like this might be happening here. Independent in hygiene would demonstrate competency in a relatively complex multistep task— assembling toiletries, a towel and change of clothes, adjusting water temp, washing and rinsing hair and body with the proper products without a prompt, drying off, combing hair and dressing.

While the symptoms list mobility issues, increased falls and eventual need for a wheelchair, there is a subset of PWD who are like Energizer Bunnies and do walk the hallways for hours a day well into the end stages. At dad's MCF, there were 2 or 3 ladies who did this. It's common enough that most purpose-built MCFs have a design that allows for this behavior.

Every PWD is going to have a slightly different presentation. My dad walked and was conversation until he died from complications of aspiration pneumonia resulting from swallowing difficulties.

HB

livlea

https://alzconnected.org/discussion/comment/229721#Comment_229721

Thank you for your insights , it does help us figure out her current stage so we could plan for the future , if she is at stage 6 the disease progressed rather quickly , she is definitely not independent in hygiene , except for brushing her teeth , she claims bathing is not necessary , her hair is long so she is still able to make a pony tail in the morning. Her biggest stress at the Psych hospital was to brake her elastic and not have a backup .

The transfer back to AL was unusual … she refused to leave the Psych Hospital ! they had to escort her out , although she likes her new room in the secured wing of her building , she's not sure why and where she is .. she is completely mixed up , she can't use the phone ,she is also very afraid of a "crazy lady" wandering around , like her !

Her meds are now : per day; RISPERIDONE 0.5mg, CITALOPRAM 5mg, VENLAFAXINE 75 mg , blood thinner APIXABAN 5mg

housefinch

Sounds like she probably needs memory care and very close follow up with a geriatric psychiatrist. I hope everything goes smoothly and you can have some peace and relationship today.

livlea

https://alzconnected.org/discussion/comment/229749#Comment_229749

She spent one month with a geriatric psychiatrist, and is now back in memory care , we also hope for peace but are now resigned otherwise , she is a complicated « case », extremely anxious and agitated even with all the medication

harshedbuzz

@livlea

I'm sorry the anxiety/agitation piece is so difficult to manage.

Does she have on-going geripsych care at the AL? Her 3 psychoactive medications are all at a dose level that allows for adjustment up if needed.

HB