What to do, what to do…

TSHarriott

My father in law suffers from dementia. He has lived by himself for the past two years and is capable of caring for his daily needs. Still fine with the few meds he takes. He has regular interactions with each of his kids as well as occasional visits from family friends. He sundowns pretty severely each evening. We encourage him to go to bed at a reasonable hour and he seems better able to remember after sleeping the night. He asks regularly where Mom is (his bride of 50 years who passed away two years ago). He calls upset that no one is there with him and asks where we all are and if we are mad at him. We are all very patient and answer his questions as many times as he asks them. He does not remember having visitors, celebrating his birthday, etc. He fixates on one situation or conversation and starts it several times per hour. I know that each person is different, but does any of this sound familiar to anyone/everyone out there?

towhee

Hello and welcome to the discussion boards although sorry for the reason you are here. Yes, the fixations, conversation loops, and short term memory loss are all common. The length of time between conversation loops will become less as his short term memory continues to degrade, and as you have noticed the fixations and loops are also related to anxiety.

I am glad that there are multiple family members and that they seem to be working together. Thank you for supporting your wife. As a son in law your role is probably more support than input, but I do want to say that you have noted the visible symptoms. Less visible are the lack of judgement and inability to know when something is dangerous. Also, sometimes you can get very quick changes with no warning. I would be looking into some kind of monitoring system for nights especially. Persons with dementia can fall, or wander outdoors, or think someone is breaking in and call the police. It is really important to prepare for problems as much as you can before they actually occur. If you look under "Groups" on this site you will see one called New Caregiver Help. There are some good resources there.

SDianeL

welcome. It is no longer safe for him to be alone. He would not know what to do in an emergency. He is vulnerable to scams. He could wander off. He could start a fire and not know what to do. He needs 24/7 care. Either in home care or a memory care facility. Read the book “The 36 Hour Day” which was recommended by a nurse. Search online for dementia caregiving videos by Tam Cummings and Teepa Snow. Search online for a chart of the 7 stages of dementia that lists behaviors within each stage. That will give you a general idea of where he is. Does someone have a DPOA? Medical POA? If not, meet with an Elder Care attorney immediately. Start planning on his long term care. Don’t wait.

H1235

Welcome, what you have described is all pretty common with dementia. Dementia is about so much more than memory. Judgment, planning, prioritization, even basic needs. Not wanting to shower is common. Anosognosia is common with dementia and is the inability to recognize symptoms or limitations. This mean he may try to do things he is not capable of that are dangerous for him, because he believes he is perfectly capable. What if he out of the blue decides to make himself a grilled cheese and then forgets it’s on the stove?, if a fire alarm went off would he know what the noise was?, if there was a fire, would he leave the house or try to put the fire out, or search the house for his wife?, if a predator comes to the door would he give them things (money, check, the new lawn mower)? Wandering is a very common symptom you might expect to see in the near future. He should be moved to a safe environment before he wanders into the road and gets hit by a car. I will attach a couple of staging tools. It might be a good idea for family to take a good look at these to determine his stage. They should then note the level of care recommended at that stage. Dbat give a rough age equivalency. Would they let a child live alone at that age? Based on what you have described I don’t think it’s safe for him to live on his own. Is there a family member with DPOA? This is very important. He sounds lonely, which makes me think an Al facility might be good for him. My mom enjoyed making friends and having people to talk with, although she was very angry with the move. Medication may also help with the sundowning. Al can have a waiting list so this should be looked into soon. It’s difficult being the in-law, I’ve been there. You want to be helpful but not too intrusive. Good luck.

https://www.alzinfo.org/understand-alzheimers/clinical-stages-of-alzheimers/

DBAT.pdf

https://www.agingcare.com/topics/295/anosognosia

psg712

I know all of this advice can sound scary and overwhelming but I have to agree with the others who have posted. Suggest some verification of the activities you think he still handles well. For example, check his supply of meds. Look at the dates they were filled and count the remaining pills. Ask him what he takes each of them for. If he can't remember that you visited last weekend, how can he remember that he took his daily meds? If he repeats conversations, might he repeat his meds more than prescribed, or neglect to take them at all? If a doctor has prescribed something new, has your FIL remembered to pick it up at the pharmacy, and does he understand how to use it? Verify. Don't take his word for it. PWD, especially in earlier stages, will always insist they are fine and can be skilled in putting on a good show.

Who among his children has power of attorney? That person also needs access to medical records (such as an online patient portal), banking and investment info. A real wake up call for me occurred when I got into my mom's bank records and saw how many checks (over 80 in one month!) she had been writing to various charity and political groups, thinking that the mail solicitations were bills that she owed. Again, verify. Scammers are smooth operators and PWD are easy marks.

Ask him what he'd do in case of fire or medical emergency. Better yet, set off his smoke detector when you are there and see how he responds.

I hate to bring up this touchy subject, but does he still drive? Check the car for unexplained damage and watch his mileage. Someone who shows the cognitive changes that you have described likely does not have the judgment to drive safely.

This is a lot. Gather the family and talk it over. Your FIL is blessed to have family who care. Remember, he is unlikely to recognize his limitations and you wont be able to convince him. That's one of the toughest parts. You just have to do what needs to be done to keep him safe. There are lots of great resources and support here. Keep us informed, we have all been there!

harshedbuzz

@TSHarriott

Your FIL is fortunate to have a DIL who cares enough to ask questions.

It does sound like perhaps the family has a rosier view of his abilities than is realistic. A man who has forgotten the death of his wife 2 years ago is not someone who should be living alone.

The level of care for your FIL needs to be appropriate to his need for support when he's struggling the most, not on a good day or when he is showtiming for family.

I would urge you to check his car for random dings and dents and when the oil was last changed. Check his mail to see if bills are being paid or he's being solicited by sketchy "charities", check the contents of his fridge and cabinets for spoiled or out-of-code foods. Also check his prescriptions that he's truly taking them as directed and not forgetting or doubling up which might be more dangerous.

HB