Move now or later

This is always a difficult decision. I would move now while your husband does not need your assistance 24/7 or is immobile. Many on this site have moved to where they see themselves living after stage 8. It’s something to think about.

It is true only you can make the ultimate decision. Things to consider: if he is still driving, he will need to stop soon. Can you drive to all appts and what happens when you can't? Are there services to come give assistance at your rural location, drs, nurses, aides? I decided to move us across the country before my husband became incontinent, wheelchair bound, wandered or no longer recognized me. Was it hard?Extremely hard but the best thing for both of us. Lots for you to consider but do think of what's best FOR BOTH OF YOU. He will decline, it will get harder and pls prioritize your needs and what will be best for you in the later stages of this disease. Best of luck to you, there is no right answer for everyone. You need to consider now and later and it's your decision to make.

That is exactly why we moved. We lived on a 25 acre horse farm and it was getting hard for my DH to even cut the grass without getting the lawn mower stuck on something. I’m so glad we did move because we couldn’t go through that now with him progressing more everyday. Plus moving in itself is exhausting.

A big difficult decision. We moved 450klms from our home of 25 years 4 1/2 years ago. I was 72, DH with VD and aphasia was 74, we also downsized. It took its toll initially, we didn’t want to move, but now I am so glad we did.

You need two things

1. A reason to move; and

2. Somewhere to go

To make the transition smooth you both need to be on the same page. I think that’s the main thing to work on while you can. Discuss the pros and cons together write them in a book for later reference. I do agree with Lolita being somewhere where you are happy is important but being practical is sensible. Good luck.

@barclays

Therapeutic lies, aka "fiblets", are how most caregivers manage to make the changes they need to make to keep their LO safe. You are being gifted a couple of great options you can build on. If you want to move, using the "I want you to get the best care possible and be near the doctors" is one way to position the move so that it's not based on him being unable to maintain the home. And the TKR could be used going forward as an excuse to keep him off ladders and driving if you can get a male PT to prescribe this as a "not for a while" activity.

Sometimes a PWD will agree to something like a move or giving up driving at some future point and then insist they didn't when the time comes. Sometimes the forget because of short term memory deficits. Sometimes, anosognosia creeps in and they are unable to perceive their impairments and deny needing to move forward with the original plan. In a year, he might not make it easy to move ahead with the plan.

I know you didn't ask, but because you brought it up.

TKR is not a minor procedure. Two concerns which might not apply here but are worth asking about— what sort of anesthesia will be used and is this an inpatient procedure. There still seems to be quite a bit of variation around this particular procedure. Mom had both her knees done in the hospital as an inpatient with a 2-day stay because of other health concerns. I had my first knee done at a free-standing orthopedic clinic (like a hospital but no ED)— it was "ambulatory" but there was an overnight stay months after mom's second knee with the same surgeon. The second knee was truly same-day with surgery at 1pm and home on my own sofa by 4:30pm. Hospital stays can induce delirium in PWD; even mom (no dementia) had considerable agitation with her second and she's normally the model-patient. If he does stay overnight, you might plan to stay with him.

Most docs use a regional anesthesia with sedation which isn't too huge a burden on the brain. Ask if this can be the case. General anesthesia can cause progression in some people that sometimes results in a lower functioning baseline than prior. Make sure the surgeon and anesthesiologist are aware of the diagnosis.

The standard for PT is currently 2-3 months post-surgery. Most folks I know are doing 3x weekly the first 4-6 weeks and 2x weekly for another 4-6 weeks. He'll have exercises to do at home during this time and beyond. Assuming he's cooperative, this could be something you segue into a new hobby for both of you.

Depression is pretty common in PWD. Emotional intelligence (the ability to intuit how others feel about them) and feelings remain well into the end stages of the disease and processing or rationalizing those feelings iisn't really possible anymore which leads to depression as their world becomes smaller. In some people, men especially, depression looks like irritability. Medication can be really helpful with this.

IME, the rate of progression seems to be different for each PWD. I don't know that depression impacts the rate. That's a good question for his doctors.

HB