In This Episode:
Dr. K answers nine audience questions related to helping older parents:
- How to find a facility for an older father with dementia who is a “two-person assist”? How to make sense of the jargon on care levels and how are facilities classified?
- How to help an older mother with bipolar, especially if she seems to be going into a manic phase?
- How to maintain sanity and better respond to an older father with Alzheimer’s disease, who gets agitated and angry in the afternoons and evenings?
- Whether to worry about withdrawal symptoms, after an older mother is hospitalized and treated with haloperidol for delirium
- How to keep assisting without losing hope, in the context of a mother with Alzheimer’s and an older father with Parkinson’s and sleep problems
- What to do when it’s hard to get an older mother to take her medications, and how to get her to understand the importance of recommended procedures such as cataract surgery
- What to do if both you and your elderly mother have been diagnosed with mild cognitive impairment, and how to handle caregiving issues
- Whether anxiety can cause abdominal pain and shortness of breath in someone with dementia, and how to improve bad breath that has been attributed to acid reflux
- What can be done if an older father with mild cognitive impairment has been refusing to leave the house for several months
Expert contributors to some answers:
- Carolyn Rosenblatt, RN, Elderlaw Attorney, AgingParents.com
- Mary Hulme, LCSW, Licensed Geriatric Social Worker, MoonstoneGeriatric.com
008 Helping Families with Memory Loss: The Care to Plan Online Tool
- Eldercare Locator (Use to find your local Area Agency on Aging)
- Assisted Living Levels of Care
- Depression & Bipolar Support Alliance: Helping Others Throughout Their Lives
- Symptoms, Signs & Effects of Bipolar Disorder in Seniors
- Durable Financial Power of Attorney: How It Works
- Family Caregiver Alliance: Caregiver’s Guide to Understanding Dementia Behaviors
- Alzheimer’s Association Care Training Resources
- Taking Care of YOU: Self-Care for Family Caregivers
- Powerful Tools for Caregivers
- How to Age Better by Optimizing Chronic Conditions: The Healthy Aging Checklist Part 4
- How to Promote Brain Health
- Alzheimer’s Association: Mild Cognitive Impairment
- Mayo Clinic: Mild Cognitive Impairment
- The 2015 American Geriatrics Society Updated Beers Criteria: Medications that Older Adults Should Avoid or Use with Caution
- Mayo Clinic: Symptoms & Causes of Bad Breath
Neftali Fernandez says
Hi Dr. Kernisan, this is Neftali Fernandez. I submitted the last question on this podcast and I want to thank you kindly for discussing my Dad’s situation. Although I was told by a ARNP who specializes in Neurology that Dad doesn’t have dementia, I still have doubts that my Dad only has MCI. I believe he has dementia or is headed in that direction. His 84 year old brother is in end stages of Alzheimer’s himself. Dad’s main doctor who sees him at home monthly diagnosed him with depression and started the low dose Lexapro based on my discussion with her. I have to imagine that a person who hasn’t left the house since August has to have some degree of depression. I will try to apply what you discuss on this podcast. Again, thank you and God Bless you and yours.
Leslie Kernisan, MD MPH says
How wonderful that your father has a doctor who visits him at home.
I recall you said your father is 89. For people at this age, mild cognitive impairment (MCI) does often progress to dementia, but not always.
I explain how we often diagnose dementia in this post. If the MCI diagnosis is recent and you are concerned that it’s incorrect, you can review the criteria for dementia diagnosis and then ask the ARNP for more information on how she reached her conclusion. You may also want to request copies of whatever cognitive testing was done.
Regarding depression, the most important symptoms to consider are frequent sadness and/or loss of interest in activities the person used to enjoy (this is called anhedonia). If the older person doesn’t have at least one of those two symptoms, depression is less likely. There is more on depression in older adults here.
Depression can cause people to not want to leave the house, but so can other things, such as anxiety, paranoia, some kind of delusion, or a variety of other problems not related to mental health problems. Again, I would encourage you to ask your dad about his reasons.
Good luck; I hope the situation gets better soon.
Very helpful and great information. We appreciate advice especially coming from a professional.
Thanks again and keep up the great work!
I wrote this to you during your Q & A request around April 2016. You were kind enough to reply and ask that I post this question on this site so you could answer it. I am just now getting around to it due to family issues. If you have time I’d love to get your perspective on our situation and any recommendations on who we can contact or where we can go to obtain additional info. Thank you for your time and your helpful site and newsletter. I have really appreciated the info and have shared with others.
Both of my parents are 80 or are nearing 80 years old. They are or have been very independent, but we are transitioning them (separately) into CCRC communities.
One concern I have is with my mother. She seems to have lost confidence in herself. She puts herself down, she seems discouraged, and she is just more unsure of herself than I have ever known her to be. Although she is active she has pulled herself out of many activities she once enjoyed (volunteering, church, cards, etc.).
She has a difficult time talking on the phone (simply having reasonable conversation) and friends and family have recognized this recently. My guess is these symptoms may be due to some declining ability to reason, retrieve words, and use/read numbers. She seems to get nervous when speaking, even to the most familiar of people, on the phone. She is a little bit better at conversing with others in person, but she still seems nervous when speaking with someone new. She does have some hearing loss (I am an audiologist and we have tested her within the last year), but this, I believe, is beyond a hearing loss concern. She is not interested in hearing aids (naturally).
She often starts a sentence assuming that I know what she is talking about. It is as if she has had a conversation in her mind/head and she begins talking about it assuming we had been discussing it for several minutes. She expects that I know what she is talking about and she gets irritated when I need or simply ask for clarification.
For example: We may be talking about her grandsons basketball game… in the middle of that conversation she then starts talking about her taxes (without telling me we are talking about taxes). She then becomes annoyed when I don’t understand what she is talking about and that she has to take the time to make me understand.
She has trouble (significant trouble at times) with word retrieval and with numbers. She can describe the word or the idea but cannot come up with the actual word. I try and gather enough info that I can recognize what she is saying or trying to say, but she gets frustrated and irritated at times and gives up. Her ability to read numbers has rapidly declined. In reading a statement she is unable to spontaneously read numbers (without us breaking the number down) above the thousands.
In addition to the issues listed above, she has recently been a victim of identity theft. The criminals who stole her ID manipulated her out of several thousands of dollars before we (the family) were aware of what was happening. They were able to obtain her SS number and passwords to her accounts. We have since then remedied this, but she did loose a fair amount money and this truly shook all of us to the core. She has to be reminded of what happened. Nevertheless, she is also aware that much of this is happening (her memory, word retrieval, ID theft, etc..)
She has had an MRI which we are told showed no signs of dementia or Alzheimers…we will be going for an ultra sound of her carotid soon.
There are so many signs that something is not right (more than I can list here), but we don’t know where to turn or what to ask for … when or if we find the right doctor. She is on some meds but we don’t really feel this is helping too much. We are desperate to help her more than we are able to right now.
Any direction you can provide in this form of communication would be appreciated. Even if it is a description of what to look for in a good gerontology physician or some additional direction you would take if it were your family member involved.
Thank you for your time.
Leslie Kernisan, MD MPH says
Oh wow. I’m sorry to hear your mother has been having all these problems, and unfortunate that she was scammed, too.
Unfortunately, the problems you describe are not unusual in older parents. I agree with you that they are extremely concerning for cognitive impairment, so the thing to work on is getting a thorough assessment so that your family and the doctors can identify all probably or possible causes of her cognitive impairment.
MRIs are not a good way to rule in or rule out dementia, although they do sometimes show signs of damage from small strokes. An ultrasound of the carotids usually is not very helpful; partial blockages are common but generally it’s best to not consider any procedures to fix a blockage until you’ve sorted out why she’s having the thinking problems you’ve described.
Re what kind of assessment to get, I recommend you start by reviewing my article How We Diagnose Dementia: The Practical Basics to Know.
This covers the many non-dementia causes of cognitive impairment, and it would be good for your mom to be evaluated for these. There is also a link to a free PDF cheatsheet, to help you make sure you get a thorough evaluation from the doctors.
Re what kind of doctor, anyone board-certified in geriatrics should be suitable. Many neurologists are used to evaluating cognitive impairment as well. Otherwise, a general internist or family physician should be able to do this assessment as well, but they have to be willing/able to take the time. You will speed up the process if you come to the visit prepared with the right information (the PDF cheatsheet can help with this).
I have tips on finding a geriatrician — or other qualified physician — in the following article: How to find geriatric care — or a medication review — near you.
Good luck, and please feel free to post follow-up questions here or below the dementia assessment article.