Why would you need to discuss dementia with your charge?
If you have experience with dementia, you should know that a great many people with the condition refuse to acknowledge or accept it. In fact, they vehemently deny it. My mother is 94 and lives in a Memory Care Assisted Living community for the past 21 months. For No Good Reason, either. There's nothing wrong with her, it's the others who are "stupid morons" and "crazy", not her. She's fit as a fiddle. She was diagnosed with progressive dementia in 2016 and is at the moderately advanced stage these days. I don't mention it, and neither does her doctor or her caregivers. She'd only get angry and argue it anyway, so what's the point?
Makes perfect sense to me. If you have a memory problem and thoughts distorted, you probably don't know you have an issue. How could you? Whatever your brain has you believe at this moment is truth.
Don't discuss it with the patient unless they specifically ask you a question about forgetting things.
Her denial does not change the fact that she has it. Let her be. She is probably scared to death that she has it. She is losing who she used to be and it hurts. It's not a battle worth fighting. Just love her.
What is a "charge". Are you speaking of a relative? Someone you give care to? Most people with dementia are in denial about it. It certainly isn't worth a fight you can't win under any circumstances. I would simply reply with open ended questions. Such as "I am glad to hear that. Who told you that?" A "yes you do", "no I don't" won't go far.
It doesn’t need discussing with her. When in the presence of medical professionals or others who may need to know about the dementia, it’s kinder to give them a note or discuss it away from her
Your client suffers from anosognosia, the inability to perceive one's own true condition. Since she can not perceive that she does indeed have dementia. trying to convince her of the truth will only cause anger and frustration. It might be better to just say, your _________ (family, the state,...) want you to have more help at home and I'm the help (said in a positive and humorous manner). She'll probably thank you for your help and you can move on with the day. Please make sure to notify family or your agency if you notice problems with advancing disease that must be addressed. Your client will not notice or be aware of changes to tell doctors and family.
Unless anyone is asking you about her history, your correct response in this situation is the Five Mile Stare. You are there to accompany her safely to and from her appointment, and to write down any information or instructions she is given during the appointment. You do not comment, you do not correct her, you do not contribute to the exchange between her and her clinician *unless asked.*
If the question were put to her as part of an assessment, and her dementia is relevant to whatever issue is being assessed, and you know the answer to be misleading and you know that the clinician is not aware that it is misleading, you can prompt the clinician to refer to the patient's medical history. This might tactfully be done by saying to your charge: "don't worry, Mrs X, the doctor will have all your notes to refer to, she's just checking that there's nothing new to add." If the doctor seems to be particularly obtuse, you can even throw in a meaningful look - but mind your charge doesn't catch you at it.
I am assuming she has been diagnosed with dementia and your concern is what the doctor is making of her statement? Obviously you can't just contradict her. The doctor should be familiar with dementia and will know that patients are not reliable when asked this question. If you are asked to input then that would be different. However if you are concerned that the wrong information is being pushed or an assessment needs doing, then approaching a next of kin or reporting a specific issue to her doctor may be the way to go.
Why did she require a hospital visit? Why do you think she has dementia? What have you seen in her behavior, besides any short term memory issues, if she has them, that would cause you to suspect dementia? Dementia is more than absentmindedness. Was she officially diagnosed with dementia? If not, and you suspect it, make an appt with her family dr. PCPs today routinely conduct brief dementia screening tests. If the test shows probability of dementia, the dr will refer her to a specialist to determine what's causing the dementia.
It doesn't matter that she says she doesn't have dementia, she may or may not have it. That's for the drs to decide. Don't even bring up the subject and cause her anxiety or to be defensive.
There's really no point in trying to discuss dementia with someone who has dementia. Dementia lies to the person who has it. Wiring has gone astray and new connections are made, sometimes with the past, leaving anything new on the floor. Some of those "connections" are just baffling! I liken it to a car I had electrical problem with. They replaced so many items, maybe it's this, maybe it's that, but things just got worse over time. Turns out it was a $7 fusible link hanging off the battery that had frayed wires. BIG headache and cost me a lot of money before my YB found that! Point is, the brain issues are like that. One little area can wreak so much havoc, for them AND you! Sadly there's no $7 part to fix it.
I would say IF and ONLY if someone asks what's wrong, if they realize something is wrong, then you can try discussing it with them. Otherwise, why? They likely won't agree, won't believe and most definitely won't remember. If you try and they disagree, get angry, shut down, or any other negative reaction, there's your answer. Don't go there.
The only real "test" mom had was done by a nurse from the aide company we were hiring. They wanted an assessment and did the test in mom's kitchen, at the table. Two of us were there. I'd already figured it out, doing some research online based on what I was seeing/hearing, but they wanted to assess her first and Medicare covers the cost.
She confirmed my suspicions and gave me recommendations, like using a timed/locked dispenser for her meds. Mom was still "capable", and I only hired the aides for the minimum 1 hr/day to check on her and her meds. I lived about 1.5 hours away and couldn't check daily. Between bad hearing, misplacing the hearing aid or forgetting to change the battery, phone checks couldn't be done daily. I even had to have the PD do a wellness check when she didn't answer for 2 days! Officer was smart enough to see there were 3 quick call buttons with our names and called me. She asked me to call back and determined that mom had turned off the ringer!
That said, we were NEVER sent for additional testing, to determine the underlying cause. It CAN make a difference in some cases. Mom's was likely vascular dementia. Having been on high BP meds for MANY years, she was predisposed to this. In retrospect, she may have had some TIAs, which don't cause too much problem and often resolve, mostly. Her decline was slow - one step down after 9 months in MC, then just very very slow decline. It was two strokes that took her.
Anyway, never EVER would I use the "D" word around my mother! She thought it meant you were "off your rocker", aka crazy, and you'd never convince her otherwise. She also felt she was "fine, independent and could cook." She wasn't and couldn't. Forgetting things? Oh, I'm old and entitled to forget things once in a while. So, sometimes you just go with the flow and work some minimal magic around her, without getting her dander up.
Please understand a simple fact of life. If people have dementia or on the way to dementia, they will not accept or believe or admit they have dementia. In their eyes, there is nothing wrong with them. You can see signs but a doctor must make it official. It is senseless to argue - they won't see it. Deflect the conversation or say something that everyone forgets things, etc. It is hopeless to convince them. Just seek proper help and treatment from the pro's and let them advise you or handle it themselves. It is hopeless.
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If you have experience with dementia, you should know that a great many people with the condition refuse to acknowledge or accept it. In fact, they vehemently deny it. My mother is 94 and lives in a Memory Care Assisted Living community for the past 21 months. For No Good Reason, either. There's nothing wrong with her, it's the others who are "stupid morons" and "crazy", not her. She's fit as a fiddle. She was diagnosed with progressive dementia in 2016 and is at the moderately advanced stage these days. I don't mention it, and neither does her doctor or her caregivers. She'd only get angry and argue it anyway, so what's the point?
Don't discuss it with the patient unless they specifically ask you a question about forgetting things.
Just love her.
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Are you speaking of a relative? Someone you give care to?
Most people with dementia are in denial about it. It certainly isn't worth a fight you can't win under any circumstances. I would simply reply with open ended questions. Such as "I am glad to hear that. Who told you that?" A "yes you do", "no I don't" won't go far.
Unless anyone is asking you about her history, your correct response in this situation is the Five Mile Stare. You are there to accompany her safely to and from her appointment, and to write down any information or instructions she is given during the appointment. You do not comment, you do not correct her, you do not contribute to the exchange between her and her clinician *unless asked.*
If the question were put to her as part of an assessment, and her dementia is relevant to whatever issue is being assessed, and you know the answer to be misleading and you know that the clinician is not aware that it is misleading, you can prompt the clinician to refer to the patient's medical history. This might tactfully be done by saying to your charge: "don't worry, Mrs X, the doctor will have all your notes to refer to, she's just checking that there's nothing new to add." If the doctor seems to be particularly obtuse, you can even throw in a meaningful look - but mind your charge doesn't catch you at it.
Obviously you can't just contradict her. The doctor should be familiar with dementia and will know that patients are not reliable when asked this question.
If you are asked to input then that would be different. However if you are concerned that the wrong information is being pushed or an assessment needs doing, then approaching a next of kin or reporting a specific issue to her doctor may be the way to go.
Why did she require a hospital visit? Why do you think she has dementia? What have you seen in her behavior, besides any short term memory issues, if she has them, that would cause you to suspect dementia? Dementia is more than absentmindedness. Was she officially diagnosed with dementia? If not, and you suspect it, make an appt with her family dr. PCPs today routinely conduct brief dementia screening tests. If the test shows probability of dementia, the dr will refer her to a specialist to determine what's causing the dementia.
It doesn't matter that she says she doesn't have dementia, she may or may not have it. That's for the drs to decide. Don't even bring up the subject and cause her anxiety or to be defensive.
I would say IF and ONLY if someone asks what's wrong, if they realize something is wrong, then you can try discussing it with them. Otherwise, why? They likely won't agree, won't believe and most definitely won't remember. If you try and they disagree, get angry, shut down, or any other negative reaction, there's your answer. Don't go there.
The only real "test" mom had was done by a nurse from the aide company we were hiring. They wanted an assessment and did the test in mom's kitchen, at the table. Two of us were there. I'd already figured it out, doing some research online based on what I was seeing/hearing, but they wanted to assess her first and Medicare covers the cost.
She confirmed my suspicions and gave me recommendations, like using a timed/locked dispenser for her meds. Mom was still "capable", and I only hired the aides for the minimum 1 hr/day to check on her and her meds. I lived about 1.5 hours away and couldn't check daily. Between bad hearing, misplacing the hearing aid or forgetting to change the battery, phone checks couldn't be done daily. I even had to have the PD do a wellness check when she didn't answer for 2 days! Officer was smart enough to see there were 3 quick call buttons with our names and called me. She asked me to call back and determined that mom had turned off the ringer!
That said, we were NEVER sent for additional testing, to determine the underlying cause. It CAN make a difference in some cases. Mom's was likely vascular dementia. Having been on high BP meds for MANY years, she was predisposed to this. In retrospect, she may have had some TIAs, which don't cause too much problem and often resolve, mostly. Her decline was slow - one step down after 9 months in MC, then just very very slow decline. It was two strokes that took her.
Anyway, never EVER would I use the "D" word around my mother! She thought it meant you were "off your rocker", aka crazy, and you'd never convince her otherwise. She also felt she was "fine, independent and could cook." She wasn't and couldn't. Forgetting things? Oh, I'm old and entitled to forget things once in a while. So, sometimes you just go with the flow and work some minimal magic around her, without getting her dander up.
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