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Medical Forum / Diseases and Disorders / Alzheimer's / November 2005Who is responsible?
I have had a penpal in Texas for several years. I thought he was pretty level headed. His 82 year old Mother was living on her own and he had always spoken of her as being very independent and strong willed. Seems she was diagnosed with Alzheimers a few months ago. Decided if she had it, she wanted to go to a nursing home. (I think the diagnosis scared her to death) So, he put her in the only nursing home in her little town. He has power of attorney over his Mother. He and his wife live 2 hours away. He is still working full time. His wife just retired. Dr. started her on Aricept and Namenda. Last week, Dr. stopped the Aricept and started Zoloft because he told Dr. she was hostile on the phone with him. She is telling him they don't treat her right. Now he says she is begging to go back to her home. He thinks it is because her roommate left to go live with relatives. She also has a car and was talking about driving. I hope he has enough brains to hide the car somewhere or sell it. There is no other family to help besides his wife. Nobody to even look in on her once in a while. So, his wife is planning to spend a week with her and then they are going to leave her "totally" alone for the next week, followed by another weeks visit from his wife. Wife is going to prepare dinners in advance for a week at a time for the microwave. He said they will visit on every week-end and will call her everyday. I told him I am kind of nervous about this decision. (I have been reading your group since he told me she had Alzheimers.) What if she scalds herself in the shower, burns the house down or wanders off? He says she isn't like that. ??????? The Dr. said she didn't need to be home alone. I told him if he takes her out of the nursing home and something happens, he might find himself in jail for neglect or whatever they might call it. He says I am over-reacting. That old people die everyday in their homes and they don't put their family in jail because they died alone. He said what was the difference? Home or nursing home? (sometimes, I think he sounds quite cold) I tried to explain, that HE KNOWS she has Alzheimers and has been in a nursing home for 2 months or so. That wasn't a cure. I think he is so stressed, he is not understanding. I asked why he couldn't bring her to his house. They have a spare bedroom. He said, wouldn't work. House is too small and they never got along all that well in the first place. He and his wife can't move in with her because it is a 4 hour drive to work for him from where she lives. Does anyone think he might be in trouble like I do? Deliberately leaving her alone? Thanks, Mar. suppose it depends on the laws wherever you are.... here in Ontario there has been a recent case in the news re: a man being charged with gross negligence for failing to provide care for his father >I have had a penpal in Texas for several years. > I thought he was pretty level headed. [quoted text clipped - 69 lines] > > Thanks, Mar. Thank you. I just sent him the article from the Toronto Star.. I know I have heard of it here too. I used to live in Windsor. Loved it. Mar --------------------- > suppose it depends on the laws wherever you are.... here in Ontario there > has been a recent case in the news re: a man being charged with gross > negligence for failing to provide care for his father > Does anyone think he might be in trouble like I do? > Deliberately leaving her alone? he will be IF YOU REPORT IT to your state's adult protective services office. at the very least, they may appoint a guardian for her. check out http://www.elderabusecenter.org/ to locate phone number for your state. IIRC complaints should be kept anonymous. Dr. started her on Aricept and Namenda. Last week, Dr. stopped the Aricept and started Zoloft because he told Dr. she was hostile on the phone with him. She is telling him they don't treat her right I find this very strange Dr stops Aricept which helps slow the progression of this disease and puts her on Zoloft an anti-depressant Strange Dr. giving this more thought, Has this lady been assessed to determine her current capabilities Is the said Dr a specialist in the disease of AD Has the Nursing home staff been asked as to their information on her abilities as after all they are the ones who have looked after her for 2 months and this care should be well documented How was she coping in her own home prior to diagnosis. given time she would probably adjust to the loss of her room mate make new friends and hopefully readjust > giving this more thought, > Has this lady been assessed to determine her current capabilities [quoted text clipped - 5 lines] > given time she would probably adjust to the loss of her room mate make > new friends and hopefully readjust All important factors, yes. I think the fellow has not considered one very important issue.... the fact that this is a progressive illness that will continue to rob his mother of her abilities. It isn't just how she is NOW that matters, but how she will be in a few months. Sometimes a decline happens almost overnight. My mother in law turned on a faucet and couldn't remember how to turn it off. She all of a sudden began to pee the bed at night. She couldn't even remember HOW to operate a microwave. She got lost in her own neighborhood. It seems very inhumane to let this poor lady alone in her house.  SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') > Dr. started her on Aricept and Namenda. > Last week, Dr. stopped the Aricept and started Zoloft because he told [quoted text clipped - 6 lines] > progression of this disease and puts her on Zoloft an anti-depressant > Strange Dr. Yes, Michelle is absolutely correct. There is no reason why she couldn't be given Zoloft along with the Aricept, and there is very good reason to try and keep her on Aricept throughout the duration of the illness. What is more, leaving her alone in the house could be inviting disaster. At least in a nursing home they are looked after and not in any danger. There are a lot of misconceptions and very bad ideas in this whole scenario. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') The medications situation is puzzling. And I wonder if she's been evaluated by a neurologist to rule out other problems. Sometimes taking the person with ALZ into your home just isn't feasible and I can understand that. There are a lot of elder abuse cases that wouldn't happen if someone had just been able to admit they couldn't do it (or didn't have the right situation to do it). And possibly, she could stay in her home if he hired someone to stay there with her. Leaving her by herself may safe now but the only way he will know when it isn't safe is when something happens. Depending on where they live, the authorities may or may not have a problem with this approach if she's not that far along yet. If it's a small town, they may be willing to have the police keep a special eye on her too. The local police did this for my MIL until we could get her into assisted living. Small town police are better about doing that. He may be uninformed on the progression and reality of the disease and making decisions on the basis of ignorance. Not everyone is willing to go read books to find out what they are dealing with. Or he may be in a situation like we were with my MIL. She refused to leave her town and her house. We had to put her in a facility in her town against her will and the assisted living place kept her on the Alzheimer's unit that was behind locked doors until she one day decided she had put herself there (then they moved her to the AL side with more freedom). When she became so confused that she didn't know where she was, we moved her to our town. If his Mom is refusing to leave her small town (and that is a very scary thing in itself) he may not feel like there's much he can do until she gets further along. Keeping her in his house may not be a good option for them. Not everyone has good relationships with their parents. And he may not be able to quit working and may be too proud to tell you that. Honestly, on the face of it, it doesn't look good. But I have to admit I try to not pass judgment on some of these situations because I've been in an impossible situation with a family member that wasn't rational but wasn't far enough into irrational that I could control the situation better. It's a crazy maker. Karen Thanks so much for everyone's input. He is only 58 and cannot stop working yet. Also has added worries that his company has been sold. New owners were in this week and there are rumors people will be laid off. I know he is under a huge amount of stress with all this. I just didn't want him to end up in a worse mess regarding his Mother. We don't live in the same state. I'd hate to report him and cause him more problems. I don't really know her true condition. He hasn't taken her out of the nursing home yet. That isn't happening til the middle of the month. Who knows, he could even change his mind because of all the static I am giving him. I will suggest he get her re-evaluated by another Dr. and talk to the nursing home staff to see what they have to say. Also ask why the Aricept was stopped when the Zoloft was added. I did tell him I had read about the progression happening pretty fast sometimes. I am hoping he will just leave her there now as long as they are treating her well. He needs to investigate that also. Myself, I thought it sounded awful to leave her alone, especially after having been around people for these last few months. I don't think she will know what to do with herself. And to not have her car. I am afraid she will feel very alone and stranded to say the least. Thanks again everyone. I have great respect for all of you who are currently, or in the past, had to take care of someone with this horrid disease. I appreciate all the information and links. You are a great help to many people I am sure. Mar- generally v bad news to stop Aricept or Memantine, as they slow the disease progression, and the usual reason for stopping them is either adverse side effects or they have gone past their usefulness, neither of which seem to apply in your case. SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com > Thanks so much for everyone's input. > [quoted text clipped - 36 lines] > > Mar- I'd been wondering about this. My mother doesn't talk much anymore and I'm wondering how to tell if the Aricept and Namenda make sense anymore. I'm reluctant to stop giving her them if they might be doing some good but I don't really know how to tell. John > generally v bad news to stop Aricept or Memantine, as they slow the disease > progression, and the usual reason for stopping them is either adverse side > effects or they have gone past their usefulness, neither of which seem to > apply in your case. > I'd been wondering about this. My mother doesn't talk much anymore and > I'm wondering how to tell if the Aricept and Namenda make sense anymore. > I'm reluctant to stop giving her them if they might be doing some good but > I don't really know how to tell. > > John Unfortunately the only way to tell is to stop :-( She may not talk much, but what about walking, continence, balance? Unless you have some reason for taking her off them (financial I presume) its hard to see what harm they might do, if she is OK with them at the moment. No need to worry about long tem side effects here :-( SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com Balance isn't so hot. Walks very slowly. Manages to get outside with the home care person most days. Mostly incontinent. Guess if it can't hurt I'll keep going with the pills. Thanks, John >>I'd been wondering about this. My mother doesn't talk much anymore and >>I'm wondering how to tell if the Aricept and Namenda make sense anymore. [quoted text clipped - 9 lines] > to see what harm they might do, if she is OK with them at the moment. No > need to worry about long tem side effects here :-( > Balance isn't so hot. Walks very slowly. Manages to get outside with > the home care person most days. Mostly incontinent. was she tested for normal pressure hydrocephalus? balance problems and shuffling are symptoms of NPH. see http://www.emedicine.com/neuro/topic277.htm "Normal pressure hydrocephalus (NPH) is a clinical symptom complex characterized by abnormal gait, urinary incontinence, and dementia. It is an important clinical diagnosis because it is a potentially reversible cause of dementia." see also http://www.emedicine.com/neuro/topic277.htm since her doc apparently doesn't have a clue about dementias (or he would never have taken her off aricept) you should tell the responsible relative that it's time to change docs, and to ask about having more tests to rule out NPH. Dennis, testing for normal presure hydrocephalus is what caused my husband's brain hemorrhage, inability to do anything for himself and 8 months in the nursing home before he died./ Gwen >> Balance isn't so hot. Walks very slowly. Manages to get outside with >> the home care person most days. Mostly incontinent. [quoted text clipped - 14 lines] > responsible relative that it's time to change docs, and to ask > about having more tests to rule out NPH. > Dennis, testing for normal presure hydrocephalus is what caused my husband's > brain hemorrhage, inability to do anything for himself and 8 months in the > nursing home before he died There are several tests that are less invasive than the procedure that caused your husband's hemorrhage, including some scans. From the original post, it sounded like testing had been minimal, which is why I suggested that she look into it, especially given the symptoms. Grayson had two sets of scans but they were inconclusive so the neurosurgeon said the only way to tell was to measure the pressure. The good part of it was that he died before he got to the end stages of AD. Before he had the surgery, he was recognizing all the family and walking with help and was still continent. Gwen >> Dennis, testing for normal presure hydrocephalus is what caused my >> husband's [quoted text clipped - 7 lines] > which is why I suggested that she look into it, especially given > the symptoms. we all must take our comfort in small blessing Linda Jean > Grayson had two sets of scans but they were inconclusive so the > neurosurgeon [quoted text clipped - 16 lines] >> which is why I suggested that she look into it, especially given >> the symptoms. >> Balance isn't so hot. Walks very slowly. Manages to get outside with >> the home care person most days. Mostly incontinent. [quoted text clipped - 7 lines] > dementia. It is an important clinical diagnosis because it is a > potentially reversible cause of dementia." When I go to the home to see my dad, I'd say 90% of the residents have a shuffling gait, incontinence (& dementia obviously). I believe the OP's mother has had Az for some time and I would guess, in common with most, that the shuffling gait & incontinence came much later? Bear in mind his original post which was to the effect, "are the Aricept/namenda still doing any good after all this tme?" SignatureTumbleweed email replies not necessary but to contact use; tumbleweednews at hotmail dot com I believe her neurologist tested her for NPH. Her balance hasn't been so hot for a long time, she's got a bad ear problem. I think she actually has a punctured right eardrum. She doesn't actually shuffle, just walks slowly. She's got arthritis as well. She's hasn't been off the aricept ever, I think you were thinking of another poster. I know the original AZ diagnosis was partly based on some sort of a scan that showed atrophy of the brain. Would that rule out NPH? John >>Balance isn't so hot. Walks very slowly. Manages to get outside with >>the home care person most days. Mostly incontinent. [quoted text clipped - 14 lines] > responsible relative that it's time to change docs, and to ask > about having more tests to rule out NPH. > She's hasn't been off > the aricept ever, I think you were thinking of another poster. I know > the original AZ diagnosis was partly based on some sort of a scan that > showed atrophy of the brain. Would that rule out NPH? yeah, sorry, too many similard cases posted i guess, i was thinking of someone else. atrophy would not normally be occuring with NPH, AFAIK. the way to find out if aricept was doing any good would be to take her off it, but sometimes when that's done, there is a precipitous decline that is not reversed when the aricept is resumed. if it's not causing any harm or costing a lot of money, why change? if it ain't broke, why fix it? > I'd been wondering about this. My mother doesn't talk much anymore and > I'm wondering how to tell if the Aricept and Namenda make sense anymore. > I'm reluctant to stop giving her them if they might be doing some good but > I don't really know how to tell. > > John The way we were able to discern that it was helping was when the doctor wanted us to try another drug instead of the Aricept. We were supposed to stop the Aricept then start with a very small dose of the newer one at first. WELL! The very first day she was off the Aricept she was so confused and mixed up it was completely evident that this was a terrible mistake. We continued for about a week on the new drug, to give it a fair chance, but it was hell-week for us. I called the doctor and begged him to let us put her back on the Aricept. He said OK, and when we did, the exact reverse occurred. The very first day she went back on the Aricept she was in much better shape and it was obvious to all that we had our Ida back!..... at least 'back' as much as she had been before stopping it. Without the Aricept she was just totally lost and confused about everything. Everybody is different though, and I am sure your doctor would be the best one to talk to about trying to stop it and see if there is any difference. SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') >> generally v bad news to stop Aricept or Memantine, as they slow the >> disease progression, and the usual reason for stopping them is either >> adverse side effects or they have gone past their usefulness, neither of >> which seem to apply in your case. > Yes, Michelle is absolutely correct. There is no reason why she couldn't > be given Zoloft along with the Aricept, and there is very good reason to try [quoted text clipped - 3 lines] > At least in a nursing home they are looked after and not in any danger. > There are a lot of misconceptions and very bad ideas in this whole scenario. sounds to me like time for a new doctor! Thank you, I agree. What is the Doctor doing?? Just because she was "hostile" (more like she yelled at him. He going to stop a drug that helps her. He need to reported to the state. > Dr. started her on Aricept and Namenda. > Last week, Dr. stopped the Aricept and started Zoloft because he told [quoted text clipped - 6 lines] > progression of this disease and puts her on Zoloft an anti-depressant > Strange Dr. Going to try to respond to this, hope I'm not top posting or breaking any other netique rule, but as I understand the lady was scared by the diagnosis and requested to be put in a nurseing home. Seems she was diagnosed with Alzheimers a few months ago. Decided if she had it, she wanted to go to a nursing home. (I think the diagnosis scared her to death) Last week, Dr. stopped the Aricept and started Zoloft because he told Dr. she was hostile on the phone with him. She is telling him they don't treat her right. His Mom was hostile on the phone with him? ... a person can be in control of their facilaties and still be hostile, think we call it upset. and I will wager that any of us put in a home would say that we are not being treated right. Aricept has been a Godsend for us, the time that Dad was off it was "Hell Week" for both of us, and as noted else where in this thread has an almost imediate effect. So unless there are major side effects IMO Aricept should be continued. asked why he couldn't bring her to his house. They have a spare bedroom. He said, wouldn't work. House is too small and they never got along all that well in the first place Were we suposed to get along well with out parents? guess maybe I'm missing something here... love em yep! don't always like em [So, his wife is planning to spend a week with her and then they are going to leave her "totally" alone for the next week. Mar] ============================= Thanks again for all the input. My friend's, Mom's Dr. said NO after he told him of his plan. Dr. is not releasing her unless she is supervised 24 hours a day and it has to be proven to him in advance. Or that son is putting her in another facility. Something to do with taking and recording her blood pressure everyday also. So, that is that. Mar Good ! Linda Jean > Thanks again for all the input. > [quoted text clipped - 6 lines] > > Mar > [So, his wife is planning to spend a week with her and then they are going > to [quoted text clipped - 13 lines] > > Mar Glad to hear it! SignatureBest Regards, Evelyn (to reply to me personally, remove 'sox') I've been following most of this thread... Glad she is saved by the smart doctor!!!!! > [So, his wife is planning to spend a week with her and then they are going > to [quoted text clipped - 13 lines] > > Mar |
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