Dementia: Life and Death

https://healthunits.com/dementia/dementia-types-symptoms-causes-treatment/

      I can remember clearly the first time I noticed when something was wrong. In 2009, my grandmother decided that I should no longer live with her and my grandfather anymore. I wash crushed because I had just moved 900 miles away from my family to live with them. Everything had been fine up to this point so I didn't really understand where this was coming from. Shortly after, I moved out on my own and was forced into adulthood, which in retrospect was probably for the best. Before I moved, my grandfather came to me and told me that something was wrong with my grandmother and this is why she kicked me out.

     As a teenager, I didn't understand, but over the years,  I realized that my grandmother had dementia. She started by having severe mood swings and would go missing sometimes. We would look for her at family functions and would find her lying on the floor, in her closet, crying. It was difficult for everyone and my grandfather, also not in the best health, cared for her. Later on, my grandmother's driving privileges were removed because she would get lost and would be found in a completely foreign part of town. She began to wander and would start walking off in any direction not knowing where exactly she was going. 

     Not to long after her dementia worsened, my grandfather passed and my family shared time in her care. She lost the ability to remember names and recognize her children and grandchildren. She lost her ability to read and had bouts of paranoia. Eventually, she stopped almost everything. She no longer could bathe, feed herself, walk around or do anything. It is like a regression back into infancy. She began going to daycare to relieve the strain on the family and now lives in a nursing home full-time. Often, she stares of blankly and carries no facial expression, which begs to question whether there is anyone there at all. 

Please include attribution to https://www.kindlycare.com/ with this infographic.

     Dementia affects so many people and working in the hospital, I care for many patients who suffer from the disease. It is a difficult task caring for the confused, and they are at high risk for falls and other injuries. Family members often leave their demented loved ones in the care of the hospital so they can have time for respite. However, hospital staffs are unable to dedicate the time to keep them safe, which is why dementia patients are often subject to falls and self injury. Patients with dementia often experience hallucinations and will try to "play" out their current reality in their hospital rooms. 

     Some patients become verbally abusive or combative to their caregivers. In the home environment, this phenomena is more dangerous because they lack the tools of the hospital environment. However, the hospital environment can cause a person who does not have dementia to go into a type of delirium which can be ten-fold for a dementia patient. Patients with the disease thrive best in the same environment, with the same people every day. When the environment is disrupted, it messes with their mind, and the typical pleasantly confused individual can become aggressive. In this situation, the hospital may be forced to restrain them. This exacerbates their anxiety and behaviors. I have seen many patients go through the grief process after being restrained, especially when the individual has PTSD from a prior event in their life.
     In the past few weeks, I encountered a man with dementia who was admitted for breathing problems. He and his wife had been married for more than 70 years. He exhibited extreme confusion and aggression and would call out for help all night long. After some investigation, I discovered that the man was staying up all night and sleeping all day and his spouse was being forced to stay up all night caring for him and was being deprived of sleep. The couples was well into their nineties. The man was a full code, which means do everything to save him... He was 97. The burden of care was too high and the full code status in this situation seemed unethical. 

     So, I propose that the best solution is keeping these patients out of the hospital as much as possible and keeping high acuity individuals in skilled nursing facilities or with home health. In addition advanced directives should be discussed early on, because dementia can occur very early in life. If a person with dementia has no directive or the directive is no longer appropriate, the individual should be placed in the Do Not Resuscitate status due to an absence of quality of life. This proposal is made to counteract family members who go through every measure to prolong the life of their demented family member even when that member is well into their 90s and is no longer the person that they were.
    

Quiz Questions:

1. ________ in every 10 people is likely to develop dementia in their lifetime.
2. List a "Code Status" and explain what it means.
3. Name one of the diseases that is a source of dementia.
4. What is a living will?
5. Advance directives have a high level of ________ which means you can dictate whatever
    measures you would like to be taken in the event of a cardiac arrest. 

6. In the stage model, how many stages are there in the progression of dementia?

I posted on Sean and Emilia's final report post.