Dr. Cheryl Woodson

Straight Talk with Dr Cheryl: Protecting Seniors-Balancing Independence and Safely

The National Weather Service says this has been the warmest twelve months on record, but I don’t think you’ll get an “AMEN!” from people under mounds of snow, or dealing with wind chills of twenty to thirty below.
In Chicago:
A ninety-year-old woman froze to death on her stoop, wearing sandals without a coat.
An elderly couple was missing for three days, but praise God and the Silver Alert, a policeman recognized their minivan and found them unhurt, seventy miles away from home. They had gotten lost, and if they had run out of gas, this could have been a disaster, too.
One newscaster reported that these seniors had “a little dementia.”
Why were these seniors alone? I think it’s because families don’t get it.
Prescription medicine may have short-term effects on mood and behavior in Alzheimer’s patients, and there is ongoing research, but we don’t have a cure yet. Alzheimer’s disease and other dementias are terminal illnesses.
People die of dementia, which starts with problems in cognition (memory and complex brain functions), but ends with neuromuscular disorders (miscommunication between the brain and the muscles). This can cause falls and difficulty in self-care, but it also affects the epiglottis, a little muscle the throat. When we swallow, the epiglottis covers the airway to decrease the risk of aspiration (getting food and saliva in the lungs). It can malfunction in any condition that decreases brain health, like stroke and illnesses, or substances that make people less alert. The cause of death in most dementia patients is aspiration pneumonia, but the current news reports highlight other risks.
Long before people aspirate, can’t dress themselves, or don’t recognize their grandchildren, they have trouble making sound decisions: how to dress appropriately for weather (or knowing to stay out of bad weather altogether), manage money, medications, meals, and housekeeping, drive, follow directions, take care of children, or maintain work performance. These problems begin well before doctors diagnose dementia. In fact, many people come to medical attention when families recognize (or admit) that these changes have occurred; others have to wait for dangerous incidents.
I know you don’t want to make them angry. I know want to respect their dignity and independence. I know you don’t want to impose unnecessary restrictions. I know you don’t want your life, your relationships, or your ability to rely on the senior to change. I get it. Once you acknowledge the problem, for the rest of the senior’s life, their needs will be up there on your ‘To Do’ list, along with all your other challenges. My mother died of dementia in 2003 after a ten-year battle. I started as a long distance caregiver, raised two little kids, and had a high-stress career in academic medicine and solo private practice. I get it, but I always ask people, “Will you be able to you look yourself in the mirror if something happens to them?”
Don’t wait for a tragedy. When seniors stop doing things they used to do, when they have trouble doing things they once did well, or if they start doing strange things (see my blog post ‘Did Mom Just Put the Turkey in the Dishwasher?’), find a team that specializes in dementia evaluations (You might get lucky; instead of dementia, it could be something doctors can treat). Initiate support at the current level of need, but think about what you would do “if.” You have to plan ahead; they will never say, “you know, I’m going to get lost tomorrow.” Be especially watchful and increase support in extreme heat and cold, but remember, nobody says people have “a little metastatic cancer.” Even when dementia is early, it is NEVER little.

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