Alzheimer's Disease Q&A

Q. I live out of state and my 85 year old Mom is Dad's primary caregiver. Several weeks ago she was diagnosed with a terminal illness with which she will experience gradually increasing fatigue. I was just in Cleveland a few weeks ago and she had not been telling me how bad things had gotten. Since that time, I have had to get Powers of Attorney and take over all finances since my Dad had bounced checks, thrown bills away without paying them, etc. etc. etc.

He has been verbally abusive to her lately and his MD has placed him on Zoloft to see if that will help. He is VERY resistant to anyone, including me, assisting him with financial matters and becomes very angry. When he bounced three checks he drove to the bank and screamed at the teller that the bank was "scamming him." I had to intervene with the manager who was extremely kind and helped me to fix the problem but this is the kind of thing Dad is doing.

The problem is, he is not anywhere close to ready for nursing home placement. He is incapable of caring for himself -- my Mom has to get him up, otherwise he would literally sleep all day, coax him to eat and get out to visit with friends who are willing to come and pick him up, and tell him what to wear.

My question is this: she would be OK by herself with some help with cleaning and she has friends who drive her around. He, however, really has started to sap the energy from her, physically and mentally. She needs to take care of herself now. I have to find something to do with Dad so that my Mom can start to care for herself. I am increasingly concerned, as is her MD, about his abusive outbursts.

It's one thing to say, "Mom, it's the disease, don't take it personally" but I have been there and I know that is easier said than done. She has essentially lost her partner of 59 years. Fatigue will become worse and my Dad will require more mental energy to deal with him. I have even thought about putting HIM in as assisted living facility but his temper and mood swings would have to be more under control before that would be possible.

I'm sorry for the long involved story but I wanted to make the problem as clear as I could. Thanks for any assistance you can offer.

A. Thank you for writing. It sounds like you have been through a lot in the last couple of weeks and have done a great job handling a very difficult and stressful situation in a short period of time.

From the symptoms you describe in your question (not getting up in the mornings, loss of appetite, withdrawal from family and friends) it does sound as if your father is clinically depressed, which is very common in people with a diagnosis of dementia. It's good to hear the doctor has placed him on an anti-depressant. It usually takes 3-4 weeks for the medicine to start working and for family members to notice a change in mood and behavior.

I am wondering if your father has had a formal geriatric assessment to determine what type of dementia he might have. The benefits in your situation, would be two fold. You would be able to determine your father's level of competence to see if guardianship is needed and it would address the issue of appropriate long term care placement. (Assisted Living, Nursing Home, Group Home). There are several Geriatric Assessment Center s in the Cleveland area.

I would, however, recommend an inpatient geriatric assessment in your father's case due to the challenging behaviors you made mention of including his suspiciousness, intense anger and abusive outbursts. Specifically, a gero-psch evaluation where he could spend a week or two in the hospital. Here the hospital staff could evaluate the need for additional medications for his difficult moods and monitor the changes in a safe environment. This would also give you and your mother time to make future plans regarding your father's care. A list of Geriatric Assessment Centers is available by calling the Alzheimer's Association Helpline (see below.)

These are general answers to your questions. The Alzheimer's Association, Cleveland Area Chapter, provides several free services that can provide more specific answers.

The Alzheimer's Association's Helpline is a telephone information and support service for families. It provides information about community resources, tips on safety, challenging behaviors and other practical concerns surrounding dementia. An individualized packet of information from our resource library containing over 100 written resources will be mailed following the call.

Also, a family meeting where you and your mother could sit down with a social worker to discuss your needs and options surrounding your father's care in terms of his depression, difficult behaviors, and living situation could be helpful in your situation.

You can call Helpline at 1 800 441-3322 to ask for a Getting Started meeting.

I hope this information is of assistance to you and that you will give us a call so we can be of further assistance.

Margaret M. Miller, LPC
Helpline Team Leader
Alzheimer's Association, Cleveland Area Chapter

For more information, please call the Helpline at

216-721-8457

440-974-7785 or

1-800-441-3322

or visit the website at www.alzclv.org

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