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Alzheimer`s Disease/advanced vascular dementia

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Question
Hi Mary:
My father is 91 years old and has advanced vascular dementia. He doesn't speak any more and if he does nothing makes any sense.  His days are nights and nights are days.  My mother who is 84 years old is taking care of him at home for now, but I don't know how much longer that can last as it is truly taking a toll on her even though my sister and I do as much as we can to help her (we both work).  My question is this:  My dad takes various medications (i.e., plavix, enalapril, ranitidine, xanac).  The problem is he doesn't swallow any of these pills as he did before.  He chews them all.  Does this impact their purpose?  He does not understand that they need to be swallowed.  Any information/advice would be greatly appreciated.  Thanks.

Answer
Hi Margaret, all of the medications you mention are available in liquid form. I would talk to his doctor and the pharmacist about the options. Besides liquid forms, there might be other options, such as patch form, or suppositories. It is really unsafe for him to chew up medications like that - he may choke on them or inhale the fragments. You are quite right also in that some medications are not meant to be chewed. Some can cause irritation in the mouth, throat or stomach and have coatings to protect you.

Many people in later dementia have trouble with chewing and swallowing. It's called dysphagia, and it's caused by the loss of fine coordination. You also know that he really doesn't understand spoken language any more, and couldn't remember what you told him to do, even if he understood the words. Anything crunchy can be dangerous. I am guessing he is eating softer foods routinely.

You might also want to ask the pharmacist or doctor about ways to hide his medications - even the liquids might not taste great - and might have to be masked by putting them into something like applesauce or juice. The professionals can advise you on that. You may even be able to crush up his pills and put them in food, but that totally depends on what the medication is and what the pharmacist and doctor suggest.

I am worried about your mother. Tell her she has your support and your permission to place him in care if she needs to - she has done the best she could, and if she keeps going, she may get sick herself.  If she gets run down from all the stress and work of caregiving around the clock, it doesn't help him at all. He needs her healthy and rested so she can love him and look out for him. She doesn't have to be the one who is actually doing the bathing and feeding and dressing. She might want to try respite care to see how it goes and give herself a little holiday. I doubt very much he is very aware of where he really is or who he is with most of the time.

We were reluctant to place my mother in law in assisted living. However, once she went, she did much better than we expected and seemed quite content. We were very happy that they were taking such good care of her. It was actually a huge relief to us to see her doing well.  We had not realized how much stress we had been under worrying about her 24/7.  Then we were able to go back to just being her family and caring about her, and finding ways to bring her happiness. After all, in a good care facility, they have a fresh set of staff every 8 hours, who have had a good nights sleep and time to themselves. They can be more patient that a family member who is tired and frustrated. They also have access to special equipment to make it easier to look after a person, like special bathrooms, lifts and railings. Anyone can help him put on his sweater. Only your mother loves him the way she does.

Your father is a very different person than he was, with very different needs. He may survive some time yet. It is very hard to predict. They are as fragile as glass and as tough as steel. Sometimes a small thing can send them into a downward spiral, and other times they survive for a very long time, even though they seem to be in terrible shape.  Your mother may feel she made commitments to him she can't keep - but she should not feel guilty. It's an overwhelming job for anyone.  

Hope this helps.

Thinking of you.  

Alzheimer`s Disease

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Mary Gordon

Expertise

Several years direct experience as caregiver for family member who died of end stage AD. Did lots of research and dealt with a lot of health care professionals and caregivers over the 7 years from diagnosis to the end. Used various care options from community based resources to increasing levels of institutional. Mother of three, two born during our loved one's decline, so I know what it is to be the ham in the sandwich, taking care of the older generation and the younger at the same time and trying to balance everyone`s needs. Ask me, I`ve probably been there, done that. We made lost of mistakes and learned everything the hard way - but you don`t have to! If I can`t answer your question, I`ll steer you to a place or person who can.

Experience

Currently a program manager for a large utility company. My Alzheimers experience comes from having the illness in our family. Out of necessity, we did a lot of research in order to understand the disease, plan for what might come next, and make the right decisions to help and support our loved one. Please note, I am a Canadian living in Toronto, and therefore am not the best person to ask about US regulations and insurance rules!

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