Alzheimer`s Disease/Alzheimer's Progression
My mother-in-law was diagnosed with Alzheimerís 5-6 years ago. Since her diagnosis, she has steadily declined and, as a result, can no longer live by herself. She cannot remember how to cook or even heat something up in the microwave. In addition, she never wants to eat, always saying she is full. She is now at the point where she no longer knows the day, month, or year and will repeatedly ask the same question over and over even though we answered five seconds before. When she first came to live with us a little over a year ago, she would do a sponge bath, using water and a wash cloth (no soap) saying she didnít need a full bath because she wasnít really dirty. Now her personal hygiene has declined to the point where she no longer even takes sponge baths. She does not know her address or phone number and does not remember significant events like Christmas, Thanksgiving, or going to a wedding. Her ability to count has diminished to the point that she believes 2 comes after 3 when counting to 10. She can still dress herself though she needs to be told how to dress for occasions and she doesnít need any assistance with toileting. She still remembers the names of close family members but does not know more distant family members or family friends she has known for many years. She used to stand straight as an arrow when she walked. Now she stoops forward when she stands and walks very slowly and deliberately. My husband feels that his mother is not that bad off and we should not worry about discussing the possibility of putting her into a nursing home when the time warrants. Currently, she does not need to live in such a facility, but I know that she will at some point. As far as staging, where do you think she is? How long before we will see even more decline (need help dressing, toileting, wandering issues, etc.)? How can I help him understand that these issues need to be discussed?
Hello Katy: I'm very sorry to hear of your mother-in-law's increasing decline. I'm sure it's very, very difficult for your husband to accept this even though it is happening right in front of him. It's a natural response to try to mitigate the progression and it sounds as if he is doing that. You are correct in that she will continue to progress in her dementia. She will not improve. There are several scales in use for staging the dementia, but I tend to just go with mild, moderate and severe, and based on what you've told me, I might rate her as moving into the severe stage. It's not really important to put a label on it. You must meet her wherever she is today, in this moment regardless of the stage and react accordingly to keep her safe, happy and healthy. My advice is to begin looking at facilities now. Get on their waiting lists so that when (not IF), the crisis happens, you will be ahead of the game in a stressful time. If the facility calls you with a bed, you can always tell them "Not right now, thanks." Ask them to keep you on the list. She will have a crisis--either a fall with a fracture, or severe injury; or she will wander outside and become lost, or injured. She may aspirate food or fluids and get pneumonia. Her brain is forgetting how to walk, how to swallow and how to keep herself safe. There are endless possibilities, and the more prepared you are, the easier it will be for all of you. Wherever she eventually gets placed will depend on her mobility. If she's mobile and could escape, she should be in a secure dementia unit. If she's not mobile, then somewhere where she would be comfortable and your husband would be happy leaving her in that setting. If your husband is adamant about not seeing the reality of this situation, please don't press him to. When the crisis happens, he will be forced to act, and it will work out one way or another, but asking him to look down the road now and see the sad ending may be too much for him. He has to come to the table in his own way with this. As long as she is receiving care, and not being neglected in any way, she's in an okay place. Just don't hesitate to act once the crisis does happen.
The rate of her decline is not a question that can be easily answered. It's best answered by her primary physician. It will depend on if she has other conditions going on such as heart disease, diabetes, etc. Conditions such as those will hasten the decline, but again, it's a guess as to how much. She could very well linger where she is for several years. It's vitally important that you are not being overly burdened with her care, so you must speak up if it reaches that point. I wish you much luck Katy with your troubling situation. Cindy