Expert: Paula Damgaard - 10/10/2006

Question
Hi,
  I hope you can help us because we are at wits end.  My father-in-law has dementia.  My wife and I guided him and mom thru the process of selling their home and moving into an independent living condo in a step place which supposedly has nursing care built in.  
   My mother in law has been complaining for over a year that dad is driving her crazy because he asks the same question 30x and waunders around at night and just seems like a lost soul.  She has kept his behavior under control but lately she has gone into the hospital and is now in respite care for who knows how long.  My wife has had to take an absense from work and lived in their condo and taken meals with him in the dining room, etc.   Now she is a nervous wreck trying to be dad's mind for him.  Now he is at our house and she is always awake listening for him getting up and I can see the effect of the stress on her.  
   I have dealt with people with dementia and urged her to speak with his doctor.  The doctor is no help at all and she couldn't care less.  She prescribed Arecopt and some other drug but it isn't working, he is still all fretful.  I urged her to get a referal to a doctor that specializes in this but that has become easier said than done.  
    I have also urged my wife to look at her dad like our children were when they were small and guide them through each step of the day.  But she has a big problem treating her dad who was such a great man as a little kid.
     At the independent living place they told my wife that her father cannot be left alone but that she cannot take meals with him.  This drives him batty as he can't understand it.  They also are scruitinizing him as to whether they can stay there.  Yet nursing care doesn't seem needed yet and it would kill her mom to be separated from him (yet that is also changing with her)
    In other words she is at her wits ends and nobody seems to care.  Can you offer any suggestions?

Answer
Don, I really like your idea of getting a doctor who specializes in dementia.  You said it was easier said then done, have you contacted the Alzheimer's Association?  They would know physicians in the area that deal with dementia patients.  Also, if you are near a University hospital, there may be a research unit.  

Aricept will be good for helping to slow down his disease, but not necessarily his behaviors.  He needs to get some sleep so that you all can.  There are several medicines that could help.  Antipsychotics can help to calm him down.  Trazadone can help him to sleep too.  This of course depends on what other meds he is taking to prevent side effects.  

Unfortuantly your wife is going to have to deal with her dad as a "child".  He is going backwards in his developmental growth.  So if she can think of his behaviors as that of a teen rather than him the man as a teen that may help her.  

Many of the buy into senior settings, do have rules regarding who can live where.  They may insist that he be moved into a different unit.  Do they have an Alzheimer's unit there?  An argument for your wife and her mother is that 50% of caregivers die before the patient due to the stress of caring for them.  Where will he be if his wife were to die?  Is there another place they could move to?  Some of them are better customer service.  I would look around if I were you.  It doesn't seem as if the one they are in if they insist that you can't even eat together!

I hope this helps.  I am leaving on vacation tomorrow, and will be back on the 26th.  So please feel free to ask again.  Good luck.  Paula