@5050100 I’m not sure I see the benefit of a comprensive neuro exam for a healthy 90 year old woman. With your close relationship to your mom, you would pick up any changes before a detailed exam would. Also, as a primary care provider, I don’t see any benefit to a more comprehensive primary care exam.
As to medications, when my mom was diagnosed with dementia, I got her off all but a blood pressure medication and she stabilized. Be aware of cholesterol medications everyone!
@GTalum - Thanks - that’s really how I feel. My gut tells me that I will be able to notice any changes and address them at that time rather than drag her unwillingly to a doctor - that would most likely do more harm than good. It’s a fine balance, that’s for sure…
@somemom I would start with just a vision check as perhaps your mom could use some new glasses? Or simple cataract surgery? As to the balance, no surprise with a 90 plus year old. I would start with a physical therapy rx.
@somemom, @5050100 - agree with GTalum, based on experience with my mother … waited to have consult with neurologist
Falls & Dementia - when my mother was diagnosed with mixed dementia, symptoms of both Alz & vascular dementia, we were told that a fall can accelerate symptoms. She had signs of short-term memory problems for a few years before she was evaluated by a neurologist. She had 2 minor falls (no traumatic injuries, only bruises) earlier in the year she was diagnosed.
Early Signs of Memory Problems or possible neurological-cognitive impairment: One could ask one’s primary physician to perform a mental status exam (MSE). It’s very brief & is a way to screen for impairment & the possible recommendation for further evaluation. A more thorough version is the Montreal Cognitive Assessment (MoCA). Although both tests require some training to administer, they could be administered by a lay person. Having one’s doctor administer either test provides data to focus and discuss one’s concerns about changes in functioning.
She has regular eye doctor appointments, every 3 months for a pressure check, has had a couple of procedures, her eyes are up to date; her hearing has been tested and she has hearing aids which she hates.
I wonder about the PT, having gone through this with other parents, I can see that it helps, until the PT stops, because she would, and others did not, continue any efforts on her own. But maybe the balance improvement would be worth it.
Mom is totally able to walk, it’s just that she is accustomed to holding her walker handles with both hands and she can’t with this splint on her arm. She also will do whatever somebody else tells her to do; it’s just that she wants me to do everything for her. She can hold a dish and eat out of it. We were concerned with the “dangling” and throwing her feet in strange directions until we watched her do everything perfectly for somebody else.
She is 97 and has been going downhill fast for the last year. She wants to live here with me and have me stay home and take care of her like a baby. But I have a business to run; thank God the people who work for me have kept things going this week. Now my new bookkeeper has flu, I think. Plus, we have ice and snow on the ground and streets so that is slowing business down.
“Did your father improve after the surgery?”
“If she develops symptoms such as you describe (so far just the same dementia) I’m not sure I want her evaluated if the surgery will just bring her back to worsening baseline dementia (she is 5/7 now.”
In hind sight, we believe that the Warfarin/fall combo resulted in my dad’s brain bleed. Even if he didn’t hit his head, the jarring effect could have been enough to cause damage and allow the bleeding to continue.
@5050100 ,@gtalum regarding Blood pressure medications and side effects.
Please don’t make any changes in meds based on this info-
As a pharmaceutical rep in the early 80’s I discussed “detailed” a beta blocker - corgard.
Squibb’s position was that their medication, Corgard didn’t cross the blood brain Barrier, vs propanolol and other lipid beta blockers.
This meant fewer "central nervous system " CNS - side effects-fewer nightmares, sexual dysfunction, and depression.
Often we don’t think of blood pressure medications having these kinds of side effects. Just sharing this to emphasis, these kinds of effects and then if you add on drug interactions with any the other medications , who knows!
I always suspect drug side effects - I’m biased.
Thanks @SnLMom I am grateful that I have mom off even her aspirin in light of her falls and at this point, as with statins, I don’t see much of a point with anti-coagulants. I am just wondering in the hypothetical case of a subdural hematoma if I would just delaying the inevitable.
I spent 4 hours with the folks yesterday as there is an unexpected and unusual for here 8-10 inches of snow. It’s hard to say if my mom is worse, or just more of the same. She has delusions which seems to come and go. She thinks I’m her sister which is going on 2 months now. She asks me repeatedly about her parents (dead for over 30 years) and wondering where they are. The problem is that if you tell her they are OK, she wants to see them and is waiting for them to pick her up (in their green Studebaker!) and as a minimum wants to talk to them and starts packing. The staff has lately told her that they aren’t alive which didn’t upset her and seemed to work. However, yesterday she was angry at me (her sister) because “I just talked to them yesterday.” Any ideas on how to manage such delusions?
@SouthJerseyChessMom No worries. I made changes to my parents meds years ago. Mom’s primary was cooperative, Dad’s not. My goal for the elderly is to have them on as few of medications as possible.
@gtalum- Google teepa Snow- a dementia expert who has some helpful you tube videos- about delusions, anger, “asking to go home” , excellent resource. I follow her on Facebook
“delaying the inevitable”
@GTalum, we were led to believe that once the bleeding stopped, the subdural hematoma was not likely to change Dad’s expiration date, but rather reduce his quality of life. We were just hoping to provide him with some time spent at stage 6 rather than linger at 7. Whether that guidance was accurate, we will never know. . . :-??
My mom had a subdural hematoma several years ago (18 or so) after she slipped on ice and fell, hitting the back of her head. Symptoms of the hematoma, including numbness in her legs, developed several weeks later. She had surgery and recovered without incident. She is now 89 and still working part time.
I had lunch today with my step-daughter, at the assisted living she works in (she’s in the office part but everybody knows everybody); it has to be the nicest one I have ever seen. Mom will be going into the memory care unit, but she will be going in already known as Jill’s grandmother. In the dining room for the regular assisted living, there is a menu and it’s an extensive menu (and the food is delicious). The memory care people are presented with several dishes until they see something they want; if they need to be fed, they are fed. There is almost no staff turnover because everybody is treated so very well. Mom is eager to go, she is excited about activities; I have thought that she has to be bored out of her mind here with nothing to do. Half of me is euphoric, the other half is grief-stricken. If we can get all the medical orders taken care of, she will move in on Monday; we are looking at it as a trial thing to begin with.
I moved my father from AL to Skilled Nursing last August. I took away the check book and debit cards then. I sold his car over a year ago. He’s always hated the activities other than exercise class and he’s in a wheelchair and can’t do much anyway.
@GTalum -
Yes, my aunt had both Ativan and Xanax. I am not sure how she got them. I never filled a prescription for either of them, but she had 100’s, literally, when she came to live with me. I got her off them and onto Aricept.
One Day Your Mind May Fade. At Least You’ll Have a Plan.
A doctor has developed an advance directive specifically to plan for medical care in the event of dementia.
https://www.nytimes.com/2018/01/19/health/dementia-advance-directive.html
Thank you @oldmom4896
MIL still in the ICU, largely non-responsive. She has answered yes or no questions, followed some simple commands, and said “Hi” when someone says her name. Still inconsistent. But vitals are good and she’s breathing on her own.
We wanted her spot at the CCRC held, and they’ll do that and get her into whatever level of care she needs if she progresses to that point. They’ll refund her money if she doesn’t go in as a resident.
At least she was stable enough for DH to head back down to Virginia as scheduled. In time to be furloughed, though that seems to be resolving. I told him not to fill out one of those life event quizzes for a while.
DS2 is coming out for a week, and DS1 lives within a couple hours’ drive so can get here on short notice if needed. DH coming back for a week Saturday. The dog needs continued training and daily walks, etc., to avoid becoming a monster, my mother still has doctor’s appointments and needs groceries, MIL’s bills and paperwork need to be addressed, and I need a shower.
@HouseChatte Hope you got the shower, and a nap and here is an extra {{{hug}}}, cause I bet you need one of those, too. That is a lot.