Submitted by Dr. Nerene Kleinhans
David is a 79-year-old retired school teacher who has declining memory, increasing difficulties in word-finding and withdrawal from his hobby of fishing over the past 6 months. He has a history of hypertension. His family physician sees him and rules out other organic causes (eg depression, infection, thyroid disease) for his cognitive decline. Further testing over a few visits leads to a diagnosis of dementia, likely Alzheimer disease. His physician shares the diagnosis with David and his wife, Dawn. The family is fully aware of what is going on. However, they live in Calgary. His wife asks what else they can do for David locally, in Creston, BC.
Dementia can roughly be divided into early, middle, and late stages. It is a long and emotionally draining journey for the patient, family and the primary caregiver. This is the first of three articles taking David and his family through this journey. Dawn feels overwhelmed by the diagnosis. David is not fully accepting of this either and does not want to talk about it. They feel isolated from their friends. David agrees to connect with First Link. (East Kootenay 250 426 0534 or visit www.alzheimerbc.org) They find this link incredibly helpful, as it provides education on dementia and they support Dawn with how to deal with caring for someone with dementia and discuss issues of guilt, grief, and loss with her. Most importantly, First Link gets them in touch with local support groups in Creston. Some days are harder than others, and Dawn phones the Family Caregivers of BC support line (for those caring for a loved one with dementia). By phoning 1-877-520-3267 (Monday-Friday, 8:30 - 4pm). They provide her with coaching and more resources. Dawn also attends the caregiver support group in the Creston Library Community Room on the first and third Friday of each month, from 1 - 3 pm. Talking to other caregivers that understand what she is going through is a tremendous help.
David is worried about their will and is starting to forget his PIN code for his bank cards. Their children come for a visit, and he agrees to talk with them about advance care planning. He admits that it’s overwhelming, and he doesn’t know where to start.
Dawn has never been one for numbers and bookkeeping, but she now knows where to get the help she needs. She sets up an appointment with Shannon Romano from Motivation Medics (Toll-Free 1-877-331-9412 or info@motivationmedics.com) who helps them with advanced care planning and representative agreements etc. They then meet with Lorne Mann (Notary Public, 250-428-7194 or info@notarycreston.com) to finalize their will. Other options that David and Dawn could explore include 1. His family physician can refer them to a social worker to help navigate the process of advance care planning. 2. Kootenai Community Centre Society has a staff member that advocates for anyone age 55 and over. They can help with legal documents, filling out paperwork, budgeting and dealing with abuse and neglect. Book an appointment during office hours at 250-402-0068.
During their children’s visit, David and Dawn go to the Creston & District Community Complex (250-428-7127) and they sign up for Tai Chi. They are very impressed with the facilities and they decide to make it part of their daily routine. Dawn has been educated on how exercise can help prevent the progression of cognitive decline. Feeling more comfortable with the diagnosis of Alzheimer’s Dementia, they tell their friends and, once again, meet up regularly to play cards and board games. Even though David asks the same question a few times, he loves being around people that treat him like a person and understand his condition. They take him fishing as often as they can. After having put this off for many years, David and Dawn now realize that their acreage is simply too much work for them. They decide to downsize, while David is still well enough to be a part of the process. David and Dawn visit their family physician on a regular basis who talks to them about the focus of quality of life and he discontinues all medications that do not add to this. They discuss the MOST (Medical Orders for Scope of Treatment) form and agree to let nature take its course and to not do CPR in the case of cardiac arrest.
(Next week: follow David’s journey through the middle stage of dementia.)