vrijdag 29 maart 2013

What was he thinking?







Some years ago I worked with a delightful 83year old man, who together with his wife, had spent many years running a pub in a small Australian outback town. During our many meetings, he told me many stories about the pub and the people he served.  His favorite stories related to his time spent coaching the local football team, which included aboriginal men.  These football stories dated back to the 1950s-60s, a time in rural Australia not known for race equality, so there were many interesting twists in his narratives.  Later,  the couple moved to the city to live closer to their children.

This man had been diagnosed with Alzheimer’s disease.  His wife was confined to a wheelchair and needed oxygen therapy 24 hours a day.  They lived in a small apartment, with some help from community services and family. 

His initial admission to the dementia ward followed a call to emergency services by his wife.  The man had jammed her oxygen tubing between a door and its frame, effectively blocking off her supply of oxygen.  She was terrified and believed that he was trying to kill her.  Similarly, a second admission followed the man placing the tubing under the legs of a chair and then sitting on the chair, again resulting in the oxygen flow stopping.  Yet, throughout a very long marriage, there were no reports of violence or abuse between the couple.

As with most people in the early-mid stages of a dementing illness, the implications to his cognitive levels were unclear.  Upon admission to the dementia ward, the man went through a period of increased confusion, being disoriented to both time and place.  This commonly occurs when people with dementia are taken out of their familiar environment.  He was unable to elaborate on what he had been doing with the oxygen tubing, and in fact, couldn’t accept that it had actually happened.  When his wife was brought to the hospital to visit him, the couple sat close, quietly talking.  Sadly following the second hospital admission, she did not feel safe enough to agree with plans to discharge him home to their apartment.  He was subsequently relocated to a dementia specific aged care facility.

What is the point of story?  My point is this:  dementia destroys cognitive functioning, including the ability to plan and to reason.  Many times it is impossible to understand why someone with dementia is behaving in a certain way.  With dementia, a loss of reason equals a loss of responsibility.  As family members and health professionals, we need to remember to blame the disease – and not the person. 

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“And there was this sweet-looking little old lady with her white hair in a bun and everything, the typical grandmother type, and she was swearing her head off. I guess Alzheimer's had brought out her inner sailor.” 
                                                                                                         ― Vivian Vande Velde, Remembering Raquel