Four Dementias, Four Approaches: Part IV

  • Alice in Wonderland. That is how I’ve though of my mother-in-law’s last years. Alice had always been a very intelligent, sweet woman, but her personality contained a fair amount of anxiety. Age only made this worse. We got along famously, however, because she was comfortable with me from the moment we met.

    After my father-in-law died, Alice remained in her apartment. Physically, she did quite well. She had some problems with balance and she had arthritis. The real problem, though, was the creeping anxiety and paranoia that would come to rule her world.

    When I would stop at her apartment, on my elder rounds, and bring her lunch, she would be sitting on the couch, drenched in olive green light that was streaming through her unopened curtains. She’d been there all night. She’d been there all morning. On occasion, she would invite me to sit beside her, but told me, “Don’t sit on the kids.” She’d motion to the paper laden couch as she said this. I don’t know if she imagined kids from her teaching days, decades past, or if she just thought there were random kids there, but I said I wouldn’t sit on them.
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    This was where distraction really paid off. I would chat with her about the kids, then move the conversation to “How about if I open the curtains and let the sun in?” Since she would not reach over her doorsill to get her newspaper from the hallway – she was too paranoid of who or what was “out there” – I would have brought that in with me. So, I’d mention something in the paper, and guide her to the table as I put out her lunch. Then I’d fix her hair and chat and she would gradually normalize, to some extent.

    It was becoming more obvious, however, that she had to get out of the apartment. When an opening came up at the nursing home across the avenue from her condo – yes, the same one as Mom, Dad and Uncle Wilkes lived in – we got a room secured for Alice. I told her that she’d have the same view as she had from her condo, and that she could see the condo from the home’s hallway window. But Alice didn’t care. Once she entered the doors at Rosewood, she never looked back. She was one of their great success stories. Alice felt safe there. Secure and cared for.

    I visited everyday, so she saw me just as often as she did when she was in the apartment. She’d sit by the elevator door and watch for me, or wait in the dining room, if I went at noon. But she made friends with the staff, too, and they encouraged her to play the piano again – something she had given up years ago. She laughed and joked with them. It was delightful to witness.

    Yes, her paranoia was there to some extent, as was her anxiety, but she was much better and much happier. This wonderful change lasted until she nearly died of pneumonia. She came out of the infection, but was never the same. Then, the more classic signs of memory loss were stronger. Her paranoia grew worse. She had some seizures. The downward slide became more obvious.

    Alice was a person who could be distracted fairly well, however. I could bring a church newsletter, or a note from her daughter, and read them to her, then put them in her pocket, and she would take them out from time to time and look at them. This made her quite content for awhile. She could be re-directed if she was in a situation where she was off-course. A good natured reminder could get her back to some semblance of reality. She would let go of whatever she had been determined to do, and get on with things. I believe a part of that was her naturally cooperative nature.

  • In the end, Alice remained sweet and – mostly – cooperative, until her death. She had her moments of stubbornness, but they were few. Alice slept away as I hoped she would. A peaceful death for a peaceful woman.
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    Distraction. Redirection. Get into their world? A caregiver has to think on his or her feet. Do what is needed at the time. Try this. Try that. All we can do is our best.

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Published On: October 16, 2006