If one is a geriatrician, a good part of one’s practice is focused on individuals either living with dementia or concerned about having symptoms that might be dementia. It is often a frightening prospect, at times more so for the family members than for the person with the symptoms, depending on their awareness of the problem and insight into the implications.
As I looked through the health record, I saw the neuropsychological report that supported my initial clinical diagnosis of likely dementia. The symptoms suggested it was probably a type of Alzheimer’s type. There was a note that my secretary handed to me from the patient’s spouse which reminded me of many requests I have received over the years from family members accompanying a loved one to such a medical visit. She did not want me to share an adverse diagnosis with her husband
Years ago, families and physicians sometimes conspired to withhold the true nature of a patient’s condition. As a result, patients and families were denied the opportunity to honestly express their important thoughts and feelings to each other before the patient died.
What should I do about this latest request? I looked again at the wife’s note and asked the couple to come into my office. I knew that I would have to gain the couple’s trust to ensure our future relationship would be productive. After our initial greetings, I turned to the issue of the neuropsychological report. “So how did that go?” I asked the patient. “I think pretty well. What was the result?” he replied.
I responded that the reason I sent him for the examination was because his wife and I had concerns about his memory, and that I suspected dementia. I could see the patient tense up when I used the term dementia. I continued, “You know that we use the term dementia to mean something is not right with the way the brain and its ability to remember things works. There are many disorders that can cause dementia…”
Breaking the news
The patient concentrated on my every word. I continued, “Fortunately, we now have medications and other treatments that can treat these conditions, including Alzheimer’s disease.”
I want to try one with you and start it now at a low dose to give you the best chance of tolerating it until I see you in a few weeks for follow- up. Is this OK with you?” I could see his wife with a bit of trepidation waiting for his response. “Sure…are there any side effects?” he asked. I replied, “Most people tolerate the medication well but I always start with a small dose just to make sure.”
As he got up to leave with his prescription, I said that I looked forward to seeing him. I did not tell him or his wife what to expect so that there would be no pre-conceived ideas of his treatment. As she left the room, the wife said, “Thank you, I did not believe we could do this and we did.” I’ve learned through many years that open and honest communication between doctor and patient (and their family) is more helpful than avoiding the truth. It has to be done with sensitivity and sometimes over time rather than in one meeting.
A few years ago as my mother was sliding slowly but surely into her own mind’s dark spaces, engaging her become more and more difficult.
She’d more or less stopped talking in sentences and for periods of time barely spoke more than two or three connected words. She’d begun to eat less at most meals, and had stopped using utensils. When she fed herself at all, it was using her fingers.
Sleep was more often than not the activity of the day.
A few of my friends in the field of geriatrics suggested I play music for my mother. Figuring I had nothing to lose by trying, I bought a small CD player with a good quality headset. I remembered that she really used to like the Viennese waltzes and that she also liked the 1920s and 1930s musicals, which we used to play on an old ’78 record player when I was young.
Music made her day
The first time I showed her what I bought she shook her head, almost violently. So with great caution and very slowly and methodically, I organized the play and one of the CDs. I first put the headset on my ears to show her how it worked and that it was okay.
Then I applied the headset to her ears and hit the play button for the waltz CD. For about two minutes there was absolutely no reaction whatsoever. And then there was the hint of a little smile. A moment or two later, my mother’s eyes, which had be almost wildly open, slowly receded almost entirely from view as her eyelids became small slits.
She liked the music. She liked listening to the music.
What I discovered from a number of other like-minded children of aging parents at her nursing home was that indeed, soothing, known and liked music was calming and welcomed.
And the more I asked around, the more I found that the right kinds of music seemed to be just about as good as some of the prescription mood management drugs were… and with a lot less potential negative interactions with yet other drugs.
Even musicals and music shows on the communal television set seemed to make my mother more engaged.
Miss the music
One of the part time helpers I’d retained to spend time with my mother on weekends decided my mother actually didn’t really want to listen to music. It never registered on me until weeks later that when I’d go visit my mother on weekends she seemed more withdrawn and even more agitated.
I was baffled until one Saturday it dawned on me that there was no music. I asked the helper where the music was. She said my mother didn’t need it, that it made no difference. So I found the CD player, flipped in a CD, put the headset on my mother’s ears and upped the volume a bit. She liked the music.
That’s when I suggested to the helper that if she failed to ensure my mother had her music at least a couple of hours a day, she’d be looking for another job.
Diversions, distractions, pacifiers
The past years, I’ve spoken with many personal support workers, health care professionals and families; I’ve read reports and medical journal articles.
All suggest that music, pets, children, plants… whatever the diversion, distraction, pacifier might be… seem to help refocus the elderly, especially those with some form of dementia, to some kind of better, gentler, nicer personal place.
I suppose there are no guarantees, but there’s nothing to lose by trying the right kind of music or other mental pacifiers with your aging loved ones. Just remember, the first time may not work; it may take a few efforts before there is a benefit.
In just days, we're starting to post blogs on a regular basis.
Our goal is to provide good counsel that helps all those with aging parents and other loved ones better address the issues they face. We will be posting blogs on a regular basis.
As well, our newest Parenting Your Parents book will be in bookstores and available online as of September 21st. Pre-ordering can be done now.
We are looking forward to engaging you, offering sound insight into the issues we all face around eldercare in the family, and receiving your feedback.
Our newest book in the Parenting Your Parents series is just making its appearance. We believe it's more fulsome and robust in terms of content and relevance than the earlier editions.
And we’re committed to more engagement than ever with our readers. In fact, we’ll be posting helpful tips and stories on a regular basis on this site. We’ll also share other useful articles and references that we think will be of interest to you.
That’s because we can see how pressing eldercare in the family is becoming as a North American issue. The needs of aging parents and other loved ones are a reality and challenge millions across our continent are facing. Usually, though, there’s no preparation, no planning, and no safety system in place.
Over the years, we have together and separately written almost a dozen books on various aspects of the challenges and consequences of aging in the family. We each write in other publications and speak extensively on the subject.
What we want to share with you is our knowledge. And all we ask is that you start planning now for the issues that come with aging in the family: inevitable and often intense situations that can take their toll on families and friends in many unwanted ways.
By planning and preparing, you can navigate the uncharted shoals of eldercare more effectively and successfully. That’s what we’re all about and what our books are all about: anticipating, learning, setting the groundwork, helping yourselves and your aging parents and other loved ones do better. The fact is, by preparing now you can change your family’s future.
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