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 How to address a LO's fears 
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Joined: Sun Aug 29, 2010 5:46 pm
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Post How to address a LO's fears
My mother, who lives in a SNF, is regressing emotionally and intellectually. In the past few months, I think she has begun to realize how much her mind is deteriorating and it is worrying her, though she won't admit it to me. She is really impossible to deal with, very defensive about anything she forgets or whenever she makes any kind of mistake.

The SNF has suggested having her see a geriatric psychiatrist for therapy, but how can therapy work on someone whose memory is almost gone? (My mother turned 87 today but could not remember how old she is or what year it is. She leaves phone messages and doesn't remember why she called, even a half hour later.) But I don't know anything else to help resolve her fears. (She is already on antidepressants and an anti-anxiety drug.)

Julianne


Sun Apr 10, 2011 10:15 pm
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Location: Minnesota
Post Re: How to address a LO's fears
Is that a practical suggestion? Is there a geriatric psychiatrist within a reasonable distance, or who comes to the SNF?

I agree that the idea of talk therapy for someone in your mother's state doesn't sound very promising. But I'd follow through on the suggestion anyway, if it is practical to do so. Such a specialist can review medications, and may be able to help you and the staff with ways to deal with her fears constructively.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Sun Apr 10, 2011 10:23 pm
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Location: SF Bay Area (Northern CA)
Post Re: How to address a LO's fears
Julianne,

Perhaps the thinking is that the geriatric psychiatrist would be able to prescribe appropriate medication??

How is it that your mother becomes aware she's forgotten things or she's made a mistake? Does she have enough insight to know this about herself?

Robin


Sun Apr 10, 2011 10:48 pm
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Post Re: How to address a LO's fears
Actually, they aren't suggesting it just to review meds but actually for therapy. If it were just for meds, I would understand, though I also told them that I am taking her to a new neurologist next week, and I am looking to him to make recommendations on meds, too.

She doesn't have enough insight anymore to recognize that she's forgotten or made a mistake. A year or more ago, she would have. Things come up because someone else mentions them. For instance, on Saturday morning, she called me and I was in the shower so she left a message. I called her back within the hour and said, "I got your message," and she asked, "What message?" She really had no recollection of calling, and sounded anxious because she didn't know. That happens all the time. I am not deliberately correcting her because there is no point, but I am still learning not to phrase things in ways that will lead to her realizing she has forgotten or made a mistake. There is no point in making her feel bad, of course.

Julianne


Mon Apr 11, 2011 9:19 am
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Post Re: How to address a LO's fears
Usually, 'therapy', in psychiatry, involves medications. Geriatric psychiatrists are often the best choice for fine tuning meds in complicated situations like Lewy.

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Apr 11, 2011 9:34 am
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Post Re: How to address a LO's fears
Yes, that's true, but they specifically mean talk therapy in addition to meds. The talk therapy is the part I don't get when the patient has such cognitive losses, particularly in memory. It's fine if they want to have a geriatric psychiatrist consult on her meds.

Julianne


Mon Apr 11, 2011 9:36 am
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Post Re: How to address a LO's fears
Julianne,

It may be that the psychiatrist can get her to talk about her fears, just to find out the specifics, and then identify if a medication can help or if there is a way to allay the fears through changing the way the SNF staff interacts with her.

When Mom first entered the SNF, she had quite a few behavior issues. After a few weeks, though, she was able to tell us what she was afraid of - everything from a masculine appearing roommate to African-American aides. Once we knew what was going on, we are able to get her on Seroquel for the hallucinations and delusions that made her afraid of her roommate and of aides who were so different from the people in the community she grew up in (where her family were the newcomers because they were Scottish instead of German). (Note: Mom has been actively welcoming African Americans into her sphere since the 60's, but her LBD comfort zone is pretty much whatever she grew up with.) The hallucinations and delusions are now at bay and Mom only gets worried about unfamiliar people. But if that unfamiliar staff person is introduced to her by a staff member she trusts, things work out - this being a change in the way the staff interacts with Mom.

I know Mom is aware (on the truly cognitive days) what is happening to her and it upsets her. I guess that just surrounding her with love and recognizing that she is still capable of many things is about all that lets her get through those days. It's almost easier on the less cognitive days. It does help, in a strange way, that Mom has been through this with her parents and that she lets me remind her of what she and my aunt experienced with their mother. I'm learning that, though Mom has trouble demonstrating how much she is aware of and how well she can reason, there are plenty of times when she is very aware and reasonable. Reminding myself of that and seeing her instead of her LBD is sometimes hard, but very important for both of us.

It can't hurt to try the psychiatrist. It may even help.

Kate

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Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Mon Apr 11, 2011 1:23 pm
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Post Re: How to address a LO's fears
I agree, Kate, that the psychiatrist might be able to identify some of her fears and see that her meds are appropriate.

What the SNF was talking about, however, was ongoing talk-type therapy, which as I understand it, not having experienced it, is that the patient and the psychiatrist talk about the patient's past, or whatever is bothering her, and eventually the patient gains insight into her issues and the psychiatrist guides the process.

That is the kind of therapy the staff is suggesting for my mother, and I don't understand how someone who is extremely forgetful and cognitively operating at about a three-year-old level is going to get any benefit.

I guess if it is covered by Medicare and her supplemental insurance and they want to try whatever with the psychiatrist, I don't object. If there is any chance of improving her quality of life, I am all for it. It's just that I don't see how it's going to improve it.

Part of the background on this is that my mother is extremely private and won't talk with anyone about anything that is bothering her. She was that way before her cognitive decline and if anything has become much worse. She gets into these hysterical crying jags and the staff can never get it out of her what is wrong. So if she won't explain her issues, that's another layer. Sigh.

Julianne


Mon Apr 11, 2011 1:40 pm
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Location: Minnesota
Post Re: How to address a LO's fears
Julianne, talk therapy might be what the staff has in mind, but that doesn't mean it is what the geriatric psychiatrist would actually do. I still think it would be worth a shot, in case the specialist would have some insights into the drug interactions, and in case he or she would have advice for you and for the staff. You could ask the opinion of the new neuro you are going to see soon.

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Jeanne, 68 cared for husband Coy, 86. RBD for 30+ years; LDB since 2003, Coy at home, in early stage, until death in 2012


Mon Apr 11, 2011 1:49 pm
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Post Re: How to address a LO's fears
Yes, I am happy to let them try the psychiatrist for whatever good it might do.

Julianne


Mon Apr 11, 2011 2:06 pm
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Post Re: How to address a LO's fears
Julianne, what you are describing sounds more like what psychologists and counselors do. I guess some psychiatrists still do that sort of thing but not the ones I've worked with. And my neighbor's husband [who has FTD] has seen a geriatric psychiatrist and all she did was get his meds sorted out. But I agree, if talk therapy is what it's about, it certainly doesn't seem appropriate for dementia.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Apr 11, 2011 2:46 pm
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Post Re: How to address a LO's fears
Yes, they are talking about actual talk therapy. I'm just going to let them do whatever they want to do as far as the psychiatrist, hoping that it will all sort itself out. I can't imagine talk therapy being beneficial to someone in her condition, but no doubt the psychiatrist will know what to do.

Thanks for the clarification, Pat!

Julianne


Mon Apr 11, 2011 3:40 pm
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Post Re: How to address a LO's fears
A geriatric Psychiatrist is the only Dr Frank sees. He never tries to talk through his problems, he'll ask questions just to get an idea of where Frank is with this disease. He controls the medications and makes suggestions, to me, as how to handle some of the situations. I email him the morning of our visit so he has an idea of how things are going.

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Mon Apr 11, 2011 4:32 pm
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Post Re: How to address a LO's fears
In our rural area, geriatric psychiatrists--well, any kind of psychiatrists--are pretty thin on the ground. I needed one for an elderly person's guardianship proceeding recently and finally went with a psychologist for an examination and report because the closest psychiatrists had no openings for months. So the whole issue may be moot. At least I have an appointment for my mother to see a new neurologist who specializes in dementias. I am looking forward to hearing what he says.

Julianne


Mon Apr 11, 2011 5:25 pm
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Joined: Sat Jan 03, 2009 2:59 pm
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Post Re: How to address a LO's fears
Julianne,
I do hope this new Neuro can be helpful and that it is a good fit for you and your mom. Suggestions for her telephone calls, when she calls and leaves a message try just calling her and just saying Hi Mom and not mention the message and see if she remembers on her own and if not, it will not cause her anxiety for not remembering.
Let us know how the new appointment goes !

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Irene Selak


Mon Apr 11, 2011 11:09 pm
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