Stefano Morri
We were warned by numerous senior-care specialists: The move will be hard on her.
And so we prepared as thoroughly as we could. Aunty B is nearly 90 and has dementia. My husband's aunt, she'd had a long career as a professional and lived independently until moving into a retirement residence in a small city a few hours away from us. But as her condition progressed, we needed to move her closer so we could assist with her care.
We researched, consulted, hired. A small army of experts helped us orchestrate her move. There was a specialist who helped us find the most appropriate residence for Aunty B's condition. Advice from staff at her current and new residences about how to minimize stress. Medication from her family doctor to help her through the upheaval. A mover that specialized in senior relocations. Caregivers to help orient her in her new home.
Since she has little short-term memory, we repeated to her – over and over – the reasons why she would be moving: We want you to be closer because you're an important part of our family. Each time, a pleased Aunty B would reply: That's just wonderful!
At first, Aunty B was delighted with her new home, a virtual recreation of the suite she had left behind. But, just as we were congratulating ourselves on the smooth move we had organized, the "hard on her" part happened.
Despite extra care-giving and daily visits from family, she became confused and frustrated. With dementia affecting her memory, attention and patience, she couldn't remember our responses to her echoed questions: Where am I? Why am I here? Why didn't you tell me I was moving?
Time. Patience. Distraction. Redirection. Exercise. Repetition. These were the words of advice we were given. Her doctor adjusted the dosage of an anti-anxiety medication. Still, one moment Aunty B would be happy and the next moment she would be agitated, refusing to participate in activities or to eat, making repeated phone calls to family members, emptying drawers, packing. It was obvious she needed more help for her confusion and stress. We asked about an assessment with a geriatrician, but were told there would be a six-month waiting list.
Despite everyone's efforts, Aunty B was not becoming more settled. One day, less than three weeks after moving in, she strode to the door and informed staff that she was leaving. When they tried to redirect her, her agitation escalated and she grabbed a vase and threatened to throw it through a window.
By the time we got there, she was sitting in her room calmly speaking with two police officers while two paramedics waited in the hall. She had no recollection of what had just happened.
The paramedics offered to sedate and restrain her and transport her to the hospital. We opted for the less traumatic option of driving her ourselves, accompanied by police. In the emergency room, we worried and waited while nurses took blood samples and hooked her up to a heart monitor. The doctor came, asked questions, left.
Close to midnight, he returned with test results. Informing us that Aunty B had a urinary tract infection, he said he would prescribe antibiotics and release her. Now? we asked incredulously. Won't you keep her in for an assessment?
No. He told us that such infections are a common cause of delirium in seniors. A prescription for antibiotics and proper behaviour management should resolve the problem, he said.
Once she was home, Aunty B's behavioural problems continued. She tried to kick the receptionist, took a swing with her cane at one of her caregivers, then managed to push open the doors of the residence. Unable to stop her, a caregiver followed while Aunty B took off up the street. Another 911 call. Paramedics arrived, sedated her and, with her second police escort in a week, transported her to hospital.
When we arrived, Aunty B was strapped to the bed, hands and arms covered in bruises where the paramedics had administered a sedative. She was confused and angry as the drug wore off.
Just like the previous week, we waited while she had the same series of tests. Several hours later, a doctor told us they had found another infection and, since they had a potential "source" for Aunty B's meltdown, they would release her.
It was our turn for a meltdown. We insisted the situation was too dangerous to release her – we had been through the same routine the previous week and her condition had not improved. The physician said he'd see what could be done.
Several hours later, another doctor informed us that they would do a CT scan and a psychiatric assessment. Over the next six days, a geriatric specialist examined Aunty B, prescribed various antidepressant, antipsychotic and anti-anxiety medications and observed her behaviour.
They found the right balance of medications, and our familiar Aunty B was back. Settled again in her seniors' residence, she was cheerful, content and lacking any urges to run, kick, hit or bite.
It makes you wonder: With our aging population and a rising tide of seniors with dementia, wouldn't timely assessments by geriatricians be a more effective, less costly, less traumatizing form of care than police, paramedics and hospital emergency rooms?
Corinne LaBossiere lives in Toronto.