A dementia patient can be very deceiving when dealing with doctors or other care providers who are trying to evaluate their mental and physical abilities. It is the responsibility of the caregiver to be one step ahead of the patient, if the provider is to achieve an accurate analysis of the patient’s capabilities.
Charlie is a perfect example of a patient who, either knowingly or unknowingly, misleads the provider when it comes to how much he is capable of. Last week, a VA nurse was attempting to determine whether or not Charlie’s problems had worsened since he was first seen six months earlier. She began by asking him about his ability to perform activities of daily living (ADLs). In response to the question, “Can you dress yourself,” he responded, “Oh, yes!” He was offended that she would even ask such a question. But the truth is, today he came out with a T-shirt, no outer shirt, a miss-buttoned sweater and his pull-on pants on backwards. I had to speak up and tell her the truth about his capabilities in this area.
Her next question was, “Can you use the phone?” Again, Charlie responded in the affirmative. Yes, if I hand him the phone he can speak to whomever is calling. But if he tries to pick up the phone and dial a number, he gets totally confused. I don’t believe he could even successfully reach 911 in case of an emergency. Again, I had to step in and qualify his answer.
The nurse then asked him if he could take a shower without help. Charlie responded with some indignation, “Of course.” However, I have found that he gets very confused over how to turn on the water, how to proceed with washing his hair, and how to safely enter and exit the shower. So, the correct answer to that question was no, he can’t take a shower without help.
The nurse also asked Charlie if he was having any pain, to which he answered no. The truth is, he had been complaining for several days of neck pain and had been taking pain meds and using a heating pad for relief. When I asked him later why he told her no, his answer was that it only hurts if he turns his head. Fortunately, I was available to alert her to his true condition.
Those are just a few examples of the difference between how a patient perceives his/her capabilities and the truth about their limitations. If the providers aren’t given the correct information, they can wrongly determine that the patient does not need or qualify for assistance from the various agencies that are available. It is embarrassing to the patient to have their answers corrected by the caregiver, and may even trigger anger. It would be better if we, as caregivers, could warn the doctor or other provider in advance, of the patient’s limitations and lack of understanding of their capabilities. We should never let a dementia patient see a doctor or other health provider without being accompanied by someone who is familiar with his or her situation. If you are unable to accompany your loved one to an appointment, make sure that you have contacted the doctor about their current health status beforehand and/or secured another caregiver or family member to attend the appointment with them.
Charlie was upset with me for qualifying his answers, but due to his dementia, by the time the nurse left the house, he had forgotten my betrayal. Such is life with a loved one with dementia.