A few months ago, I took my beloved dachshund, Retta, to the vet because I thought she was acting “weird”.The vet checked her over, took her temp, felt of her back, looked at her ears and decided that maybe she had allergies of some type. Now, I love my dogs. I mean LOVE. There are days…..ok, most every day, that I love my dogs more than any human being. So, for the vet to use words such as “I think”, or “it might be”, troubled me.
But you know, we do the same thing every day with our dementia patients. We guess and assume all of their wants and needs.Due to the progression of the disease process, most can not verbalize if they are in pain, or where the pain is located. Dementia is very deceptive, often masking symptoms causing the patient to become behavioral, which in turn, we then medicate . For instance, a patient may become extremely aggressive and agitated for no apparent reason. We may assume it is related to dementia, since behavioral unrest is associated with the progression of the disease process. So, we medicate. We alter the person’s mental status by using psychotropic medications to create a calmer, less agitated person. But how do we know that we are treating the right thing? We don’t. After a few days on the meds, we reassess, hoping to see a marked improvement. If we don’t see a change…..guess what we do? Yep, we increase the dosage….higher and higher…higher still. Soon, we create a zombie. Now, on the other side of the coin, same patient, same symptoms, same behaviors. Instead of assuming and guessing…..we start with the basics. We look head to toe, for open areas, wounds or any type of painful swelling. We then draw their blood, a full blood panel….looking to see if an infection is present…..next we send their urine out to the lab for a culture…….BAM…we get a hit….the person has a urinary tract infection. Instead of giving psychotropic medications, we give antibiotics.. The result? The patient returns back to their normal within ten days.
The problem is…..each of the tests, labs and urinalysis cost money. Money some people don’t have.Often, prisoners in our jails and prisons receive better medical care than our seniors. If a prisoner has a any type of medical issue, off they go to the infirmary, receiving the best medical care the state can provide because they are entitled. I have 96 year old grandmothers living in my facility who have served in the military, worked in factories, raised her children and aged herself by having such a hard life. YET, she may go without some things, including medical care because she has no money. Hmmmmm. It just doesn’t seem right to me. Someone told me the other day that under the new Health Care Reform, our seniors would receive much better care. My response was….ïf they could afford the $6000 dollar deductible,they would not need help paying for the 489.00 lab test”……. Sorry for the rant….I have digressed………
They key to caring for our dementia patients is observation. By observing their behaviors, their mannerisms and their attitudes, we can continue to assess for signs and symptoms of illness or distress. Observation requires having a staff who cares and understands the disease process well enough to make a difference. But I still applaud the efforts of guessing and assuming….that’s actually the only way some issues are ever resolved.
Retta? She was fine after all. It wasn’t allergies. It was her just being persnickety and moody. She didn’t need benadryl, Xanax, anti depressants or even mood elevators. She simply needed a good old fashioned belly rub. Ahhhh, who would have guessed it?