Hi All, the doctor just recommended taking BF's Mom to a Geriatric Psyc. facility to have her evaluated. There have been some major changes going on with her, extreme crying (for hours on end), more paranoid episodes than usual and sundowing early in the afternoon, just to name a few. Oh the the wonderful spit bubbles can't forget them. I trust her doctor and knows he is doing what he can to help us learn and deal with this awful disease. I guess my concern is:

I don't know what to expect. What kinds of things will they do? How do I explain to her what is going on? Will I be allowed to be there when she is being evaluated, and just what the heck does it mean to evaluate her? We know that she has been DX with ALZ and she is somewhere in stage 6.

I know that her doctor wants to make sure that she is taking the right medications and that the medications she is taking are working for her, but is that the only thing they will be checking?

I want the best for her and she doesn't have a clue that she will be going, right now. Do i tell her?

I have seen on here where others have had their LO's seen at a geriatric Psyc facility. I thought if someone could sort of explain to me what to expect, then the major fear of the unknown will be a little easier to handle.

D

Hey, Denise, I'm not sure exactly what is done. The geriatric pshyc hold has been mentioned here several times in "getting to the bottom" of medication changes. Go to the find tab and try looking it up.

My MIL became unable to speak and respond and stand alone in Nov. Her neuro pulled her off her rx's and she regained most of what she lost mentally, but not all...or it is just the progression. She's been off them about a month now, and we don't plan to go back on them...except the Fosamax for bones, I think.

Denise--A Geriatric Psyc. facility sounds like it would be a whole lot less threatening than a geneal psych. facility where your boy friend's mother would be part of group of people that consisted of many ages. Many of the people in a geriatric facility probably share the same problems and the facility hopefully will be staffed with people familiar with dealing with those types of problems.

I don't have any idea of what procedures are or how to explain the situation. Maybe the neurologist or the facility could best answer those question. If you do end up contacting them, please post their responses.

Thanks Christie,
BF's Mom has been on some form of antidepressant for most of her adult life. About 1 1/2 years ago they changed her to Cymbalta and it seemed to be working Great. But over the past few weeks you can't even tell she has take any and she is on a pretty high dose of it. Her doctor is just a g. p. but he is really a wonderful doctor. If he doesn't know how to handle parts of AD then he is great about trying to connect us with the resources that we need to find out or to get help. His Mom had ALZ but passed before she needed extensive help.

He isn't really to sure about what to expect from geriatric pshyc. either. But I do know that he will do what he can to find the best one located near us. He wants to make sure that we have her on the right medications as well and if there is something that we don't need to have her on (aricept and Namenda being a couple of them, she's been on them a couple of years now) then we need to see how we can get her off of them.

Part of what I don't understand is how the whole process works. How can they determine that her medications are right by one visit? Or is this something I am going to have to struggle getting her in and out of the car 3 or 4 times for weeks on end.. oh brother.. See so many questions!!! It's mind boggling some times..

Some days I even wonder whose worse off BF and myself or her..

It will be a good thing for her and for all of you. They will observe her and properly adjust her meds so she is more balanced. They specialize in the elderly so that is a plus.

quote:

I don't have any idea of what procedures are or how to explain the situation. Maybe the neurologist or the facility could best answer those question. If you do end up contacting them, please post their responses

I sure will.

I know that the Doctor's office is going to contact them and set up the appointment. Once I know who to call and time frames I will call them and unload on them a barge of questions, before I take her in.

She has seen a general psyciatrist for years, well until 3 months ago. He was no longer doing her any good except for supplying her prescriptions for antidepressants and namenda / aricept. It was getting so hard and frustrating just to get her to see him every month, that he confered with her regular Dr. about medications and we all agreed that she could stop seeing him, although I have to admit I miss getting a chance to talk to him about things.. I know it was doing me more good than it was her.. Oh well.

Hopefully i will know a little more in a few days about what is ahead of me. I did request that if she was going to have to stay for a couple of days that we make it after the holidays, even though she doesn't have a clue what time of the year it is.. guess it's more for us than for her. I just hate the idea of her not being here at home for Christmas.

quote:

Originally posted by Twice Blessed:
It will be a good thing for her and for all of you. They will observe her and properly adjust her meds so she is more balanced. They specialize in the elderly so that is a plus.

Thanks TB.
I guess I am afraid that we wont be able to keep her here with us at home. I don't want her to be scared, I am the only one she is used to having care for her, i go into EVERY doctor's apointment with her so i can ask questions and understand. I even went in with her when they were doing the scale test on her for AD.

It was very hard for me to sit and watch her get frustrated when they would ask her a simple question and not be able to answer it.. she would look at me with those big eyes and want me to help her, of course I couldn't because they had to find out where she was at in this awful disease.

One of the reasons I felt like I needed to be there when they were doing it was so she wouldn't be scared.

What if they wont let me be with her during this evaulation. She is going to be terrified.

How do i explain to her were aren't leaving her and make her understand.?

quote:

Originally posted by Denise E: What kinds of things will they do? How do I explain to her what is going on? Will I be allowed to be there when she is being evaluated, and just what the heck does it mean to evaluate her? We know that she has been DX with ALZ and she is somewhere in stage 6.

I know that her doctor wants to make sure that she is taking the right medications and that the medications she is taking are working for her, but is that the only thing they will be checking?

I have seen on here where others have had their LO's seen at a geriatric Psyc facility. I thought if someone could sort of explain to me what to expect, then the major fear of the unknown will be a little easier to handle.
D

What do you know? Someone else is asking questions that I posed a little while back.
I really do hope you get some answers, Denise. All I got was flack. I have no idea what goes on during this eval., either.
Maebee

I would be very careful on what is given by any doctor. My mom has been given some meds that cause more problems than solving the ones she had. Do your homework on verything that goes in her mouth. My mom only takes something to sleep at night and her insulin. It has been 9 years that I have her and the first 2-3 we were on everything and I honestly dont know how I got here today. ALOT OF PRAYING

Perhaps I can lend a little light on this subject. Last summer, my mother was admitted to a GeroPsych Unit.

I stayed with her up until admission to her room, and settled her in. GeroPsych is not like an acute hospital. One does not go in and stay the entire day on a visit.

Initial physical and psychological assessment was done in a very kind and non-threatening manner. Mom was interviewed by nursing, a psychiatric social worker and by a psychiatrist as well as a neurologist.

Verbal assessment was done by questions, letting her talk, memory tests, and later; after several days a whole battery of tests were given by a psychologist.

Mom was also worked up for thyroid, cardiac and other conditions. She was given a SPECT Scan of the brain.

She was observed on each shift for her mood, affect, ability to socialize, speak, reason, etc. The social worker worked with her daily. The psychiatrist saw her daily.

Now . . . my mother has frontotemporal dementia so her reality base is much higher functioning. While the unit was clean, orderly, staffed well with educated staff, it still can be a bit unsettling as many patients were quite a bit more compromised than Mom.

Getting your Mom into a room with people who function at her level would be a positive. Sometimes at night, there is noise; but there also is the same at any SNF.

There were daily therapy sessions, group, etc.
Mom could have benefitted greatly, but she refused to cooperate or attend groups or socialization, crafts, etc.

Medication is discussed with family. One of the reasons to have the patient on a unit is the absolute ability to assess changes in behavior and ability to function on any new meds which may be started.

While one can visit each day, they really need the patient to have some time without the relative so they can conduct therapy, etc.

Also . . . often, the outcome of various mental tests can be shaded with someone else present. Performance is not the same.

Some physicians do not mind a family member being present, others prefer not to. One never knows what the relationship has been. I know that my Mom gets performance anxiety if a family member is present.

Unfortunately, my mother's psychiatrist was dreadfully sub-optimal. She did not get the benefit she could have gotten by being there because he was off the wall. I asked for and got authorization for second opinion but Mom refused, and they must comply.

I kept close contact with the social worker who is very close to the patients, and communicated with the psychiatrist; but the social worker was key to much information.

I wish you the best.

Thank You So very much Johanna. At least I have a little to go by.

I feel better about the whole thing. BF got home from a business trip last night and we sat down and talked about everything.

Like me he fears that unknown factor of it. I will tell him tonight what you have said. As long as I can communicate with them and know what is going on. We can handle it. I am pretty smart and since I am her main caregiver, I know how she reacts to certian things, so I am going to be asking major questions about medications and the changes that she is going through with the medication changes. There have been a few times that it's been lucky I do ask questions about medications, we have had doctors that wanted to put her on blood pressure medication (her BP usually runs low) oh and one doctor even stopped her antidepressant for 4 days cold turkey and then couldn't understand why she was wanting to commit suicide.. I almost commited murder over that one!!!!!!! The one with the BP medication I just told him NO it wasn't going to happen unless her regular doctor that was familuar with her past history did it.

I know when she was doing some of the kills tests at the neurologist, she kept looking at me before she answered, I don't know if she was waiting for me to answer the question for her or waiting to see how I was reacting to the question.

It was really hard to see her get upset when she struggled with an answer (even thought the nurse kept telling her tht there wasno right or wrong answers), I spend all my time trying to make sure she isn't upset or frustrated and there I was having to watch her become frustrated.

I don't think I could handle going through that again. He mental status has declined a lot since then, so frustration is easier now. Yet I don't want her to feel like we think she is crazy (one of her paranoias) and are just leaving her there either.

They might have a problem getting her to do any social activities as well. Even back before she came to live with us she was in an ALF and we had to just force her to do some of thier activities (simply to get her out of the room). I would go over there and go to the teas or ice cream socials just to get her to go. I even did a few games of bingo on my lunch hour some days. But if I wasn't there she wasn't doing any of it.

I know that I want to make sure we are doing the right thing as far as her medication goes. If she doesn't actually need it then we don't want to keep giving it to her.

We are pretty lucky because she doesn't have any real health issues other than hyperthyroid and even then it isn't off by much and easily controled.

She has taken anti-depressants for a number of years (even when BF was a teenager and he's 48 now). The doctor she was going to see in that small town she lived in before we got her down here had her on all kinds of medication that she didn't need. She was even taking 3mg of Xanax everyday (more if she forgot that she had already taken it for the day). Can you say ZOMBIE! he had her on plavix and had her on heart medication, because she had an enlarged heart. (What ever). He let her stay on the same anti-depressant for 12 years (knowing it wasn't working.. just added the Xanax to fix it).

Boy was she a mess. it took me over 2 years to get her off of the Xanax. Now she gets .25mg only when she is really upset. Since she has started crying so much lately, I haven't been giving her that because it doesn't stop the crying and she can't do anything even eat for herself if I give it to her. She can take a few steps as long as I hold on to her. I get her out of the wheelchair and walk her to her comfy chair or her bed (depending on when it is during hte day) and back to her wheelchair to take her in other rooms, for meals or bathroom, but when I give her the Xanax she can't even take a few steps. She is bigger than me and strong, so it's hard to get her moved if she can't help a little. So I am truly hoping that is one of them that they remove from her all together.

Thank you for sharing, Johanna!

You know, I forgot to mention; ask around and find out who the "best" psychiatrist is who admits to your unit. If you have a Neurologist, they know what's what and can assist with the name of a good person.

Remember; when your loved one is admitted to GeroPsych, she doesn't have to stay there. If at any time you feel she is getting short shrift, you can have her discharged to home. She can also be followed as an outpatient - however; having her in a controlled environment which is on a routine schedule is often the best setting for assessing needs, performance and any new meds.

It was really best for Mom to have her battery of psychological tests without me present. The psychologist administering the tests was very kind and patient and she just adored him and wanted to know when he could come back! There is indeed a "shading" or effect when testing is done with others present. Often, the performance anxiety is present as they do not want us to think they cannot perform, so it blocks their actual responses.

However - though I was not the one who initiated her admission to GeroPsych, (I agreed with it tho'), she continues to be extremely hateful toward me who she continues to believe, "Locked me up, tried to get people to say I was crazy, you want me to be locked away and you're waiting for me to die." Sigh!

quote:

However - though I was not the one who initiated her admission to GeroPsych, (I agreed with it tho'), she continues to be extremely hateful toward me who she continues to believe, "Locked me up, tried to get people to say I was crazy, you want me to be locked away and you're waiting for me to die." Sigh!

I can already see that one coming for us, so we are preparing for it now, in our own mind set. But sure it's not going to make it any easier.

Of course I am getting ready to hear that "real" DIL would never have locked her away, blah blah blah.. I will just agree and say no your right "real" DIL wouldn't have done this, then when I leave the room or walk away I will finish my sentence, because "real" DIL doesn't want the responsibility of caring.. or understanding. (hmmm was that me being catty??? Oh well Meowwwww

Denise - I can totally relate to your fears on this issue. I had the same ones. I was really afraid that the experience and not having someone around her that she is familiar with would definitely create a downslide in her mental status. She therefore never went and we have been successful in adjusting her meds at home.

I'm sure there are great places and this out of home evaluation is beneficial for many. Like Joanne said, she knew her mom would do better with her not there. For my mom, not the case. Maybe because your BF's mom had been in an ALF before it won't be as traumatic as I feared it would be for my mom.

I think we just need to do the best we can and that's the best we can do. Praying about things for guidance has always helped me too.

Thanks, We really aren't sure how we are going to handle it yet. We still want to find out as much as possible before deciding.

I just spend all my time trying to make sure that we keep her from getting any more frustrated or scared than she already is..

I have really tried to build a level of trust with her so that she knows (even if she can't say it sometimes) that she can trust we are making the right decisions for her well being.

I don't want this to come back and bite me in my butt and tear down all that we have worked for over the past 3 years. By the same token:

We have dealt with medication changes with her here at home and it has been awful.. the worst was trying to get her off of the Xanax that she was addicted to. For the life of me I still can't understand how a physician can give 70+ elderly person (that is already unstable) 3mg of Xanax (knowing it makes her like a Zombie) and think it's o.k.

She was in ALF for 6 months and she didn't do well at it. That was one of the reasons we decided to move all of us in together. She got her DX with ALZ while she was in there and we decided it would be better for her to get her in the home with us, so that she would realize that she had a family to rely on and we would take care of her.

We do a lot of Praying for guidance, patience and strength. We wouldn't have made it this far if it wasn't for our prayer's and prayer's from others.

Thank you for your input. It helps to know other's experiences or thoughts.

if it is what we tried to get mom to go to by the time she was there she was over the hill basket case (and I'm very very respectful this illness and refuse to lower it so some jokey name) My older siste (yep speaking at the time--that was before the brother and sil became bff with her)mom would not leave the car flipped out completly---we left her there kind of to figure out what these pople whould say and possibly to answer questions---well she really didn't know hwere she was and then decided she would walk home but could not fiugure out how to unlock the car door
they somehow found us and the psych guy said she is have a pshychicalogical breakdown you need to get to her (didn't even offer to follow us down with a potential shot!) well it was the uglist sight to behold people were arond mom security reports were file and whenI went ot comfort mom----she HIT me accros the face fractured a tooth and no one said a thing......she was in the front seat and to add to that moved to back and screamed and cried all the way home which was over an hour and half thought for sure she would have heart attact. Thinking back we should have has her addmitted somewhere....called sister out of town but in town for the week after we dropped mom off and asked if she would call mom just in case ----- well she couldn't becuase she was EATING LUNCH AND COUL NOT BE DISTURBED!!!!
later about 5 called brother (speaking at the time) he called and mom was fine ---I think she was scared we were taking her to the crazy house she has envisioned in her mind and it grows worse each day--- out of state sister---her rathionale ---what good could she do???? WELL for one get in your call and it might take a while but check on your mother see if she is alive.....she certainly didn't want us around if that coat hit me one more time....I personally plan on burning it one day....hate that coat! just a talke I was exhaused just one of the many pleasant memories of this wonderful disease

Denise,

I have been pondering your problem. You are in a tough spot. If you decide to continue with the eval., you will be risking everything you have done for the last three years. Is it worth it or is there another way to do this?

She she was seeing a psych, would it be possible for you to consult him for:

his views on the benifits/risks to her

he would be more able to tell you how the eval would be done

he would know the facilities available in your area and would be able to give you a better recomendation of which one would be better for her.

he might be able to do the testing himself or oversee the eval.

he would be able to work with you to introduce new meds and monitor them from home so she would not need to be hospitalized for a long period of time. You are more familiar with her and would be able to pick up changes than strangers.

A long time ago someone advised me to ask a question that has helped me many times. They told me when I am talking to a doctor or specialist to ask them if they would do the recommended treatment if it was their LO. The other thing I ask myself is if it were me, would I agree to the recommended test or treatment on myself.

I dont know you and have not been around long enough to tell for sure but I think your heart is telling you your answer. The fact that you are questioning all of this should give you your direction.

I personally would not do an in-psych eval. unless every other option had been tried and failed.

Good Luck and please keep us posted.

Vicki B, C.G.

Denise--Vickie's quote holds true for me "They told me when I am talking to a doctor or specialist to ask them if they would do the recommended treatment if it was their LO." During the time since I saw the suggestion on this site and been asking the question, I've been amazed at the number of doctors who have suddently changed their tune and decided that a test or procedure was not really required.

It would be wonderful if you could find a psyciatrist willing to work with your boy friend's mother in a home environment. If not an evaluation at a geriatric psyche facility is a better bet than a general psyche ward. Vicki's list of questions to her general psyciatrist sounds like a winner. I would tack on the magical question....and....if I received a yes answer about the need for a psyche evaluation, I would ask where and by whom.

Hi All, Thanks for all the input.. We have an appointment set up for after the first of the year to do a consultation with the new psych. (she specializes in geriatrics). So I guess after I get a feel for how she is going to respond to my questions, we will decide at that time what we should do.

Vicki I have asked tht very question (if it were your LO what would you do) from her regular doctor. His Mom had AD so I know that when he gives us advice or assistance it is from the heart, because he knows what we are faced with).

You can bet that I will be armed with some of the same questions for this new psych.

Thanks again to everyone that gave their input or advice. My biggest fear is the unknown, so I feel a little more at ease with the upcoming appointment due to all my helpful friends across the world (here on this forum).

I hope it goes well and gives you some improvement, Denise.

Denise: Just popped in on this site again. I want to wish you the very best.

I hope that your psych visit is able to help get things going in the right direction.

Let us know how it all turns out. I guess when you do, a new message should be started, as I had to look all over for this one as it is older.

Thinking of you, Johanna.

quote:

Originally posted by Johanna C:
Denise: Just popped in on this site again. I want to wish you the very best.

I hope that your psych visit is able to help get things going in the right direction.

Let us know how it all turns out. I guess when you do, a new message should be started, as I had to look all over for this one as it is older.

Thinking of you, Johanna.

Johanna, still counting the days until initial appointment with Geri Psych.

We feel a little better about starting down this new path with BF's Mom though..
I called the psych that she (BF's Mom) used to go to and ask some questions about this new Dr.

We have found out that she is one of the top Geri. Psych in this area and goes to great lengths to help not only the person struggling with dementia (all forms) but also the families and or caregivers of that person.

I called her office last week and asked some general questions about concerns.. (mostly dealing with how she would do a medication evaluation) and was told that in some cases it works out better to put the patient in a controled enviroment to monitor changes. If that is required (and only if the family or caregiver thinks it is the best situation for the patient) it will be for only as long as absolutely needed.

She (the Geri Psyc.) called me back and told me that she would discuss with us during the initial visit, how BF's Mom does when away from home and what kind of changes take place with any kind of change. If we all feel it will be better to do the evaluation and try to keep her (BF's Mom) at home.. she will guide me and tell me exactly what to keep track of and what signs to look for..

It did ease our minds a little, just knowing that she would take the time to call me and discuss our fears before we have ever stepped foot in the door of her office.

Thanks for thinking about us and all that we go through.. keep us in your prayers, while we are getting through this next step.. I will definately keep you updated on how it is going.. and will probably be asking for help from my wonderful support group that I have in this forum..

Thanks again God Bless all of you!!!!

Denise: How great this is already going! Thanks for writing back, and we will be waiting to hear how this comes out for you and your famiy.

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