Dementia Makes Even Simple Decisions Difficult for Caregivers


I have mentioned before that Charlie has a fixation on his teeth. And rightly so; they are deteriorating at an alarmingly rapid rate. Since I met him in 1998, he has never had to have a cavity filled; he had very good teeth.

"Had" is the key word here.

After Charlie's dementia set in, he developed the habit of swishing with every beverage he puts in his mouth; coffee, tea, juice and wine. When I noticed this strange behavior, I asked him why he was swishing. His response was that he was cleaning his teeth.

The dentist began to notice that the enamel was disappearing from his teeth. He asked Charlie about it, but he was unable to come up with an explanation. When the dentist mentioned it to me, I immediately suspected the swishing. The dentist agreed that was the likely cause of the problem.

Since that visit, every time I catch Charlie swishing, I explain that he must stop the habit. He agrees, at the time, but the dementia lets that warning slip down a rat hole in his brain. The next time he picks up a beverage, it is back to the swishing.

He had a dentist appointment last week and the dentist informed me that the enamel problem had reached crisis status and some serious dental reconstruction was going to be needed if Charlie is to keep his teeth. He said he would send us a proposal for the options available for his care.

The proposal has arrived; what a shock. The ideal treatment would be to attach porcelain crowns to the teeth, at a cost of over $13,000. The second option would be to do a "core-build-up" at a cost of over $3,000. The first treatment would probably last Charlie for whatever time he has left on this earth. The second option will be functional, will not look pretty, and is not guaranteed to last long.

The dentist did not address the possibility of dentures, because he does not do them, but suggested that the cost would be in $7,000 range. When I suggested this option to Charlie he was adamantly opposed to losing his teeth in favor of dental plates. The last option is to do nothing and deal with remove each tooth, one at a time, as it disintegrates.

We have Delta Dental, but I was informed that they would pay only about $1,500 of the cost for the most expensive procedure and less on the other options.

When I think about the fact that the man had very good teeth until he began the ridiculous swishing habit, I want to scream. He is unable to make a realistic decision as to what treatment is best.It is a decision I am going to have to make for him. My preference would be dentures, but I don't feel I can force him to do something he so strongly opposes.

The man is 81 years old. Does it make any sense to put $13,000 into the teeth of a man whose life expectancy is probably two-three years? But surely, if we take the cheapest route, he will live another fifteen years and outlive his teeth.

What a dilemma. Dementia is such a cruel disease.

Marlis describes herself as a “Gramma who loves technology and has a lot to say.” She blogs about whatever catches her interest: food, books, family and more. For, she writes about the issues facing the elderly and her experiences caring for her husband, Charlie, who suffers from dementia.

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Please get your personal medical doctor to refer you two to a speech pathologist/therapist. What crosses my mind is to provide him with a sip cup or a cup with a lid and straw so that he sucks the liquid in. Harder to relocate the liquid bolus to do the swishing thing. A speech therapist will no doubt have plenty of other ideas. How about enamel building rinses, so he can 'swish' to his hearts content with stuff that builds the enamel back up. Seems like your choices are being limited....
I am facing the same kinds of issues with my 67 year old husband. He is fixated on things that are really detrimental to his health and no amount of logic or trying to convince him helps. He forgets immediately and goes back to those negative behaviors. And like you, I am torn about the decisions I have to make.

For example, how will my husband deal with sitting at the dentist's office and have teeth removed slowly? And can he sit for a denture fitting and then remember how to prepare them and put them in? If not, can he eat without teeth? Can I put him through any painful procedures that won't have any lasting effects? Not to mention the financial costs!

And that's just his teeth! There are so many other issues with food, sweets, cough drops, hearing aids, handkerchiefs, etc., etc.! It never ends. And each becomes a crisis that I have to find some way to deal with and pay for. That's why we caregivers wear out faster than our loved ones. Because this disease is equally if not more cruel to the caregiver.

Great writing, Marlis. Thanx for sharing your problems with us. My husband has a good mind, but his body has been deteriorating for a long time. He now has advanced, metastatic prostate cancer which is all up and down his spine. In addition to that, he has diabetes and lots and lots of arthritis. Just this week he has decided he ought not drive anymore, which is a great choice, but it leaves more on my plate. Now I have to chauffeur him to all the places he goes, primarily to many different doctors. It is so hard, I am now 81 with aches and pains of my own. John is 83. Who knows the future? And how to plan for it? Like you, we have several choices, but which ones to take? Should we sell our home? I know I would not be able to keep it up should he go to Heaven before me. If we do sell our home, where should we locate? It would have to be somewhere that does not require any yard maintenance. .Should we sell all his multitude of tools,
machinery, wood working supplies? We disagree on when to do that, it would be a huge emotional step for him to see his 'toys' leave here. Last year before he was
diagnosed with cancer he had a lot of his teeth extracted, preparing for dentures. Now there is a choice similar to yours - should he go ahead with dentures? And the list goes on and on, including end of life decisions. "Old age" is also a cruel disease for some.