Imagine having Alzheimer’s disease or another form of dementia. You’re becoming increasingly confused and disoriented, and the world no longer makes much sense. Your daughter takes you to an ophthalmologist for a complete eye exam, because you seem to be having issues with your eyesight and your glasses aren’t helping much anymore.
Your daughter helps you into a chair at the office and the doctor covers one of your eyes and asks you to read off the letters you see. You’re unable to fully comprehend the task at hand and begin to panic. What letters are they talking about? Why are they trying to cover your face? You start to squirm and then push the doctor away. Anxiety builds because you don’t understand what they want with you.
This hypothetical scenario may seem exaggerated, but for dementia patients, routine medical assessments can be difficult and even downright upsetting. Eye exams, dental appointments and hearing tests are often the most disorienting and difficult for seniors living with cognitive impairment. Age-related changes in vision and hearing can be challenging enough, but when these deficits are combined with dementia, they add an extra layer of confusion and frustration for seniors and can even exacerbate dementia-related behaviors.
Unfortunately, as dementia progresses, patients become less capable of articulating changes in their health, such as blurry vision, tooth pain and hearing loss. The disease also makes it difficult to focus, follow directions and tolerate discomfort—three things that are often involved in eye exams, dentist appointments and audiology tests. Dementia caregivers face many obstacles when it comes to ensuring their loved ones receive proper vision, hearing and dental care. In the mild and sometimes moderate stages, there are some tips and tricks you can use to make these appointments go more smoothly, but eventually it may not be sensible to put your loved one through routine check-ups.
Eye Exams for Dementia Patients
After my father developed dementia, I only took him to the eye doctor once. He still enjoyed trying to read, but his thick glasses were far too heavy. The frames made his nose and ears sore and easily slipped off his thinning face. It just so happened that this fateful appointment was on one of his worst days and his broken brain convinced him that the optometrist was trying to kill him. That was our last attempt at obtaining a new eyeglass prescription for Dad.
Complete eye exams are important for detecting and monitoring age-related eye diseases and ensuring seniors have the correct eyeglasses and/or contact lens prescription. Visual impairment and blindness can make life even more complicated, confusing and dangerous for seniors with dementia, so it is best to maintain annual or biannual eye exams for as long as possible. However, at a certain point having a current eyeglasses prescription isn’t necessarily beneficial if a dementia patient forgets to wear their glasses or constantly misplaces them.
Each senior living with cognitive impairment experiences different symptoms that progress at a unique pace, so determining when to stop routine eye exams should be done on a case by case basis. Communication between dementia caregivers and eye care professionals is vital. I worked closely with my dad’s eye doctor to brainstorm possible strategies for future eye exams and solutions for Dad’s problematic glasses, but dementia ultimately stumped both of us.
Although it broke my heart that I couldn’t resolve these issues, I had to accept that I had tried my best. Many dementia caregivers will eventually encounter this dilemma as well. Unless there is an eye care emergency, such as a foreign body in a loved one’s eye or a sudden loss of vision, routine eye exams tend to fall by the wayside at a certain point in the progression of their cognitive decline.
Dental Care for Dementia Patients
Dentist appointments are notoriously stressful for dementia patients and caregivers alike. Trying to care for my dad’s teeth was another huge issue. He had worn dentures for many decades but had experienced significant bone loss that caused them to fit poorly. I resorted to “gluing” his false teeth into his mouth with gobs of denture adhesive. That is, until he somehow managed to lose his lower denture. (Residents losing dentures is a very common occurrence in long-term care facilities.)
We went to the dentist and fortunately Dad was in better spirits than the day of his eventful eye exam. However, the dentist was frank in telling me that there wasn’t enough jawbone left to fit a new set of dentures. We were stuck with buying another copy of the old dentures, and I continued the icky process of gluing in poor Dad’s teeth. Still, we had no choice. This was the best I could do.
My mother-in-law had a different dental issue. She had her own teeth and they served her fairly well until she caught a severe case of pneumonia. I don’t know for sure if the medication was what caused her rapid tooth decay or if it was general age-related decline, but her teeth literally rotted off at the roots.
She couldn’t withstand surgery to have them removed, and, even if operating was an option, her advanced dementia would have prevented her from understanding how and why to use dentures. So, we did what we could. Moving forward, her routine dental care consisted of minimizing tooth pain and keeping her mouth as clean and as comfortable as possible.
Many people without dementia experience anxiety about going to the dentist, if not outright dread. According to the Alzheimer’s Association, caregivers should prioritize dentist appointments and preventative dental care throughout the early stages of the disease to prevent more serious problems from arising. Establishing a daily oral hygiene routine early on may help your loved one retain their habits longer, even as they require more help over time.
As a loved one’s dementia progresses, regular check-ups may no longer be feasible. It becomes even more important for caregivers to assist with daily oral care and keep an eye out for changes in eating habits, oral sores, and signs that their loved ones are experiencing tooth or gum pain. Some dentists do have experience treating dementia patients if a serious dental issue arises. Try contacting your local Alzheimer’s Association chapter to see if they can provide a referral. Local nursing homes, memory care facilities and your state’s dental society can also be valuable sources of information on dentists for dementia patients.
Hearing Tests for Dementia Patients
Hearing tests and eye tests are similarly challenging in a way. How is a person who doesn’t understand directions supposed to figure out how to respond to meticulous hearing tests? I know there are some vision and hearing tests used for infants, but this is not an option that has ever been suggested to me by any of my loved ones’ doctors.
Furthermore, purchasing hearing aids for a dementia patient can be an expensive exercise in futility. Even if a loved one with dementia manages to complete the required hearing tests, it may be impossible to properly fit their hearing aids. There is also no guarantee that a senior will wear their hearing aids once they receive them. Countless caregivers have been distraught to find that one or both of a senior’s pricy hearing aids have gone missing. (Much like dentures and eyeglasses, hearing aids have a way of disappearing both at home and in long-term care facilities.)
Knowing When to Forgo Routine Check-Ups
In the end, dementia caregivers and healthcare professionals can only do their best. For my dad, that meant lighter eyeglass frames and plastic lenses in an attempt to provide a more comfortable fit. The struggle to get a more accurate prescription was one we had to give up. As his primary caregiver, I had hopes of something better for him, but it simply wasn’t meant to be.
This was a recurring obstacle as I cared for several elders with cognitive issues over the years. Yet, I took my loved ones to the best doctors I could find and at least attempted to get them check-ups. I consulted with the experts about what options were available and then went with the best we could do in each situation. Care decisions become increasingly complex and disheartening when Alzheimer’s disease and other types of dementia are present, but I did have the satisfaction of knowing I tried my best.
Often, as a caregiver, that is all we can do. We can’t fix what is wrong, so we strive to make it better. When we hit that brick wall of reality, we must accept what is possible, do it and move on. These exams are hard on the elder and hard on us. Working with specialists who are knowledgeable about dementia can help us feel more confident that we’re getting sound medical advice and making the right decisions for our loved ones. The truth is that we have many other things to concentrate on as we work to give our elders the best care possible. Letting go of the things we can’t change is essential. Only then can we give our full focus to the things we do have some control over.