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Mom has end stage renal disease, clinical depression, and dementia. The dementia is progressing at a rapidly accelerated rate due to her kidney disease and surrounding issues. She sleeps a lot, falls once or twice a week, can no longer walk more than a few steps (and usually needs assistance for that), has little to no appetite, and is very weak, depressed, confused, has short-term memory issues, and is sometimes pretty zoned out. At times, she's almost catatonic, even while sitting up (like, not even hearing directions even when I repeat them many times). Sometimes I need to walk her through very basic things, like every single step of getting from the car seat to the wheelchair ("Put this hand here, now move this leg here," etc.). She has also started to have mild delusions in the hours after dialysis, but they don't last too long, and she seems to find them more entertaining than troublesome.


Just as recently as last night, she had several tests and scans to rule out stroke, brain injury, dehydration, and infection.


The nurse on the renal ward told me yesterday there's nothing they can do to help beyond her renal care, and that I need to get a referral to geriatric psych from our GP, and then get mom some meds for her dementia.


I don't know anything about what to expect from geriatric psych. I gather they will do a cognitive assessment and probably prescribe some meds, but I don't know much about the meds. I don't want her to take something that will make her worse or harm her health! Can anyone tell me what I might expect, or what kind of meds are available and what the pros and cons are? (For example, I've heard that some meds only work for a limited period of time.)


I'd especially appreciate hearing about people's personal experiences with medicating their loved ones' dementia.


Mom is palliative - meaning the doctors think she has less than 6 months to live, but can continue treatment until she is ready for hospice care. She has been on a low dose of Zoloft for 20 years for her depression, but I think it stopped helping about 5 - 10 years ago. In her alert moments, she is very interested in something that would help her with her "confusion."

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Dorianne, I don't have any suggestions but wanted to offer my support and sympathy for your mother's situation, and for you. I've been thinking of what I can do for my own father as he enters the last stages of life.

He loves red, so I made a bouquet of red roses with small ivy vines and brought it to his room for him. That produced a smile. He also likes receiving cards, so I'm going through my stash and will create a group of them, with added comments. Some years ago a family member was ill, I was in a creative mood, so I used my massive collection of rubber stamps to create some humorous additions to land and sea animal cards. I'm going to do that for my father as well.

And I'm searching for the old portable CD player so I can bring some of his favorite CDs, polkas, mariachi bands, and of course Strauss waltzes.

I hope you find something that helps your mother, but it may just be that these end of life situations are depressing and unsettling and meds won't help....just my opinion though. I'm sure others who have more experience can offer better suggestions.
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Dori, try to relax, you getting anxious won't help. My mom was on namenda for probably eight years. They say the benefits from it will only work for a few years. I didn't want her to stop it as "if it is not broke, don't fix it". My mom could not take aricept, diarrhea even worse than normal. Meds are a funny thing. Some will work for some but not for others. It is trial and error, forever. Adjustments, additions, subtraction a couple times a year.

If you think about it some take the drugs, they work or not. How do we really know it is the med that is causing any improvement or decline. If you feel anything new is helping mom, that is great! And definitely try whatever the doc thinks, if confusion gets worse, let doc know, it could be a reaction to the med.

Dori, I am so sorry you are going through this. There is nothing harder and the disease will continue to progress. How long ago was your mom diagnosed? I am wishing you the best and know you are providing mom excellent care and she is very happy you are with her, I am sure.

And one thing to remember, shoot, I forgot!

Now I remember. Many meds that are prescribed have a black box warning that the med may cause additional risk to the elderly for a variety of reasons. Many meds regardless of the carry the same warning. My mom took Seroquel, it carries black box warning, but it helped her tremendously. You need to weigh the benefit/risk for their well-being.
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Golden should we form an oldest club?
Still does not excuse not enrolling those over 75 in clinical trials. Us olderster have just as much right to benefit whatever comes on the market.
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Dori, there isn't anything that will help with mom's confusion. There are med options though to ease her anxiety. It was the anxiety that was very hard on my mom and everyone that came in contact with her. Do not think of the meds as being harmful to her. Just remember the ultimate goal is to keep her comfortable.
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Dorianne, I agree that if her suffering can be abated, it's worth the effort and/or the meds. There comes a point when comfort is the primary concern. We're reaching that point.

If I can't find the little portable CD player, I'll be looking for one as well. I'll let you know if I find anything.

I think I'll bring some more flowers to Dad's room as well. We may have a little garden in there by the time I'm through brightening the room.

As to Aricept, I recall asking one of my mother's internists about it. This was back in the late 90s or early 2000's. I'm not sure if it was before she broke her leg or afterwards. Mom was sundowning at that time and it was confusing her, and saddening us to see her in that situation. The doctor said he wouldn't consider using it b/c of the side effects.
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GA - mother's mobility is so compromised that she cannot put in her own hearing aids, so the staff do it. They lost a few in the NH she moved into in October, so they decided that only the nurses, not the aides could deal with them. The nurses put them in in the morning, take them out at night and put them on her meditray (for meds) and lock them up in the nurse's room. This only started a few weeks ago, so I don't know how well it is working. In the ALF, the staff did it too and they only lost one in 2 years. You could discuss with the staff placing them for your dad . Mother is quite deaf and feels very isolated without them.

Mother is hanging in there - heart, lungs, kidneys, liver etc. are all doing well. Thanks for asking. She is declining cognitively, very slowly, but still recognizes us. She has good colour, can manage feeding herself a bit, but they help her every meal. Her muscles have to been weakening continually due to the VaD, but I don't see anything different from last year.

I have a few artificial white orchids in mother's room. Latterly they were her choice for plants. Two walls are a soft sage green so they go well. We put some of her "Haiti" paintings, and others, which are colourful, on the walls, so her room looks very nice. Thinking of sending an arrangement of fresh flowers for Easter. She loved the lacy hydrangeas.
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Since when did over 75 become "the oldest old"? My understanding is that term applies to those over 85, and now that centenarians are becoming almost commonplace the age limit should be going up, not down.
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Oh my. I am the oldest of the old...and some days I feel like it.
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GA - Thank you.  I've been bringing in little pots of flowers from the garden centre - that brightens mom a little. Also I was going to ask my brother to hunt down an inexpensive portable CD player....he likes doing that kind of stuff, and we could take it with us to hospice house when the time comes. I know from losing my dad and stepmom that hearing is the last thing to go.

I'm going to go ahead with the geriatric psych meeting, as my mom is depressed and troubled by her confusion. So anything that might help ease her mental suffering would be beneficial. Even if it only has a placebo affect!
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(((((dori))))) these are scary times. The geri psychs have good knowledge about what works, but, as glad said, it is individual, so there may be some trial and error. With your mum it may be complicated by her renal disease. Mother was put on risperdal which helped her enormously, Now, a couple of years later, they have discontinued it with no obvious effect. She is also on an antidepressant. She has vascular dementia - different from Alz,
GA - lovely ideas too brighten up your dad's room. I have the disadvantage of being at a distance, so flowers/arrangements have to be sent which is a different from bringing pots in. Now that the hearing aid problem is solved, I hope, I want to bring an old boom box that was my youngest son's and some cd's for mother. The nurses have said they will operate it. It is large enough it should stand up to wear and tear.

Relax Dori, I think they they know what they are doing, The geri psychs we had both were excellent, sensitive, caring...
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