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Suggest treatment for dementia

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Psychiatrist
Practicing since : 2000
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My 90 year old Mother with dementia has sadly been placed against our wills in a substandard facility X1 year 4 months. Prior to this she was 100% healthy. Athletic. No GI problems. No cardiovascular, musculoskeletal, nothing. Her cognitive decline was unusually slow. She walked a minimum of 10 miles/week. Average 25. Energy to burn. Slept 8-10 hours a night, raring to go. For 85 years she had a healthy diet of several snacks of nuts, fruits, vegetables, dried fruits, lean meats, occasional breads, cheeses, milk. Plenty of fluids. Began as a young child with both parents working. This diet was immediately abolished for staff convenience. No exercise. Depressed, nothing to do. Denied contact with all of her friends and with me, primary bond. Allowed to sleep up to 22 hours a day - "we do not wake our elders, we want them to be in charge of their own destiny." I am an R.N., lived with her for 10+ years, branded a troublemaker by house "Doctor" and LPN, (no RN on duty or on call) staff of people who are required no more than sixth grade education and 20 hrs. training, administration, status quo. Son who gained power without (our) knowledge when she lacked capacity has at times made sure I stay away. Constipation, vomiting ensued. Placed on Prilosec, Miralax FOREVER to produce BMs for staff convenience. Now, leaks stool ALL OF THE TIME, hides this from everyone except me, has recurrent UTI's, was alternating constipation/diarrhea, now chronic constipation. I have given all of my common sense, nursing judgment, talked to colleagues, begged for consultations, told them what my Mom confides only in me, which includes abdominal pain, I see the leaking stool, (she is lucid enough to clean herself up and use a paper pad so no one knows and no one would look) that her oral mucosa indicates she is dehydrated - LPNs would not check in this place, that she c/o being woozy, she is incredibly weak and feeble - due to everything of course, she is hungry for food I give her....I have reported these things calmly and politely but am told that I am not a Dr. and that she is "fine, there is nothing wrong with her, but there is something wrong with me for thinking there is. That I am "obsessive, and disruptive to my Mother and staff for continuing this line of thought." I had her reports from her internist sent to the "house Doctor" and the rest of her "carers" which I read first - that say clearly that she was in excellent health, even saying that she had "no gastrointestinal difficulties." "Normal daily bowel movements." "Has never required use of laxatives in her lifetime." "Robust, athletic for age.' (In addition to the rest of the stuff about her other systems being so healthy, too.) I received a curt e-mail from the administrator of the facility; "Although we understand your concern, records from Mrs. Fry's internist while she was his patient have NO merit to her medical care, treatment or concerns at this point in time! Rest assured your Mother is in excellent health. Sincerely, " (My Mother is so feeble now she cannot walk more than 3 steps without having to stop and rest for TEN MINUTES? With vomiting and bowel disease now? With dehydration? With weight loss and an 7 inch increase in abdominal girth? Straight as a board she now has marked kyphosis? Screaming out in pain? Asking where is my child I need my daughter as much as thirty times a day? Excellent health? She has written over 500 notes to this effect even having suicidal ideations: dismissed as "meaningless." "She has dementia, she is not lucid, you can not believe anything she says or writes."

My Mother has willfully and deliberately been made ill and is suffering unconscionably. She screams in pain and is drugged with sedating anti-psychotics, as it is assumed she is "crazy." She says - "Help me please." Worse, she often says, "Get my daughter, my daughter always knows how to help me." And I am bad news because I am a whistle blower. I have had allies there who tell me. So I want a gastroenterologist to state strongly, professionally, why my Mother needs to be treated as the healthy woman she was - stop laxatives which are destroying her GI health. Give her back her 85 year long healthy diet, get her out of bed and moving, give her emotional health, and MOVE HER TO A GOOD PLACE! I need to have it said the way a good doctor would say it to get a consultation and stop the abuse.

I realize this is a multi faceted question. It involves elder mistreatment, neglect, the "warehousing" of elderly dementia clients for profit. I am branded crazy, a troublemaker because I pointed out dangerous errors - and pockets of unconscionable neglect, and I won't stop. I love my Mother. The powers that be - including my brother want to maintain the status quo, to hasten her deterioration, and get me out of the picture.
So I seek from you, professional, non biased, well written statements that indicate WHY it is imperative my Mom MUST have a consultation NOW, based on what I have told you, with an expert. I purchased an unlimited month to month membership, so please consult with anyone else you think would be helpful, like a geriatric/dementia forensic psychiatrist. She has been appointed a personal needs guardian by Title 81 NYS who have REFUSED to have her seen by any other physician than this "house Dr." Refused known standard dementia care protocol, never seen a geriatric psychiatrist, despite marked deterioration psychologically and physically, and polypharmacy, NOTHING. Excellent health, my ass. She has suicidal ideations! She can't walk? Past medical history irrelevant? New onset kyphosis??? What the hay? Thanks. And she has a history of squamous cell skin cancer, and a familial history of malignant melanoma, but for 14 months, no one put sunscreen on her. I was told it is impossible to get sun in winter, you are crazy. In XXXXXXX NY I told them sun reflects off snow you can get 2.5 times as much dangerous UV rays....The "house doctor" REFUSED TO ORDER SUNSCREEN! "I am not a dermatologist, I do not feel comfortable ordering sunscreen!!! (over the counter for infants for this blue eyed fair skinned blond with significant history)! FIVE MONTHS LATER she gets sunscreen! We were sneaking it on. I got caught and it was wrestled out of my hand. INSANITY. I am attaching a report for a dementia elder psychiatrist if you can next pass this on. Her abusive guardians agreed to have us evaluated by an expert. Mom's money is spent ONLY on keeping us apart - on her deterioration and abuse, neglect. THEY DISMISSED EVERYTHING SHE SAID. My Mother begs me to help her when I see her my allotted few hours - chaperoned - three days a week. She is dying, as per Dr. Klein because of this willful abuse, separation from her only known source of love and comfort and security in the world. Willful medical neglect, disuse, cruelty. She is being made ill. It is willful as her guardians, physician are "elder and dementia care experts, "legally responsible to maintain her health, safety and overall well being...." When I asked why our visits are restricted and chaperoned I was told recently by her court appointed guardian, "I have no validation for that," "I do not know why," "I have no reason," but it continues. I will check my e-mail in a couple of days, as I went way off just gastroenterology, but that's a good place to start...I am being abused too. My Mom is lucid. She said, "This is human evil, why do they hate us?"
Posted Tue, 26 Aug 2014 in Mental Health
 
 
Answered by Dr. Ashok Kumar 1 hour later
Brief Answer:
You need to talk to authority or to the court

Detailed Answer:
Hello,
I read your query word by word and understand your concern.

Before I give my comments I acknowledge that I have only one side of story and there is no direct information from patient. I know there are lot of concerns but we should accept the reality and try to make a change toward better side in life of your mother.

For a patient of dementia it is quite common to have rapid cognitive decline if they are shifted from their usual surroundings to unfamiliar place like nursing home. That explains the rapid decline in your mother after shifting her to new facility. I usually advice my clients to keep there elderly in home till their behavior is not too disruptive or you are unable to care.

As you said she passes stool and wipes. That is common type of behavior in demented patient. The reason is they are not able to accept the reality of dementia and try to cover up the lapses in memory.

Passage of stool indicates either she had advanced dementia or chronic constipation. In my view she should be provided stool softener and there should be someone to take her to toilet periodically. This is the way we can keep her dry and clean.

Presence of depression and having suicidal ideation is either due to feeling low because of their poor condition or way to get away from all these problems.I think you need to talk to her and try to instill hope and help her to find the meaning of life. If you find a geriatric psychologist that could be of much help.

For the behavior problems low doses of antipsychotics can be given but they should be stopped as soon as possible.

Rather than being a whistle blower or trouble maker for the nursing home, try to take part in care of your mother. I assure you once they get helping hand from you they will share all the details about your mother and you will know what they are doing exactly. Blaming from outside is easy but taking part in care of your mother will make you calm and compose and her help seeking behavior will come down drastically.
Other than this talk to your brother. If you think he have some ill motivation taking the court order or taking help from other family members is a option.

'Hope I have answered your query. If you have any further questions I will be happy to help".
Thanks

Above answer was peer-reviewed by
 
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