Case 1: Mrs Brown
Mrs Brown is an 86-year-old lady who lives with her elderly husband. According to Mrs Brown husband they have two sons together and 3 grandchildren, they both visit occasionally. She used to work as a secretary until she retired in her early 60s.She clearly had a good memory. She enjoyed travelling abroad, with her husband. For many years she had attended services at the local church where she was well known .as a kind, warm-hearted popular lady in her town for the good things she did. She was diagnosed with dementia the Alzheimer disease 12 years ago. Alzheimer's is a brain disease that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks Her husband has been her main caregiver ever since. She attends a day center once a week and has caregivers coming in twice a week to assist with personal care. The staff at the day center has also reported that Mrs Brown now showed no interest and was reluctant to comply with activities which showed that she had lost sense of pleasure.
Mr Brown stated that before the diagnosis, they were several episodes when she got lost and was picked up by police to be returned at home. Mrs Brown became disorientated about where she was because of her dementia. She became confused about time. She will also miss her doctor's appointments. Mrs Brown couldn't even remember her son's names later on recognize her husband and would lose track of conversations. Mr Brown stated that he made an appointment then to see the general practitioner (GP) who then referred them to the memory clinic where she was diagnosed with Alzheimer.
In the last year Mrs Brown mental and physical health has deteriorated rapidly. She can no longer do her activities of daily living and she needs support with personal care. Her behavior has gradually become more and more eccentric that her husband is no longer coping. Mrs Brown was recently admitted to hospital with chest and urinary tract infection, which would also increase her level of confusion and lack of orientation. Although now discharged from hospital Mrs Brown's sleep pattern was disturbed, she now wanders around at night.
She has become more physical and verbally aggressive towards her husband, Mr Brown has raised concerns' that he can no longer cope with her behaviors. Mr Brown was considering looking for permanent placement in a nursing home for his wife
Client 2: Terry
Terry age 68, was diagnosed with Alzheimer's disease in 5 years ago after undergoing a series of tests and having to spend time in a psychiatric hospital. The time he spent in the hospital before his diagnosis was very difficult for him and his family, because unlike with other illnesses, Alzheimer's takes away sufferers' ability to think rationally. Terry did not fully understand why he was in the hospital with other people who had mental disorders, and at times he was very frustrated at not being allowed to go home.
After a trying few weeks and after undergoing weeks of tests, Terry was prescribed Aricept, a drug used to help slow down the progression of Alzheimer's disease. Terry has lived back at home ever since. He is constantly cared for by his wife of over 20 years Christine 62, Terry’s eldest daughter Sharon, who also plays a large part in Terry's life.
As part of a couple, there are many day-to-day tasks that are often split between the two people. When one half of the couple is struck down by a disease such as Alzheimer's, those tasks can no longer be equally shared, and more pressure falls on the other half of the couple as well as the family as a whole. When Terry could not drive anymore, it became Christine's responsibility as the sole driver as Terry can no longer drive; just a few months ago after fastening Terry into the car and walking around to the driver's side, he had released the handbrake in confusion over his seatbelt holder.
It can be very upsetting to deal with the different aspects of the illness, as the sufferer sometimes forgets the names of those closest to them, or maybe even the fact they are married or have children. These are the times when it is vital to remember that it is the illness talking, not your loved one. Having to explain to someone where they live, who they are married to and even the names of their friends and family is perhaps one of the most heartbreaking things for a family to endure.
At times, Terry has questioned his relation to Christine and there even came a time when he dialed 911 to ask about the welfare of one of his daughters as he had not seen her for a while.
Familiarity is usually the key when dealing with Alzheimer's; if the surroundings and people are the same then they can develop some sense of routine - a word that is crucial to the day-to-day life of someone living as a identified patient or caregiver.. However, sometimes it can also be good to have a short break, as Christine and Terry found out when they went to a holiday respite center last month. They went as part of a respite plan offered by the Alzheimer's society, and spent the week being looked after by professionals. As well as giving them both a change of scenery, it offered lots of activities for them to take part in as well as day trips and was fully equipped with qualified caregivers to deal with Alzheimer's clients, taking some of the pressure off Christine.
It is often said that with Alzheimer's there are 'good days' and 'bad days' and it is true up to a point. However, the good days are not as good as they once would have been, and unfortunately once Alzhiemer's takes over, the person you once knew becomes a shadow of their former selves.
Another problem that can arise when spending time with someone suffering from Alzhiemer's is that they can very quickly become paranoid, for example if someone laughs they might think it is directed at them, causing them to become irate. This can make it hard to socialize as normal without making them feel uncomfortable, and it is important to keep their feelings in mind at all times.
While dealing with Alzheimer's is no walk in the park, it is something that must be done, and it does have light moments. For all of the difficult times and the sadness faced there are times when the person suffering from Alzheimer's will show a flash of their personality as it used to be. These are the times that Terry's family have cherished and will continue to cherish throughout his illness. Perhaps in a conversation about one of his favorite television shows or when talking about football he will let out a little quip, a quick-witted comment and remind everyone that his sense of humor remains very much intact, if a little distorted at times. Sharing a joke with a loved one is always a special moment, but in these circumstances; it is made even more precious.
Case 3: Miriam
After her husband died two years ago, Miriam a retired social worker who is now 87, moved into an independent living facility. It was a difficult transition to make late in life.
“It was really strange to me, and I couldn’t seem to make any friends here,” Miriam. said. “I really couldn’t find my way. I was having a terrible time.”
A doctor at the center told her that her problems were not unusual for someone in her situation and encouraged her to make some friends. He prescribed Xanax to help with anxiety, which she said she rarely takes, and he put her in touch with a social worker, whom Mariam saw once a week until the social worker moved (Mariam now has a new social worker she talks to). They strategized on how she could reach out. And slowly, she did.
“Sitting at the table for dinner, you talk to people,” said Miriam, who has become president of her building.
Case 4: Judith
After a debilitating depression in which she spent three months unable to get out of bed, Judith, 69, of Small Town, Fla., decided to see a doctor who prescribed medication. (She also tried group therapy but didn’t like it.) He also practiced some cognitive behavioral techniques with her — for instance, requiring her to get dressed every day for a minimum of 15 minutes.
Eventually, she began to feel better. “I learned to adjust my thinking, and I don’t get as anxious as I used to,” said Judith, who has since begun making and selling jewelry. “I found out at this age that I am artistic and creative and innovative and smart. I just woke up to the fact that I have a mind of my own. Talk about a late bloomer.”
Her doctor who still meets with Judith monthly, said, “You might not be able to gain a magical insight and wrap up their entire life in therapy, but you might be able to accomplish one or two small but meaningful goals.”
Case 5: Marvin
Marvin was 83 when he decided that the unexamined life wasn’t worth living. Until then, it had never occurred to him that there might be emotional “issues” he wanted to explore with a counselor. “I don’t think I ever needed therapy,” said Marvin a retired manufacturer of women’s undergarments who lives suburban New York.. Though he wasn’t clinically depressed, Marvin did suffer from migraines and “struggled through a lot of things in my life” — the demise of a long-term business partnership, the sudden death of his first wife 18 years ago. He worried about his children and grandchildren, and his relationship with his current wife, Carole.
“When I hit my 80s I thought, ‘The hell with this.’ I don’t know how long I’m going to live, I want to make it easier,” said Marvin, now 86. “Everybody needs help, and everybody makes mistakes. I needed to reach outside my own capabilities.”
So Marvin began seeing a counselor. They meet once a month for 45 minutes, exploring the problems that were weighing on Marvin. “My counselor is giving me a perspective that I didn’t think about,” he said. “It’s been making the transition of living at this age in relation to my family very doable and very livable.” Marvin is one of many seniors who are seeking psychological help late in life. Most never set foot near a counselor’s couch in their younger years. But now, as people are living longer, and the stigma of psychological counseling has diminished, they are recognizing that their golden years might be easier if they alleviate the problems they have been carrying around for decades. It also helps that Medicare pays for psychiatric assessments and therapy.
Therapists have been seeing more people in their 80s and older over the past few years, many who have never done therapy before. Usually, they’ve tried other resources like their church, or talked to family. They’re realizing that they’re living longer, and if you’ve got another 10 or 15 years, why be miserable if there’s something that can help you?”
Some of these older patients are clinically depressed. The National Alliance on Mental Illness reports that more than 6.5 million Americans over age 65 suffer from depression. But many are grappling with mental health issues unaddressed for decades, as well as contemporary concerns about new living arrangements, finances, chronic health problems, the loss of loved ones and their own mortality. “It’s never too late, if someone has never dealt with issues,” said a therapist in New York who works almost exclusively with older patients, many of whom are seeking help for the first time. “A combination of stresses late in life can bring up problems that weren’t resolved.”
Marvin’s counselor said: “Things can be seen differently from the perspective of old age that relieve some guilt and challenge assumptions that you’ve had for decades. Maybe it wasn’t too terrible after all; maybe I shouldn’t blame myself.’ Maybe some of your worst mistakes weren’t so egregious, and maybe there were unavoidable circumstances you couldn’t control.”
Marvin still stops by his counselor’s office for a monthly checkup. “Everybody has a certain amount of heartache in life — it’s how you handle the heartache that is the essential core of your life,” Marvin said. “I found that my attitude was important, and I had to reinforce positive things all the time.” He said he wishes he had tried therapy years ago. But he adds: “I can’t go back. I can only go forward.”
