Caring for a loved one experiencing a cognitive decline is emotionally draining, and the caregiver can experience a wide range of stressors. Keeping your person safe can be a daunting challenge. Ensure medications are being taken properly and monitor potential side effects.
Why is safety a problem?
Changes in the brain include poor judgment and impulsivity, making dementia patients more prone to injuries that could lead to death. Poor insight into the person’s ability to perform previously routine tasks is especially dangerous when there is access to a car.
Misjudging one’s physical abilities can lead to other, potentially life-threatening injuries. Sometimes the person will forget to use a cane or a walker. Balance problems can cause the person to fall and break a bone slipping in the tub, climbing on a step stool to reach something high on a shelf, or navigating stairs. A fall with a head bump requires a trip to the doctor or emergency room.
Loss of mobility due to a fracture, a head injury, or fear of falling again can result in a host of other problems leading to mortality. Very often, becoming sedentary leads to pneumonia, which can be tough to beat. Falls can be linked to many different circumstances and warrant further investigation.
How can the caregiver learn of a recent fall?
The person who has memory loss may have had a fall, but either forgot about it or is embarrassed and doesn’t want to tell.
- Observe a change in the person’s mentation
- Distinct injuries such as skin tears or bruises
- Unusual pain complaints, crying, grimacing, engaging in less activity, having trouble sleeping
- New deformity of a limb.
A kitchen is a dangerous place for someone who is confused or weak. Burns from hot food, boiling water, or appliances can occur. Forgetting something’s cooking or leaving appliances on, such as a coffee maker or stove, can lead to a fire. Ascertain smoke detectors are in working order and aware that the person may no longer be capable of self-preservation.
Medication Management - Best Practices
There are medications available to hinder the progression of the symptoms of dementia, but there is no known cure. All medicines have side effects, and some may be persistent and intolerable and may require discontinuing. Some side-effects are transient and tolerable while the body adjusts. It is important to report side effects and never stop or start taking a medication without first consulting the prescriber.
The elderly person with dementia will eventually need to have his medication administration monitored. Forgetfulness contributes to non-adherence to the medication regimen. However, psychiatric symptoms can do the same. Paranoia is not uncommon, and the person may be suspicious and refuse to take medications out of fear that someone is trying to cause them harm. As an aside, this also happens with food and fluids. Frequent medication reviews should take place, and the prescriber should discontinue any unnecessary meds.
As a recommended best practice, continuing on medications for other chronic diseases is essential. Insulin-dependent diabetics may need assistance with injections. Inhalers present some difficulty because they require coordination between squeezing the unit and inhaling. Powder-based inhalers are less tricky to coordinate, but they may not be inhaled deeply enough to benefit from the medication. A nebulizer could work if the person can cooperate with keeping a mask on. Notify the prescriber if there is difficulty administering respiratory treatments because more significant problems can develop.
Patients with dementia will eventually lose the ability to swallow pills. Consult with a pharmacist for advice on safe medication administration.
Some medications can create safety problems, and the benefit must be honestly weighed against the risk. There is a range of drug classes used to help the patient manage behavioral issues.
Some medications can lead to dry mouth, which can make eating more complicated, and urinary retention can lead to infection and discomfort. Many conditions are treated with this type of medication, so it is worth investigating.
Whenever possible, avoid narcotics because of unsafe side effects. Use over-the-counter analgesics whenever possible.
Opioid pain meds can:
- Depress the respiratory drive and lead to pneumonia
- Increase confusion
- Cause falls
- Contribute to constipation
Over the counter pain pills take some of the worries out of managing an elderly patient’s medications.
Dementia and substance use disorders
Drinking alcohol can contribute to the risk of injury, so developing strategies to manage alcohol intake is wise. Alcohol-induced dementia patients should not drink at all. In addition to intoxication, problems with clearing the alcohol from the body can occur in people with liver, heart, or kidney problems. Using alcohol with narcotic medications or sedatives increases the risk of death or injury.
Smoking is unhealthy, as we all know, but the patient with dementia shouldn’t smoke for safety reasons and to preserve their health. Forgetfulness or falling asleep with a cigarette may cause a fire or a burn injury.
Dementia brings forth a constellation of symptoms associated with a variety of diseases. Ensuring your loved one is comfortable and safe either at home or in a memory care unit at a skilled nursing facility will ease your mind and reduce your stress levels.