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Jules

Medicare Needs To Revise Dementia Test

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Once you're on Medicare, your doctor has to give you a dementia test.  For the most part, it's easy stuff, like this:

Nurse holds up a Sharpie and asks you what it is.

I answer, "It's a Sharpie, used to alter hurricane forecasts."  Pretty easy, right?

But then she asks what the date is and what day of the week it is. 

I said, "I'm retired.  I don't know and I don't care."  Isn't that one of the advantages of being retired?  You're no longer a slave to the clock?

Personally, I think the creators of the dementia test are just jealous of retired people and are trying to make us feel crazy.  But I didn't fall for it. 

Hang on.  There are some guys at the door wearing white coats...

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I've had a cognition test, and also watched my 92-year-old mother take one.  She's still got most of her marbles, and she's always been pretty shrewd about privacy.

"Mrs. X, do you know what day it is?"

  "Yes."

and on and on. . .

 

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10 minutes ago, bplipschitz said:

I've had a cognition test, and also watched my 92-year-old mother take one.  She's still got most of her marbles, and she's always been pretty shrewd about privacy.

"Mrs. X, do you know what day it is?"

  "Yes."

and on and on. . .

 

:D

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Saving the details I had to go to a competency hearing once... not for me, though sometimes I wonder.  :lol:

Anyway the judge asked a few questions of the person in question like who is the president if the US, do you know why you are here today, what is today's date, can you tell me where you live etc... 

Thanks to the Lanterman-Petris-Short Act they really can't ask much more after that.

 

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1 minute ago, nacradriver said:

Anyway the judge asked a few questions of the person in question like who is the president if the US...

The nurse asked me what country we are in.  I said, "Russia?"  Not even a glimmer of a smile.  She was very serious. 

They say people devoid of a sense of humor...;)  Maybe she should have given herself the test.

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56 minutes ago, bplipschitz said:

I've had a cognition test, and also watched my 92-year-old mother take one.  She's still got most of her marbles, and she's always been pretty shrewd about privacy.

"Mrs. X, do you know what day it is?"

  "Yes."

and on and on. . .

 

was she a lawyer?

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My mom would have told them to fuck themself.I am old and deserve to be a little crazy

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It's part of the Medicare Annual Wellness Visit created by Congress in Obamacare.  It's not required to have the AWV, but if you choose to have it there are requirements (or your doc won't get paid).

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AWV-Chart-ICN905706TextOnly.pdf

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3 hours ago, Jules said:

Once you're on Medicare, your doctor has to give you a dementia test.  For the most part, it's easy stuff, like this:

Nurse holds up a Sharpie and asks you what it is.

I answer, "It's a Sharpie, used to alter hurricane forecasts."  Pretty easy, right?

But then she asks what the date is and what day of the week it is. 

I said, "I'm retired.  I don't know and I don't care."  Isn't that one of the advantages of being retired?  You're no longer a slave to the clock?

Personally, I think the creators of the dementia test are just jealous of retired people and are trying to make us feel crazy.  But I didn't fall for it. 

Hang on.  There are some guys at the door wearing white coats...

Agree, it's ridiculous.

As people age and lose their physical abilities, their perceptions and priorities change too. One of the dementia tests is they draw a little clock and ask the patient what time it is on the clock. But a lot of elderly people with failing sight tend to use digital clocks because they can see the numbers easier, and when you're old, what the point of remembering anything that you don't use regularly.

My son is in school now, he can tell me the day of the week, the month, the President, etc.. But during the summer, when his entire existence is filled with dirt bikes, baseball and video games, I've tested his knowledge of the day of the week, the month and the President, and we're both epic dumbshits on that because we don't think about it.

It's a form of anthropomorphism but to the elderly, where we immediately assume that the things that are important to us, must obviously be important to them. They worked their asses off their whole lives so they could not have to think about things like The President, the day of the week and the time on some shitting hand-drawn clock that some snot-nosed Millennial nurse's aid drew on a sheet of yellow lined paper.

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Until your elderly mother loses all comprehension of what the day of the week it is, or what month it is, who loses all ability to remember something you told her 10 minutes ago.

To see a once proud mother slowly lose the ability to remember the names of her grandchildren, the name of your wife, every day a slow long good bye.

I realize the OP is trying to make a point of the absurdity of the medical industrial complex, and I am in complete agreement. But to be living that long goodbye going on 3 years - Not sure who it's harder on - Mom or her adult children.

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7 minutes ago, MaxHeadroom said:

Until your elderly mother loses all comprehension of what the day of the week it is, or what month it is, who loses all ability to remember something you told her 10 minutes ago.

To see a once proud mother slowly lose the ability to remember the names of her grandchildren, the name of your wife, every day a slow long good bye.

I realize the OP is trying to make a point of the absurdity of the medical industrial complex, and I am in complete agreement. But to be living that long goodbye going on 3 years - Not sure who it's harder on - Mom or her adult children.

That is horrible. I feel for you.

On a lighter note, went to visit dad at his assisted living place. When we arrived I noticed a sign out front for an Alzheimer's walk that just happened. Got to talking to dad, usual stuff, then he told us about this walk he went on. Dad "We did this walk the other day, real good time. What the hell was it, damn can't remember what it was about" Me "You mean the Alzheimer's walk?" Dad "Yep, that's what it was". Mind you he has been like that his entire life.

A friend has this as his only clock.

s-l1600.jpg&d=69302eacac7ea94e478e672077

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19 minutes ago, MaxHeadroom said:

Until your elderly mother loses all comprehension of what the day of the week it is, or what month it is, who loses all ability to remember something you told her 10 minutes ago.

To see a once proud mother slowly lose the ability to remember the names of her grandchildren, the name of your wife, every day a slow long good bye.

I realize the OP is trying to make a point of the absurdity of the medical industrial complex, and I am in complete agreement. But to be living that long goodbye going on 3 years - Not sure who it's harder on - Mom or her adult children.

So sad...............sorry you (or anyone) has to face that. Thats pretty much the only thing I am afraid of. Not so much for me but for my loved ones.......heck I won't know.......if I am ever diagnosed with that I will really need to think about my options. I think I know what I'll do.

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7 minutes ago, bmiller said:

That is horrible. I feel for you.

On a lighter note, went to visit dad at his assisted living place. When we arrived I noticed a sign out front for an Alzheimer's walk that just happened. Got to talking to dad, usual stuff, then he told us about this walk he went on. Dad "We did this walk the other day, real good time. What the hell was it, damn can't remember what it was about" Me "You mean the Alzheimer's walk?" Dad "Yep, that's what it was". Mind you he has been like that his entire life.

A friend has this as his only clock.

s-l1600.jpg&d=69302eacac7ea94e478e672077

She has a large format digital clock,  mounted next to the large calendar on the fridge, showing the day of the week, the month/day/year as well as the time. She doesn't know what those things are anymore.

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44 minutes ago, mikewof said:

Agree, it's ridiculous.

As people age and lose their physical abilities, their perceptions and priorities change too. One of the dementia tests is they draw a little clock and ask the patient what time it is on the clock. But a lot of elderly people with failing sight tend to use digital clocks because they can see the numbers easier, and when you're old, what the point of remembering anything that you don't use regularly.

My son is in school now, he can tell me the day of the week, the month, the President, etc.. But during the summer, when his entire existence is filled with dirt bikes, baseball and video games, I've tested his knowledge of the day of the week, the month and the President, and we're both epic dumbshits on that because we don't think about it.

It's a form of anthropomorphism but to the elderly, where we immediately assume that the things that are important to us, must obviously be important to them. They worked their asses off their whole lives so they could not have to think about things like The President, the day of the week and the time on some shitting hand-drawn clock that some snot-nosed Millennial nurse's aid drew on a sheet of yellow lined paper.

So of course medical professionals will immediately declare an older person non compos mentis based solely on the answers to what is universally regarded as an extremely basic and limited screening tool.  Maybe you should save your outrage for the things you claim some experience in like bike messaging, print shop work, solar stills, folding boats, etc.  I don't remember seeing gerontology, Native American expert or psychology an your rather extensive CV.  

You often claim I stalk you and start shit fights with you.  That's incorrect.  It's hard to avoid you here given your rather prolific presence on this site and you often say shit that has no basis in reality.  We joined this site within a month of each other and you have almost 3 times the posts here.  Given your busy life, I am surprised you have so much time to bloviate here.   Another failing of my old age is that I have a habit of calling bull shit when I see it.  And I see a lot of it from you.  Of course I could just put you on ignore, but then I wouldn't be entertained by your whoppers.  Everyone needs a hobby, right?

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42 minutes ago, MaxHeadroom said:

Until your elderly mother loses all comprehension of what the day of the week it is, or what month it is, who loses all ability to remember something you told her 10 minutes ago.

To see a once proud mother slowly lose the ability to remember the names of her grandchildren, the name of your wife, every day a slow long good bye.

I realize the OP is trying to make a point of the absurdity of the medical industrial complex, and I am in complete agreement. But to be living that long goodbye going on 3 years - Not sure who it's harder on - Mom or her adult children.

That's a very difficult and painful thing to deal with.  In many ways, I think it is harder for the family than it is for the affected member.  At some point, many people with some form of dementia are pretty much unaware of their condition, whereas the family has to deal with the harsh realities.  My mother was ravaged by an aggressive brain tumor, and the last 3 months of her life, she was pretty much a raving lunatic.  She was a very intelligent, compassionate, wonderful woman.  It wasn't an easy to live through and I was only 30 at the time.  

20 minutes ago, Point Break said:

So sad...............sorry you (or anyone) has to face that. Thats pretty much the only thing I am afraid of. Not so much for me but for my loved ones.......heck I won't know.......if I am ever diagnosed with that I will really need to think about my options. I think I know what I'll do.

As you know better than most, we don't often get the death we want, we get the death we get.  Of course suicide is an option and I wish more than a handful of states in the US had a 'Death with Dignity' law (doctor assisted suicde).  California does.  The trouble with dementia is that it can be insidious and an individual might not be capable of taking their own life either physically, mentally or both if they wait too long to make the decision

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I was at the hearing when my Sister in Law hauled MIL before a judge to become guardian. MIL was definitely lucid, but the ravages of alcohol made her incapable of caring for herself. A very kind and compassionate judge who knew her when she was younger, approved the guardianship, but also approved a Conservator as a firewall between Sister in Law and the very modest nest egg. He was a very wise man....

Agree that most don't get the exit we want.....except my Mom. She was 87 and on top of her game. Had a stroke and gone in 10 days, Just long enough for the grandkids to all love on her.  I'm still looking for where I sign up!

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1 hour ago, Point Break said:

So sad...............sorry you (or anyone) has to face that. Thats pretty much the only thing I am afraid of. Not so much for me but for my loved ones.......heck I won't know.......if I am ever diagnosed with that I will really need to think about my options. I think I know what I'll do.

Christmas Day, 2017. My wife and kids, me and my two parents at the table, doing what that particular group loved to do; eat a long meal together.

At one end of the table you have my dad, a chemistry PhD from Cambridge, and my son, a science student at UCD, where Dad got his primary degree. God and Stephen Hawking alone know what they were talking about but they enjoyed it. Mrs Sox and I chatting with Mum about, again, God knows what. Then there's my daughter, who'd talk to a hole in the wall and will represent her country when talking becomes an Olympic sport, flitting hither and yon, dropping bombs into the various conversations and leaving before they exploded.

Mum had been sort of losing words and parts of sentences for a while and we all just "minded" her.

She got a bit obstreperous but i finally realised how bad she had become when she asked me who I was anyway.

That was Christmas. In January 2018, Dad went into hospital for some tests before a scheduled heart op. We all felt it best that she go into a nursing home while he was away.

Something went wrong and he ended up in ICU with kidney failure, internal bleeds and the divil and all. He came out a few months later. By this time, Mum had been transferred into the Dementia unit of the nursing home.

He was at home, struggling health-wise but optimistic about the upcoming heart op. He got down to see her as often as he could but not as often as he would have liked, mainly due to fatigue. By now she didn't know who he was but he still talked, and I mean talked, to her as much as he could. About anything but mostly their travels together.

Dad went in for the heart op in November 2018. It didn't go well and he died a few days later, 13 November 2018. There was a medical explanation but  "He died of a broken heart." is good enough for me

Mum, by that point, was completely away with the fairies so she wasn't at all heartbroken. His death would have broken her. Clouds and linings?

She's still with us, in body anyway. She is warm and dry, well-fed and, most importantly, very content in the world she inhabits.

For some people, visiting is a chore. I look forward to my visits to see Mum because there is no sadness, no fear, no worry. We read the paper and do the crossword together, which is to say that I read articles of interest to me, to her, and I read out the clues and she burbles away, words, phrases, sometimes just yesses and noes.

She has become, for me, a island of tranquility.

I still miss them both.

Sorry if I posted this before but it seems relevant in this thread.

 

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1 hour ago, On The Hard said:

I was at the hearing when my Sister in Law hauled MIL before a judge to become guardian. MIL was definitely lucid, but the ravages of alcohol made her incapable of caring for herself. A very kind and compassionate judge who knew her when she was younger, approved the guardianship, but also approved a Conservator as a firewall between Sister in Law and the very modest nest egg. He was a very wise man....

Agree that most don't get the exit we want.....except my Mom. She was 87 and on top of her game. Had a stroke and gone in 10 days, Just long enough for the grandkids to all love on her.  I'm still looking for where I sign up!

My dad had a major stroke at age 59 and then lived a severely handicapped life for 33 more years and died of Alzheimer’s.  With him and the father of a close friend, we have seen that monster close up. With some of you, I think I’d have to move to a Death with dignity state if that came up for me. 
 

Mom remarried and lived about 5 more years and got to chose her time. Had neuropathy from Shingles, COPD, CHF and Kidney disease.  Funny because she was a non smoker and essentially a teetotaler.  She was pretty much all there until the kidneys  gave out. She was smart enough to recognize some cognitive decline and gave me a POA and control of her finances about a year before she died. Lawyer recommended we not do the guardianship as long as we felt that she was ok with family support and didn’t do anything “dumb”. I gave her a debit card and checkbook to an account not linked to overdraft protection and kept a modest amount in that. She had “walking around money” but not the ability to drain all of her accounts.  I got an email at a minimum balance and could recharge it it nothing unusual was happening. 
 

She got to choose her death. She had a strong DNR and always said she would never go on dialysis.  When her kidneys quit, she had an opportunity out to revisit that decision, visited with the clinic and the nephrologist and came back to say “I made a decision to not live that way and I see no reason to change it. I’ve outlived 2 husbands and have 3 good kids, 7 grandkids and 3 great grandkids. If this is my time, so be it.”  The day before she slipped away, she told me it was time but did tell me with a bit of a laugh “I I thought it would take a bit longer than this..”  

I’m glad she lived a good life and left it in good mental health and with good humor. I’d like to go her way. 

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2 hours ago, Ed Lada said:

Now there's irony.  Studying for a dementia test.  

Reminds me of Sutherland in Space Cowboys - he memorized the bottom line of the eye chart and told the Dr. that to save time he'd skip the rest and just read the bottom line. :D

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16 hours ago, Ed Lada said:

So of course medical professionals will immediately declare an older person non compos mentis based solely on the answers to what is universally regarded as an extremely basic and limited screening tool.  Maybe you should save your outrage for the things you claim some experience in like bike messaging, print shop work, solar stills, folding boats, etc.  I don't remember seeing gerontology, Native American expert or psychology an your rather extensive CV.  

You often claim I stalk you and start shit fights with you.  That's incorrect.  It's hard to avoid you here given your rather prolific presence on this site and you often say shit that has no basis in reality.  We joined this site within a month of each other and you have almost 3 times the posts here.  Given your busy life, I am surprised you have so much time to bloviate here.   Another failing of my old age is that I have a habit of calling bull shit when I see it.  And I see a lot of it from you.  Of course I could just put you on ignore, but then I wouldn't be entertained by your whoppers.  Everyone needs a hobby, right?

Dementia is not Alzheimer's.

I've had sufficient experience caring for loved ones with dementia that I can have an opinion. I went through this with my dad, and learned enough about it with my mom to agree with the OP. Jules has a good point.

As for your fixation, it shows up here on occasion, it's insidious. Best of luck with it.

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My father passed away in his recliner and my FIL on his couch. Both had a history of heart problems. But the day of both of their deaths neither had any issues until not feeling well for about 10 minutes. 

My mother had Alzheimer’s for 10 years before she passed, my MIL is at about 5 years, in the past 3 of them she has spoken maybe a total of 100 words to my wife. 

The different ways my parents passed has given me insight into grief. With my father, he was a young man (45) and I was a young boy (9). I always wondered if I said the right things at the right times to let him know how much I loved and appreciated him. With my mother I knew I had, I just didn’t know if she understood. People say you get all your grieving out of the way when you are dealing with a parent with Alzheimers, but they don’t tell you about the guilt you feel when they finally pass and your first feeling is relief. 

I’d take my father’s way out 100 times out of 100, just not at 45 since I am way past that already.  

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2 hours ago, mikewof said:

Dementia is not Alzheimer's.

I've had sufficient experience caring for loved ones with dementia that I can have an opinion. I went through this with my dad, and learned enough about it with my mom to agree with the OP. Jules has a good point.

As for your fixation, it shows up here on occasion, it's insidious. Best of luck with it.

You are a complete fuckwit Mikey (big surprise there!).  The OP was mostly speaking tongue in cheek.  Quit putting words in my mouth.  I never said dementia was Alzheimer's.  Alzheimer's is a degenerative brain disease in which dementia is but one aspect.  In Alzheimer's the dementia has a different cause than in normal, old age dementia, but the behaviors are essentially the same.  If you want to think that medical professionals have a vested interest in busting people's balls for some insidious reason, then you go right ahead and think that.  The hundreds of medical care people I have worked with in a variety of big and small hospitals and clinics are generally the most hard working, caring, compassionate, good people I have ever known and worked with.    A medical professional here explained that the exam in question is only mandated for people choosing a certain Medicare option.  Believe it or not, in the medical business, caregivers often need to ask seemingly stupid questions for good reasons.  Usually, if asked, they will explain why, but the explanation is never "Because we want to fuck with you and waste our valuable time and yours."   This whole thing is just you shooting off your mouth and showing your vast ignorance, something you do here often.  What you went through with your folks has no bearing on the subject here, it is one experience, big fucking deal.  Perhaps you should just ignore whatever insidious fixation I have that shows up here occasionally, how hard would that be?  Go back to your high plains existence, fiddle with your spark plugs, folding boats, solar stills, printing supply business, masturbating in a corner, reading SA during your working hours, and whatever else you do with your time.  I have a lot of free time and I do as I please, but I will for the most part avoid your idiocy and move on as I usually do.  But Sometimes, you say things that are so stupid, and then squirm all around trying to defend your idiocy, that I just can't resist.  Sorry, but as I said, everybody has a hobby.  

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19 hours ago, Ed Lada said:

Now there's irony.  Studying for a dementia test.  

I didde to, past it!  Saide they nevere sawe such greate answeres!                                       :)

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Just now, Snaggletooth said:

I didde to, past it!  Saide they nevere sawe such greate answeres!                                       :)

Probably because the answers are given orally, not written!  :lol:

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24 minutes ago, Ed Lada said:

You are a complete fuckwit Mikey (big surprise there!).  The OP was mostly speaking tongue in cheek.  Quit putting words in my mouth.  I never said dementia was Alzheimer's.  Alzheimer's is a degenerative brain disease in which dementia is but one aspect.  In Alzheimer's the dementia has a different cause than in normal, old age dementia, but the behaviors are essentially the same.  If you want to think that medical professionals have a vested interest in busting people's balls for some insidious reason, then you go right ahead and think that.  The hundreds of medical care people I have worked with in a variety of big and small hospitals and clinics are generally the most hard working, caring, compassionate, good people I have ever known and worked with.    A medical professional here explained that the exam in question is only mandated for people choosing a certain Medicare option.  Believe it or not, in the medical business, caregivers often need to ask seemingly stupid questions for good reasons.  Usually, if asked, they will explain why, but the explanation is never "Because we want to fuck with you and waste our valuable time and yours."   This whole thing is just you shooting off your mouth and showing your vast ignorance, something you do here often.  What you went through with your folks has no bearing on the subject here, it is one experience, big fucking deal.  Perhaps you should just ignore whatever insidious fixation I have that shows up here occasionally, how hard would that be?  Go back to your high plains existence, fiddle with your spark plugs, folding boats, solar stills, printing supply business, masturbating in a corner, reading SA during your working hours, and whatever else you do with your time.  I have a lot of free time and I do as I please, but I will for the most part avoid your idiocy and move on as I usually do.  But Sometimes, you say things that are so stupid, and then squirm all around trying to defend your idiocy, that I just can't resist.  Sorry, but as I said, everybody has a hobby.  

I took care of my dad and his "dementia" until literally his last moments of life.

Every clinician who gave him the "dementia" exam told me about his significant loss of neural function. He even agreed with them, to a point.

But "dementia" is a dangerous label because it moves treatable conditions in the elderly out of general practice and into the domain of primarily the psychology profession. I have a problem with this, and so do others. You don't like my opinion on this? Not my problem.

My dad did micron-level engineering, until literally two days before his death. Anyone who took the time to interact with him in his last few years found that he was still able to solve engineering problems. At the peak of my professional career, I couldn't do half of what he could do with so-called "dementia."

The term "dementia" has questionable medical diagnosis at best. It's a derogatory term that is used to disempower the elderly.

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52 minutes ago, mikewof said:

I took care of my dad and his "dementia" until literally his last moments of life.

Every clinician who gave him the "dementia" exam told me about his significant loss of neural function. He even agreed with them, to a point.

But "dementia" is a dangerous label because it moves treatable conditions in the elderly out of general practice and into the domain of primarily the psychology profession. I have a problem with this, and so do others. You don't like my opinion on this? Not my problem.

My dad did micron-level engineering, until literally two days before his death. Anyone who took the time to interact with him in his last few years found that he was still able to solve engineering problems. At the peak of my professional career, I couldn't do half of what he could do with so-called "dementia."

The term "dementia" has questionable medical diagnosis at best. It's a derogatory term that is used to disempower the elderly.

The two things I have made bold are so ludicrous that they aren't worth a rebuttal.  I will only say that the medical community recognizes dementia as a physical condition that is caused by many reasons, including Alzheimer's and the primary treatment is conducted by medical professionals, not psychologists.  And those aren't my opinions based on one incident in my personal life, those are facts.  

Here is a good place to learn more:  NIH National Institute on Aging

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42 minutes ago, Ed Lada said:

The two things I have made bold are so ludicrous that they aren't worth a rebuttal.  I will only say that the medical community recognizes dementia as a physical condition that is caused by many reasons, including Alzheimer's and the primary treatment is conducted by medical professionals, not psychologists.  And those aren't my opinions based on one incident in my personal life, those are facts.  

Here is a good place to learn more:  NIH National Institute on Aging

Now the problem becomes a new one, I'm going to debate this topic with someone who isn't really a researcher, but more of a clinician. We're not going to agree, but you're going to need to try to see this from a different angle. And remember, not too long ago, children with treatable medical conditions were labeled "retarded" and condemned to a life of crappy schools, half-careers and poor medical treatment.

And I get that you were trained as a clinician, and not a researchers, but this isn't rocket science.

The clinical definition (roughly) of "dementia" is category of diseases in the brain and nervous system that negatively impacts rational thought and the ability to function. Please agree or disagree with that, but we need some kind of starting point.

So how is "dementia" diagnosed? Or in other words, how is this disease which consists of brain and neurological disease diagnosed? MRI scans? Exhaustive neurological screening? Blood samples to detect serum biomarkers? Nope. As Nacra noted earlier in the thread, without consent, it is diagnosed with those "exams" about the clock and the President, and the month. Perhaps they do it differently in Poland, but I know from direct experience that this is how they do it with the U.S. Veteran's Administration Hospitals and with at least two public hospitals in Denver. Perhaps others in the thread may chime in if they do it differently in other countries. Now, with consent, fine, they can go all the way up to taking brain tissue samples.

So, when an elderly patient is being treated for specific medical issues, like a broken bone, or a skin tear from losing their balance, or being bitten by a black widow, or even a skin infection, they can be tested with this "dementia" test, and often are tested, and the results are brought to the family members or guardians, if they are in an extended care facility.

They were thus given a medical diagnosis (i.e. degenerative brain disease) without a medical examination. This medical diagnosis can then be used to remove the patient's rights, change guardianship, impact the patient's job, the relationship with their family, and even their own ability to confidently care for themselves.

Two major problems just popped up here ...

1. The medical "diagnosis" was often conducted by someone with limited medical training, limited residency, limited internship. It would be like going to the dentist and having the hygienist declare that you need to have your tooth extracted before the dentist even enters the room, and then having that hygienist empowered with the ability to give this diagnosis to the home yank-a-tooth pliers representative.

2. The diagnosis of "dementia" then removes the medical imperative to treat potentially treatable conditions. Can we give that patient a blood test to check for sufficient magnesium and vitamin B absorption? Are they chronically dehydrated? Is their COPD inhibiting their ability to communicate? What medicines are they currently using that might be tweaked to increase cognitive function?

Making a diagnosis of even a common cold isn't something that anyone less than a full Medical Doctor is licensed to do in the United States, or at least a physician who is supervising some Physician Assistants and Nurse Practitioners. And that's just a fairly simple, treatable disease with a relatively simple pathway, nowhere near as complicated as brain and neurological disease that involve at least three or more medical areas. "Dementia" is far more complicated, with potential emotional illness, brain disease, potential cancer, neurology, blood diseases, and several others. And so, Ed Lada, how much actual training does it take for someone in a VA Hospital or in a U.S. hospital to approach family members and tell them that their loved one has "dementia"?

And that's the key problem with diagnosing anyone with "dementia." It isn't an actual medical diagnosis, it's as dim-witted now in 2019, as someone in 1950 diagnosing a child with Multiple Sclerosis as "mentally retarded."

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3 hours ago, Ed Lada said:

Probably because the answers are given orally, not written!  :lol:

I wouldn't be so sure - none of us have heard him speak Snagglese.

I figure he sounds like Norm Crosby.

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In his prime my dad was the smartest person I ever knew - PhD microbiologist, read at least 3 books a week for more than 80 years etc. He literally read the entire library in the town we lived in.

I could see the decline in his mental abilities as he approached 90 - classic dementia but it never advanced to a crippling state.

My next door neighbour was a very smart woman also - a teacher. She got Old Timers Disease and it was an entirely different thing - after a few years she was nothing but a functioning body. No different than a person in a persistent vegetative state kept alive by machines.

The only thing the two have in common is a decline in intellectual ability.

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Dementia is a constellation of chronic generally progressive signs and symptoms with diminished functional ability over time, which can be caused by Alzheimers, FTD, Parkinsons, and many other conditions like recurring small strokes.  As a medical specialty it is more neurology than psych.  While the deposition of beta amyloid in the brain is a hypothesized cause of Alzheimers, over 200 drug trials have failed.  There are other putative causes as well.  It will not be a simple solution if one is eventually found.  

We ask patients “dumb” questions because the folks are often unaware or in denial and try to compensate In various ways, some dysfunctional.  or they don’t think the doc would be interested.  So you ask to open the door for whatever they have to say.  That‘s why I asked old folks about their sex lives.  Got some surprises along the way, bit glad to see there’s reason to stay optimistic as I get old.  But I did treat a 100 ur old guy for syphilis  

Current treatments for dementias are hit and miss, and overall not terribly impressive.  Personally I’d rather have cancer than dementia because of the family burden.  Not to underestimate cancer - I worked in a university cancer center and saw a lot of suffering.  

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1 hour ago, NaptimeAgain said:

Dementia is a constellation of chronic generally progressive signs and symptoms with diminished functional ability over time, which can be caused by Alzheimers, FTD, Parkinsons, and many other conditions like recurring small strokes.  As a medical specialty it is more neurology than psych.  While the deposition of beta amyloid in the brain is a hypothesized cause of Alzheimers, over 200 drug trials have failed.  There are other putative causes as well.  It will not be a simple solution if one is eventually found.  

We ask patients “dumb” questions because the folks are often unaware or in denial and try to compensate In various ways, some dysfunctional.  or they don’t think the doc would be interested.  So you ask to open the door for whatever they have to say.  That‘s why I asked old folks about their sex lives.  Got some surprises along the way, bit glad to see there’s reason to stay optimistic as I get old.  But I did treat a 100 ur old guy for syphilis  

Current treatments for dementias are hit and miss, and overall not terribly impressive.  Personally I’d rather have cancer than dementia because of the family burden.  Not to underestimate cancer - I worked in a university cancer center and saw a lot of suffering.  

There is a difference between "dementia" and Parkinsons, Alzheimers, Sclerosis ... the latter are specific diseases with testable biomarkers, or visibility in scans. Parkinson's for example is very hard to diagnose, it takes a highly experienced physician with a lot of hard-won expertise. And then these diseases can be treated, or sometimes not treated.

But "dementia" is just this laundry list of symptoms, sometimes diagnosed by clinicians without advanced medical degrees, and often as noted, by simple questions about clock faces and Presidents. Yet even though the diagnosis is laughable, often with no specific cause identified (unlike Parkinson's or Alzheimers), it is then used to create actions on behalf of the patient, like guardianship and loss of independence.

But without an actual medical diagnosis to the physical cause of "dementia" there is no good way to know what caused it. One patient might have near complete loss of socialization as she lives alone in her house with a cat and she might interact with people only on the occasion that she is in the hospital. Is she in denial of a medical condition, or has she lost some of the ability to communicate well due to a treatable condition? Someone else may have found themselves bedridden with little ability to do any physical activity at all, other than rolling over to let the nurse put in the bed pan. Is the "dementia" a result of a highly medicated person who hasn't stood on their own two feet in months, or the result of a degenerative nerve condition? Without an actual examination, there really isn't a way to know.

Obviously, there is nothing wrong with a general practitioner asking "dumb" questions to develop a rapport with the patient, uncover something hidden, or get an idea of their general state. But that's a world away from a first year psychology resident diagnosing a patient with "dementia" based on some of those same "stupid" questions.

 

Again, this is nothing new in some ways ... just a generation and two ago, treatable conditions were often not treated in children who were labeled "retarded." And it literally took an act of Congress with Rosa's Law to even get the wording to change to something medically actionable, instead of continuing to rely on a catch-all non-diagnosis. In this case, we should forever banish the word "dementia" from clinical use, because it has little or no clinical backbone, and it causes more harm than good. If someone shows a reason why they are a harm to themselves or others, and need to remove or change guardianship, then this should be relegated strictly to the legal definition, and any suggestions of clinical diagnosis based on a drawing of a clock or the month, or anything other than repeatable, biologic-based testing, should be viewed as unreliable and problematic.

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On 10/29/2019 at 12:30 PM, nacradriver said:

Saving the details I had to go to a competency hearing once... not for me, though sometimes I wonder.  :lol:

As do we.... often ;)

 

I work for an upscale retirement community with a memory ward. There is a guy who gets to tell the family that mom /dad can't live alone any more or worse they have to go into the memory ward. Never a happy day. I don't know what the process entails but I'm sure it's more than just his command decision. However once he points his bony finger the resident rarely gets to stay and play in independent living.

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1 hour ago, mikewof said:

 In this case, we should forever banish the word "dementia" from clinical use, because it has little or no clinical backbone, and it causes more harm than good.

The word dementia was reclassified with major neurocognitive disorder and mild neurocognitive disorder with the publishing of the DSM-5 a few years back.

It was also changed in the ICD-9 at that time and now ICD-10.

But I have to ask... are you mild or major?   :D

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1 hour ago, nacradriver said:

The word dementia was reclassified with major neurocognitive disorder and mild neurocognitive disorder with the publishing of the DSM-5 a few years back.

It was also changed in the ICD-9 at that time and now ICD-10.

But I have to ask... are you mild or major?   :D

If "dementia" is genuinely caused by physical diseases in the brain, then how can it be diagnosed with the DSM and by people with little or no medical training?

Or ... if psychologists and clinical counselors want to be able to diagnose "dementia" as they would any other mental illness, then the medical community would then need to disconnect it from physical causes, and just classify it as a collection of "mental illnesses" that can be classified in the DSM.

So which is it? Is "dementia" a physical illness or a mental illness? I may have only stayed at a Holiday Inn, but I'm pretty sure that only medical clinicians can diagnose physical illnesses.

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Somehow arguing about dementia seems a bit dysfunctional.  Naming conventions are getting PC.  Venereal disease (VD) became sexually transmitted disease (STD) became sexually transmitted infection (STI).  I doubt the syphilis, gonorrhea, and chlamydia care what we call them.

The intersection between "organic" and "functional" neuropsychiatric conditions seems to depend on whether we think we can confidently figure out the pathophysiology versus just cataloguing symptoms.  Dementia is a clinical syndrome with multiple causes.  When we think we understand some of them we tend call it physical illness.  Unfortunately we still have huge knowledge (and evidence) gaps.

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52 minutes ago, NaptimeAgain said:

Somehow arguing about dementia seems a bit dysfunctional.  Naming conventions are getting PC.  Venereal disease (VD) became sexually transmitted disease (STD) became sexually transmitted infection (STI).  I doubt the syphilis, gonorrhea, and chlamydia care what we call them.

The intersection between "organic" and "functional" neuropsychiatric conditions seems to depend on whether we think we can confidently figure out the pathophysiology versus just cataloguing symptoms.  Dementia is a clinical syndrome with multiple causes.  When we think we understand some of them we tend call it physical illness.  Unfortunately we still have huge knowledge (and evidence) gaps.

If someone with medical training is willing to take a guess to the physical disease from which the patient is suffering, that's good, the patient might get help.

If someone with training in mental illness is willing to take a guess to the mental diseases from which the patient is suffering, that's good, the patient might get help.

But when someone with only training in mental illness identifies "dementia" then they need to be very clear with the family that this isn't a physical illness, that they can't even comment on the patient's physical health. And then the family member, on hearing this, might say something like "That Uncle Charlie, his memory was always shit and he was always crazier than a hoot owl, I think he's okay to make his own decisions for a while longer."

But that's not what happens, is it?

Instead, someone with no medical training in physical diagnosis tells the family members that the patient shows signs of "dementia" to which is often caused by physical diseases in the brain and nervous system. Now the specter of physical illness has been suggested and implied by someone who has no training to make such a diagnosis, and the family then acts on that advice as if the diagnosis strongly suggests a physical illness.

I'll take it from the other direction ... you seem to be a medical clinician ... if you diagnose and then treat a patient for say, Chronic Obstructive Pulmonary Disorder, would you then tell the family something like "We're treating his lung problems, but I also noticed while I was speaking with him, that he suffers from a co-occurring disorder of alcoholism and borderline personality disorder, but he's probably going to refuse my treatment because he probably suffers from dyscalculia, so I'm going to suggest that your have his self-guardianship removed and have him placed into managed care." Medical people would say something to the effect of "I recommend a social worker, or psychologist or substance abuse counselor to discuss the other issues, and I treated his lung problems."

 

As it stands, officially, "Dementia" is a disease resulting from physical illness. If we're going to stick with that definition, then we can't have mental health workers "diagnose" this illness with drawings of clocks. It will require actual diagnosis from the medical profession. And if the tools to diagnose it aren't available to the medical community, then a pseudo-diagnostic cannot be presented to the family who then use this pseudo-diagnostic to remove that patient's rights. Continuing on this path is an abuse of the elderly.

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1 hour ago, NaptimeAgain said:

Somehow arguing about dementia seems a bit dysfunctional.  Naming conventions are getting PC.  Venereal disease (VD) became sexually transmitted disease (STD) became sexually transmitted infection (STI).  I doubt the syphilis, gonorrhea, and chlamydia care what we call them.

The intersection between "organic" and "functional" neuropsychiatric conditions seems to depend on whether we think we can confidently figure out the pathophysiology versus just cataloguing symptoms.  Dementia is a clinical syndrome with multiple causes.  When we think we understand some of them we tend call it physical illness.  Unfortunately we still have huge knowledge (and evidence) gaps.

It just isn't worth engaging with Mike.  He obviously knows very little about mental health and psychology. It is pretty obvious that Mike has a deep personal hatred against people in the mental health business.  Personally I think the root cause might be some issues he has had in the past, maybe even an involuntary commitment, that often pisses people off, in my experience.  Given his often delusional behavior here and his lengthy list of past jobs and many side projects, it wouldn't surprise me if he is bi-polar manic.  Just idle speculation of course.  

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17 hours ago, mikewof said:

If "dementia" is genuinely caused by physical diseases in the brain, then how can it be diagnosed with the DSM and by people with little or no medical training?

Or ... if psychologists and clinical counselors want to be able to diagnose "dementia" as they would any other mental illness, then the medical community would then need to disconnect it from physical causes, and just classify it as a collection of "mental illnesses" that can be classified in the DSM.

So which is it? Is "dementia" a physical illness or a mental illness? I may have only stayed at a Holiday Inn, but I'm pretty sure that only medical clinicians can diagnose physical illnesses.

You do understand the purpose of the DSM do you?

 

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1 minute ago, nacradriver said:

You do understand the purpose of the DSM do you?

 

Pretty much. I studied it right alongside my then-sweetie when she was doing her state boards in clinical counseling. What's your question/point about it?

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27 minutes ago, Ed Lada said:

It just isn't worth engaging with Mike.  He obviously knows very little about mental health and psychology. It is pretty obvious that Mike has a deep personal hatred against people in the mental health business.  Personally I think the root cause might be some issues he has had in the past, maybe even an involuntary commitment, that often pisses people off, in my experience.  Given his often delusional behavior here and his lengthy list of past jobs and many side projects, it wouldn't surprise me if he is bi-polar manic.  Just idle speculation of course.  

And yet, funny enough, you seem completely incapable of addressing my point, and instead try to change the subject to my emotional condition and possibly the reason why I like the taste of tequila.

But it does always amuse me when lightly-trained mental health semi-pros make armchair diagnosis that highly-trained psychiatrists and psychologist would need extensive clinical time to diagnose. Kind of like the tire boy at the garage who thinks he's actually qualified to rebuild a transmission because he once watched a YouTube video.

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I'm too lazy to look back through dozens of posts to check but has anyone pointed out the irony of a discussion of dementia in this place - the most demented sailing site on the Interweb?

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I just took my 89 yo dad to the neurologist today. Sister and assisted living nurse thinks he has Parkinsons or Lewy Body Dementia.  NOT! The doctor gave him the cognitive test. He could not tell time and could not draw a clock, did not know the day of the week, year or month. Scored 14 out of 30. I have watcged him heading downhill for the last year. Often cant tell day from night. Cant tell time with either a analog or digital clock. I made three posters for breakfast, lunch an d dinner along with a drawing of what the analog and digital clocks look like. Almost every day I get calls when he can't figure out "what he is suppose to do next". Sometimes 2 or 3 in the morning. Sometimes he gets up and walks the halls hours before breakfast. Along with this, his anxiety level is high. Worry about being sent to memory care or doing something wrong.

It is defiantly not fun for me or him. I find the days get repetitive answering the same questions day after day.

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1 hour ago, SloopJonB said:

I'm too lazy to look back through dozens of posts to check but has anyone pointed out the irony of a discussion of dementia in this place - the most demented sailing site on the Interweb?

Without doing the research, I submit it might be among the most demented sites irrespective of sport or activity.

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8 hours ago, Great White said:

I just took my 89 yo dad to the neurologist today. Sister and assisted living nurse thinks he has Parkinsons or Lewy Body Dementia.  NOT! The doctor gave him the cognitive test. He could not tell time and could not draw a clock, did not know the day of the week, year or month. Scored 14 out of 30. I have watcged him heading downhill for the last year. Often cant tell day from night. Cant tell time with either a analog or digital clock. I made three posters for breakfast, lunch an d dinner along with a drawing of what the analog and digital clocks look like. Almost every day I get calls when he can't figure out "what he is suppose to do next". Sometimes 2 or 3 in the morning. Sometimes he gets up and walks the halls hours before breakfast. Along with this, his anxiety level is high. Worry about being sent to memory care or doing something wrong.

It is defiantly not fun for me or him. I find the days get repetitive answering the same questions day after day.

Best of luck, it's hard. But it's hard on them even more, they don't want to die alone. It sucks when you end up having to care for an adult the way you would a baby, wiping their ass and feeding them their food with a spoon.

But it makes it easier when you remind yourself that inside, they are becoming like a child again, as they rely on you to survive. You grip the hand of the person who once held you as a baby and they grip back harder, sometimes terrified and cold. They're usually cold, bundle them like babies with soft hats and sweaters.

They tend to follow clearly-laid rules very well, like "don't ever touch the stove" or "don't leave the house without first telling someone." The fewer the rules the less rules they forget.

It's one thing to do this and change diapers for a few months at end-of-life and home hospice, because it's a full time job. But those family members who do it for years on end deserve special consideration from siblings, it's exceedingly rough when it extends that long.

But unlike babies, they are adults. You can have your friends over and get shitfaced and give them alcohol as long as it doesn't interfere with their medicine, let them smoke if you're okay with the smoke. My 95 year old dad and I smoked weed together, and drank lots of cheap whisky. Old people and booze go together like chicken and waffles. It did suck when he woke me up every night at 3 am for more whisky, but he loved that sip or two of whisky and he never had to touch any of the painkillers in the hospice box. The shit they put in that hospice box, sweet smoking Rachel ... morphine, fentanyl, haloperidol (though without cogentin, which is stupid) and oxycontin, I think dilaudid, Percocet. I wasn't tempted to take any of that stuff, but I'm sure that a lot of home hospice family members do take it. Seems like a really dumb idea to have that kind of firepower in the house. 

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On 10/31/2019 at 7:11 PM, SloopJonB said:

I'm too lazy to look back through dozens of posts to check but has anyone pointed out the irony of a discussion of dementia in this place - the most demented sailing site on the Interweb?

Sorry I forget, what's your point?

Oh look a squirrel....

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On 10/30/2019 at 6:59 AM, bmiller said:

That is horrible. I feel for you.

On a lighter note, went to visit dad at his assisted living place. When we arrived I noticed a sign out front for an Alzheimer's walk that just happened. Got to talking to dad, usual stuff, then he told us about this walk he went on. Dad "We did this walk the other day, real good time. What the hell was it, damn can't remember what it was about" Me "You mean the Alzheimer's walk?" Dad "Yep, that's what it was". Mind you he has been like that his entire life.

A friend has this as his only clock.

s-l1600.jpg&d=69302eacac7ea94e478e672077

I frankly can't see why anyone needs any other clock than one of these.....

https://www.ebay.com.au/itm/Endurance-Brass-Time-Tide-125mm-by-Weems-Plath/153252902069?epid=2150354037&hash=item23ae95b4b5:g:WVIAAOSwbbtdNkyg&frcectupt=true

FKT

 

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17 hours ago, mikewof said:

Best of luck, it's hard. But it's hard on them even more, they don't want to die alone. It sucks when you end up having to care for an adult the way you would a baby, wiping their ass and feeding them their food with a spoon.

But it makes it easier when you remind yourself that inside, they are becoming like a child again, as they rely on you to survive. You grip the hand of the person who once held you as a baby and they grip back harder, sometimes terrified and cold. They're usually cold, bundle them like babies with soft hats and sweaters.

They tend to follow clearly-laid rules very well, like "don't ever touch the stove" or "don't leave the house without first telling someone." The fewer the rules the less rules they forget.

It's one thing to do this and change diapers for a few months at end-of-life and home hospice, because it's a full time job. But those family members who do it for years on end deserve special consideration from siblings, it's exceedingly rough when it extends that long.

But unlike babies, they are adults. You can have your friends over and get shitfaced and give them alcohol as long as it doesn't interfere with their medicine, let them smoke if you're okay with the smoke. My 95 year old dad and I smoked weed together, and drank lots of cheap whisky. Old people and booze go together like chicken and waffles. It did suck when he woke me up every night at 3 am for more whisky, but he loved that sip or two of whisky and he never had to touch any of the painkillers in the hospice box. The shit they put in that hospice box, sweet smoking Rachel ... morphine, fentanyl, haloperidol (though without cogentin, which is stupid) and oxycontin, I think dilaudid, Percocet. I wasn't tempted to take any of that stuff, but I'm sure that a lot of home hospice family members do take it. Seems like a really dumb idea to have that kind of firepower in the house. 

Mike

Lots of words here, but nothing that is helpful to my situation.

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11 hours ago, Great White said:

Mike

Lots of words here, but nothing that is helpful to my situation.

Everyone's situation is different. I also get tired of answering the same questions every day. But then I ask myself if I was similarly annoyed to the edge of insanity when my toddlers asked me the same questions over and over.

I wasn't. You probably weren't annoyed by your toddlers either. We have patience for toddlers because we know that they grow out of it, and this too shall pass.

But old people with toddler brains don't grow out of it, they grow into it. Each day they lose more of their abilities, and that's hard on the people who care for them. Sometimes the old person loses physical ability, sometimes mental ability, sometimes both ... usually both, to varying degrees.

But it's worth it, in my opinion, if at all possible, to keep them at home, and let them go out of this world the way they came in, with a familiar face at their side. They'll fuck up, they'll nearly burn the place down, or flood it, or make it filthy. But if you or/and your sister can care for him until the end, and help him avoid that memory care that stresses him out, it might be just as valuable to you as raising your children.

It's difficult, it's often disgusting, it's stressful and we're not wired to take care of old people the way we take care of babies. But it's worth it.

And I think that when we make the commitment to stay with them until the end, we start to see actual growth and learning that we would otherwise miss when we put them into an extended care facility.

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