For 40 years, they played cards every week. Wednesday nights they went to the duplicate bridge club. One Wednesday, Mom began to get ready for their evening of bridge. Dad sat on the sofa, re-reading the morning paper. Mom was putting on her lipstick before she realized that Dad hadn't started to dress to go out.
"It's nearly 7:30. If you don't get a wiggle on, we'll be late," she said.
"What are you talking about? What will we be late for? We don't have any plans for tonight. My God, is this what it's come to. You just go ahead and make plans and don't even bother to think of me." And on he went, furious that she was pretending she'd told him about the bridge game at the club when he knew she was really planning to go out on her own.
While she was in the bathroom, repairing her makeup ruined by tears, he slipped out the front door and drove away. It was the first of many such frantic evenings my mother spent, wondering if he'd have an accident. Wondering when he had gone from being a little stubborn to being downright unreasonable. Wondering where he went when he drove off, not to return for several hours.
As it turned out, Dad had been suffering a series of TIAs, or mini-strokes. Each little stroke robbed him of more memory. The change was so gradual that no one really noticed any change. Dad was a brusque, jovial, hale and hearty kind of guy. He had learned to hide his memory loss from Mom by brushing off her questions with, "Can't a man have a moment to himself?" When he stormed out and took the car, he often forgot what he was doing so he continued to drive around hoping he'd remember what he was supposed to be doing.
Dr. Alan Slusky, a psychologist with the Psychogeriatric Outreach Team at Deer Lodge Centre in Winnipeg, Manitoba, says that this type of situation is common. The onset of dementia can be so gradual that the spouse often doesn't realize anything is wrong physically until something unusually unreasonable happens.
Alzheimer's disease accounts for at least 80 percent of the cases of dementia with strokes following closely behind. What happens with dementia is that the person begins to lose the ability to reason and remember. At the same time, they sometimes lose their inhibitions so that emotions that were once easily controlled become uncontrollable.
It also seems that a person's most difficult personality traits can become exaggerated. For instance, if the person has always been slightly suspicious, as dementia sets in they may become extremely suspicious. Barb Miller, a nurse with the Psychogeriatric Outreach Team, said, "It would be easier if we could just blame the disease." However, if the person has always been a little difficult, they may become very difficult and the caregiver has to deal with their own emotions in response to that.
Dr. Slusky said there is no point trying to change such behaviour. It is beyond changing. It's best to go along with the person's notions, if possible. For instance, if the person insists that someone is stealing household items, help the person look for the item. If all else fails, simply change the subject.
These are times of high emotions and the impact on the caregiver can be tremendous. Usually the caregiving falls to the spouse or one of the grown children and this brings a whole range of separate problems. For children cast in the role of caregiver, there is a dramatic reversal of roles. The parent may balk at taking directions from a child. For spouses, it can be heart-breaking. A wife can tell her Alzheimer-stricken husband he shouldn't be driving and his reaction will be to blame her for ruining all his fun. She's worried about him having an accident. He thinks he is perfectly reasonable and she's just trying to control him.
Suzanne Rutledge is a mental health worker with Deer Lodge's Psychogeriatric Services. According to Suzanne, guilt and anger often accompany the caregiving role. Because we base our value on what other people think of us, our self-esteem can take a beating when people we love become irritated with us. This often happens when dealing with a loved one who is suffering from dementia.
We become angry with the person and then feel guilty at our anger. If we were loving children or loving spouses, then we should be able to do all that is necessary. Or so we think. For the sake of your own health, Suzanne said, it is essential that you take time out for yourself. Join a support group, if possible. Whatever you do, don't try to handle it all on your own. Being along in such a situation can cost you dearly in terms of your emotional health and energy.