The Pitfalls and Dangers of Moderate Cognitive Impairment
Caregivers prefer to avoid saying the words Alzheimer’s disease or dementia. Professionals, recognizing fear, use terms like mild cognitive impairment or moderate cognitive impairment to dance around the reality of making a diagnosis. I take many of my clients to medical appointments. At a particular appointment, the doctor performed cognitive testing and diagnosed my client with moderate cognitive impairment.
The doctor omitted discussion of medication options. Nor was there a discussion of the consequences and future prognosis. The doctor was extremely kind and compassionate. He could not have had a better bedside manner. However in my opinion he sidestepped his responsibility to tell his patient what to expect relative to progression of his memory loss. If I had to guess, the doctor was probably relieved no questions were asked. Fortunately for my client I am well versed in the consequences of such a diagnosis, the prognosis and related costs of care. Most patients do not find themselves in this situation.
Doctors today are limited by time and insurance reimbursements. They treat diseases and conditions but do not see the havoc that results on a day to day basis in the life of a patient diagnosed with moderate cognitive impairment.
Let me give you a slice of the day to day reality remains hidden until the point where I usually become involved in care situations relating to memory loss. One of my clients forgot to pay his property taxes for two years and a lien was placed on his home. Income taxes were not paid. Notices were frequently sent with penalty amounts due and tossed in a huge pile of mail. He purchased Canadian lottery tickets on a credit card now maxed out to $50,000. The bank was thankful that I intervened because checks bounced monthly on the account due to lack of funds. A plumber took advantage of my client by having him write monthly checks of $500 for plumbing maintenance that was never completed. My client, due to memory loss was a prime target for abuse and financial exploitation.
I spoke with my client’s neighbors. They expressed concerned but did not know what to do or how to help. His barber told me that he has known there were issues for about two years but had no information about available family who might be contacted. His insurance agent knew there were problems due to claims for car repairs, hint: frequent accidents. So I ask, how can so many people know there are problems and NO ONE DOES ANYTHING? These individuals told me that they did nothing because they felt “guilty” about reporting the issues and possibly having the wrong person step in to help.
Once involved, it becomes my responsibility to discuss concerns about cognitive impairment with my client. I am often the bearer of bad news because no one, not even his doctor wanted to say the words Alzheimer’s or dementia because of the reaction and fear that might result.
Avoiding discussions about memory loss result in more significant problems for diagnosed individuals who rarely realize there is a problem with memory. Some lose their entire financial savings to scams or financial abuse. Others lose medical care because they forget to pay premiums. Others become involved in car accidents and not only seriously injure others but seriously injure themselves. Some end up lost in a strange neighborhood.
In working with forgetful clients I explain the situation and the realities time after time because my clients see this as a new conversation each time I visit. One client feels responsible for the issues with his checking account and believes he should be able to handle it, but the reality is that he cannot. Another forgets discussions we have about topics and has to go back and read notes I write in a notebook at her house documenting our conversations. Moderate cognitive impairment may be called moderate but the implications are monumental if left unaddressed.
The difficulty is that many individuals diagnosed with “moderate cognitive impairment” seem to do well in social situations. They carry on appropriate conversations, perhaps forgetting a piece of information here and there. They laugh at jokes and appear moderately well groomed. They seem to be doing generally well.
However it is the underlying, hidden issues that have the potential to cause the greatest harm. And yet friends and acquaintances feel guilty if they try to find an appropriate person to help. Some family members fear anger from their parent and are immobilized to take action. I always ask, what’s worse? Having your friend or parent temporarily angry with you or having them face financial exploitation or significant health issues that cannot be remedied?
Here’s a quick checklist of signs indicating that you must act responsibly for a friend or family member who may not be able to manage their own affairs:
- If you have access to their home are there piles of mail, newspapers and notes everywhere? This may indicate unpaid bills and mismanaged finances.
- Is the home clean or dirty?
- Do you see repairman or handyman constantly going in and out of their home?
- Have other neighbors or friends expressed concern?
- Has the individual lost weight or appear to have health issues, hearing loss, vision loss?
- Do you see the individual driving in an unsafe manner?
- Is the individual wearing the same clothing day after day?
- If you have started to help the person, are they relying more and more on you for daily tasks and to help with making decisions?
- Do you notice if the individual repeats information? Does he or she ask the same questions or forget that you spoke to them yesterday or 10 minutes ago?
- Does the individual appear generally confused?
- Are there medication bottles throughout the home but no system of taking medications?
- Has someone moved into the home to “help out” but the situation seems to be getting worse instead of better? This may indicate abuse.
- Does the individual express fear of a family member or friend?
You will be doing your friend or family member a kindness by reporting these issues to family or county adult protective services and asking for help on their behalf. I often receive calls from embarrassed or frustrated individuals. I thank them for caring enough to make the phone call and then make an appointment to visit the individual to see how I might provide support to reduce the risk of the hidden pitfalls I know I will discover.
© 2012, 2013 Pamela D. Wilson. All Rights Reserved.