Evaluating Your Loved Ones Cognitive Stage

The truth is that people often can hide their deteriorating mental condition.  My father in law could play 9 holes of golf near the end but could not remember that he had played yesterday. He would tell me he was playing in a golf game with his friends in the next day or two. In his mind it was true.  He managed to fool his doctor and adult protective services as well. The DMV was convinced that he was fine on the road. They didn’t see him go through stop signs and refuse to use turn signals when he changed lanes. 

Evaluating Your Loved Ones Cognitive Stage  Through Careful Observation and Gentle Testing

When we brought dad to live with us, I realized he could not be trusted with his medicine or how to take it. Living with him on a daily basis demonstrated how bad he was at that point. When he took two doses of medicine over a short time span, I took away the medicine box despite his anger that he could do it fine.  Anger came frequently because at times he would admit that his memory was bad and other times deny it.  He knew it deep inside and it frightened him.  In this stage he knew he was losing it.  He would try his best to hide his inability to do these chores.  He said he was fine but he was not.

As things moved along, I would write him simple notes like go to the restaurant at 5 which was connected to his apt by a walkway. In the beginning he could read the words as long as they were printed clearly. He could read me the note which I asked him to do. Then I would ask him to tell me what it meant.  He did it well in the beginning.

As time went on, he could not follow the note unless each small step was written down.  If he ate his lunch and part of it was left, you had to tell him to put in the refrigerator o he would leave it out.  If you put go to dinner at 5 pm, you had to clearly state he must walk down to the restaurant at 5 pm . 

Then it became needed to spend the evening there as well because he could not follow the note to take his evening dose of pills.  We had to lock up his  pill bottles in the closet to keep him from raiding the closet to take a unscheduled dose of pills. He could not remember he had taken them an hour earlier.

Right before he went into the nursing home in March 2015 for the last 5 weeks, I was staying at his apartment 24 hours.  He would wake up in the middle of the night confused and wake me up often to go to breakfast or its time to get up and its 3 AM.  Mentally if I wasn’t there to instruct him on what he should do, he would panic.   He could not and would not follow directions such as use your cane or hold my arm.  This resulted in several falls.  He would go down to the restaurant at 8 pm thinking it was 8 am. He had a clock that stated the date, day, hour, and time in AM or PM but he couldn’t understand those simple terms.  This is when they need 24 hour supervision for their safety.  That was when I realized he could not be admitted into independent living, he was too bad mentally. I realized too with his anger and refusal to follow any advice and instruction, he would need a locked facility.

In 2015 he could read printed magazine articles on golf.  Not too long after that he refused to read anything other than notes.  TV shows he had watched for years now were a problem. He could not understand the fast pace of the show.   Even watching golf he drifted off and seemed uninterested.   I spent hours a day with him and watched the changes in his ability to comprehend the world around him. Most people meeting him for a few minutes, thought he was doing well.  This is a problem when a nursing home comes to take an evaluation. Dad was still taking care of himself personally even though he could not be trusted not to wear the same clothes for a week. He could not be trusted with ointments or medicine.  To the social worker he seemed to be functioning well.  They spend about an hour often in these evaluations. It takes hours to see the real state of their mind and abilities.  That is why dad passed his doctors short tests but totally failed the test given over hours during a day long evaluation.  You must spend some time with your loved one to evaluate their real mental health often.  

You cannot evaluate your loved one unless you spend time with them. If you live in another state or hours away, you cannot tell if they are really still self sufficient or if they just appear to be in limited phone calls.  They will tell you the they have just cleaned the house when in reality there is trash with gnats hatching out.  They will wear the same clothes for a week or put the dishes away dirty.  The bills are laying there untouched. They will lie to you to protect their independence and fear of a nursing home. Your loved ones don’t want to bother you or be any trouble.  They may even think they are doing those things when they are not.  In their mind they paid the bill or cleaned the house.

We had no idea his dad had gotten so bad. When I went out to CA to pack him up, there were gnats all over the house from the trash and food he left sitting around.  Seeing is the only evidence of the real truth of their mental and physical capabilities.  Refusing to read anymore is one of the strong signs. It is because the printed word is confusing and they can no longer understand its meaning.  Look for that sign. They will stop watching favorite TV shows if the plot is too fast or complicated. They may ask you questions if you are watching it with them, letting you know they are having problems following the plot.

Evaluating Your Loved Ones Cognitive Stage  Through Careful Observation and Gentle Testing

  • Ask them questions to see if they really understand your notes and their meaning. 
  • Quiz them on do they remember this house or a family member? See what they can remember about the family and close relatives.
  • Ask questions like who is the president now, what time of year is this, what month is it, what year is it, and how old are you.  If they knew these answers earlier, and cannot give you correct answers now, you can see the memory loss.
  • Ask them to interpret a show they are watching. If its sports and they know a certain sport, ask them questions as if you want to know the answer.
  • Have them draw a clock with the hands at a certain place.
  • Give them 4 words to remember, then ask them 5 min later for the words.
  • Give them a simple math question, then go a little tougher if they get the simple one.
  • If they are a storyteller, ask them to tell you their stories again, the ones you know they always could tell.  When they stop telling their stories and cannot remember them at all, you know the true extend of their failing memory.
  • Ask them questions like when is the rent due or when is the telephone bill due?  Have you paid them this month? 
  • These are some of what is in the easy mental test the doctor in the office will give.  The longer version performed at a facility goes over many hours to see if their long term memory is going and how they process and retain information over time. In 2015 dad could pass the simple tests but not the longer one. By April of 2018, he could not remember much from an hour earlier.
  • Ask these questions at every point you have doubts about their continuing  mental decline.
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