When I became manager of a care home in Portland Oregon, I had been involved in Alzheimer's dementia care for about 8 years.
I was still in the innocent phase when I thought an diagnosis of Alzheimer's meant something specific and exact.
I was hired to bring in a Alzheimer's only program for a multi-home owner who was losing ground to the incoming Rumanian immigrants who had friendly lively homes full of a mix of elders and jolly Rumanians.
There were four elders living in Charley's home.
All said to have Alzheimer's.
And we soon located one more elder with Alzheimer's, so we had a full house of elders with Alzheimer's.
Except that wasn't true, as it turned out.
Back then, in the 90s, people were still using the term Alzheimer's to apply to any kind of dementia.
That's no longer true.
We now at least differentiate more, but we still fail to diagnose mental illness in elders.
Looking back, I would now say we had one resident with probable Alzheimer's, two with very mild cognitive impairment and then the two seriously mentally ill residents.
One heard voices and had extremely paranoid issues, the other had outbreaks of physical violence with night hours of moving heavy furniture around to barricade her door.
Does it matter that mentally ill people are thrown into a dementia basket? YES.
Here's why.
It is these seriously mentally ill people who are usually the perpetrators of violent attacks in care situations.
Look at any violent deaths in Alzheimer's care facilities, and you will find someone whose real diagnosis should have been a serious intractable mental illness.
It is not a safe mix to bring together those with dementia and those who may be schizophenic, psychotic, bipolar and so on.
Even with appropriate medication, I have doubts about the safety factors of mixing them.
Here's why.
People with serious mental illness can find those with dementia both threatening and very annoying.
There was a recent incident in a nursing home where one old woman strangled her room-mate to death and put a plastic bag over her head.
This is psychotic stuff -- not that I'm diagnosing, you understand.
People with dementia may hit out when frightened, but they don't make plans to murder room-mates.
Why not? Failure of deductive reasoning, is why.
That old lady in my care home -- she wound a radio cord all about her arm one night, got a caregiver to kneel down to help with her slipper and whopped him on the head with her heavy portable radio.
He called the police and she was hauled away to a geriatric psych unit and the state banned her from ever living in a care home again.
Families have a lot of trouble admitting their mother or father is seriously mentally ill.
Shame, fear, genuine ignorance -- these are all reasons for the failure to admit.
But that does not account for the medical failure to diagnose.
Sometimes I wonder if the medical view is simply, "Hey, they're all old and dying, what's it matter?" As a caregiver, I can tell you: it matters.
People with dementia deserve to be safe.
They deserve to be living in care where the mentally ill have not been admitted for monetary gain.
And, for that matter, people with serious mental illness deserve to have some peace from the torments of their illness.
So, yes, let's diagnose and differentiate, okay?
I was still in the innocent phase when I thought an diagnosis of Alzheimer's meant something specific and exact.
I was hired to bring in a Alzheimer's only program for a multi-home owner who was losing ground to the incoming Rumanian immigrants who had friendly lively homes full of a mix of elders and jolly Rumanians.
There were four elders living in Charley's home.
All said to have Alzheimer's.
And we soon located one more elder with Alzheimer's, so we had a full house of elders with Alzheimer's.
Except that wasn't true, as it turned out.
Back then, in the 90s, people were still using the term Alzheimer's to apply to any kind of dementia.
That's no longer true.
We now at least differentiate more, but we still fail to diagnose mental illness in elders.
Looking back, I would now say we had one resident with probable Alzheimer's, two with very mild cognitive impairment and then the two seriously mentally ill residents.
One heard voices and had extremely paranoid issues, the other had outbreaks of physical violence with night hours of moving heavy furniture around to barricade her door.
Does it matter that mentally ill people are thrown into a dementia basket? YES.
Here's why.
It is these seriously mentally ill people who are usually the perpetrators of violent attacks in care situations.
Look at any violent deaths in Alzheimer's care facilities, and you will find someone whose real diagnosis should have been a serious intractable mental illness.
It is not a safe mix to bring together those with dementia and those who may be schizophenic, psychotic, bipolar and so on.
Even with appropriate medication, I have doubts about the safety factors of mixing them.
Here's why.
People with serious mental illness can find those with dementia both threatening and very annoying.
There was a recent incident in a nursing home where one old woman strangled her room-mate to death and put a plastic bag over her head.
This is psychotic stuff -- not that I'm diagnosing, you understand.
People with dementia may hit out when frightened, but they don't make plans to murder room-mates.
Why not? Failure of deductive reasoning, is why.
That old lady in my care home -- she wound a radio cord all about her arm one night, got a caregiver to kneel down to help with her slipper and whopped him on the head with her heavy portable radio.
He called the police and she was hauled away to a geriatric psych unit and the state banned her from ever living in a care home again.
Families have a lot of trouble admitting their mother or father is seriously mentally ill.
Shame, fear, genuine ignorance -- these are all reasons for the failure to admit.
But that does not account for the medical failure to diagnose.
Sometimes I wonder if the medical view is simply, "Hey, they're all old and dying, what's it matter?" As a caregiver, I can tell you: it matters.
People with dementia deserve to be safe.
They deserve to be living in care where the mentally ill have not been admitted for monetary gain.
And, for that matter, people with serious mental illness deserve to have some peace from the torments of their illness.
So, yes, let's diagnose and differentiate, okay?