Dementia can be variable, and factors like hydration and medications can impact the level of dementia at any point in time. (long post below…)
It’s clear if someone is able to walk but can’t remember to get up and go to the bathroom in time, and can’t remember to eat, they have pretty bad mental impairment. But if we are talking about forgetting names on occasion, or forgetting conversations, but that same person can drive to the local store without getting lost, and cook and feed themselves, and use the bathroom appropriately, and take their medications on time, and call their children and grandchildren on the phone, is it really dementia or is it just a mild impairment that is not systemic?
I had a medical condition which caused dementia, and the worst thing was that I could not talk clearly or understand where I was, but I could remember that when led to dinner, I should eat. And how to eat. I could remember that the people I was with were my loved ones, and that I should listen to them. I could not remember names though. I had trouble understanding where I was, but I knew I was safe. That level of dementia sustained (thank you to modern medicine as I got treatment which cured the episodes) would be too much to let someone live on their own.
Nowadays, I hold down a job but do forget where my car is on occasion. I have no problem realizing where I am and what I am doing (except if I have a severe illness which requires medication adjustment; my spouse aka caregiver knows what to look for symptom-wise). I am terrible with names but always have been.
My point is, I feel that the more we can go through a list of the most important life skills down to the least important life skills, and figure out which are there and which are not, and how often it is an issue, the better off we are about deciding if a loved one needs care part of the day or all day, and/or care outside their home.
Working backwards, and noting all of these can be other problems than dementia:
- does the person know where they are and who they are?
- does the person bathroom appropriately, either use the bathroom on their own or tell a caregiver that they need to use a urinal or bedpan, or change a depends?
- does the person eat appropriately, do they prepare their own food with little help, can they safely use a stove and/or microwave? do they take their medications as prescribed?
- does the person move around as able, follow PT/exercise instructions when given if bedridden, or walk around as opposed to sit all day? do they tie their shoes, dress themselves, zip their zippers and button their buttons?
- does the person recognize loved ones, and know they are loved ones, with or without remembering names?
- is the person agitated and upset regularly, and talking negatively and suspicious of others? is the person violent at all?
- does the person forget names of objects and places, and names of close loved ones? does the person show agitation when they forget a name, or is it clear they don’t even know who the person is (like that their son is their son, whether they know his name or not)?
That’s about all I can think of now. And the “regularly” part can be important, but at some point, even some of these being a concern 25% of the time can be enough to consider long-term care of some sort.
My dad is still driving, but we have given him restrictions that he follows - no night driving, no driving more than 15 minutes except for one doctor where he goes local roads, and is comfortable. He will tell us to pick him up if he comes to our house, which although it is within 15 minutes, often he would be at our house at night so we don’t want him to have to stay over or drive at night.
He shops and cooks his food himself. He has done things like left cooling food in the oven for weeks, but honestly he was never a cook and had a family event, and it was our bad that we didn’t check on the oven before we left the gathering. He forgets conversations on occasion, but for more than 30 years he has retold stories that were repeats (who hasn’t had that from their parents?), and oddly enough, I’ve heard more new stories over the past five years than I ever had.
Am I worried that he has mild dementia? Yes. Do I try to convince him to let me know if any new symptoms appear, like getting confused where he is when driving or losing track of money or eating? Yes. Does he need 24/7 care? No, I don’t think so.
I’m thinking that within 5 years, he should be living with one of his kids. But for now, he is happy where he is and stable.
As for travel - my dad is not amenable to travel more than an hour or two as he does not like to sit for very long without standing up. It’s just not comfortable for him. He goes to his church and church events, he goes to our houses and will go to school events or sports events on occasion if they are near his house. But that is it. He was forced to travel last year with my brother, and hated it. He went as a caregiver to my adult autistic nephew during the trip, and that was very taxing. I will INSIST that he never go again, despite the “inconvenience” to my brother.
