The Circle of Life

Everyday at work I see the tough decisions families have to make regarding there loved ones. I get asked a lot what would I do. I have to remind them this is a personal decision but I will answer any other questions they have. My patient the other day was a 68 year old man with progressive dementia and he is affected mostly by sundowners. This happens when the sunsets. Some elderly are profoundly affected by nighttime causing hallucinations and delusions that can become harmful to them and others. It can be very depressing and upsetting to their loved ones. Generally I find that they are much milder at home because it is a familiar environment so family has a tendency to be in denial of problems

This patient wandered from the home and was missing for over a half day. He almost died. While in our care we had to us soft restraints to keep him safe he was very impulsive and agitated. His wife and daughter were extremely upset that restraints were used especially the daughter. I spent a good hour talking to the wife about her options and what we had observed in the last 24 hours. She was saddened by the fact that the best option for her husband of 30+ years was more then likely a nursing home. I reinsured her that feelings of sadness, anger and guilt are all appropriate. The daughter on the other hand is convinced that if her mother remodeled the house it would be more accommodating and he can come home. I did have to speak up on my patients and spouses behalf. This daughter only lives here in the summer and she wasn’t even willing to stay the night with him so restraints dodo not have to be used. I gave her the same talk I gave her mother hoping for a change of mind.

She did change her mind and I was grateful for everyone’s sake. Nursing homes are not always the best option but if there is no support. Safety becomes an issue.