Open full view…

Issues with sleep in 79 yo moderately demented woman

Wed, 29 May 2019 23:24:13 GMT

I am working with family of a79 yo female living in a private residence(not hers) with live in caretakers, 24/7. Major memory loss issues, moderate word finding problems (often unable to complete sentences),Incontinent of urine and stool, perfectly ambulatory. Diagnosed with mild/moderate dementia at Stanford Geriatric clinic in 2016, failed at Senior Independent Living but family set her up with caretakers in 2 bedroom apt where she is well cared for. Only medications: Losartan 25 mg Divalproate 125mg No major medical problems, was prediabetic until weight loss with well balanced meals provided for her. She has lived with caretakers for 18 months. Had major behavioral problems initially: wandering outside, destroying plants, carrying leaves into toilet, then she began defecating outside. She REFUSES to wear diapers/DEPENDS and Is completely incontinent now, basically gets washed 3-4x/day as do her surroundings. She also refuses to sleep in her bedroom and spends the ENTIRE day on the living room couch, moving from end to the other, fluffing pillows, removing he r clothes, putting on new clothes, removing them. She has a TV but does not watch it for more than a few minutes. The caretakers prepare all her meals and she eats still with fork and drinks water and fluids (no caffeine, no sugary drinks). She eats lots of fresh fruits, hard boiled eggs, vegetables. She walks outside to the porch, sits and watchs neighbors and caretakers, and the few children that visit the caretakers (Asian, primarily non English speaking). Her family visits every Sunday, somedays she recognizes the grandchildren, some days she is disinterested. PROBLEM: She takes short naps, and stays up often til 3, 4, 5 am. Wakes for breakfast, then naps. Of note, she has had sleep issues for years, often unable to sleep til 2/3am. She has never been accepting of sleep aides/benzos/medications that “alter the mind”. When going to Stanford clinic, family was offered Trazodone with no effect, Melatonin with brief effects but inconsistent, short trial of Mirtazipine. For travel to new home, family requested stronger meds and was given a few Ativan, which also had no effect (mostly because patient was highly anxious with new surroundings) She has even been given Children’s Liquid Benadryl, no effect. The family are painfully aware of 2 things: She needs some structure during the day (music, walks, looking at magazines, conversation opportunities) She needs help with sleep.

Sat, 14 Sep 2019 21:25:54 GMT

Hello, Sorry for the delay. Caring for the patients in their homes and launching the restructured web site has eaten up my summer! This is a common challenge. First I would not wake her too early. Get her up by ~ 10a, but do not allow her to have many naps in the aft, only 1 1 hour nap. Then keep her up til ~ 10p. Trazodone and Melatonin may have hangover sedation the next day. Benedry is awful, leads to more confusion, agitation. ie same as Tylenol PM. Sounds like a good Geriatric evaluation for her particular situation is needed. The depakote can be sedating, may be the daytime dose. May be pain. We can help.