While his daughter struggled to find a parking spot at the West Haven Veterans Affairs campus, Mr. W went in for his appointment with Chandrika Kumar, MD, FW ’09, associate professor, director of resident geriatric medical education. For the past few years, his memory problems had been worsening and at night, his wife would find him wandering around the house.
At the Medical Grand Rounds on Thursday, August 2, Kumar presented the case of Mr. W, a moderately severe Alzheimer’s Disease patient, to illustrate how to treat a patient suffering from dementia, and the patient’s caregivers.
According to Kumar physicians should screen all older patients, patients over 65 years old, for dementia. “We owe this to society,” she says. Catching it early can help preserve a patient’s independence. It gives caregivers and patients the opportunity to prepare for risks like delirium after surgery, and possibly delay nursing home placement.
When confronted with a dementia case, before assessing treatment options, Kumar says a physician needs to determine both the patient’s and caregivers’ goals of care. For Mr. W, the most important care goal was to prevent falls. For the caregivers, their goal was to have Mr. W sleep through the night. After discussing their options, Kumar, Mr. W, and his family settled on adult daycare as the best option for Mr. W.
Kumar emphasized that as the patient’s dementia progresses, physicians shouldn’t lose sight of caregiver health. Progressively worsening dementia symptoms are associated with caregiver stress and depression, which may impair care of the patient.