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Thursday, August 16, 2012

Joe Running

I need to back up a bit to the day that Joe took off, with the intention to never return. He had gone on very long, two hour walks up until the previous September. He had actually brought the aide home when she took him out during the 4 months before he was placed. He had always known where home was. But that day he did not know that the house we had been living in since 2004 was his home. That was somewhere else.

This had actually been going on for several days. It would start at 4 in the afternoon and continue until he was exhausted at 6 when he would need to go to bed. He would be up again by 8 and get dressed for the next day because in July it was still light out. I'd manage to get him back into bed an hour or so later when it was dark. So I basically was exhausted because there was no rest. This is called Sundowning. It is very common with dementia patients at the early part of the last stage of the disease.

That particular day he was very agitated. He needed to go. He had work to do. He had children he needed to get home to. He had no idea who I was and hadn't for a couple of years but I was the person who was keeping him from going home, where he needed to be.

Keeping him in the house got very physical. He knew how to open the locks on the back door and the front door. He couldn't manage the slider, but he tried that on every round of the house. He would get to the door first because he was much faster than I was, and unlock the door. I'd put my body between the door and him and try to get it locked again. He would give up on that door and go to the other part of the house and try that door, and we went round and round and round for 2 hours. And then he tried to go out a window. And it took me just a second longer to get to the front door. He shoved me out of the way, and got out of the house.

It wasn't possible for me to go after him, so I called the police and Safe Return. I'd bought him a Safe Return bracelet just a couple of weeks earlier. The person at Safe Return stayed on the phone with me after putting Joe's information into the system as a person who was running away.

The police came very quickly. A neighbor who had experience with geriatric nursing realized something was wrong and stopped Joe. Her husband arrived at my driveway just as the police arrived. He got into the police car and took them to where Joe was. A few minutes later another neighbor came for me and I went up there too.

The neighbor knew what she was doing. The policeman on Joe's other arm just followed her lead. They had Joe between them. By this point he was very tired and stopped fighting them and they got him back home. My neighbor and I put him to bed. Not long after she left I realized we had made a mistake. We probably should have taken Joe directly to the hospital, but I wasn't sure. Once I knew he was out for the night, after it was dark, I called the Alzheimer's Association hotline and talked to one of the caseworkers there. She told me to call his doctor the next morning since I was sure he would sleep through the night.

Looking back, it was a good thing I waited because I needed all three days at the hospital to find the right nursing home for his situation, but it was not a good thing because Joe's situation was changing rapidly, and he easily could have woken up while I was asleep and taken off again.

In the morning I called the doctor just he got into the office. I was given "magic words" because he couldn't call 911. In PA I had to do that. I told the 911 operator, "My husband has dementia. There has been a cognitive change. His doctor wants him to have a MEDICAL assessment." Those words are important. Dementia patients frequently get taken to a psych ward, and some of the time that is appropriate, but not until a MEDICAL assessment has been made. In Joe's case the first drug they tried on him got him under control. It was a bit too much to let him be alone, so they put a one on one aide on him, but he stayed on a medical floor and wasn't taken to where the psych ward was. The ER doctor and nurse knew exactly what was going on pretty early, but they checked everything just in case. But what was happening was his dementia, and not a separate medical condition.

I didn't know it but what I experienced was just the beginning of a period of anger and aggression and the need to constantly move around. There was no way I could have taken care of him with that going on. It took multiple people, an entire staff, to deal with that and work on adjusting his medications. But all of that is another post.

Take care all.

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