The experience I had with our mom was eye opening and very meaningful, but what I didn’t know is that I still had some learning to when the time came to care for my father.  Once again, here I was a Geriatric Doctor with vast experience in helping those with Mental Illness and Dementia. I was the expert, so why was it so hard to care for my own father?   

My dad and I had a good relationship we were both very academic and hungry for knowledge.  My dad was very intelligent he was a doctor in his own right, with a PHD. Looking back, I see the signs a bit more clearly, but as many know you can’t always convince someone what’s best for them, especially if they have dementia. 

My dad had lived alone many years in NYC and was fiercely independent. He started having “accidents”.  A fall outside which caused him to be hospitalized. My sister traveled to NYC to help him out after his discharge. Being with him day in and day out revealed his difficulty remembering things and managing his finances etc.  My sister and I tried to convince him at that time to come to live with us in Vegas, but he vehemently refused.  My sister and I knew we would need to have a backup plan, but within a month my Dad a very bad car accident and was hospitalized again. This time the hospital said he could no longer live alone. We finally able to convince him to come to Vegas and live with us. 

When my dad moved in with us, I realized the extent of his Dementia or Alzheimer’s Disease. He was forgetful, lacked insight and judgment & was extremely paranoid and would often accuse me of stealing his money. Of course, this was not true, he was living in my house for which I paid all the bills etc., spent time with him, tried to take him out places.   While I tried to put my expert medical cap on and remind myself that it was his disease, and his hurtful accusations were unintentional, it was still very difficult to not be affected. I found myself having negative feelings toward my dad at times. 

While I had moments of feeling sorry for myself and had difficulty managing my own feelings, I think I was more upset seeing the negative toll the dementia and paranoia had on my father. I saw firsthand, how the paranoia & confusion reduced his independence and his ability interact with me & his surroundings.

The increased paranoia significantly diminished his quality of life, so we tried treating him with an antipsychotic, Risperdal.  Even though I had seen the positive effects many times with my patients, I was pleasantly surprised at how much better my dad was with just a low dose of the medication.  It helped reduce his agitation and paranoia and gave him back some independence.  It enabled us to have more positive interactions as father and son and allowed him to participate more in his care.  We were able to watch Syracuse University Basketball games together, as we had our entire lives free of the paranoia and delusions that had negatively impacted that experience before the medication.  Medication helped him to accept assistance with care, like transfers to the wheelchair and getting in to the car which allowed both of us to enjoy going to his favorite buffet and dramatically improved his quality of life. 

Being an expert in Geriatrics, Dementia and Mental Illness, I know full well the befits and limitations of the various treatments that are available.  Some Experts suggest that behavioral therapy is the only option, and that using medications to treat the symptoms of paranoia, agitation, combativeness, etc. should be discouraged.  I do agree that behavioral therapy can be a useful tool in helping to treat the behavior symptoms that accompany Dementia & Alzheimer’s, but I also know that for people with significant behavior problems, treatment with antipsychotic medications may be needed.   It’s true that antipsychotics have “black box” warnings, which discourage many doctors from using antipsychotics in patients like my father. As with any treatment there are pros and cons, risks and benefits. Of course, having an informed doctor, who is directly involved in the care and has ongoing oversite and monitoring of the effectiveness of the medication is important to ensure the desired effect is achieved. There are things a doctor can monitor to reduce unexpected side effects like checking the magnesium level and an EKG which helps reduce unintended risks of antipsychotic. It’s often difficult to tease out what behaviors are related to “Dementia” and what behaviors could be related to an infinite number of other overlapping medical and emotional processes.  In the end it is necessary to weight the risks and benefits and give patients and families the information to make the best treatment decision for their individual circumstance.

The positive experience I was able to have with my father confirms for me the benefits of trying antipsychotic medication in those with Dementia who also have negative symptoms and behaviors, like anxiety agitation, paranoia, aggression & combativeness.  The increased quality of life we both received by taking them reinforced what I already had experienced with many of my patients that medications often make the behavioral therapies much more effective.

My father and I shared a life time of experiences, I learned many things from him over the years, but the lessons and experiences I learned about being a caregiver from both my parents gave me a depth of understanding about emotional health that I could not have learned from anyone else.  I am truly grateful for all the love and lessons both my parents gave given me.