What to do if changes in judgement are more serious

What to do if changes in judgement are more serious?

The last example was a brief and one-time experience for Waheed. However, what happens if the changes in judgement experienced by a person living with dementia are more serious? Here are three examples to help you learn how to react.

Mishandling finances

Hadeel has dementia and lives alone. Her cousin Noora has come to visit her. Despite the fact that Hadeel has always been organised, Noora arrives to find that there is a large pile of unopened mail on the kitchen table.

Noora wonders if Hadeel has had some trouble paying her bills. She asks Hadeel about her finances. Hadeel cannot remember whether she has paid her bills or not, does not know when they are due, and cannot recall how much money she has in her bank account. Noora becomes quite concerned.

2. Check your understanding

Managing more serious changes in judgement (1).

What would you recommend to Noora?
Please select all correct responses.

Stay calm and call Hadeel’s daughter.
This response is good because Noora shares her worries with Hadeel’s closest relative, her daughter, who might know more and can arrange help if needed.

Go to the bank and ask for control of Hadeel’s finances.
This is not appropriate because it is Hadeel’s decision to appoint a person that she is comfortable with to help manage her finances.

Leave because she feels uneasy.
This response is not appropriate. If Hadeel has problems dealing with her finances, letting the situation continue could make things worse.

Ask Hadeel if she would like some help in opening her mail.
This response is good because Hadeel may be able to pay her bills if given the right prompts, such as opening the bills in front of her and cueing her to pay one at a time.

Try to find out whether Hadeel has someone who handles her finances, like a family member or a professional?
This is a good response because Hadeel may be at the point in her illness where she is no longer able to handle the finances on her own. If it seems that she is not getting any help with handling her finances, Noora may want to call her daughter to share her worries.

Insisting on driving

Khalid is living with dementia. His neighbour, Jaber, notices that

his car is parked very strangely one day, obstructing some of the other cars on the street.

Jaber walks out of his apartment, sees Khalid and attempts to start a conversation.

Instead of stopping, Khalid jumps in his car, speeds off and takes an illegal left turn out of the compound. Khalid returns quickly and nothing bad seems to have happened.

Remember

It is better if the decision not to drive comes from the person living with dementia. Giving up driving is typically a difficult time in the person’s life where they are losing independence.
Alternatives such as offering regular rides, teaching the person how to use public transportation or arranging taxis will help the person stay active and involved in their community activities.
It is important that the person does not become isolated or lonely once they give up driving. More effort will be needed to keep them connected to the world outside their home.

3. Check your understanding

Managing more serious changes in judgement (2).

What would you recommend to Jaber?
Please select all correct responses.

Immediately seize Khalid ’s car keys when he returns. This will prevent it from happening again.
This is not a good response because Jaber cannot decide whether his neighbour should drive anymore, and Khalid may become angry.

Stay calm and ask whether Khalid has any other places to go that day, and if so, offer him a ride.
This is a good response because it prevents Khalid from driving unsafely and provides safe transportation, so Khalid can run his errands.

Ignore the situation because it is embarrassing.
This response is not good . because Khalid’s driving may cause harm to himself and others.

Ask Khalid if he would like some help figuring out transportation.
This response is appropriate because Khalid may be able to safely ride a bus or walk, preventing any unsafe behaviour.

Tell Khalid that he is concerned about his driving and suggest visiting his doctor to discuss it.
This is a good response as Jaber respects Khalid by being honest and raising a concern.

Report the incident to Khalid ’s carer, friend or family member.
This is a possible response. Jaber may not know if Khalid has dementia and could be concerned about the risk of harm to Khalid and others.

Inappropriate sexual advances

Hamid is in his late 70s, has dementia and lives with his family. Two days a week, an in-home aide, Zahra, who is 22 years old, comes to help him take a bath and administer his medication. This arrangement has been working well for several months.

One day, while preparing for his bath, Hamid makes some sexual remarks and tries to pull Zahra close to him. Zahra is shocked and surprised. She runs out of the room and tells the family that she can no longer work there.

Remember

If the inappropriate advances continue, the family might want to consider hiring a male in-home aide instead of a female one which could prevent this behaviour. They also might seek help from a professional.

4. Check your understanding

Managing more serious changes in judgement (3).

What would you recommend to Hamid’s family?
Please select all correct responses.

Stay calm and tell Hamid that this behaviour is unacceptable. Explain who Zahra is.
option is a good one. Hamid’s family does not overreact because they remember it is the disease taking effect. They redefine the appropriate boundaries for Zahra’s safety.

Change the bathing situation. Perhaps Zahra can set up a sponge bath and Hamid can do more himself.
This is a good option. Letting Hamid do more himself will distract him. In this way, both Zahra and Hamid’s dignity are maintained.

Change the environment. Put a towel or robe over Hamid ’s shoulders while he is being bathed to keep him covered for privacy.
This is a good response. Perhaps because Hamid is naked, he misunderstands the situation.

Shout at Hamid, shaming him for his conduct.
This response is not good because as part of his dementia Hamid may not know that these advances are inappropriate. Therefore, try not to overreact.

Ignore the situation.
This response is not good because Hamid may continue to make inappropriate sexual advances and cause distress to Zahra.

2.Activity

Let’s look at your own situation
It is important to apply what you have learned to your own situation. Earlier, we asked whether the
person you care for sometimes shows changes in judgement. After going through these examples, think again about your own situation.
The spaces below are for you, like a diary.

Does the person living with dementia sometimes show changes in judgement?

In what way could you respond?

Take a moment to summarize the points that you have learned, which will help you deal with changes in judgment in the future.

Remember

Changes in judgement may hamper decision-making. If you want to know more, review Lesson 3. Supported decision-making in Module 2.

Lesson 9. Changes in judgement

What to do if changes in judgement are more serious

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