Even though mom was in her mid-80s, she was independent and socially active. She had a "boyfriend". Yet she was also more easily confused. After taking the mini mental status exam — a screening tool for dementia — the doctor confirmed that mom was in the early stages of dementia.

The family decided to keep mom in the familiar surroundings of her condo and “independent” for as long as possible. More frequent visits ensured that she had food and that her place was clean. But it became clear that a full refrigerator doesn’t ensure three healthy meals each day. Mostly, it ensures spoiled food.

The plan “succeeded” for about 2 years, and over time there was less urgency to make adjustments to her surroundings, even as dementia progressed. Eventually, mom fell and broke her arm while getting out of bed. After lying on the floor for several hours, a neighbor heard her calls and contacted the EMTs. She was hospitalized, then moved to assisted living, and then eventually to around-the-clock care. She died in a nursing home 4 years later.

The bottom line.
The plan to keep mom in familiar surroundings was short-sighted. Family members coming to terms with dementia for the first time are ill-prepared to make these decisions without professional assistance. Sadly, they become stuck in the past every bit as much as their loved one.

The most effective care plan for patients with dementia is a tactical retreat — a flexible plan that anticipates issues associated with declining cognitive function. It requires skilled specialists to guide mom and the family through this difficult period.

To prepare yourself to care for your loved ones, click here for an excellent new book from the Alzheimer's Association. Then check with your doctor and state agencies to see how they can help. Finally, be skeptical of alternative treatments for dementia. A review of the evidence is here.

Five issues and actions that provide for the needs of the patient with dementia. More information is available at The Merck Manual. More information about the Safe Return program is here.