Signs of Physical Change
Physical changes are often overlooked or not associated with signs of dementia. We tend to think of physical symptoms as age-related only. The signs below aren’t caused by dementia, necessarily, but can definitely be exacerbated by dementia.
As with any type of change or symptom, it’s important to never assume it’s “just” dementia. Instead, make a doctor appointment. (See How To Get Someone with Dementia To Go To The Doctor.)
Sign: Falls; change in gait/strength
Why it’s a big deal: In a word: death. As in, falls can lead to a hip fracture, which can lead to death. If that doesn’t make any sense to you, no worries. It didn’t make a bit of sense to me, either, before I got into this line of work.
Hip fractures typically require surgical repair. Beyond the general risk of anesthesia for older adults (and how it worsens symptoms for people who are cognitively impaired, and how it can take up to a year to completely clear in older adults), our hips are the hinge between our upper and lower bodies. They allow us to sit/stand upright and keep fluid from collecting in our lungs…unless they’ve just been surgically repaired.
Beyond the risk of hip fracture, there are other kinds of fractures, and of course the risk of head injury. Changes in gait/strength can indicate Parkinson’s disease, Dementia with Lewy Bodies, or other neurological issues that need addressed.
When to intervene: Right away. Falls and changes in gait/strength can all be symptoms of a heart or neurological condition that requires timely intervention.
Intervention quick tip: Remove throw rugs and runners to assist with preventing falls.
Sign: Change in sleep pattern
Why it’s a big deal: Changes in sleep pattern can be an early sign of Dementia with Lewy Bodies, or due to sleep apnea (a risk factor for vascular dementia and associated with Alzheimer’s disease).
When to intervene: When you notice changes. Sleep-deprived people don’t function as well as folks who’re routinely getting a good night’s sleep, so you may notice changes in personality, mood, or cognition before you realize it’s being caused by poor sleep. Head to an appointment and request a sleep study.
Intervention quick tip: Sleep medications are contraindicated for older adults and people who are cognitively impaired. This includes Tylenol PM (and Advil PM and Excedrin PM and Benadryl and other over the counter medications, etc). Melatonin may be useful, or not; the best way to intervene is to get to the doctor and refuse any/all sleep medications. Try the ideas in Let’s Do Better.
Sign: Sudden incontinence/frequent urinary tract infections
Why it’s a big deal: UTIs have different symptoms in older adults and cognitively impaired people than they do in others. These symptoms can often be ignored as a case of “it’s just the dementia.” Untreated UTIs can lead to the wrong medications being prescribed and/or to a severe infection such as sepsis.
When to intervene: As soon as you notice a sudden change in behavior/personality, seek medical attention.
Intervention quick tip: Sudden change in behavior/personality will almost always show up prior to a urine analysis catching the problem. Track patterns (and take this log with you to the appointment) so you can show the doctor what’s going on.
Sign: Dramatic weight loss; dietary changes; eating inappropriate food items
Why it’s a big deal: A sudden spike in eating, or eating high-carbohydrate foods such as sweets, can be an indicator of frontotemporal dementia (FTD). Eating inappropriate items can be a sign of confusion, or a condition called PICA. Dramatic weight loss can be a sign of Alzheimer’s disease (forgetting to eat, or the brain sending erroneous signals one’s already eaten and is full) or another condition.
When to intervene: As soon as you notice signs or symptoms. Because of the wide variance in possible underlying conditions, it’s important to promptly seek medical attention.
Intervention quick tip: For weight loss, try offering easy to eat foods (think cheese sticks, apples slices, half sandwiches) at various points throughout the day. Using supplements such as Ensure can actually cause the problem to get worse, as appetite is gone at meal time.
If consuming non-food items is the problem, do a sweep of the environment with an eye toward removing anything small enough to fit in your person’s mouth. Likewise, remove sugary snacks and replace with higher protein foods if high-carb consumption is the problem.
Sign: Self-medicating through use of alcohol/drugs (prescription or illegal)
Why it’s a big deal: It’s dangerous, is the short answer. Additionally, self-medicating is often masking an underlying condition. It could be depression, or it could be frontotemporal dementia, or it could simply be a manifestation of poor judgment caused by any type of dementia.
When to intervene: Immediately. Seek medical attention. This could be a life-or-death situation, and it’s always better to feel “silly” later than guilty.
Intervention quick tip: No matter how big a fan of Intervention you are, resist the urge to convene your own version. If you’re reading this article, chances are high dementia is the underlying cause. Therefore, using reason and logic is not a good idea.
Sign: Repeated trips to the ER, hospital, urgent care, doctor
Why it’s a big deal: Seeking medical attention when needed is always appropriate. However, when the frequency starts picking up, that’s typically a sign something is off-track. Often, it’s a clear indicator the current living environment is not able to adequately and safely support a person’s needs. It can also be an indicator that a condition is progressing and further intervention or supports is necessary to stabilize the situation.
When to intervene: No time like the present. It’s hard to see clearly, in the moment, when we’re talking about someone we love. Take a look back over the last 30 days, 90 days, six months, and year. Do you see a pattern? Would a professional see a pattern?
Intervention quick tip: Have your review list handy, and ask a professional for help.
Next week, we’ll wrap up this series with a look at cognitive changes that can indicate it’s time to intervene.
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Christy Turner is a speaker and consultant, the founder of DementiaSherpa.com, and creator of the program What To Do When Your Parent or Partner Has Dementia. She’s a regular contributor on The Alzheimer’s Podcast with her segments “Guiding You Through Rough Terrain with The Dementia Sherpa.” Christy has enjoyed the privilege of working with over 1,200 people living with dementia and their families.