Spring 2006
Caring for Celia

When 81–year–old Celia began to suffer from both mental and physical problems, her son Eric wondered how to care for all of her needs. Here are some thoughts from Eric, and from Celia's healthcare team, about how the Geriatric Psychiatric Unit at Bridgeport Hospital has helped prepare her for the transition to a nursing home.

Eric: It's a strange feeling. You know, my mother always cared for me when I was a child; put Band-Aids on my scrapes, showed me how to tie my shoes, taught me my manners, kept me safe and happy and loved.

In her seventies, she was the one who needed help. She developed heart disease. Then I began to see mental changes. At first she just seemed absent minded, forgetful. But about a year ago, matters got worse. True, she had always been strong-willed and feisty—but now she was often angry and argumentative. Sometimes she even became combative with me when I was trying to help her.

Mother's primary care physician recommended a geriatric assessment by Dr. Beata Skudlarska at Bridgeport Hospital. Dr. Skudlarska diagnosed dementia. I had been expecting something like that, but it was still hard to hear. I knew it was time for me to trade places with my mother. I needed to find a way—and a place—to care for her.

Beata Skudlarska, MD, Chief of Geriatrics: A dramatic change in behavior may be related to changes in the brain associated with dementia—the loss of mental ability. Dementia often makes itself known by symptoms such as memory loss, difficulty performing familiar tasks, language problems, disorientation, poor judgment and changes in mood, behavior or personality. A role reversal is not uncommon with adult children like Eric, who are faced with caring for a parent stricken with such a debilitating condition—especially when combined with physical problems.

Eric: Mother is almost completely deaf. (I've been communicating with her in writing for nearly two decades.) Her heart and her hearing, combined with her dementia, complicated the decision as to where she should live, because she needed care on so many levels.

For a while, having a home health aide kept Mother fairly independent in her home, but as time went by, I realized that she really needed a more secure environment. I looked into assisted living, but it was clear to me that her demanding physical and behavioral problems required more attention than they could provide.

I was at my wits' end. I wanted to do what was best for Mother—but what was that?

I finally found the answer when Mother's doctors recommended a short stay at the Geriatric Psychiatric Unit at Bridgeport Hospital. That's where all of her issues could be addressed together and a treatment plan developed.

Sylvia Purugganan, MD, Psychiatrist, Geriatric Psychiatric Unit: This unit is designed to assess and stabilize people such as Celia, who have medical conditions combined with behavior disorders that can make it difficult to provide care. The usual length of stay here is 10–14 days, while we work out the right combination of therapies, medications and techniques to change behaviors and stabilize physical problems. We then work as a team to help families find the best living environment for their loved ones to move into.

Candace Maffei, RN, Nurse Manager, Geriatric Psychiatric Unit: We pride ourselves on creative, individualized care. For example, we found that massaging Celia's hands with a scented lotion is helpful. Her hearing loss has meant that she sometimes experiences sensory deprivation—a loss of input from the world around her; but the sense of touch from the massages and the aroma of the scented lotion make up for that loss. This often calms her so that she does not require additional medication that might make her groggy.

Karen Hutchinson, MD, Medical Liaison, Geriatric Psychiatric Unit: In view of her heart disease, we keep a close eye on Celia's heart health. It's a two-way street: her physical problems can make her mental problems worse, and her mental problems can cause physical symptoms. For example, she often suffers from anxiety, with difficulty breathing, chest pains and other symptoms that can mimic a heart attack. As an internal medicine physician, I can determine when tests are needed to rule out a heart attack, and when it is not necessary to put her through the stress of being tested. This balanced approach is key to the way we work in the Geriatric Psychiatric Unit.

Eric: Now I can be comfortable, knowing that Mother is being cared for as an individual, both physically and mentally. And her physical condition is continuing to improve.

Candace Maffei: We have found a nursing home for Celia and are now working on a "discharge plan"—a series of steps to help her make that transition—to a place where she will continue to be safe and comfortable, and will be treated based on the steps that we have evolved for her.

Mary Cilio, RN, LCSW, Discharge Planner: I will make sure that the nursing home knows not only about Celia's physical and emotional needs, but about her lifestyle issues—the foods she likes, the way she likes to dress and comb her hair, etc.—so the transition will be easier for her.

Eric: The Geriatric Psychiatric team has helped me to understand that Mother's mental condition will, sadly, continue to progress, and that she will be unable to live in an assisted living environment. But working together, we have found the nursing home and the treatment plan that will be best for her. And that has meant peace of mind for me.

[Note: Eric and Celia are not their real names.]