By PHYLLIS ZORN

Staff writer

It was hard for Kim Smith to watch her parents’ journey through dementia, but not as hard as it was for her sister.

Smith, who asked that her real name not be used, lived close enough to her parents to see them daily and had worked with dementia patients in a nursing home for years.

For her, the changes in her parents seemed more gradual because she was seeing them daily. Her sister, living in another state, would see drastic change each time she visited.

With both parents, dementia symptoms appeared after trauma.

“My father had heart problems,” she said. “That can lead to dementia.”

After a heart attack at age 75, he developed heart valve leakage, which caused infection. He had to have surgery.

“We were seeing that he couldn’t remember things,” she said.

A highly educated man, he eventually couldn’t remember people’s names.

“It wasn’t until probably the last year, when he went to the nursing home, that he stopped using my name,” Smith said. “He still treated me like a daughter.”

Like many dementia patients, he knew something was wrong and tried to hide it, she said.

“We saw little things in the beginning,” Smith said.

His mother had had Parkinson’s, so her father always was watching for things to go wrong with his central nervous system.

“Other people who knew him didn’t recognize that he had a problem,” she said.

Early on, Smith’s mother wasn’t comfortable with her husband driving by himself any more, so she rode along with him.

She feared him not being aware enough or able to make decisions quickly enough to be safe.

“At one point, he drove into oncoming traffic,” Smith said. “We slowly reduced his driving, even when he was living at Parkside Homes.”

Eventually, her mother took away his car keys.

“Mom would remind him of a lot of things, like ‘time to eat,’ or ‘time to go to the bathroom,’ or ‘time to go to bed’” Smith said.

Sometimes her mother would get upset because he wasn’t as regimented as she wanted.

“I think that was part of her own aging process,” Smith said.

The couple lived in independent living for seven years until he went into a nursing home at 85.

What ultimately took his life is that he stopped drinking water and became dehydrated, she said.

“We chose not to rehydrate him,” Smith said. “He wouldn’t have wanted that.”

Her mother’s dementia began after she fractured her hip in a fall. Her hip could not be repaired.

The dementia remained mild, but Smith would walk into her mother’s room, find her sitting in a chair, and her mother didn’t remember having fallen.

“They tell me I can’t walk,” her mother would say.

After a gastrointestinal bleed, her dementia got worse, but she remained fairly clear-headed.

On her 90th birthday, her cognitive abilities changed markedly, Smith said.

“I bet it was about a week,” Smith said. “Right away we saw huge changes in her personality and her cognitive ability.”

Smith bought her a weighted blanket and did everything she could think of.

“By the end, I was sitting by her constantly,” she said. “She still recognized me and knew my name.”

If Smith was gone for a few days, her mother would know she hadn’t been there but had no concept of how long she had been gone.

“There were little things before that,” she said. “She was getting weaker and weaker. She would play the game and act like she knew who people were.”

When her mother died, she’d been alert but went to sleep.

“I went out to dinner with my sister, and I came back and she was gone,” Smith said.

Looking back, Smith thinks she had an easier time with her parents than others.

“I don’t think things hit me as hard as they might have somebody else, because I knew more about it,” Smith said. “For me, it was a day-to-day thing. For my sister, it was harder because of the drastic change since the last time.”

Signs of dementia include problems with short-term memory, paying bills, keeping track of a purse or wallet, planning and preparing meals, remembering appointments, and traveling outside the neighborhood.

Such symptoms are not always an indication of dementia, however. The same symptoms can be caused by depression or can be side effects of medication, excess use of alcohol, thyroid problems, or vitamin deficiency.

Dementia is caused by damage to brain cells, which no longer can communicate in a normal fashion.

A common behavior among people with dementia is that they wander.

Several medications have been approved to treat dementia.

Staying mentally and socially active also help delay or reduce the progression of dementia.

Both Parkside Homes and Salem Home in Hillsboro provide care for dementia patients.

According to Lisa Donahue, director of communications for Salem Home, her facility’s staff received dementia training from a licensed clinical social worker.

“Residents with dementia can sometimes display behaviors — verbal, physical, and even sexually inappropriate behaviors at times,” Donahue said. “All behaviors can typically be traced back to an unmet need such as hunger, thirst, pain or discomfort, fear, and overstimulation.”

Staff members intervene by using techniques such as toileting, position changes, offering fluids or snacks, distraction, reducing environmental stimuli, and redirection.

“Staff are trained to enter the resident’s reality and not argue or try to convince a resident that their beliefs are untrue,” she said.

Stephanie Bryant, chief administrator of Parkside Homes, said her facility provided care for patients with different levels of dementia, from mild to advanced.

“We tailor to their needs,” Bryant said. “We find lots of activities for engaging our residents. Reminiscing is a good activity. They really love talking about the good old days. We find keeping everybody busy is a good idea.”

Doors to the facility are kept locked.

“They are certainly a vulnerable population, and it’s so important to keep them safe,” she said.

She recommends caregivers find positive approaches to caring for people with dementia.

“It’s easier to care for someone with dementia if you keep a positive outlook,” she said.