Chapter 20: Care of the Adult with Dementia

Nettie is 75 years old and lives alone in a large house set in a leafy and quiet road. She has lived there almost all her married life. Her husband died five years ago and her only son John lives over 100 miles away. He has not visited for over a year, as his wife has been very ill and unable to manage without him. Nettie speaks to him on the phone regularly and he believes his mother is coping very well. She has a wide circle of friends and interests and she mentions them frequently when chatting on the phone. Her son receives a phone call from his mother’s next-door neighbour who seems upset and says that Nettie is accusing him of stealing money from her house. Her son is horrified and makes a trip home. He discovers his mother living in a dirty house; she is unkempt and has lost weight.

What might be the cause of Nettie’s condition and behaviour?

The neighbour could be taking advantage of the isolated lifestyle Nettie is living and be stealing money from her. She could have a physical illness and this could have led to delirium, leading to a false belief that her neighbour was stealing from her. She could have depression and this has led to her no longer caring for herself and her home. She may be accusing the neighbour because she feels vulnerable. She could have dementia and this has led to a slow deterioration in her ability to care for herself and understand what is happening to her money or where she has put this.

How might you consider addressing this situation, using an integrated approach?

This needs to begin with her son who should make contact with the GP or integrated team. The first consideration should be Nettie’s safety, identifying where there are issues around abuse and neglect.

Nettie needs a physical examination and actions to address any disease process, injury or infections. Her medication concordance should be explored and any medication should be rationalised to ensure she is taking only that which is appropriate for her needs.

A range of assessments by relevant practitioners should include her functional ability to carry our activities of living, her ability to manage her home and finances and her current connections with other people and organisations to identify who supports and provides companionship. A mental health assessment should include identifying the presence of delirium, depression or dementia.

The team and her son working together with her, to address issues raised by the assessment processes, could ensure Nettie’s safety and wellbeing. This could include treatment of physical and mental ill health, provision of support services and a review of her need for safeguarding actions.

The outcomes for Nettie will depend on an integrated and collaborative approach where Nettie’s safety, dignity and quality of life are central to any actions that are taken to support and care for her.