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CARE EXAMPLE 1

Mr R is 54 years old and married, with two daughters aged 20 and 14. He lives with his wife and youngest daughter; his eldest daughter lives locally. Mr R has his own textile company, which he has managed successfully with a business partner and close friend for many years.

There is a familial history of young-onset AD; his mother developed the condition in her late 50s, which eventually resulted in her requiring nursing-home care, and died in her mid 60s.

In the months prior to referral, Mrs R had noticed increasing incidents of forgetfulness in her husband; he would forget conversations and repeat questions. She also noted that he would be searching the house for things he had misplaced and, on occasion, accuse her of hiding or losing items. He had forgotten instructions and planned tasks. This resulted in him forgetting to collect the youngest daughter following a school trip and not arriving at pre-arranged meeting places. He had taken his wife into town and, after visiting a shop on his own, had driven home without her.

His business partner had also, on an increasing number of occasions, contacted Mr R’s wife to enquire as to his whereabouts, as he had not turned up to an arranged appointment. This was having a detrimental effect on business, and customers were expressing their annoyance. Despite prompting and careful and supportive organising of his workload by his partner and secretary, the situation was deteriorating rapidly.

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Mr R did not appear to be aware of these difficulties at the time and felt it was ‘just his age’. He did however mention that people were concerned about his memory when visiting his GP regarding an unrelated health matter, resulting in a referral to the local memory clinic. Mr R was diagnosed with AD and offered acetylcholinesterase inhibitor medication.

Their daughters were also extremely distressed; the oldest was able to talk over some of her concerns with her mother, but the younger daughter found this very difficult and became quite withdrawn and declined the option of talking to a member of the clinical team.

On commencing treatment, there were issues regarding concordance with Mr R’s medication. He had a good rapport with the nurse specialist and during discussion stated, ‘If I accept that I need the medication I have to accept that I have the condition’. There seemed to be resolution following this discussion and to date Mr R is fully concordant with the treatment.

Mr R decided to sell his company in order to ‘do the things we always wanted to do while I’m still able’.

Each member of the family said they would like to talk to someone in a similar situation.

Unfortunately, Mr R quickly developed visuospatial problems and was told he should stop driving. He saw this as a ‘devastating blow’ and angrily challenged this directive. He underwent a driving assessment at the DVLA centre, the outcome of which supported clinical opinion, and his licence was withdrawn. This had a far-ranging and major effect on the family. Mrs R did not drive, and there were no local shops. They used to spend the family holidays touring in their caravan.

Mrs R had a part-time job and was understandably worried that her husband would become more isolated and housebound.

From: 4, DEMENTIA

Cover of Dementia
Dementia: A NICE-SCIE Guideline on Supporting People With Dementia and Their Carers in Health and Social Care.
NICE Clinical Guidelines, No. 42.
National Collaborating Centre for Mental Health (UK).
Leicester (UK): British Psychological Society; 2007.
Copyright © 2007, The British Psychological Society & The Royal College of Psychiatrists.

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