Part 1 The Calos-Clark Family
1.4 Calos-Clark family case study 3: Jay’s suspected dementia
Jennene Greenhill and Anna Foster
Introduction to case study
Learning Objectives
By the end of this case study you should be able to:
- Develop an understanding of the early symptoms of dementia.
- Understand a holistic approach to managing dementia.
- Explore the roles of the interdisciplinary team in diagnosing and managing dementia.
- Identify the safety issues involved in a dementia diagnosis.
Scenario
Giani is due for discharge home from hospital following his total knee replacement on Friday, 3 days after his operation. The evening before, Jay arranges to pick up Giani from the side of the ambulance bay at the hospital at 10 am. Giani completes his discharge and heads to the meeting place. Jay does not arrive at 10 am. Concerned he won’t be able to stand for long, Giani calls Jay to see how far away he is and finds that Jay is in the middle of making scones for morning tea with the next-door neighbour. Jay has no recollection of the arrangement to collect Giani. He says he thought Giani was not due for discharge for several days. Giani elects to catch an Uber home, rather than rely on Jay.
Giani has noticed that Jay has become more forgetful than usual. Initially Giani had put this down to the stress of opening the new business and the long days involved. He had thought Jay just needed a break and a good rest. When Giani arrives home, he finds Jay has forgotten the scones which are now burnt in the oven. Meanwhile, Jay is outside weeding their vegetable garden.
The following afternoon when Giani is due to see their GP for review of his knee wound, he suggests to Jay he should also see the GP about his forgetfulness. Although Jay is quite reluctant, Giani books the appointment and convinces Jay to see the GP as they are going there anyway. As Jay parks his 1964 Rover, he has a minor accident with another patient exiting the car park. He becomes irate, yelling and accusing them of backing into the front of his car. Giani took several minutes to calm Jay down and thought maybe this uncharacteristically short temper was one of his symptoms.
The GP, their long-time doctor, listens to Giani’s concerns about Jay. The doctor sees that Jay is still emotional from the car incident and asks Jay whether he has noticed other changes in his mood or his usually calm demeanour. Jay admits he has been a lot more irritable lately and sometimes becomes anxious about the smallest things. The GP explains these could be behavioural symptoms of dementia and notes the impairment of ADLs (activities of daily living). He undertakes a series of tests and begins the initial steps for cognitive assessment, including a mini-mental state exam, and is alarmed at the results. He tells Jay and Giani to return 3 days later for another appointment and for more testing. It is apparent Jay has been masking his symptoms for a very long time.
After extensive testing, it is determined that Jay is experiencing the early stages of dementia.
Case study questions
- How might a diagnosis of dementia change Giani and Jay’s relationship?
- Being gay and having dementia is referred to as ‘a double whammy’. What do you think this means?
- Before his diagnosis Jay burnt the scones. What are the safety considerations around the home for someone with a diagnosis of dementia?
- How does the interdisciplinary team ensure the living situation is safe for Jay and Giani with this diagnosis?
- A diagnosis of dementia is life changing. How should clinicians break life-changing news to patients?
- What is the role of the aged care assessment team (ACAT) in the case of a dementia diagnosis?
- How would other health professionals be involved in the diagnosis, care planning and treatment?
- What support will Giani need to manage Jay’s responsive behaviours?
Key information and links to other resources
The patient journey in dementia is complex, but the journey of care with regards to being gay may require additional support.
- Crameri, P., Barrett, C., Lambourne, S., & Latham, J. (2015). We are still gay … An evidence based resource exploring the experiences and needs of lesbian, gay, bisexual and trans people living with dementia. Australian Research Centre in Sex, Health and Society, La Trobe University. https://www.dementia.org.au/sites/default/files/NATIONAL/documents/Dementia-Narrative-Resource.pdf
Thinking Point
While living with dementia is very challenging for everyone, one glimmer of light comes from the benefits of music and the arts. Jay and Giani are both talented musicians and performers, so think about how they might respond to the calming influence of beautiful music. There is an emerging body of evidence that music helps preserve memories, for example see:
- Beard, R. L. (2012). Art therapies and dementia care: A systematic review. Dementia, 11(5), 633-656. https://doi.org/10.1177/1471301211421090
- Kuot, A., Barton, E., Tiri, G., McKinlay, T., Greenhill, J., & Isaac, V. (2021). Personalised music for residents with dementia in an Australian rural aged‐care setting. Australian Journal of Rural Health, 29(1), 71-77. https://doi.org/10.1111/ajr.12691
- Hamiduzzaman, M., Kuot, A., Greenhill, J., Strivens, E., Parajuli, D. R., & Isaac, V. (2020). The nexus of ‘music, mind, and well-being’: Effects of harmony in the bush music intervention for residents with advanced dementia in Australian rural nursing homes. Research Square. https://doi.org/10.21203/rs.3.rs-67641/v1
Case study 3 summary
The couple are even more stressed when it comes to light that Jay has symptoms of dementia. They have a supportive general practitioner who helps them to navigate the complexities of the community assessment and support services. This case study highlights the role of the general practitioner as a linchpin and gateway to other vital, specialised assessment and community health services. Many services are finding ways to support families from diverse backgrounds and some residential facilities are able to provide tailored services for the LGBTIQ+ communities.