Subtle Signs: Assessing for Dementia Warning Signs during an Acute Episode of Grief in Recently Widowed Individuals

Saturday, 7 November 2015: 3:15 PM

Debbie Nogueras, PhD, MSN, ARNP, BC
School of Nursing, Northern Arizona University, Flagstaff, AZ, USA

This presentation will discuss the importance of recognizing the similarities of grief and early warning signs of dementia that may be revealed the grieving period.  In 2012, it was estimated that 43.1 million Americans will reach 65 years of age in the next 20 years, and up to 27 million people are living with undiagnosed dementia worldwide. Early diagnosis could create a saving of up to $10,000 per person in health care costs.

A pilot study was conducted to learn more about the experiences of adult children of elderly parents who have been diagnosed with dementia. Specifically, the study sought to learn about experiences that seemed strange or unusual, but not recognized then as early warning signs of dementia.  This IRB approved pilot study utilized basic qualitative design, with nine individuals participating in interviews. The participants were asked to describe the time prior to their parents being diagnosed with dementia, using the storytelling approach recalling their earliest memories and experiences they now realize were warning signs of this disease. After transcription of the interviews and coding, the thematic analysis revealed several themes: grief, spousal covering, and failure to diagnose.

Grief is expressed physically, emotionally, socially, and spiritually. The manifestations of grief can include detachment from others, social isolation, behaving in ways that are not normal for the individual, anxiety, and forgetfulness. These are similar to the early warning signs of dementia (memory loss, difficulty performing familiar tasks, disorientation, poor or decreased judgment, and changes in mood, behavior, and personality). Participants reported a missed diagnosis of dementia in their parents by health care providers during this time. In several stories, providers delayed diagnosis stating that the changes in behavior were related to acute grief and would not consider a geriatric assessment. This failure to assess and diagnosis is a critical incident which leads to safety and quality of life issues, as well as stress in family members. Results from the study indicate a need for further research to develop assessment and educational materials for health care providers, individuals, and communities.