Derold Biggerstaff was sitting at his desk in his Playa del Rey home when his wife, Ardnell, teetered into the room.
She wore a high-heeled pump on one foot, a running shoe on the other.
"My shoes are lopsided," the distressed woman told her husband of 51 years. Biggerstaff explained about her mismatched shoes. "What should I do about it?" she asked.
The Biggerstaffs, who are in their early 70s, are among the millions of elderly Americans dealing with the wrenching reality of Alzheimer's disease and other disorders that produce cognitive impairment or dementia.
Helped by Program
Although there is no cure for Alzheimer's, the Biggerstaffs are being helped by an unusual program at Century City Hospital that offers them both comprehensive assessment and, if necessary, coordinated treatment of Ardnell Biggerstaff's medical, psychological and functional condition, as well as psychological and practical support for her husband--all at one location.
Lynne Morishita, the nurse practitioner who heads the hospital's Center for Geriatric Health, said the program is designed so that even people who are confused can take advantage of it.
Instead of making and keeping track of appointments with a host of different doctors, social workers and others, an elderly person who wants to be evaluated at the hospital only needs to make a single appointment. If necessary, the hospital will provide transportation--usually in a van that can accommodate wheelchairs.
About 10 elderly people with dementia are evaluated each week in the Alzheimer's Disease Institute, which is part of the Center for Geriatric Health, Morishita said. The cost varies according to the tests and procedures done (the center, which also evaluates elderly people who don't suffer dementia, accepts Medicare).
While being assessed, dementia patients spend one whole day at what the staff calls its geriatric day hospital, a suite of examination, conference and other rooms next to the hospital's in-patient geriatric ward.
Although they don't spend the night, they are assigned a regular hospital room with a private bath. The main reason for that, Morishita said, is to ensure their privacy. "A lot of the things we need to talk to them about are very delicate," she said, noting that many patients are embarrassed by their memory loss or other symptoms of cognitive impairment. They may also be sensitive about such symptoms as the inability to control urination.
Determined by Team
Throughout the day, patients are seen by a team of physicians, including a psychiatrist, nurses, social workers and others with geriatrics training. Patients' condition, their emotional and intellectual state and their need for speech therapy or other rehabilitation are determined by the team. Any tests needed, except for X-rays, are done in the geriatric day hospital. Patients are escorted to X-ray sessions by hospital staffers.
One advantage is that the schedule is flexible--important when dealing with people who may have enormous difficulty expressing themselves, may be irascible or may simply tire easily, Morishita said. Instead of starting right off with a medical history, "we'll have the social worker go first if the person is resistant," she said.
Because the patient is there the entire day, the staff is able to observe how well the person functions. Is the patient able to use the bathroom? Is he or she angry or withdrawn? Does the patient try to wander away? What kind of vocabulary does he or she use? During lunch, is the patient able to feed himself or herself?
An evaluation of how well the individual actually functions is as important, in its own way, as the diagnosis of any disease that may be present. "What we are most concerned about is quality of life," Morishita said.
Dr. Robert T. Wang, whose specialty is geriatric medicine, said even excellent physicians who lack special training may fail to identify the problems of elderly patients.
"They are very good at treating disease, but they may not be very good at seeing the patient as a whole and what the person needs to function more efficiently," Wang said.
Often, he noted, people who come in for dementia have already been told they have Alzheimer's when they actually have some other disorder. Although Alzheimer's is the most common cause of dementia in the elderly, affecting between 5% and 10% of all those over 65, Wang said he and his colleagues see at least as much stroke-related disease among their confused or otherwise intellectually impaired patients.
Alzheimer's can really only be diagnosed by a microscopic analysis of brain tissue, usually only done during an autopsy, Wang said. Although Alzheimer's disease is progressive and incurable, some other forms of dementia are treatable.