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Caregiving With Confidence

An Action Plan

Cognitive changes are common in patients, so it’s best to know your options. By Amy Cunningham

After my mother was diagnosed with pancreatic cancer in 2008, I found a lot of information on the physical changes to expect with her illness, but less on potential changes to her mental status. I was unprepared as her illness progressed and she began forgetting friends' names, where she was, or who she was.


Since my caregiving experience, I have learned just how common mental status changes are for cancer patients: 28 to 48 percent of patients with advanced cancer present with cognitive changes or delirium when admitted to a hospital or hospice. Research shows that adults 65 and older are more likely to experience these mental status changes than younger patients.

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Photo by Amy Cunningham  
These changes can be extremely distressing for people with cancer and their caregivers. Here is some advice on handling this challenge.
 
Be Prepared
Although we all hope that our loved ones remain mentally alert and oriented, it is important to have frank conversations with them about who will make decisions about health care, finances and other important topics if they are unable to do so themselves. Also be sure that your family member has a written care plan, in the event that he or she can no longer manage his or her own care. This is essential so that the health care team, the designated decision maker, and other family members know the patient’s wishes.

It’s necessary to formalize these choices using appropriate legal documents, and to make sure that health care providers have this documentation. The American Bar Association has created a useful toolkit for advance health care planning.
 
Know When to Seek Medical Advice
Stay on the alert for signs of mental status changes, which can include disorientation to place or time, poor recognition of familiar individuals, reduced attention span, marked changes in mood or personality, and agitation.
 
If you do see these changes, seek medical attention right away. These symptoms not only cause emotional distress, but can also impair your loved one’s decision-making abilities and may signal underlying physical changes that require treatment.
 
There are a number of potential causes of altered mental status in a cancer patient, including medications, blood sugar changes, sodium or calcium imbalances, dehydration, infections, depression and cancer metastases. Fortunately, an estimated 30 to 75 percent of cases of cognitive changes or delirium can be improved or reversed with appropriate care.
 
Stay Calm
Although seeing mental status changes is unnerving, do your best to remain calm. Creating a calming atmosphere can help your loved one by reducing confusion and other distressing symptoms.
 
Use a soothing voice and limit loud background noise. Provide your family member with a calendar and a clock so he or she knows the day and time, and keep medications out of reach. It may also help to gently remind your loved one of visitors’ identities, and to minimize the number of visitors and caregivers at any given time.

And last, but not least, remember that as a caregiver, talking about your feelings with a friend, family member or professional is also crucial. These conversations will help you to cope with your loved one’s mental status changes. 


Amy Cunningham was the primary caregiver for her mother, Salli Cunningham, who died in 2008. She continues to support pancreatic cancer survivors and caregivers as the volunteer Affiliate Coordinator for the Philadelphia affiliate of the Pancreatic Cancer Action Network.
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09/27/2012
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