The Alzheimer's Disease Patient As Childcare Provider

For many years I was the medical director of a federally commended small skilled nursing facility associated with an women's charitable organization's retirement residence. When they moved into the residence, many of the entering retired teachers, librarians and former professionals chose me as their physician and came to my office, often with their daughters (rarely with sons), for care.

I had a long-term view of the lives of these women, as they told me of their early days, education, families, professional careers, death of their spouses, their leaving the towns and homes where they had lived for decades at the urging of their families, and the trauma of their entry into the retirement residence. Because they had lifetimes of independence, I encouraged them to remain independent and to use their new living situations as a springboards to different lives. For some of them that new life included a role in the care of grandchildren and great-grandchildren, such as transporting them to and from school and other activities.

As years passed, I found that some of these women developed dementia. But when I asked about their activities, they told me that they continued their usual childcare responsibilities, including driving children throughout the community. This prompted me to ask them to have their daughters join them for the next visit, and if necessary, we contacted the daughters directly "to come in with Mom" when the other approach failed.

Most of the daughters, highly dependent on their mothers for childcare help such as driving, had not recognized that their mothers had become significantly demented from Alzheimer's disease, passing off mother as "not as sharp as she had been" but otherwise OK and responsible. Only when I performed a brief simple mental status examination (what season is this? what month is this? what year is this?who is the president? what city do you live in?) and mother answered every question wrong did the daughter acknowledge the severity of mother's impairment and agree to relieve mother of responsibility for driving and complex child care which she had undertaken. And then to take action to stop mother from driving a car entirely.

And then, angry with me because of my intervention, a number of these patients found other physicians for their care.