Things That Make You Go "HMMM"

Remember the song from the early 90’s by C+C Music Factory “Things that make you go hmmm?”  I loved that song.  When I’m reading my textbook and I come across something that I’ve never heard of before I write the word “hmmm” in the margin.  It allows me to go back and re-read the paragraph later on.  Paragraphs that get marked with a “hmmm” contain things that blow my mind.  They’ve got brand new information that seems to come out of left field.  The information may be contradictory or illogical, but it always makes me happy to read it because it reminds me that there are a lot of interesting things out there still to be discovered.

I had an experience like this when I read this text in our textbook  

“Conversing with a patient and/or observing the individual perform a familiar ADL can be misleading because people frequently retain social skills in the presence of a cognitive impairment, and ADLs are overlearned activities and, therefore, not a good measure of ability to problem-solve, learn, and safely engage in ADLs and IADLs.” 

  I, naively, thought that if someone had a cognitive impairment, I’d know it when I saw it.  It’d be written all over their face and their actions.  Right?  WRONG! 

I discovered this firsthand when I was assigned a dementia patient on fieldwork.   When I first met her she seemed “as right as rain” as the old people used to say.  (I had mistakenly equated “Communication and Social Skills” with “Cognitive Skills.”)  We talked about her children, grandchildren, hobbies, etc.  She was, and still is, delightful.  I would never have believed that she had dementia if I hadn’t given her the “Set Test.”  When I did my eyes were opened.  I struggled to believe the information.  She scored very poorly on it, and, to be honest, it made me kind of sad.  I really thought that she had it “all together.”  

Then I remembered Ms. Gonzalez lecture when she said that elderly patients can conceal their dementia with their social skills and ability to do ADLs.  I had stumbled across a perfect example of that class.

I also saw examples of this when I took a field trip to a CCRC this summer.  Not only were the patients able to carry on conversations, but one patient was able to do an intricate craft that involved gluing small pieces of wood the size of matchsticks!  He was phenomenal!  Yet he was in the early dementia art class.  You can’t judge a book by its cover.

The reason that this lesson will stick with me is that in my career I’m sure I will see more than a few elderly patients that “seem to have it all together.”  I’m going to need to be cautious when dealing with them.  Just because they can carry on a conversation doesn’t mean they have the judgment to perform a stovetop cooking activity.  I have to plan my treatment sessions carefully.

That’s where my training will come in handy.  After I have achieved competency in several of the cognitive assessments, I can help identify those patients that need extra supervision.  I can work with them, and their families, to discover other activities that are less dangerous, but still allows them independence.  

As this semester comes to an end I am left with one resounding wish.  My hope for my patients is that they are as independent as they can be for as long as they can.  That’s the same thing that I’d want for myself.