GREENFIELD — Peggy Copple wasn’t herself anymore.
The 94-year-old Morristown resident had been awake for three days and three nights, claiming to see figures who weren’t there and talking to long-dead relatives.
Having served as her caregiver for years, her son, Mike Copple, knows better than anyone how independent his mother is, knew at that moment how hard it would be for her to accept a doctor’s help.
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But he was out of choices.
So he took his mother to Hancock Regional Hospital, where she was admitted to Reflections, the hospital’s emergency medical facility for patients whose mental illness has led to aggression or other behaviors that can no longer be handled by their primary care physicians. And it was there she found herself again.
As Reflections — the county’s only short-term emergency center specializing in the care of senior citizens with progressive memory diseases — reaches its 20th anniversary this year, patients and staff are celebrating a legacy of care they say helps the county’s growing aging population live independently as long as possible while managing mental illness.
The inpatient center — stays usually last 10 days to three weeks before patients are referred elsewhere — often serves as a transitional step for patients whose loved ones can no longer care for them. While doctors work to find the right combination of medications and therapy to manage a patient’s most severe symptoms, counselors work with families to identify off-site care centers — usually nursing homes or assisted living centers — where their loved one can be referred for long-term care.
Staff at the 10-bed facility — which employs 20 doctors, nurses, therapists and staff who work solely at Reflections — say as they look to the future, their every step, including taking the mission outside hospital walls by participating in area fundraising events, honors people like Peggy Copple and the families that love them.
“Sometimes I think the people we work with do more for me than I do for them,” said Victoria Fletcher, Reflections director, who noted the facility almost always has a waiting list. “They’ve told me their biggest secrets, their biggest fears. It’s very humbling.”
Finding the problem
When doctors sat down with Peggy Copple and her son in January, they peppered them with questions. They asked about where she was living, what kind of medications she was taking and whether she had any kind of history of problems with her mental health.
They found her thyroid medication was making her symptoms worse. With a simple adjustment to her dosage, she began to act like her old self.
Reflections, which accepts Medicare and private insurance, acts almost as an emergency room, where the first goal is to stabilize patients who are having a mental health crisis, Fletcher said. Secondly, the facility provides guidance both to patients and their families as they secure the best living situation for the patient after their release.
Reflections patients come to the specialized unit through three avenues, Fletcher said: a nursing home or assisted living facility can refer them if the symptoms of their disease are causing them to be violent or disruptive; a doctor, family member or individual can refer a patient; and emergency departments can seek Reflections’ help when they encounter a patient with immediate mental health needs.
Peggy Copple fell into the third category. She had lived by herself for decades, staying the last few years with her son, but they both knew change was on the horizon, Mike Copple said. And when his mother’s behavior radically changed, Reflections helped ease what came next.
As a lifelong Morristown resident, Peggy Copple knew she wanted to move one day to Morristown Manor nursing home, where her nephew is a resident. But neither Peggy nor her son expected the harrowing experience that brought her to Reflections.
“Two to three nights, she didn’t get a lick of sleep, and I was up with her,” Mike Copple said. “You hate to see your mother in that shape. She had gotten progressively worse.”
A devastating disease
Staff members broke it to the 64-year-old that his mother had dementia.
Mike Copple knew it had gotten harder for his mother to remember day-to-day things — if she needed to recall a memory from years ago, however, she was sharp as a tack — but the diagnosis was unexpected.
Staff members say that’s not unusual. Often, those caring for patients in the Reflections unit are the first medical professionals to tell families their loved one suffers from a progressive memory loss disorder like dementia or Alzheimer’s disease.
Learning about the effects of diseases like dementia is often devastating for family members, said Deanna Miller, licensed clinical social worker at the hospital. Their first question is often, how much time do we have left?
“None of us truly knows, but we try to give families a time frame,” she said. “Knowledge is power, and this is a disease that makes you feel powerless.”
Reflections provides support in family and group therapeutic sessions during visiting hours, where family members learn about the disease affecting their loved one and what options they have to improve their quality of life, said Andrea Bell, unit coordinator.
Staff members work to reassure those individuals they’re doing the right thing and help them to find the best living situation for their family member after they’re discharged.
Recalling earlier days
Patients often come to Reflections after a caregiver has reached out about their loved one’s behavior. People with memory disorders can lash out violently after suffering from prolonged confusion or agitation, Bell said.
“They can’t communicate their pain,” she said. “Their mind is just not there anymore. They don’t know where home is, but they just know they’re not where they want to be.”
Registered nurse Tony Goodpaster’s job is in large part to calm patients in distress, redirecting their attention from their desire to leave to more pleasant topics, he said.
Reminiscence therapy, or guiding patients’ thoughts to happier times they can recall more easily, helps the process. Sometimes, a physical therapist recites “this day in history” facts during low-impact exercises or staff members talk about their lives to encourage patients to remember their own.
It’s important to encourage patients to recall what gave them joy before, whether it was their hobbies, careers or family life, Fletcher said.
When a nurse working at Reflections was preparing for her upcoming wedding, she brought in armfuls of magazines for her patients to peruse. The ladies being treated sat together, looking over the magazines, and talked about their own nuptials.
“Even though they don’t remember what happened yesterday, they remember every detail about their weddings,” Fletcher said.
A new normal
It’s easy to treat patients at Reflections like family, because most everyone working in the unit has had a family member with dementia or Alzheimer’s, Fletcher said. Her own father died from Alzheimer’s.
That compassion makes the challenge of calming patients even more rewarding, Goodpaster said.
After all, those who have had family affected by memory disorders know it’s not the person — but the disease — causing them to act out, he said.
And they celebrate the little victories alongside those they serve — seeing patients go from being confused, agitated and angry when they are admitted to being alert, calm and functioning at the best of their ability, Bell said.
That transformation was evident in Peggy Copple, who came to Reflections, hallucinating and upset, but after three weeks of slow, careful adjustment to her medications, she was back to her easygoing personality, signs of her dementia at bay.
She moved to Morristown Manor, where her son visits most every day. She likes those visits — her sister visits, too, she said.
Though Peggy Copple deals with the challenges of having lived for more than nine decades, including hearing and vision loss, she likes where she is now, she said. The staff members are kind, the food is good, and occupational therapy is interesting, she said.
Mike Copple is just so thankful his mother is herself again.
“She’s doing OK,” he said. “She’s the greatest.”
Warning signs that may indicate the need for psychiatric treatment include:
- Withdrawal from social contact
- Loss of interest in normal activities and appearance
- Panic attacks
- Severe change in eating or sleeping habits
- Substance abuse
- Talk about death
- Suicide threats and attempts
For more information on the Reflections program at Hancock Regional Hospital, contact (317) 468-4351.
Dementia is a general term for a decline in mental ability severe enough to interfere with daily life.
The term encompasses a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of cases. Vascular dementia, which occurs after a stroke, is the second most common dementia type. But there are many other conditions that can cause symptoms of dementia, including some that are reversible, such as thyroid problems and vitamin deficiencies.
Dementia is caused by damage to brain cells in various parts of the brain.
While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:
- Communication and language
- Ability to focus and pay attention
- Reasoning and judgment
- Visual perception
People with dementia may have problems with short-term memory, keeping track of a purse or wallet, paying bills, planning and preparing meals, remembering appointments or traveling out of the neighborhood.
Many dementias are progressive, meaning symptoms start out slowly and gradually get worse.
Source: Alzheimer’s Association, alz.org
Alzheimer’s Disease is a type of dementia that causes problems with memory, thinking and behavior. At about 60 to 80 percent of cases, it is the most common type of dementia.
Alzheimer’s is not a normal part of aging, although the greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not just a disease of old age. Approximately 200,000 Americans under the age of 65 have younger-onset Alzheimer’s disease.
Alzheimer’s worsens over time. Alzheimer’s is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer’s is the sixth leading cause of death in the United States. Those with Alzheimer’s live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions.
Alzheimer’s has no current cure, but treatments for symptoms are available and research continues. Although current Alzheimer’s treatments cannot stop Alzheimer’s from progressing, they can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s and their caregivers.
Source: Alzheimer’s Association, alz.org