I recently consulted on an 83 year old man from the old Check Republic. He suffers from severe Alzheimer's dementia, and has been increasingly agitated in the afternoons, a term we call "sundowning". Around 4:30 pm, Mr. C. becomes more confused and agitated, and starts to think he has to go somewhere. Progressively more restless as the evening comes, he constantly tries to get up from his wheelchair without assistance, which has resulted in several falls. When redirected by the staff, he becomes angry and belligerent, starts cussing and swinging at anyone who gets in his way.
"The other thing he does is that he sings." - said the nurse. What do you mean?, I asked. "Mr. C used to be a singer in the USO, and he toured the world, singing for the troops, and since he's been here, without warning, he'll get up and start singing at the top of his lungs. He does this during physical therapy, during personal care, even on the hallways. Sometimes he'll do it in the dinning room and the other residents will yell at him to shut up. It is kind of funny."
When I met him he was in the physical therapy gym. I greeted him and introduced myself. It was obvious he was severely cognitively impaired as he looked at me and smiled. "Where are you from?"- I asked. "I am from "Manatagua""- he said. "Manatagua?" - I said slowly to make sure I was getting it right. "Yes, Manatagua." "Hmm, I've never heard of such a place." "Yes, it is in New Jersey." "Oh, in New Jersey, I see.... how many brothers and sisters did you have?
He looks at me with puzzled eyes. "Brothers and sisters?"- he asks himself. In an instant he turn to the other patients and staff members who were in the gym - "Is there anyone here from Manatagua? Does anyone here know me? How many brothers do I have?
After a couple of minutes of his repeated questions being unanswered, he turns to me and says "you know, I am the oldest person in Manatagua, and look! they have all forgotten about me! And we both started laughing. I asked him a few more questions, but it was clear that he could not provide any reliable history. After finishing the mental status exam, I shook his hand and said goodbye. I had only taken a few steps when I hear saying -"don't leave yet, it is just now starting to get good!"
As I turn around he jumps to his feet and starts singing...
"God Bless America...
Land that I love...
Stand beside her, and guide her...
thru the night with a light from above..."
All of a sudden everyone in the gym started singing... God Bless AMERICA!!
the patients, the staff, a few family members that were walking down the hallway...
all singing... and smiling and laughing!
it was a fabulous scene!!
