How do we assist stroke victim, with severe short term memory loss…

A bit of background to the family situation. My father-in-law, aged 85 years, suffered a hemorrhagic stroke on 8 Dec 17. At the time of the stroke he was living at home, alone, but independent, having lost his wife of sixty years in November 2016. Early signs of dementia had been observed, but the major impact on his daily routine. After the stroke, the initial prognosis was not good and we did not expect his recovery. Fortunately, his physical recovery has been more than expected with his only limitations being, poor balance and tiredness after any daily activity. As a result of the stroke, the major impact has been his complete loss of short term memory, to the extent that he cannot remember any visitors he has had during the day, or even if he has eaten a meal. This short term, appears to cover period of five years ago to what happed in the last two hours. Some days are better than others, but generally, short term memory is severely limited. On the other hand, his long term memory is excellent, even to the extent that he can recall dates and times of fires attended during a long career with the fire brigade. The short term condition, has lead to a state anxiety, fear and the withdrawal from any social interaction with people other than family or past work mates. Due to the stroke and his current medical condition, it was necessary to find appropriate supported accommodation, which was achieved with a permanent placement found in residential care. Care staff are excellent, but now his daily routine consists of eating his meals and sitting in his room looking out his window and maintaining various levels of depression. He is visited daily by a family member with trips out to various locations or activities. Ex work mates have been supportive with visit at various times during any month. The impact of the short term memory is difficult for him, particularly in the early morning or early evening with a complete loss of where he is or why he is there. During these periods, family members will receive repeated phone calls from him wanting to know where is he, and why is he there, or who pays the hotel bill. We have been told that "settling in" can take time, and that his full recovery level will be difficult to determine. At this time, we seek any advice on how to reduce his depression and anxiety, steps we hound take to get him involved in social activities and to interact with other residents at the care facility. Is there a daily routine we can introduce to assist with the early "settling in" in the care facility. He has not been diagnosed with dementia or Alzheimers, but he has observed the condition with other residents, which may be having an influence on his depression. Any device or direction would be greatly appreciated.

Hi Wayne

Thank-you for reaching out to us. It sounds like you have already been a great support to your father-in-law with his transition into residential care.

Memory problems and low mood are not uncommon changes to experience following a stroke. The transition from living at home independently to being supported in a residential care environment can be an overwhelming experience for stroke survivors and family members. I have attached some information on thinking and perception, and depression and anxiety after stroke for you to have a read through.

https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Depression-and-anxiety-after-stroke-fact-sheet

https://strokefoundation.org.au/About-Stroke/Help-after-stroke/Stroke-resources-and-fact-sheets/Thinking-and-perception-after-stroke-fact-sheet

Most residential care facilities have a nurse clinical co-ordinator, leisure co-ordinator and visiting doctor that you will be able to reach out to discuss some of your concerns, and look at practical strategies to support your father-in-law.

Short term memory loss is often reported following a stroke and this affects individuals in different ways. An occupational therapist can assess the impact of the memory loss and provide advice on memory aids. Memory aids can include:

Setting up your father-in-laws room to include photos and personal items.
Have a journal for family and friends to write in when they visited and what they talked about together. Your father-in-law can read your messages or staff can remind him of who visited throughout the day.
Have a personalized calendar that is kept up to date with details of family events, dates when family/friends plan to visit and appointments that can be referred to help with orientation.
Have a photo album to refer to recent family events.

Having a weekly routine can also assist with settling into a new environment. Most residential care facilities have a leisure co-ordinator you can tap into so that your father-in-law can engage in social activities within the facility. He may be interested in participating in a few activities on a regular basis. Next time you’re visiting, ask to look at the leisure calendar, discuss the activities with your father-in-law and circle the ones he may be interested in. Make a time to speak with the leisure coordinator and see if you can make a plan together to encourage participation.

Also, having some activities that your can father-in-law enjoy doing on his own eg. A magazine subscription in an area of interest, watching a particular television series or listening to his favorite music/ radio channel.

Lastly, speak with the visiting GP who sees your father-in-law. The GP will be able to assess and monitor mood. They can provide advice on where you can access psychology support and advise if medication management would be appropriate.

Wishing you well during this time, and remember, you can always call us on Strokeline 1800 787 653 Monday-Friday 9am-5pm.

Carol, Physiotherapist, Strokeline