Unfortunately, memory issues can be a common problem among the age demographic that need specialized ophthalmic care. It can be a challenging situation for both the technician and the patient. It is important that technicians understand how to modify their work up to accommodate a patient with memory loss.
First, it is important to note that dementia and Alzheimer’s are two different diagnosis. Dementia is a term for general memory loss that affects daily activities. Alzheimer’s is a specific disease which is the most common cause of dementia. A patient can have dementia without a diagnosis of Alzheimer’s which should clearly be defined and noted in the medical history. If the memory loss is severe enough to impact the reliability of the chief complaint this should be noted under the chief complaint section of the chart under alert/ orientation. If the patient is not the historian, i.e. spouse, caretaker, etc. ensure this is documented.
According the Alzheimer’s Association, Alzheimer’s contributes to 60-80% of all dementia cases. Dementia is not a normal part of aging and a work-up should be adjusted accordingly for a dementia or Alzheimer’s patient. Some symptoms that a technician may notice when working up a patient with Alzheimer’s is that they may have difficulty swallowing, speaking or walking. This patient may need assistance from a family member or caretaker to get safely to the exam room and into the exam chair. The technician should not try to move a patient that is unsteady as this may harm the patient.
The technician should acquaint themselves with a variety of ways to check visual acuity as not every patient is able to read or comprehend the Snellen Chart. A memory loss patient may be confused seeing the complete Snellen Chart, in this case try to occlude a single row or even a single letter and gently ask the patient if they can read the letter. If the answer is no, try the number chart, Tumbling E’s, or Fix and Follows. Do not frustrate the patient if they are unable to give you adequate responses, instead politely thank them and mark “unable to assess” or ask the lead technician what your next steps should be.
Remember to encourage the patient throughout the exam and testing, as they are trying their best. Severe Alzheimer’s can lead to behavior changes and you may notice the patient becoming agitated as the work-up progresses. In that case, try to diffuse the situation by letting them know you are almost finished and that you understand their frustration. If unable to get an accurate Confrontation Visual Field or EOM type “unable to assess” and notify the scribe or doctor, if this is your clinics protocol.
It is a good rule to understand your clinics protocol when working up memory loss patients or any patient that is unable to cooperate during a work-up. This will prevent unnecessary frustration for clinical staff and the patient.
Source: Alzheimer’s Association at www.alz.org