Let’s say we have a client who has been perfectly lovely to get along with for a number of years. Service has gone smoothly and the personality of the person we are looking after is very consistent. His or her relationship with the home support caregivers has been smooth and unremarkable.

Then the caregivers start to notice little changes. The client is unhappy to see them first thing in the morning. The caregivers could even be locked out and told to go away. Suggestions for what to do that day are rejected – the client preferring to sit quietly in a chair.

If this happens once in a while – none of us would worry. But when it starts to happen over and over again, we have a responsibility as caregivers. We have to try to get to the bottom of what is bothering the client. Have they had a family disappointment? a bad diagnosis? Are they physically in pain for some reason or another? Or is there something else we can point to as a cause for the change in personality.

When changes like this occurs with one of our clients, the caregivers call me immediately. As case manager I then go over and interview the client. When I hear from the client that so and so has been lying, that such and such has gone missing, and that she is well enough to look after herself, then I know that it is time to contact the family.

Living in Quebec as we do, the family members often live out of town. In this kind of case, I would communicate with them as to the new circumstances of the client’s day to day living. The next step we would take, with the permission of the family, is to make an appointment with the client’s doctor. Blood tests and complete medical and physical examinations would be done. At the Montreal General Hospital there is a marvellous Geriatric Medicine Department, and often the family doctor will decide to send the client up there for a look-see too.

Alzheimer’s is the diagnosis that no one wants to hear. But the symptoms I have described above – sudden anger, paranoia, suspicion, a changer in habits such as a decrease in appetite, a loss of interest in things the person was usually interested in, self-imposed isolation – these are all red flags for dementia. One can reasonably assume in an elderly client who is exhibiting these behaviours, that they should be examined for Alzheimer’s.

It is not always that you can say, “our client is cranky today – they are just in a bad mood”. As caregivers our role is to be vigilant for such changes in personality and to get the client to the doctor as soon as possible. With the correct medication and support, their life – and the lives of the people who care about them – could improve greatly.