Elderly German with Dementia in Thailand

[dixonbm]

My wife's 72 year old German uncle is going crazy. Her family is unsure of what to do with him. He has little to no family remaining in Germany. Can anyone recommend a German speaking psychiatrist or psychologist is Bangkok? His English is limited.

Also, can anyone provide a recommendation as to how to handle this situation? Should the family contact the German embassy? Is there a healthcare attorney in Thailand that can help with obtaining powers of attorney?

His situation is rapidly deteriorating.

Thank you in advance for advice.

Edited April 14, 2016 by dixonbm

[HLover]

Very sad news, do you have any emails or evidence on how bad his dementia is? The embassy may be a place to start but perhaps a local mental health facility would be better. I would avoid lawyers until you are actually here.

[dixonbm]

He needs mental care support. He doesn't have email. His actions are very erratic. One family member already reported him to the police station after he threatened her. He has accused my mother in law of poisoning him when she offered him coffee. He has been seen by a Thai doctor where they prescribed medication. Evidently he is not taking his medication. My wife's family isn't ready to abandon him.

My wife is planning a trip back to Thailand in a few months. I'm trying to help her determine what she needs to do when she arrives.

[HLover]

No worries, there are many options in Bangkok.

Best if your wife sets up the POA once she is here.

Other posters are better qualified to answer those questions.

Good luck sir.

[geriatrickid]

Please consult with the German embassy for guidance.This is not the first time this has arisen. Due to the large number of German nationals in Thailand who become ill, or require emergency care, there is a resource list of German language capable physicians and specialists. Unfortunately, the number of available mental health professionals who have geriatric training can be counted on one hand, so don't hold high hopes. You may have to settle for a psychologist. If that psychologist has training in geriatric mental health you are better off than with a basic psychiatrist.

The administration of tablets, usually anxiolytics and sedatives is the standard procedure because it is the easiest thing to do and because they don't have the resources to do otherwise. Please note that the individual could still be charged with a crime if he were to injure someone. I know because my ex's mother attacked someone in a fit. She has dementia. It cost a lot to pay off the injured party and to avoid a criminal court case. You may wish to consider retaining the services of an able bodied male attendant who can control the uncle should he have an episode.

As an aside, you should consider a full physical checkup for the uncle. Some behavioral changes can be caused by an underlying medical condition such as a brain tumor or hormone imbalance.

[HLover]

Is the German Embassy actually useful?

[puck2]

Google: (I guess you are a German)

"Alzheimer Kranke in Thailand"

and you'll get a lot of ideas.

But it may be a problem of money refering to a special report in German TV, many years ago.

Edited April 14, 2016 by puck2

[Sheryl]

Given the need for professionals who speak German, and also the legal issues, should indeed start with the German Embassy.

If (as is likely given his age) it is an organic dementia (physical cause rather than pyschological) then psychiatrists and psychologists will not be of much help and better to see a neurologist specializing in dementia. This is the best one in Thailand though he does not AFAIK speak German:

https://www.bumrungrad.com/doctors/Ketchai-Suavansri

Basically the first step needs to be to rule out treatable physical causes. It will be important to have as full a history as possible so be sure to have people who live with him come along (the doctor is fluent in Thai and English). A very rapid onset or progression, for example, is more suggestive of some sort of underlying disease (brain tumor, severe metabolic problem etc) while gradual onset and gradual worsening is more consistent with Alzheimers.

If no treatable cause can be found, there are medications that can be given to try to slow the progression and manage some of the worse symptoms but, if it is Alzheimers, it will continue to get worse to the point where he cannot care for himself at all. If this proves to be the situation you will need to consider placing him in long term care either in Thailand or in Germany. The latter would be preferable in terms of language, as being an inpatient in a facility where all the staff are Thai may add to his disorientation. Need also to consider costs and what sort of state benefits he may be able to access in Germany. But do get a good work-up first to exclude any treatable causes.

[NancyL]

There are a couple of facilities in Chiang Mai that specialize in the care of German-speaking people with dementia. But first, Sheryl's advice should be followed to determine the cause of his decline and get him started on appropriate medications. The German Embassy is more helpful than many and is a good place to start.

Here are the facilities in Chiang Mai. They were started by German speaking-Swiss people:

http://www.alzheimerthailand.com/AlzheimerThailand/Index.htm

http://en.vivobene.ch/

[Sheryl]

Many thanks for that, Nancy, good to know

[fvw53]

He needs mental care support. He doesn't have email. His actions are very erratic. One family member already reported him to the police station after he threatened her. He has accused my mother in law of poisoning him when she offered him coffee. He has been seen by a Thai doctor where they prescribed medication. Evidently he is not taking his medication. My wife's family isn't ready to abandon him.

My wife is planning a trip back to Thailand in a few months. I'm trying to help her determine what she needs to do when she arrives.

This threatening behaviour and feeling of being threatened may point at schizophrenia :

- it should be possible to find out if he is still covered by German health insurance

- consultation of a psychiatrist seems urgent

[chubby]

In the US, a court would need to decide on if he is "competent" to make decisions, if he were not a "guardian" would be appointed.

and/or If he is still competent, he would set up a 'power of attourney' for finances and health care decisions, but seeing as your saying there is no one to manage for him, is there are resources, you get a reputable attourney to possibly do this.

i'm not going to be surprised to hear, that this isn't possibly in thailand legally, but , just to give you a framework, for a best case scenario .......

PS: sorry to tell you that many of the dementia medications, are dubious on slowing down the progression, and if it's both vascular and alzheimers like, they may do as much harm as good, though some of the newer atypical antipsychotics, do work for severe behaviour and 'sundowning' type issues, they have black box warnings, and are often misused by facilities for convenience.....

72 is a bit young for Alzheimers, however there is an early onset version, that I'm guessing my be more heritary than the more common form, would help if there were more informational about a diagnosis, that how he is acting ...

Edited April 17, 2016 by chubby

[geriatrickid]

72 is not young for Alzheimers. Sadly, it can start in one's early 50's. Several noted musicians have developed alzheimers causing them to stop performing. Malcolm Young of AC DC manifested his symptoms at age 58, and celtic musicians Spirit of the West have called it quits as the lead singer aged 53 has early onset alzheimers and can no longer play his guitar. It really isn't uncommon for some women to develop the disease in their late 40's. This is why it is such an insidious and tragic illness.

[chubby]

Alzheimer disease, a neurocognitive disorder, is the most common cause of dementia; it accounts for60 to 80% of dementias in the elderly. In the US, an estimated 13% of people ≥ 65 and 45% of people ≥ 85 have Alzheimer disease. The disease is twice as common among women as among men, partly because women have a longer life expectancy. Prevalence in industrialized countries is expected to increase as the proportion of the elderly increases.

Etiology

Most cases are sporadic, with late onset (≥ 65 yr) and unclear etiology. Risk of developing the disease is best predicted by age. However, about 5 to 15% of cases are familial; half of these cases have an early (presenile) onset (< 65 yr) and are typically related to specific genetic mutations.

[dixonbm]

Thank you everyone for the advice. I'll have my wife touch base with the German Embassy in Bangkok and see an attorney when she arrives next month. I am American and unfamiliar with how to handle this case.

This case certainly highlights the importance of Power of attorney documents and wills both in your home country and in Thailand for all expats.

I'll let you know how things go.

Thanks again!