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Patients with Dementia
Recently a family member talked about her mother who returned home from a doctor’s visit and announced to the family that she had passed the test for dementia. The family raised concern because they had noticed that their mother was showing signs of dementia. It was noted that she was becoming more forgetful and showing a decline in judgment. Like many in the early stages of what seemed to be dementia, this mother was embarrassed by her forgetfulness and worked hard to cover it up. She developed strategies to assist her in her daily activities such as using her well developed social skills and making to-do lists.
For many families and patients, diagnosing the dementia is the first hurdle. A diagnosis must be determined. There are several conditions that may look like dementia. Some of the illnesses will include many medical problems such as infection. The most common in the elderly are urinary tract infections and respiratory infections. Medications are often a challenge. The elderly often take multiple medications and at different times during the day. For many of them it is so easy to become confused and they will take the wrong medication at the wrong time and sometimes when they can’t remember they will often take a second dose which means they have doubled the needed dose. This possible cumulative effect can increase confusion or cause an acute condition called delirium. If the acute delirium is properly and quickly identified and treated, the problem could quickly resolve. Depression is often difficult to distinguish from dementia. The patient lacks interest in their surroundings and will show a cognitive decline. The person may also demonstrate a loss of appetite and sleeping disturbance.
We know there is difficulty in making a definitive diagnosis of dementia and its subtypes. We do know that dementia is progressive and can last for many years. Research continues on this devastating illness but in the meantime, the emphasis needs to be on determining the best diagnosis possible. This is essential because it then allows for a comprehensive plan of care for the patient and the family.
Dementia is a condition that one sees as insidious with memory and intellectual deficits, disorientation and decreased cognitive functioning becoming slowly apparent. There will also be impairment in social and occupational functional. Onset is slow and decline continues.
Sometimes the person will exhibit behaviors that others find embarrassing or disturbing. These might be getting lost, not being able to follow instructions, forgetfulness, agitation, wandering, hallucinations, sexually inappropriate behaviors, and inappropriate use of language.
A complete medical examination by a geriatrician if one is available, consultation with a neurologist and any other health care providers as indicated should be conducted to rule out any treatable illnesses or conditions. A complete medical and social history should be obtained. Some of the tests that might be done will include mental status examination, depression assessment, laboratory tests, x-rays, and other diagnostic tests that might be helpful.
Treatment options are available. The treatment has to be individualized and is geared toward maintaining the level of functioning, slowing further decline and keeping the person safe. The person may require supervision of some level. This could mean checking on the person regularly if they are still living alone. It may even be necessary to place the person in a nursing home. As the illness gets worst increasing levels supervision may be necessary. Here are some areas that will require particular attention.
1. Assistance with activities of daily living if the person isn’t eating and taking care of their personal needs or sleeping may be necessary. Be sure that the food is safe to eat.
2. Assure safety by these possibly required interventions: prevent person from driving, make sure that stoves are not left on, keep from wandering and getting lost especially at night.
3. Encourage socialization by encouraging person to engage in activities that they enjoy.
4. Be sure to treat any chronic illness. Prevent pain, treat depression if present.
5. Medication may be necessary to treat the behavior and memory problems.
If the person is being kept at home, then care of the caregiver is essential. If the care giver fails to take care of him/her self, they can become stressed, depressed, abusive and simply unable to care for the sick family member. It is therefore imperative that family caregivers seek out and find resources the help them cope. Usually there is a family support group or network. It is advised that family caregivers attend meetings with these groups. It allows the caregiver to realize that others a struggling with the same problems. They find that they care be a source for the family. Also do not be embarrassed to ask for a little respite when needed. If you are without a social support network then you can call the agency and explore how you can be relieved from care giving for short period of time. You may contact the area agency on aging, or other organization that provides service to those less fortunate.
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