Dementia 2
Understanding Dementia
Last week, we looked at the psychological effects of aging on Narayan Rao Kelkar. There is the possibility that he may have the early beginnings of dementia. Dementia has received increased attention in recent years along with the rapidly growing number of elderly people most vulnerable to it.
The causes of dementia are mostly unknown except for genetic mutations. This is an irreversible process, and there is a lot of medical research directed at discovering the cause and finding specific treatment for it. Until then, family interventions are necessary to minimize the suffering of patients and family members and to maximize the patient’s functional level.
The first step is to get a detailed examination to determine whether he suffers from dementia. The disorder has captured the attention of the mass media, leading to heightened public concern and a tendency to over-interpret normal age-related memory impairment as dementia. Due to the hereditary component of the disease, concern is justified, but sometimes a full examination can allay unfounded anxiety.
In some cases, what presents as “loss of sharpness” or “losing the edge” may not be dementia but rather depression. Advanced age and depression can create a picture similar to dementia. However, unlike dementia, depression is a reversible condition, and lost functions can normalize when the depression lifts.
What You Can Do
If dementia has started, the role of medication is to help arrest the progress of the disease. There is no medication that can reverse the effects of memory loss, but certain medications may help manage associated behavioral problems. However, the most effective help comes from social interventions provided by family members.
Optimizing the Environment
- Balanced Stimulation: Your father may do best with optimal stimulation—under-stimulation may cause withdrawal, while over-stimulation may lead to confusion and agitation.
- Environmental Adaptation:
- Maximal performance is enhanced when challenges slightly exceed his current abilities (for long-term care).
- Maximal comfort is achieved when environmental pressure is slightly below his current abilities (for immediate problems).
- Problems arise when environmental demands are too high (causing stress) or too low (causing deprivation).
Daily Routines and Social Activities
- Regular social activities slow disease progression.
- Familiar and constant surroundings enhance attention and security.
- Daily routines provide a sense of stability.
- Memory aids:
- Clocks, calendars, night lights, checklists, and diaries help with orientation.
- Simplified medication schedules improve adherence.
- Placing familiar objects like photographs and furniture in fixed places maintains familiarity.
- Newspapers and television help maintain awareness of the outside world.
Managing Relationships & Family Support
- Educate relatives about dementia to prevent misunderstandings and misplaced blame.
- Emotional support: Family members may feel anger or confusion about behavioral changes. Reassuring them that their feelings are normal can help.
- Respect autonomy, dignity, and privacy:
- Encourage participation in group activities, social, religious, and community events.
- Provide activity programs that match his interests.
- Deliver services in a way that accommodates his individual needs and preferences.
- Foster a sense of control over his life.
Adapting to Change
It becomes an ongoing challenge to modify your expectations of your father appropriately. You will need to determine whether a change in activity level is due to physical ability, personal preference, or a sign of a deeper problem.
Concept of Resilience & Adaptation
- Resilience: The ability to maintain adaptive behavior despite stress and adversity increases with age. Most elderly individuals cope well with challenges despite facing more risks.
- Selective Optimization: This involves adjusting goals to match limitations and focusing on activities that maintain self-esteem.
- Emotional Changes: As he ages, his agreeableness may shift, and the themes and conflicts he previously struggled with may evolve. He may develop a better sense of self, which can help in designing an appropriate care program.
