Lifestyle Changes For Vascular Health
Research suggests that there is a connection between the risk of developing dementia and the health of your heart and blood vessels. Taking steps to improve vascular health can lower the risk of developing dementia, and vice versa.
Whats good for the heart is good for the mind, Hashmi says. As such, he encourages dementia patients to adopt healthy lifestyle changes, like quitting smoking, establishing a daily exercise routine, and choosing foods from a heart-healthy diet plan like the Mediterranean diet.
Develop Helpful Daily Routines
Having general daily routines and activities can provide a sense of consistency for an Alzheimers or dementia patient and help ease the demands of caregiving. Of course, as your loved ones ability to handle tasks deteriorates, youll need to update and revise these routines.
Keep a sense of structure and familiarity. Try to keep consistent daily times for activities such as waking up, mealtimes, dressing, receiving visitors, and bedtime. Keeping these things at the same time and place can help orientate the person with dementia. Use cues to establish the different times of dayopening the curtains in the morning, for example, or playing soothing music at night to indicate bedtime.
Involve your loved one in daily activities as much as theyre able. For example, they may not be able to tie their shoes, but may be able to put clothes in the hamper. Clipping plants in the yard may not be safe, but they may be able to weed, plant, or water.
Vary activities to stimulate different sensessight, smell, hearing, and touchand movement. For example, you can try singing songs, telling stories, dancing, walking, or tactile activities such as painting, gardening, or playing with pets.
Spend time outdoors. Going for a drive, visiting a park, or taking a short walk can be very therapeutic. Even just sitting outside can be relaxing.
Do Not Try And Alter Undesirable Behavior
Lack of understanding may push one to try and change or stop any undesirable behavior from patients who have dementia. Keep in mind that it is almost impossible to teach new skills or even reason with the patient. Try instead to decrease frequency or intensity of the behavior. For instance, respond to emotion and not the changes in behavior. If a patient insists on always asking about a particular family member reassure them that he or she is safe and healthy as a way of keeping them calm and happy.
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Communicate Patiently Slowly And Clearly
Use physical touch to help communicate. For instance, if a person with dementia is having a hallucination, a gentle pat from you might draw them back to reality and out of their frightening hallucination.4 Sometimes holding hands, touching, hugging, and praise will get the person to respond when all else fails.
Communication or more specifically failed communication can be the crux of problems for many caregivers. Weve whittled it down to some of the key aspects that you could focus on to make it easy for you and the person with dementia:5
Can I Buy Medicines For Dementia
No – you cannot buy medicines for dementia. They are only available on prescription.
How to use the Yellow Card Scheme
If you think you have had a side-effect to one of your medicines you can report this on the Yellow Card Scheme. You can do this online at www.mhra.gov.uk/yellowcard.
The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that medicines or any other healthcare products may have caused. If you wish to report a side-effect, you will need to provide basic information about:
- The side-effect.
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Coping With Changes In Behavior And Personality
As well as changes in communication during the middle stages of dementia, troubling behavior and personality changes can also occur. These behaviors include aggressiveness, wandering, hallucinations, and eating or sleeping difficulties that can be distressing to witness and make your role as caregiver even more difficult.
Often, these behavioral issues are triggered or exacerbated by your loved ones inability to deal with stress, their frustrated attempts to communicate, or their environment. By making some simple changes, you can help ease your loved ones stress and improve their well-being, along with your own caregiving experience.
Planning For The Future: Tips For Caregivers
Making health care decisions for someone who is no longer able to do so can be overwhelming. Thats why it is important to plan health care directives in advance. To help plan for the future, you can:
- Start discussions early with your loved one so they can be involved in the decision-making process.
- Get permission in advance to talk to the doctor or lawyer of the person youre caring for, as needed. There may be questions about care, a bill, or a health insurance claim. Without consent, you may not be able to get needed information.
- Consider legal and financial matters, options for in-home care, long-term care, and funeral and burial arrangements.
Learning about your loved ones disease will help you know what to expect as the dementia progresses and what you can do.
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Dietary Supplements For Dementia
Many dietary supplements have been studied for dementia treatment, including ginkgo biloba, vitamin B, and omega-3 fatty acids. However, results havent shown significant benefits. Talk to a doctor before giving your loved one with dementia any dietary supplements or herbal medicine. This will help prevent side effects and interactions with other drugs.
No Easy Solutions But Improvement Is Usually Possible
As many of you know, behavior problems are difficult in dementia in large part because there is usually no easy way to fix them.
Many probably too many older adults with Alzheimers and other dementias are being medicated for their behavior problems.
If your family is struggling with behavior problems, I know that reading this article will not quickly solve them.
But I hope this information will enable you to make more informed decisions. This way youll help ensure that any medications are used thoughtfully, in the lowest doses necessary, and in combination with non-drug dementia behavior management approaches.
To learn about non-drug management approaches, I recommend this article: 7 Steps to Managing Difficult Dementia Behaviors
And if you are looking for a memory care facility, try to find out how many of their residents are being medicated for behavior. For people with Alzheimers and other dementias, its best to be cared for by people who dont turn first to chemical restraints such as antipsychotics and benzodiazepines.
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Repetitive Speech Or Actions
People with dementia will often repeat a word, statement, question, or activity over and over. While this type of behavior is usually harmless for the person with dementia, it can be annoying and stressful to caregivers. Sometimes the behavior is triggered by anxiety, boredom, fear, or environmental factors.
- Provide plenty of reassurance and comfort, both in words and in touch.
- Try distracting with a snack or activity.
- Avoid reminding them that they just asked the same question. Try ignoring the behavior or question, and instead try refocusing the person into an activity such as singing or âhelpingâ you with a chore.
- Donât discuss plans with a confused person until immediately prior to an event.
- You may want to try placing a sign on the kitchen table, such as, âDinner is at 6:30â or âLois comes home at 5:00â to remove anxiety and uncertainty about anticipated events.
- Learn to recognize certain behaviors. An agitated state or pulling at clothing, for example, could indicate a need to use the bathroom.
Aging Depression And Dementia
Before we examine the management of dementia, let us look at the issues related to the clinical diagnosis of dementia. Mental health problems and disablement are frequent in late life. Dementia and depression are two major mental health problems in late life. It is well known that the prevalence of dementia increases steadily with age. Normal aging itself is associated with age related decline in cognitive functions. Depressive symptoms are more common in later years of life. The differentiation between depressive disorder and a cognitive disorder can be problematic in this age group. There are many symptoms which can be seen in both in depressive disorders as well as in cognitive disorders. Depression can co-exist with mild cognitive impairment a condition which is being increasingly recognized as an important entity.
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Treatments For Behavioral Symptoms
Drugs called atypical antipsychotics are often prescribed for older adults with behavioral symptoms of dementia. However, numerous studies now show that these medications are rarely effective for these patients. Whats worse, these drugs can cause serious side effects, including stroke and death.
The American Geriatrics Society and the British National Institute for Health and Clinical Excellence and Social Care Institute of Excellence conducted some recent well-designed studies. They concluded that non-drug treatments should be tried first, and symptoms should be managed with non-drug strategies in most circumstances. Overall, these non-drug treatments are both safer and more effective than medications. Antipsychotic drugs should be tried only in cases in which non-drug approaches havent worked and there is severe distress or an immediate risk of harm to the person with dementia or others.
Non-drug treatments should be tailored to the older adults symptoms and needs. A healthcare provider can screen the older adult for behavioral symptoms and contributors to these symptoms, and work with the older adult and the caregiver to come up with strategies to address them.
How Well Do Dementia Treatments Work
It is thought that about half the people treated with a cholinesterase inhibitor will see an improvement in symptoms which affect thinking and memory. Whether they help with other symptoms such as aggression and agitation has still not been confirmed. The improvement in symptoms is usually only seen for about 6-12 months.
For memantine, some studies have shown that it can slow down the progression of symptoms in some cases.
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Tips For Everyday Care For People With Dementia
Early on in Alzheimers and related dementias, people experience changes in thinking, remembering, and reasoning in a way that affects daily life and activities. Eventually, people with these diseases will need more help with simple, everyday tasks. This may include bathing, grooming, and dressing. It may be upsetting to the person to need help with such personal activities. Here are a few tips to consider early on and as the disease progresses:
- Try to keep a routine, such as bathing, dressing, and eating at the same time each day.
- Help the person write down to-do lists, appointments, and events in a notebook or calendar.
- Plan activities that the person enjoys and try to do them at the same time each day.
- Consider a system or reminders for helping those who must take medications regularly.
- When dressing or bathing, allow the person to do as much as possible.
- Buy loose-fitting, comfortable, easy-to-use clothing, such as clothes with elastic waistbands, fabric fasteners, or large zipper pulls instead of shoelaces, buttons, or buckles.
- Use a sturdy shower chair to support a person who is unsteady and to prevent falls. You can buy shower chairs at drug stores and medical supply stores.
- Be gentle and respectful. Tell the person what you are going to do, step by step while you help them bathe or get dressed.
- Serve meals in a consistent, familiar place and give the person enough time to eat.
Dementia With Psychotic Symptoms And Schizophrenia
Presence of BPSD, especially delusions with or without hallucinations in mild to moderate dementia can resemble schizophrenia or other psychotic conditions in late life. The key differentiating features here are history of progressive cognitive decline which has onset prior to the development of psychotic symptoms the presence of clinically significant impairment in multiple cognitive domains on clinical evaluation. This distinction is rather easy when there is long duration of illness starting from adulthood. But it could be difficult when psychotic symptoms have onset after the age of 60 years and also in situations where it is difficult to test cognitive functions due to active psychotic symptoms. One could also come across individuals who after many years of illness with onset during adulthood, either schizophrenia or bipolar disorder, present with cognitive decline and clinical features suggestive of dementia. In such situations an additional diagnosis of dementia can be made apart from the diagnosis of the pre existing mental health condition. See table-3 for some clinical tips
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Importance Of Identification Of Delirium
Delirium is an important differential diagnosis of dementia. Patients with pre-existing dementia could present for the first time with superimposed delirium. Sudden worsening of cognitive functions and appearance of behavioural symptoms should alert the clinician to the possibility of delirium. Delirium is a medical emergency signs that needs to be identified early and evaluated immediately.
A diagnosis of dementia cannot be made if the cognitive deficits occur exclusively during the course of delirium. Delirium is characterized by a disturbance of consciousness and a change in cognition that develop over a short period of time. The disorder has a tendency to fluctuate during the course of the day, and there is evidence from the history, examination or investigations that the delirium is a direct consequence of a general medical condition, substance intoxication or withdrawal.
The ICD 10 diagnostic criteria for Delirium is given below
ICD 10 CRITERIA FOR DELIRIUM, NOT INDUCED BY ALCOHOL AND OTHER PSYCHOACTIVE SUBSTANCES
Clouding of consciousness, i.e. reduced clarity of awareness of the environment, with reduced ability to focus, sustain, or shift attention.
Disturbance of cognition, manifest by both:
impairment of immediate recall and recent memory, with relatively intact remote memory
disorientation in time, place or person.
At least one of the following psychomotor disturbances:
rapid, unpredictable shifts from hypo-activity to hyper-activity
Do Try To Be Pleasant
Caregivers are also humans who are prone to emotions like anger, stress, impatience, and irritation. Even when one goes through caregiver burnout, it is best that the patient does not get wind of it. It is better to step out of the room and try some breathing exercises to calm down before going back to deal with the dementia patient. Where possible, shelve the bad feelings and try and deal with them later. Dementia patients deal with a lot and they do not need more on their plate if they are to lead fulfilling and happy lives.
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Make Time For Reflection
At each new stage of dementia, you have to alter your expectations about what your loved one is capable of. By accepting each new reality and taking time to reflect on these changes, you can better cope with the emotional loss and find greater satisfaction in your caregiving role.
Keep a daily journal to record and reflect on your experiences. By writing down your thoughts, you can mourn losses, celebrate successes, and challenge negative thought patterns that impact your mood and outlook.
Count your blessings. It may sound counterintuitive in the midst of such challenges, but keeping a daily gratitude list can help chase away the blues. It can also help you focus on what your loved one is still capable of, rather than the abilities theyve lost.
Value what is possible. In the middle stages of dementia, your loved one still has many abilities. Structure activities to invite their participation on whatever level is possible. By valuing what your loved one is able to give, you can find pleasure and satisfaction on even the toughest days.
Improve your emotional awareness. Remaining engaged, focused, and calm in the midst of such tremendous responsibility can challenge even the most capable caregivers. By developing your emotional awareness skills, however, you can relieve stress, experience positive emotions, and bring new peace and clarity to your caretaking role.
If Necessary Provide Adequate Preparation For The Final Stages Of Alzheimers Disease
Nursing care for dementia and Alzheimer’s patients becomes especially critical during the final stages when patients experience memory loss, depression, hallucinations, and psychosis. Kriebel-Gasparro emphasizes the importance of skilled nurses with extensive dementia and Alzheimer’s knowledge at these severe stages. Nurses not only provide treatment to patients but also help families prepare for end-of-life decisions.
While families may find it difficult to face these issues, nurses with gerontological training can help them make important end-of-life decisions. These nurses can facilitate conversations with family members about hiring elder-law attorneys and preparing necessary documents such as living wills, medical power of attorney, and end-of-life directives. They also provide emotional support to family members and suggestions for preparing emotionally for the final stages.
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Understanding The Causes And Finding Ways To Cope
When someone with dementia lashes out at you for seemingly no reason, it’s normal to feel surprised, discouraged, hurt, irritated, and even angry at them. Learning what causes anger in dementia, and how best to respond, can help you cope.
Do Not Ignore Physical Abuse
As much as one needs to be tolerant, kind, forgiving, and patient with older adults who have dementia, it does not mean that they have to excuse the patients when they become physically aggressive and allow the abuse to continue. It is not to be accepted, and if it happens, it is best to alert your doctor who will work on the solution to make sure it stops. It will keep both the patient and caregiver in safety.
From physical manifestations to angry outbursts, taking care of an individual with dementia may not be easy. However, working with the tips above can help caregivers and loved ones to get through it. Remember that there are plenty of treatments, interventions and special care providers who can help therefore, you should never be shy about getting help when you need it.
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