What is Dementia and how to work within the haze

What is Dementia and how to work within the haze

What is Dementia?  Dementia is like many illnesses of the brain a gray area which can be hard to understand. Our brain is perhaps the most puzzling organ in our body.  Let’s look at dementia how it can manifest itself in the care of the elderly.  And remember dementia is a buzz word of our time in history.  In the 1980’s, the descriptive phrase was Organic Brain Syndrome or senile;  and further back in our history the description was crazy, mentally impaired, just not right in the head.

Dementia can be extremely passive as in many cases of Alzheimer’s disease or it can be volatile and in our face when mixed with paranoia.  Hallucinations are quite different from dementia and although they may be very important to the diagnosis of some diseases, they are not critical to Alzheimer’s disease (AD).

Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.  Definition provided by  www.ncbi.nlm.nih.gov  

This definition is very straightforward.  I like it because it is easily read; however, maybe not as easily understood.  Stop for just a minute and contemplate all of the impact of the second sentence, now look around you.  The simplest of tasks, the ability to provide for your own comfort or physical needs, even the ability to sit and do nothing, cannot be accomplished without some thought process.   So often people with dementia are misunderstood and believed to have mental health issues.  Please do not make this mistake, rather have some history about this person.  The last thing needed for addressing dementia is a misdiagnosis.

As family members of folks with dementia, the first and most important step we can make is to use small one and two work directions with only pleasant emotion in our voice.  Emotion for a person, who is very frightened by all and everything around them, is overwhelming.  Smile, slow down and ask permission to touch them in any way.  Even the act of helping a person to sit down can seem an act of harm when you have no understanding of what is happening.  Maintain the same voice inflection and tones, changing these are too difficult for people with dementia to follow.   And please do not treat them as psychiatrically impaired.  They are not; they simply are having difficulty understanding.  While this may seem like a minuscule difference, for the people suffering the dementia it is the Grand Canyon.  For their safety and everyone else, we do not want to anger or frighten them.  Truly they are not responsible for their actions.  The person standing or sitting before us is not the person we have known, the words and actions are the disease (dementia, AD, Parkinson’s, Aids and so forth.  We must try very hard to not judge them or mistreat them because of their actions.

Always keep in mind that the person you are with can step out of the fog of dementia at any time.  Look for signs of recognition and understanding.  And remember that dementia is only one symptom of the illness this person has.  Just as though we would not forget about the itching of chicken pox, don’t forget about the dementia of Parkinson’s disease.  We cannot see or feel the itching and we cannot see or feel the dementia, but we all know it is there nevertheless.

Dementia is no different than any other illness, being afraid of it will invite fear and suspicion, while confidence and pleasant attitude will pave the way for reliability and acceptance.  Medication to help master the trials and tribulations of dementia in many cases seem to make the symptoms worse.  When medicated many patients go from spontaneity to placid, from animated to dull and forlorn.  Sometimes there is no other choice and sometimes in an effort to help manage the disease process which is the precursor to the dementia, we do find we have also treated the dementia.  What is the best of both worlds is to work very closely with your physician to strike a good resolution to both problems.

It is sometimes hard to remember just how much dementia will affect our daily lives, or to look at what is happening as a form of dementia.  A good example of this would be when a patient comes into the doctor for help due to the patient not eating.  A physician will begin looking for a physical cause, and we begin to worry about what this will mean to the overall disease outcome.  Both of these are very real and very important things to look at.  However, what if the person (with dementia) is sitting down at the table and simply cannot figure out why the white plate has a blue line running around the lip of the dish.  Our patient cannot get pass the blue line to be concerned about the food.  Or what if we have prepared the food as always before and placed meat, potatoes and vegetable on the plate and our patient cannot deduce of the three items which is food.

The above are very real situations which happen on a daily basis and determine our ability to help.  If you will think for just a minute all the aspects of our lives these touch.  First a doctor appointment (cost involved), our guilt and frustration as to why we can’t help, medical testing (again the cost), our lack of timing in accomplishing our chores (now we will need to work harder to finish), The lack of understanding by another caregiver (our total stress level is out of sight), perhaps the family now wants more help due to the decline in our patient’s health (again cost), the failure of the patient to regain the loss of effectual thinking (due to the lack of nutrition).

All of the above will have a demanding and straining effect on our present health care system, due to the age of the population (less workers putting into the Social Security and Medicare) and (monetarily) out of control medical systems.  No one person can fix or even patch this problem, but perhaps now there is a better understanding of this picture through one symptom of a disease.