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Dementia

  • Emotions
    • Disappointment
    • Frustration
    • Tension
    • Guilt
    • Shame
    • Obliviousness
    • Nervous
    • Lost
    • Emotionally attached
    • Blame
    • Jealousy
  • Practical aspects
    • Reduced mobility
    • Nonsensical conversation
    • Remember past

Video: journey of no return

  • Lock front door
    • Turn off water mains because Joan can forget to turn off the tap
  • Conversation is hard
  • Needs to feed her
  • Friends are gone
  • Respite centre (3x/week)
  • Carer
    • Independent carer, emotional drain
  • Music and dance
  • Personality changes
  • Sensory room
  • Teary periods - late stage of disease
  • 1/15 of 65+ people have dementia. 1/4 of 85+ people have dementia.
  • $40k per year to stay in a high-care nursing home
  • People live an average of 8 years with dementia, can live up to 20 years
  • Issues: the caregiver becomes obsessed with their job of being a carer and might not have a life after they've passed
    • Huge amount of grief

Dysfunction

  • Memory loss
  • Loss of identity
  • Loss of simple tasks
  • Teary
  • Depression
  • Weight loss
  • Incontinence
  • Can they drive?

Carer

  • Simple physical activities
  • Sensory
  • Pet
  • Music and dancing
  • Lose social connectedness (AD/VD patients often contribute negatively to social situations and so are excluded, also the carer doesn't go out much)
    • When the other partner dies, there will be nothing for the carer
    • After the dependent partner dies, the other one goes downhill quickly
  • Personality changes in patient
  • Children of patient have own kids, fulltime job - no time to look after parent
  • Very expensive to put someone in a nursing home - where does the money come from?

Support

  • Nursing homes/care homes
  • Helplines
  • Doctors, volunteers and health care workers all need special skills to deal with dementia patients
    • Ability to communicate well - they'll get confused, and they'll start to compensate (e.g. by lying etc). Confabulation.
    • Make sure they eat!
  • Assessment
    • Psychological
    • Atrophy on MRI

Dementia handout

  • Activities
    • Should promote self-esteem
    • Maintain residual skills
    • Compensate for lost activities
    • Provide an opportunity for enjoyment etc
  • Guidelines
    • Consider what made the person unique
    • Activities that re-establish old roles, make them feel useful
    • Relaxation and pleasure
    • Simple and unhurried activities
    • Safe working area
    • Consistency
    • An emotional outlet
    • Sensory experiences
    • Don’t give up
  • Respite care
    • Gives carers a break
    • Allows patients to meet other similar sufferers
    • Communication important
  • Driving
    • Are they fit to drive?
  • Continence
  • Intimacy and sexuality
  • Looking after carers
    • Taking a break
    • Taking care of yourself
    • Taking feelings into account
    • Coping with death
  • Changed behaviours o Wandering
    • Sundowning – confusion/restlessness at night
    • Aggression
    • Agitation
    • Hallucinations

Dementia

Causes: AD, VD, LBD, FTD, AlcoD, PD

  • Temporary
    • Heavy metal poisoning
    • Hydrocephalus
    • Subdural haematoma