Dementia- Alzheimer’s what is the difference?ELENI KONSTANTOPOULOU
Dementia is not a specific disease: It’s an overall term that describes a wide range of symptoms, associated with a decline in memory or other thinking skills, and that reduces a person’s ability to perform everyday activities. Alzheimer’s is the most common form of dementia; however, there are many others. Other irreversible dementias include vascular dementia (due to strokes), Lewy Body disease, frontotemporal dementia, Creutzfeldt-Jakob disease, Parkinson’s disease, and Huntington’s disease.
Current Estimates and Projections of Dementia:
Prevalence in Canada using rates drawn from the Canadian Study on Health and Aging, it was estimated that in 2016 there were 564,000 persons in Canada living with dementia. By 2031 it is estimated that the number will increase to 937,000.
Today, estimates suggest these diseases affect almost one in 12 Canadians and cost Canada $22-billion a year. If nothing changes, in just one generation that number will grow to almost one in seven and the costs will at least double, ultimately overwhelming our health-care system, our economy and society. Globally, the statistics are equally staggering. The estimated global cost of dementia is expected to be $1-trillion by 2018. Currently, the direct costs of dementia represent 0.6 per cent of global GDP. This doesn’t include less tangible costs, such as the social and financial impact of the “sandwich generation” – the group caring for both aging parents and children.
Dementia disrupts memory, language, thinking and reasoning, these are what are referred to as the “cognitive effects” of the disease. The term “neuropsychiatric” describes a large group of additional symptoms & behaviors that occur in many, but by no means in all the population with Dementia. Many dementias are progressive meaning symptoms start slowly and gradually get worse. The disease has stages, and people with dementia may experience changes in personality, irritability, anxiety, or depression, and some levels of disorientation. Symptoms can vary greatly in the population, at least two of the following core mental functions must be significantly impaired to be considered dementia.
Symptoms of Dementia
- Memory Loss
- Communications and Language
- Ability to focus and pay attention
- Reasoning and Judgement
- Visual Perception
- Sleep disturbance
- Agitation in the form of verbal or physical outbursts
- Emotional distress and yelling
- Pacing or wandering
- Delusions (beliefs in things that are not real)
- Hallucinations (seeing and hearing things that are not there)
The greatest difficulty for families is to deal with the neuropsychiatric and behavioral effects of the disease. These are the most challenging and distressing symptoms for families, and is a contributing factor in the decision to place their loved one in Long Term Health Care facility. For families and care providers understanding these cognitive and behavioral symptoms and finding ways to cope and manage effectively is often a learning experience.
Common behaviors exhibited by people with progressed dementia
People with dementia walk seemingly aimlessly, for a variety of reasons, such as boredom, medication side effects, or to look for “something” or someone. They also may be trying to fulfill a physical need—thirst, hunger, a need to use the toilet, or exercise. Discovering the triggers for wandering are not always easy, but they can provide insights to dealing with the behavior.
The loss of bladder or bowel control often occurs as dementia progresses. Sometimes accidents result from environmental factors; for example, someone can’t remember where the bathroom is located or can’t get to it in time. If an accident occurs, your understanding and reassurance will help the person maintain dignity and minimize embarrassment.
Agitation refers to a range of behaviors associated with dementia, including irritability, sleeplessness, and verbal or physical aggression. Often these types of behavior problems progress with the stages of dementia, from mild to more severe. Agitation may be triggered by a variety of things, including environmental factors, fear, and fatigue. Most often, agitation is triggered when the person experiences “control” being taken from him or her. 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.
Seeing a loved one suddenly become suspicious, jealous, or accusatory is unsettling. Remember, what the person is experiencing is very real to them. It is best not to argue or disagree. This, too, is part of the dementia—try not to take it personally.
Restlessness, agitation, disorientation, and other troubling behavior in people with dementia often get worse at the end of the day and sometimes continue throughout the night. Experts believe this behavior, commonly called sundowning, is caused by a combination of factors, such as exhaustion from the day’s events and changes in the person’s biological clock that confuse day and night. Sometimes eliminating afternoon naps helps, and integrating exercise into the routine with positive effects for health, while individuals are physically tired enough to sleep.
Ensuring that your loved one is eating enough nutritious foods and drinking enough fluids is a challenge. People with progressed dementia literally begin to forget that they need to eat and drink. Complicating the issue may be dental problems or medications that decrease appetite or make food taste “funny.” The consequences of poor nutrition are many, including weight loss, irritability, sleeplessness, bladder or bowel problems, and disorientation.
read our blog on: Top 8 Eating Tips to Minimize Aging and Related Conditions
People with dementia may become uncooperative and resistant to daily activities such as bathing, dressing, and eating. Often this is a response to feeling out of control, rushed, afraid, or confused by what you are asking of them. Break each task into steps and, in a reassuring voice, explain each step before you do it. Allow plenty of time. Find ways to have them assist to their ability in the process, or follow with an activity that they can perform. If they are very resistant to bathing. For example, replacing a shower with a sponge bath where you assist senior to wash their face, hands and body.
Getting a medical evaluation is the first step to determine associated symptoms of dementia, and discussing your care options and management of symptoms. Sometimes there may be medical issues for the agitation being displayed such as: urinary tract infection, pneumonia, ear or sinus infection, hearing or vision may also impact. Intervention requires that we can correctly identify what has triggered the behavior and symptoms. People with dementia get disorientated easily, and often a change in environment may trigger these behavioral symptoms.
- Change in Caregiver
- Change in Living Arrangements
- Presence of houseguests
- Being asked to change clothing
People who live with progressed dementia, require more supports to manage their Activities of Daily Living (ADL’s) in all care environments. There is no cure for dementia and Alzheimer’s, though researchers around the world are working to find a cure and identify new ways to diagnose dementia earlier; and to slow the decline in cognitive functions, while managing neuropsychiatric expressions. Behavioral problems can have underlying medical reason: perhaps the person is in pain or experiencing an adverse side effect from medications. In some cases, like incontinence or hallucinations, there may be some medication or treatment that can assist in managing the problem. Check in with your doctor for possible underlying medical conditions for the behaviors
Handling Troubling Behavior
Some of the greatest challenges of caring for a loved one with dementia are the personality and behavior changes that often occur. You can best meet these challenges by using creativity, flexibility, patience, and compassion. It also helps to not take things personally and maintain your sense of humor.
We can not change the Person
The person you are caring for has a brain disorder that shapes who they have become. When you try to control or change their behavior, you’ll most likely be unsuccessful or be met with resistance. It’s important to: Try to accommodate the behavior, not control the behavior. For example, if the person insists on sleeping on the floor, place a mattress on the floor to make them more comfortable. Changing our own behavior will often result in a change in our loved one’s behavior and make them feel understood.
Behavior has a purpose:
Remember that we can change our behavior and responses to dementia by understanding symptoms and behaviors of the disease. People with dementia typically cannot tell us what they want or need. They might do something, like take all the clothes out of the closet every day, and we wonder why? It is very likely that the person is fulfilling a need to be busy and productive. Always consider what need the person might be trying to meet with their behavior—and, when possible, try to accommodate or redirect them.
Behavior is Triggered:
It is important to understand that all behavior is triggered—it occurs for a reason. It might be something a person did or said that triggered a behavior, or it could be a change in the physical environment. The root to changing behavior is disrupting the patterns that we create. Try a different approach, or try a different consequence.
10 Tips to improve your care interactions when dealing with dementia
Engage with respect, patience, and positive attitude
- Set a Positive Mood for Interactions: Your attitude and body language communicate your feelings and thoughts more strongly than your words do. Set a positive mood by speaking to your loved one in a pleasant and respectful manner. Use facial expressions, tone of voice, and physical touch to help convey your message and show your feelings of affection.
- Get the person’s attention. Limit distractions and noise—turn off the radio or TV, close the curtains or shut the door, or move to quieter surroundings. Before speaking, make sure you have their attention; address them by name, identify yourself by name and relation, and use nonverbal cues and touch to help keep them focused. If seated, get down to their level and maintain eye contact.
- State your message clearly. Use simple words and sentences. Speak slowly, distinctly, and in a reassuring tone. Refrain from raising your voice higher or louder; instead, pitch your voice lower. If you are not understood the first time, use the same wording to repeat your message or question. If person still doesn’t understand, wait a few minutes and rephrase the question. Use the names of people and places instead of pronouns (he, she, they) or abbreviations. Make communication, simple clear, and to the point
- Ask simple, answerable questions. Ask one question at a time; those with yes or no answers work best. Refrain from asking open-ended questions or giving too many choices. For example, ask, “Would you like to wear your white shirt or your blue shirt?” Better still, show the choices, with visual prompts, while visual cues also help clarify your question and can help guide response.
- Listen with your ears, eyes, and heart. Be patient in waiting for your loved one’s reply. If they are struggling for an answer, it’s okay to suggest words. Watch for nonverbal cues and body language, and respond appropriately. Always strive to listen for the meaning and feelings that underlie the words.
- Break down activities into a series of steps. This makes many tasks much more manageable. You can encourage your loved one to do what they can, gently remind them of steps they tend to forget, and assist with steps they are no longer able to accomplish on their own. Using visual cues, such as showing and demonstrating with your hand where to place the dinner plate, can be very helpful. For ideas on keeping busy and structuring activities , read our blog Creating a Daily Plan:
- When the going gets tough, distract and redirect. If your loved one becomes upset or agitated, try changing the subject or the environment. For example, ask him for help or suggest going for a walk. It is important to connect with the person on a feeling level, before you redirect. You might say, “I see you’re feeling sad—I’m sorry you’re upset. Let’s go get something to eat.”
- Respond with affection and reassurance. People with dementia often feel confused, anxious, and unsure of themselves. Further, they often get reality confused and may recall things that never really occurred. Avoid trying to convince them they are wrong. Stay focused on the feelings they are demonstrating (which are real) and respond with verbal and physical expressions of comfort, support, and reassurance. Sometimes holding hands, touching, hugging, and praise will get the person to respond when all else fails.
- Remember the good old days. Remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, such as asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past—this information is more likely to be retained.
- Use humor whenever possible. Though not at the person’s expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you. What works today, may not tomorrow. The multiple factors that influence troubling behaviors, and the natural progression of the disease process, means that solutions that are effective today may need to be modified tomorrow—or may no longer work at all. The key to managing difficult behaviors is being creative and flexible in your strategies to address a given issue.
Get support: Families should not be alone when supporting someone with dementia, they need respite care, and aids in how to cope with dementia. Get help do not go it alone. Share the burden of care with a trained care provider Registered Nurse, Registered Practical Nurse (RPN), or a Personal Support Worker who has training or experience managing Activities of Daily Living, for people with dementia. Get help and share the care plan, allowing you to keep your loved one @home living independently for as long as possible.
To learn more about uCarenet visit our site here: uCarenet a social enetrprise connecting families with vetted care providers.
Are you a senior/family living with dementia @ home, join our pilot study MATCH Marketplace to Access Trusted Care @ Home, and lend your voice to how home care is delivered.
Looking for care providers, search, connect and hire care providers directly. Get extra help caring for your loved ones. Search Care Providers.
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Here are sites that provide training/educational resources to assist care providers and families to support Seniors with Dementia.
The below link is an excellent resource guide for dementia and palliative care- A Tool Kit for primary care practitioners.
Alzheimer’s Canada. www.alz.ca is dedicated to delivering training and education resources for the community.
There is Good news for families/seniors the government announced more supports for home care and dementia.
 Prevalence and Monetary Costs of Dementia in Canada. Population Health Expert Panel. Alzheimer’s Canada. P.3.