What is Dementia?

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Dementia is a disorder of some functions of the brain and mostly demonstrated by memory loss and impaired judgment. People who suffer from dementia often experience difficulty performing activity of daily living. The inability to complete certain tasks often leads to frustration. Some of the symptoms associated with dementia are exhibited by difficulty processing new information i.e short term memory deficit, trouble with speech, self care and inability to recognize objects and people. Dementia is not part of normal aging, but it is rather common in the geriatric population.

Alzheimer’s disease is the most common form of dementia and is demonstrated by short term memory deficit, difficulty with language and speech and trouble mimicking motor movements. Scientific evidence shows severe brain cells damage in dementia which prevent normal cell communication by creating plagues deposits. The brain cells damage also create threads of protein that are twisted into tangles. This action interferes with normal transport system and may lead to death of brain cells.

There are over five million of people currently diagnosed with dementia/Alzheimer’s disease in the United States, and scientist expect this number to grow bigger in the near future. The disease is mostly common among geriatric population (65 or older) Alzheimer’s disease is also considered to be the 6th leading cause of death, but people usually live twenty years following diagnosis. However, others with more severe symptoms live on average four to eight years.

Vascular dementia is related to blood vessels damage in the brain, and some of the symptoms include memory loss, poor concentration, poor motor coordination ( tremors and shuffling gait) Frontotemporal dementia is mostly associated with damage to the frontal and temporal lobes and often leads to extreme behavior i.e anger, rudeness and inappropriate social interaction. People with that type of dementia often demonstrate cognitive deficit, lack of judgment, poor impulse control and lack of motivation and committment.

I will not be able to cover all types of dementia because there are many types that can be diagnosed following serial testing. I had the opportunity to manage the care of a group of retired residents diagnosed with a type of Alzheimer disease, and the experience has truly gratifying and has enabled me to appreciate life. I observed behavioral changes almost every day among the residents and noticed they have difficulty to express their immediate needs. They also demonstrated delay in response to stimuli and delay reaction to immediate danger. Based on the pathophysiology mentioned above, I knew the delay was related to interference in communication due to brain cell damages. Care givers should strive to reduce safety risk among people living with dementia.

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Caring for People with Dementia/Alzheimer’s disease

As you can see, people living with Alzheimer’s disease can be unpredictable and require constant supervision to maintain their safety. The goal is to provide individual centered care to promote compliance and maximize outcomes. Care givers should incorporate activities that interest those living with the disease. It is highly recommended to collect clinical data about personal hobbies, profession, skills and different activities. I learned that patients with dementia lose the ability to control their impulses and therefore, unable to formulate intellectual judgment and often unaware of misbehavior. However, they are able to retain life skills acquired many years ago. For instance, they might clean all day if they used to be a housekeeper or love playing with the phone if they held telemarketing or communication jobs in the past. In summary, they are often 20 years behind and remain trapped in the past.

A former preacher might spend most of the day reading biblical scriptures whereas, a singer might spend the day singing old lyrics. I must also add that people living with dementia respond well to music and art therapy. I strongly encourage relationship building in order to promote trust. When developing a care plan for people with dementia, it is important to include simple tasks that are short and easy to mimic, consider individual cognitive level and physical ability and modification in physical environment to promote safety. By now, I hope you understand that patience is very important when caring for people with dementia.

Managing Aggressive Behaviors

My professional’s approach when caring for patients with dementia is to monitor acute changes in behavior or mental status. Most acute illnesses in the geriatric population are demonstrated with neurological changes. When patients exhibit signs and symptoms of increased confusion, aggressive behavior, withdrawal , lack of interest in activities, I try to deescalate the situation first , assess vital signs, provide appropriate treatment when indicated and obtain orders from a provider for diagnostic testing to rule out acute processes. As the care giver, I have to protect the patient and understand that aggressive behaviors are often underlying symptoms of undiagnosed conditions. Care givers can also engage in different activities with patient and should strive to keep Alzheimer’s patients busy most of the time. Cognitive simulation exercises are very beneficial to those patients.

In conclusion, it is very challenging to care for people with dementia. However, person centered care often promotes collaboration and better outcomes. Aggressive behaviors are often associated with acute illness or process and should be managed immediately to prevent rapid decline. The geriatric population is expected to increase in the next 25 years with baby boomers reaching retirement age, so nurses should acquire disease specific knowledge and participate in training in order to provide patient centered care. Alzheimer’s disease is not associated with aging, but is mostly common among geriatric population. With patience and critical thinking, care givers will successfully provide safe care to patients living with dementia. Pharmacological intervention is often based on series of trial until patients demonstrate symptoms management.

Safety Advice: Never fight patients or people living with dementia!

Sophia Georges MSN, RN

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