Preserving quality of life for elderly with dementia

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MANY do not look forward to old age for a variety of reasons. For some, it is the thought of not being able to do the things they used to do due to illness, injury or simply because their bodies are not as strong and agile as they once were.

Old age may also bring an increased sense of isolation, such as when an elderly parent moves in with their children, especially if the individual has to leave familiar environments and social circles – like moving to another area.

Sometimes, they also lose a certain degree of the independence they have gotten used to. This happens when they have to depend increasingly on another person, who may be ill-prepared to take on the role of caregiver.

For others, it’s the growing feeling of loneliness as acquaintances, peers and family pass away.

All of these can be a real blow to a person’s self-esteem. It is not unusual to feel embarrassed to need assistance in areas they were formerly able to handle on their own.

Thus, as one ages, it’s important to stay active physically, mentally and socially to continue experiencing a higher quality of life. This is true especially for the elderly who have dementia.

Trinity ElderCare Centre (TEC) is a non-profit integrated elderly daycare facility supported by Trinity Methodist Church.

The centre is open to anyone aged 55 and over. The majority of its clients suffer some degree of memory loss due to their age.

About 20 per cent of their clients have been clinically diagnosed with dementia, while the remaining are either recovering from stroke or are healthy adults who are alone at home during the day, according to TEC manager Lee Mee Ling.

“Many of our elderly population in Kuching are probably suffering from dementia. However, many are undiagnosed due to the lack of awareness about the disease in our society,” she said.

Dementia is an umbrella term which describes a group of symptoms caused by many diseases that affect the brain. Perhaps the best known is Alzheimer’s disease, which accounts for a significant portion of dementia cases – up to 50 or 60 per cent, according to the Malaysian Psychiatric Association website.

The association notes that dementia is considered a late-life disease because it tends to develop mostly in elderly people with about 5 to 8 per cent of people over the age of 65 having some form of dementia, and that this figure doubles every five years above that age.

It is estimated as many as half of people in their 80s suffer from dementia.

Dementia develops when the parts of the brain involved with learning, memory, decision-making and language, are affected by one or more of a variety of infections or diseases.

While some types of dementia may be treated, most cannot be cured. Depending on its cause, the best that medical personnel and caregivers can do is manage its symptoms and reduce risk factors.

It’s not always easy to deal with clients with dementia, who are not only struggling to understand and manage their situation but also cannot control some aspects of their behaviour.

“The only thing the family and caregivers can do for the person is to help him or her live with as much dignity, quality and enjoyment as they can,” Lee said.

More than patience

More than patience is required when it concerns caring for and living with an individual with dementia.

“I tell my staff and the family caregivers the same thing. Most people will think you need a lot of patience, but for me, patience is not the main point because patience can run out. One time. Two times. If my limit is three times, the fourth time I will lose my temper,” she said.

“I think the first important thing to understand is what dementia is, including its symptoms and how it affects a person’s behaviour. I think understanding and sympathy is the most important.”

She added that once family and staff understand what dementia is and how it affects behaviour, it becomes much easier to empathise with clients and take action to assist them.

“Some elders with dementia cannot understand why they need to go to the toilet. They need you to tell them. Only when you understand this, then you will take action to remind them to go to the toilet.

“They are not being purposely spiteful towards family members as they themselves do not know why they do some of the things that they do.”

Planned activities

Lee pointed out that structure and routine are important in helping clients with dementia to go about their lives as normally as possible.

“Not only can this provide a comforting sense of familiarity but repeating certain patterns of behaviour such as drinking water or brushing teeth at certain times of the day may help them to remember these activities better and will also assist them in taking care of themselves.

“Routines help them to familiarise themselves with their surroundings and the people around them. Additionally, seemingly small details like asking clients their names, what day of the week it is, and simple games to engage their brains and bodies all have a way of adding up.”

The centre has a daily and weekly schedule with fixed slots for various activities such as morning walks and exercise, meals and nap times. Afternoons are usually reserved for programmes – mainly run by volunteers but with guidelines and instructions from the centre.

On Mondays and Wednesdays on alternative weeks, it’s art therapy. Tuesdays are games days, which also include mathematical games with simple rewards or prizes, while Thursdays are for food therapy where clients can learn how to make simple dishes such as pau and kueh.

Fridays are for music therapy, followed by a small gotong-royong to tidy up the centre, which is a voluntary activity.

In between there will be one-to-one time for clients who have special needs such as additional muscle-strengthening exercise sessions, mainly for stroke patients.

They also provide services such as nursing aides, basic physiotherapy and occupational rehabilitation with socially relevant activities while fostering mental and physical stimulation.

The programmes and activities are structured to encourage clients to keep their bodies and minds active by moving, vocalising and socialising. Not only does this engage their motor and cognitive skills but also does their self-esteem good when they are among their friends and peers.

Power of peers

For most people, it’s hard to imagine how to stay active and positive when faced with dementia but that’s what the centre’s care staff try to encourage their clients to do every day, using a combination of good humour, gentle persuasion, and peer support.

Depression is a common symptom in people with dementia, especially those with Alzheimer’s. Being able to socialise regularly with friends can do a lot to improve a person’s outlook on life.

Belonging to a social group can also help senior citizens stay more physically and mentally active. Additionally, as they are among people their age and who understand what they are experiencing, it can also help them to be less defensive and more open to trying something new or acknowledging they need help.

“It’s good to have a group of people to encourage the quieter or newer people to take part in the centre’s activities. Some may be reluctant to take part because

they may feel shy or because they are experiencing a bad mood but when their friends invite them, they tend to respond positively,” Lee said.

She added that the most popular activity among the women is the food therapy session where they get to help prepare the ingredients for cooking, while the most popular among the men are games and crafts. The morning singalongs also tend to draw a lot of participation with Chinese oldies being the favourites.

Every client’s needs are different, so during the initial assessment period to determine if the centre is a good fit for them, the care staff will closely observe the potential clients to know them better, determine their likes and dislikes as well as how they can befriend the clients – details which will help the staff create a care plan suited for the client.

A potential new client will be given a five-day trial to see if the client can adapt to the centre’s environment and be engaged in the programmes and activities as well as for the staff to assess and develop a care plan that caters to the said individual if such a need is required.

TEC operates on weekdays from 7.30am to 6pm. It is located at Lot 59, Section 58, Ellis Road, 93300 Kuching.

For more information about their services, call or fax 082-255758 or email [email protected].

Activities such as fitting coloured wooden blocks into their appropriate slots help reinforce cognitive skills.

Activities such as fitting coloured wooden blocks into their appropriate slots help reinforce cognitive skills.

Common early symptoms of dementia

1. Frequent and inexplicable states of forgetfulness and confusion.

2. Difficulties in carrying out familiar activities. People who are very busy are sometimes absent-minded – for example forgetting the pot on the stove. People with dementia possibly not only forget the pot on the stove but also that they have cooked at all.

3. Language and communication problems such as not being able to remember simple words and using inappropriate fillers.

4. Problems with spatial and temporal orientation. Dementia sufferers might be in their own street and no longer know where they are, how they got there and how to get home again.

5. Impaired capacity of judgment, such as wearing totally inappropriate clothes such as bathrobes while shopping or several layers of clothes on a hot day.

6. Problems with abstract thinking – unable to recognise numbers or carry out simple calculations.

7. Leaving things behind and putting things in completely inappropriate places such as leaving the iron in the fridge or a watch in the sugar bowl. They also do not remember doing it.

8. Sudden mood swings and behavioural changes, often without discernible cause.

9. People affected by dementia may experience a very pronounced personality change suddenly or over a longer period of time. For example, somebody who is generally friendly becomes unexpectedly angry, jealous or timid.

10. Dementia patients sometimes lose the zest in their work and the interest in their hobbies completely without enjoying new activities.

Source: Malaysian Psychiatric Association