Dementia Care: Here's Everything You Need To Know About Dementia Management From Expert

Dementia is one of the major causes of disability and dependency among older people worldwide. About 50 million people are suffering from this condition worldwide- a number which is expected to rise to 82 million by 2030. While dementia is more common as people grow older, it is not a normal part of ageing. Dementia occurs as a result of a disease process that increasingly damages the brain over time. Signs and symptoms of dementia result when once-healthy neurons (nerve cells) in the brain stop working, lose connections with other brain cells, and die. While everyone loses some neurons as they age, people with dementia experience far greater loss.

Dementia is often misunderstood

Dementia is also a very misunderstood disease. It is a neurological condition often accompanied by behavioural and psychiatric symptoms. Many a times it is often confused as a mental health condition. Symptoms vary from person to person, depending on type and stage of dementia, making it even more difficult to come up with a standardised care management plan suitable for all.

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Dementia is a syndrome (usually of a chronic or progressive nature) in which there is deterioration of cognitive functioning (thinking, remembering, and reasoning) and behavioural abilities. Functions impacted include memory, language skills, visual perception, problem solving, self-management, and the ability to focus and pay attention. The impairment in cognitive function is commonly accompanied, and occasionally preceded, by deterioration in social behaviour, motivation or emotional control.

Dementia: Management in each stage is critical

Since dementia is progressive in nature, management of each stage is very critical to ensure that the pace of deterioration can be controlled to some extent. Normally it takes about 8-10 years for the condition to progress to the last stage (there are 7 stages of dementia) but can be shorter or longer depending on the management strategy and presence of co-morbidities. The overall dementia management should focus on having a holistic approach instead of just a clinical one. All aspects of care including physical, social, cognitive, emotional and spiritual should be well thought of.

Dealing with difficult behaviours in dementia especially agitation, mood swings and sun downing (increase in symptoms after sunset) can be distressing for both the caregiver and the elder. Using non-pharmacological strategies (identifying triggers, not arguing with them, distraction or validation) should be our top priority and one must invest time to learn what works or not for long-term solutions.

Dementia patients must have a regular routine

Don't undermine the relevance of maintaining a regular routine for your family member with dementia. Since new learning becomes very challenging in this condition, keeping activities consistent helps in reducing confusion for the elder and stress for the caregiver. Right from the onset of dementia, the patient tends to feel emotionally cut off from the family leading to isolation. This can be because of the initial understanding that 'something is not right' or also to do with the feeling of helplessness due to memory loss and increasing cognitive impairment. Continuing with social engagement is very beneficial to help them feel included and to encourage them to lead a normal life for as long as possible. Having meals together, having small groups of people at home or celebrating occasions should be done religiously.

Music therapy and musical activities help stimulate long term memory and improve mood thereby leading to better cognition. Additionally, playing simple board games, art and craft activities or sorting and matching activities can be used to improve hand eye coordination-something which helps retain functionality for a longer period.

Encouraging them to be involved in day-to-day household activities (shelling pea pods, de-peeling fruits, laying the table for a meal, folding clothes, gardening etc) would help add structure to their day and also make the elder feel productive. Choosing such activities should depend on their past interests and current skill sets.

Whilst it is key to optimise the quality of life in the present, planning for the future to ensure that dementia patient is provided person-centred care is also important- whether it is care at home, or care in an assisted elder care facility. More so, the society also needs to come together to drive acceptance and normalisation of dementia through public awareness and policy.

(Neha Sinha is a dementia specialist and a clinical psychologist; CEO and Co-Founder, Epoch Elder Care)

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