What is it about ?
Most older people prefer to stay in their familiar surroundings for as long as possible. As long as they don’t have too big of a health problem, it can be relatively easy to organize. Effective teamwork with all healthcare providers can lay a good foundation.
Things get more complicated when the elderly person has or becomes demented, especially if they are living alone. Often, for example, the elderly person with dementia is no longer able to remain alone, and professional helpers must necessarily work with a network of close caregivers.
Caregivers are non-professional people who take care of a sick person: parents, neighbors, friends and volunteers. Their activities are diverse, from the simple company to the housekeeper, including transport or even night duty. It is important to properly coordinate the assistance provided by the various care providers and informal caregivers.
What is its frequency?
Dementia is not a normal part of the aging process, but its frequency increases with age. 5-7 in 100 people have dementia by the age of 60. That number jumps to 20 out of 100 by the age of 85.
How to recognize it?
There are different types of dementia. The two main ones are vascular dementia and Alzheimer’s dementia. The vascular dementia is due to an abnormality in the blood supply to the brain, while the Alzheimer’s dementia is caused by a disease of the brain cells. It is not always easy to distinguish between the different types of dementia. The first signs that may suggest dementia, whatever the cause, are:
- memory impairment;
- apathy;
- weight loss;
- difficulty walking;
- unexplained physical complaints.
Sometimes nurses are the first to suspect the onset of dementia. Ideally, he will share it with the general practitioner or family caregivers.
How is the diagnosis made?
Diagnosis is based mainly on the recognition of certain characteristics rather than on technical examinations.
The doctor can use specific questionnaires to get a more accurate picture of the symptoms. The most widely used is the MMSE (Mini-Mental State Examination). If a test reveals an anomaly but there are no consequences for daily functioning, a cautious waiting attitude is adopted and the test repeated after a certain time. These tests are also used to follow the clinical course.
Along with dementia, there is what is called a ‘mild cognitive decline’, which is a deterioration of mental and intellectual functions, such as memory, without reference to dementia. However, the risk of dementia is slightly higher in the presence of cognitive decline.
Once the diagnosis of dementia is made, the doctor will schedule the necessary tests to try to identify the cause. These exams can include a blood test, a CT scan or an MRI of the brain, a neurological exam, …
Any behavior that is difficult to manage should be assessed by a specialist dementia care provider (dementia reference person). The person’s day-to-day functioning is examined in the familiar setting of the home.
A psychiatrist or geriatrician will ideally screen people with dementia for depression, in 20-30 out of 100 cases these two conditions occur together and can reinforce each other.
According to the law on patient rights, the doctor should check whether the patient wants to know the diagnosis of dementia. The doctor has an obligation to communicate the diagnosis of dementia to this person, unless the person clearly asks “not to know”.
What can caregivers and informal caregivers do?
Caring for an elderly person with dementia at home always requires teamwork. A team meeting can therefore be organized, preferably at the home of the elderly person, in order to develop a care plan. All professional healthcare providers and informal caregivers are invited, including the patient. When caring for a person with dementia, it is important to designate a manager who will coordinate and assess care. This could be a nurse, a social worker or someone involved with the required skills.
If the person with dementia is no longer able to make decisions, a legal representative is appointed.
In addition to home care, there are various other options apart from admission to a nursing home. During the day, a day center can accommodate the elderly for one or more days or half-days per week. The person can also spend a short stay in a nursing home, so that informal caregivers can also take vacations. There are intensive rehabilitation services, with experienced care providers, who stimulate people to the maximum and help them take care of themselves on a daily basis and maintain their independence.
Special attention is also given to psychological aspects in order to reduce and prevent anxiety and depression. If this care can be applied at an early stage, the patient’s quality of life is markedly improved.
Sometimes drug treatment is started.
The doctor and caregivers will also pay close attention to informal caregivers, regularly assessing needs, putting them in contact with others who are going through the same experience and sharing methods that will help them cope with certain situations. Caregivers are naturally involved in all decision-making.
Want to know more?
- Alzheimer’s disease: a progressive memory disease – mongeneraliste.be – SSMG – Scientific Society of General Medicine
- Memory problems and other cognitive functions – CHU Montreal
- Scanner (CT-scan) – Erasme Hospital
- MRI, here, Where to find on this page of Saint-Luc University Clinics (UCLouvain)
Are you looking for more specialized help?
- Alzheimer League
- Proximity agents-dementia (Proxidem agents) – Alzheimer League
- Caregivers – An association that supports people who regularly help a loved one who is dependent on their age, illness or disability
- GymSana – An adapted physical activity for vulnerable people
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