Caring for people with dementia at home and in hospital

From this article you will learn:

What is dementia
What are its symptoms and manifestations
How to care for someone with dementia
How does home care for a person with dementia differ from care in a boarding house?

Dementia is an incurable disease that can develop over a long period of time. It changes the life of both the patient and his loved ones. People who suffer from this disease need constant supervision. This places not only an emotional and physical burden on the caregiver, but also a financial one.

Caring for people with dementia usually involves protecting and ensuring their comfort. Often such care is perceived by the patient with aggression and disapproval, since the disease destroys his memory and changes his perception of the world, which does not always allow a person to consciously react to people close to them.

What is dementia

As a result of a malfunction of higher nervous activity, in addition to memory, dementia reduces a person’s ability to learn and contributes to the loss of many knowledge and skills that he acquired during his life.
Elderly people often suffer from forgetfulness, which does not always signal the presence of a more serious illness. But like memory problems, the development of dementia can be caused by numerous factors that affect the brain and nervous system. These include: alcohol or drug use, head injuries, tumors, atherosclerosis, meningitis, Parkinson's disease, encephalitis, Alzheimer's disease and others. Read material on the topic: Mixed dementia - causes, features of diagnosis and treatment

The nature of dementia and characteristics of the disease

Dementia is an irreversible mental disorder that is expressed by a decrease in intellectual, cognitive, speech, and psychomotor abilities. The disease is common in elderly patients: according to statistics, it affects 25% of men and women over the age of 80, and at a younger age the incidence of the pathology is 7-15%.

To understand how difficult life becomes with an individual suffering from dementia, and how to organize proper care for him, it is worth understanding the features of this disease.

At its core, dementia is a chronic, progressive mental disorder that can have various forms and types.

Pathology cannot be prevented or reversed. However, modern medicine offers many measures to slow the progression of the disease, and only some types of age-related dementia can be completely eliminated.

Regardless of the causes and forms, the disease leads to a complete loss of the qualities that distinguish a reasonable person from the closest species. Older people gradually lose the ability to express their emotions and thoughts through speech. Their character changes, the most “toxic” traits become aggravated: aggression, pessimism, prejudiced attitude towards others.

Causes of senile dementia

As we have already mentioned, older people are susceptible to senile dementia, or dementia, which is directly related to a disorder in the cognitive function of the brain. Not all aspects of the occurrence of this disease are clear, but the following main reasons are identified:

Atrophy of brain tissue due to a failure of the metabolic process and lack of oxygen, all its resources are lost in this situation.
Diseases of the cardiovascular system, as a result of which degenerative changes occur (neurons die), which is why dementia is considered incurable.
Infectious diseases, cancer. They may also underlie senile dementia.

Read the material on the topic: Senile dementia is an enemy that can be successfully fought

Nutrition for dementia syndrome

Eating problems in dementia become increasingly worse. This is explained by a progressive inability to remember what and when you can and should eat, which can ultimately result in complete atrophy of a person’s chewing and swallowing functions. The main difficulties when eating with dementia are:

patients' inability to recognize food;
patients’ inability to decide what food they like and want to eat at the moment;
complete refusal of food;
refusal of force feeding;
requirements for inadequate combinations of products.

Any questions that arise in this case must be discussed with your doctor. If the patient’s condition allows, it is better to let him handle the cutlery himself, directing the cutlery placed in the patient’s hand into his mouth. This process cannot be rushed, so it is necessary to allocate a sufficient amount of time each time to feed the patient.

Patients with dementia very often completely forget about the need to eat or the rules for using cutlery. In severe and late stages, a person needs to be spoon-fed. Among the main physical problems when eating food is the inability to chew or swallow food normally. A person needs to be constantly reminded of what to eat. It is important to offer him food that can be easily eaten with his hands. Also, food should be cut very finely so that in the absence of normal chewing it cannot be choked on.

In complex, severe stages of dementia, the patient should be fed liquid food that is not too hot, since the patient may not differentiate between hot and cold and may get burned. If you have problems with the swallowing reflex, it is important that your doctor prescribe the necessary stimulants for this process.

Clinical manifestations of dementia

Senile dementia develops gradually, completely unnoticed at first. Dementia is most pronounced in those who suffer from atherosclerosis of the cerebral and coronary vessels and arterial hypertension. As a rule, the deterioration of the situation is facilitated by strokes, after which changes in memory, thinking and behavior are noticeable. The main causes of senile dementia are considered to be Alzheimer's disease and vascular dementia. The first symptom of developing dementia is a slowdown in a person's thought processes. This is expressed in the fact that solving any problems, even the simplest ones, for example, household ones, takes more than the allotted time, and the ability to think quickly and concentrate is reduced.

The character and behavior of a person at the initial stage of development of dementia changes for the worse.
Rudeness, stubbornness, and excessive straightforwardness appear. Such symptoms are attributed to the “selfishness of old age,” since the patient does not notice these changes and believes that this is normal. Forewarned is forearmed. A greater effect will be achieved if dementia prevention is started as early as possible. Properly selected treatment will help slow down destructive processes. Read the material on the topic: Alzheimer's disease

If there are children in the house

There is no need to completely exclude communication between children and patients with dementia in the early stages and in partial forms (partial disorders). Communication with children in such cases, on the contrary, can help patients retain their intelligence longer, and can teach children to be caring and merciful. Of course, you need to monitor these contacts and leaving a child with a person with dementia, even in the early stages, is impossible, this can cause stress both in the child and in the elderly patient, as this is an excessive burden for him, which can lead to a worsening of the condition.

If the degree of communication of the patient is significantly reduced, he forgets loved ones, loses the consistency and coherence of speech, as well as all interests; contacts with children make sense only if the child is older, attached to the patient and wants to help care for him. Systematic aggressiveness or chaotic agitation on the part of the patient should exclude contacts with younger family members.

Caring for people with dementia at home

Caring for people with dementia at home is a complex and time-consuming task. Trustees usually become close relatives: spouse, children. The choice depends on the gender of the patient, as well as on which of them has the best living conditions and financial situation. Often the daughters or daughters-in-law of the sick become guardians. Caring for patients with dementia is a huge amount of work associated with extreme stress for all loved ones, which is why the term “caring burden” is recognized internationally and includes not only emotional and physical stress, but also the financial costs of the caregiver. A person caring for someone with dementia must ensure that their physical health and well-being are not neglected. The illness of a loved one can destroy the usual structure of the family and lead to chronic fatigue of its members, their emotional burnout, feelings of guilt and indignation.

A properly organized daily routine should become an important part of the patient’s life. At the same time, it would be good to retain at least some activities related to the person’s past, habitual life. Organization and orderliness will make him feel protected and confident.
Promote greater independence for the patient. This will make your job easier and help maintain the patient's self-respect.
Do not forget that the patient, under any circumstances, remains a person who can be hurt by a careless word or deed. Help in maintaining self-esteem is an important aspect of care and attitude towards the patient. Treat him condescendingly; it is unacceptable to discuss his condition in front of him.
Do not conflict with the patient. Quarrels will only cause unnecessary tension for you and the patient. You need to remain calm in any situation, always remember that it is not the person who is to blame, but his illness.
The patient should always be busy with something. Give him simple tasks. Difficult ones can cause stress and worsen the patient's condition.
The busier the patient is, the better. You must create situations in which the patient can demonstrate his skills and abilities. Constant employment gives his life meaning and increases self-esteem. But be careful, as the disease progresses every day, which means the abilities of your ward are changing. In this case, you just need to change the nature of the activities so as not to cause his irritation and anger.
Think about how to make the patient's stay in the home safe. Due to such manifestations of the disease as memory loss and impaired coordination of movements, the risk of injury to the patient increases.
Make life comfortable for someone with dementia. Have his vision and hearing checked and, if necessary, order a hearing aid or stronger glasses. This will help the person communicate with you or the service staff. This way he won't feel socially isolated.

Bathing and personal hygiene

A person suffering from dementia may forget to wash their face or not remember how to do it. Gently offer him your help, so that the patient manages to maintain his self-esteem.

When washing, try to adhere to the way the patient is used to doing it.
Help him relax, make this process enjoyable for the patient.
Before the procedure, be sure to find out what exactly the patient prefers: take a bath or wash in the shower. Unusual actions may bother him.
If you cannot persuade the patient to swim at the moment, just wait until he changes his mind.
Give the patient the opportunity to do everything he can on his own.
If the patient does not want to completely undress, meet him halfway and leave certain areas of the body covered.
Make the patient's bathing as safe as possible: securely secure handles that you can hold on to, place an anti-slip mat, and additionally place a chair.
If you feel uncomfortable or find it difficult to bathe a patient, ask someone for help.

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Dressing

Often people with dementia forget how to dress and why it should be done. In addition, they may dress inappropriately.

Arrange your client's clothes so that they wear them in a certain order.
It is advisable to choose clothes without fasteners; it is better if they have Velcro or a zipper.
Encourage the patient's attempts to dress themselves.
Choose comfortable, loose-fitting, non-slip (preferably rubber-soled) shoes.

Toileting and incontinence

Patients with dementia may forget what it means to “go to the toilet” and stop feeling when to do it.

Praise the patient for going to the toilet.
Develop a toilet routine.
Highlight the toilet door with bright colored letters.
Keep the toilet door open to make it easier for the patient to find it.
Clothes should be easy to remove.
Limit fluids at night within reasonable limits.
Place the chamber pot close to the bed.
When the need arises, use diapers.

Nutrition and cooking

Even eating can be a very difficult process for someone with dementia. Often you have to feed him, because the patient simply forgets how to use cutlery.

Every time, tell the patient that it is time to eat.
Feed him something that is easy to handle.
Cut food into small pieces to make it easier for the patient to swallow and prevent choking. In the later stages of the disease, feed him liquid food.
Make sure that the food is warm, as sometimes patients cease to distinguish between cold and hot.
During each meal, remind them to eat slowly.
Do not offer more than one serving to the patient.
Sometimes patients forget how to swallow; consult a doctor, he will tell you about techniques for stimulating this process.
A patient suffering from dementia must eat well. But in the later stages of the disease, he may forget how to prepare food. This is an even more serious problem if the patient lives alone. Poor coordination of movements also leads to injury: a person can cut himself or get burned. Therefore, you, as a guardian, must provide him with ready-made meals.

Read material on the topic: Nutrition in old age: the most important recommendations

Poor sleep of the patient

Another challenge of caring for someone with dementia is that they may not sleep at night. What can be done in this case?

Do not allow the patient to sleep during the day.
Make exercise and daily walks mandatory and regular.
Make sure that the patient feels comfortable when going to bed.

Complaints about lost items

The patient often forgets where he put this or that item, so he can easily accuse you of theft. To avoid such situations, check if your ward has a secluded place where he puts his clothes or personal items.
Make it a rule to keep a bunch of keys or glasses in reserve.
Check your trash can before you throw it away.
Never get irritated in response to patient accusations, be calm and reasonable. Agree that a lost item must be found.

Vagrancy

Often people with dementia develop a tendency to wander; they may wander away or go far from home or get lost. Therefore, the guardian’s task is to ensure that the ward always has a passport or other document with him that will help determine his identity.

The patient must have a note with him with an address and telephone number for contacting relatives or a guardian.
Keep the patient's home safe by locking doors and windows to ensure that your patient does not leave without your knowledge.
If the patient does get lost, do not show your emotions, be calm, when they find him, support him.
Always have a photo of your ward with you in case you need it when searching for him.
Attach unbreakable mirrors to the doors of your apartment or house: your own reflection will distract the patient from the desire to open the door.

Aggressive behavior

The reasons for this behavior of the patient may be:

Stress from mental or physical exertion.
Despair from the fact that others do not understand or do not want to understand his desires.
The likelihood of another disease.

Read material on the topic: Senile insanity

We build a line of behavior

It must be remembered that it is much more difficult for people with dementia to learn new things and adapt to an unknown environment. If dementia begins, it is important for the patient to be in familiar, comfortable conditions. If a person is able to maintain conversations on certain topics, you should strive to communicate with him on them, maintain interest - this is also a factor inhibiting the development of dementia. But here it is important to understand that you should only talk about what has some kind of response on his part. If you try to talk about things that a person no longer understands and cannot perceive, the dialogue loses its meaning. Unfortunately, in more severe forms of dementia, communication with the patient is gradually lost.

You need to understand that if a patient with dementia appears in the house, it means that another child has appeared in the house. Only if the child gradually learns new things and becomes independent, does the patient with dementia develop in the opposite direction—regress. It is important to remember that if a person with dementia can still retain some functions: solving crosswords, doing something around the house, etc., you should not deprive him of these tasks - they will allow him to concentrate longer and maintain his mental abilities at a certain level. level. Isolation of a person will lead to the fact that the process of loss of his functions will begin to develop faster.

Article on the topic

We train our memory. Nine ways to improve it When it comes to home improvement, you need to look at the severity of the situation. If we are talking about severe disorders, such as those found in Alzheimer's disease, a person needs constant care. It happens that during this period he becomes more passive and is not interested in anything.

But there are also situations when the disintegration of personality continues, and against this background a person acquires special activity - he is eager to go somewhere, strive for something. In this case, of course, vigilant monitoring is required. So, it is worth securing the house with the help of various items that are usually used in families with small children - plugs for sockets, locks for doors, etc. In states of agitation, it is necessary to consult a doctor; the use of medications can reduce it.

In the early stages, a person does not change dramatically and not so noticeably, so the patient himself is sure that he retains his functions completely. But disorders can manifest themselves suddenly; a person may begin an action and not be able to complete it, for example, go outside but not find the way, turn on an electrical appliance and use it absolutely incorrectly. This is partly why the early stages require no less attention from relatives. But care from relatives should be delicate and not rude. After all, a person is often partially aware that familiar functions are being lost, sometimes he experiences this very deeply, and, as a rule, is able to understand that he is being controlled, which causes resentment, irritation, and can lead to conflicts and disruption of communication with loved ones.

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Dementia alert! Why is it important to slow down its development?

How to remove aggression

Aggression is not uncommon in patients with dementia. The causes of aggression in this case may be:

other concurrent diseases;
despair due to the lack of understanding of his needs by those around him;
stress due to physical or mental overstrain.

When communicating with an aggressive patient, you cannot show your own fear; you must communicate calmly and evenly, as if nothing is happening. Retaliatory aggression can only worsen the patient's condition. Also, you should not stand too close to a patient in a state of aggression, since they will subconsciously perceive this as a threat.

To relieve aggression, it is necessary to switch the patient’s attention to some calming activity or simply wait until the attack of aggression ends. However, all dangerous and heavy objects, such as knives or sticks, should be kept out of the patient’s reach at the time of aggression.

To further prevent aggression, it is necessary to find out what exactly causes it and try to avoid such preconditions in the future. If you experience frequent attacks of aggressive behavior, you should tell your doctor about this.