This section is devoted to Pathologies of older people and care management.
Information on a number of conditions is provided.
You may visit each page by clicking on boxes below or by clicking on your left side list.
Dementia in numbers
Dementia affects 8% of people over 65 years, a percentage that increases significantly with age, as highlighted by a significant number of surveys. It is estimated that if people lived until the age of 95, then one out of two would suffer from some type of Dementia.
It is estimated that 44 million cases are suffering from dementia worldwide and 10 million in Europe. It is estimated that this percentage will rise to 104 million worldwide, while the proportion of people over 65 years old in Europe accounts for 35% of the general population.
What is Dementia?
The term “Dementia” refers to a group of symptoms that appears to people with conditions which destroy brain cells and cause a gradual deterioration of cognitive abilities. People suffering from types of dementia, actually means that memory, attention, judgment, speech, behaviour are affected.
In order to Dementia to be officially diagnosed, cognitive symptoms should represent a significant loss of previous level of functioning in everyday life.
The types of Dementia
Dementia is an umbrella term that describes the neurodegenerative brain conditions, which differ in aetiology, symptoms and progression.
The main types of dementia are:
- Vascular Dementia
- Dementia with Lewy bodies
- Parkinson’s Disease Dementia
- Frontotemporal Dementia
- Other types of Dementia
In the above mentioned types of dementia progression is irreversible. There are also reversible types, where Dementia occurs as a result of metabolic disorders, endocrine’s gland disorders and traumatic brain injury or as a result of toxic action of a medication. These types can be cured or stabilised if the cause of dementia is treated.
Alzheimer’s is the most common type of Dementia as it is the cause for 60-70% of cases with Dementia. Usually Alzheimer’s occurs in people over 65 years and in rare cases in younger age.
Alzheimer’s got its name from Alois Alzheimer, a German neurologist who first described the disease, the symptoms and pathology of the condition in the brain of one of his patient, Augusta D at a scientific conference, in 1907. The patient was hospitalized in Frankfurt’s asylum and came up with strange behavioural symptoms. What is more, the symptoms included a loss of orientation and short-term memory. After her death, her brain was examined and showed severe brain atrophy.
Alzheimer’s is characterised by impaired memory and other cognitive functions. The symptoms differ between patients and also differ between stages of the condition. The symptoms that made their appearance at the beginning of the condition gradually get worse, while in the course of the condition new symptoms appear.
The progression of the condition may not follow exactly the following course and patients may not exhibit all the symptoms described.
In the early stages of the condition, symptoms often go unnoticed and are interpreted as normal signs of age.
In the first stage, the person:
- display memory difficulties
- has difficulty naming persons and objects
- may lose decision making ability
- may lose interest in occupations that used to like
- may show symptoms of depression and irritability
As the condition progresses, difficulties become more apparent and the person becomes unable to function independently.
At this stage the person:
- displays pronounced memory impairment
- has difficulty expressing himself
- is becoming disoriented in time and space
- is unable to perform simple daily tasks
- needs help with personal hygiene
- shows “immoral” or “unusual” behaviours
- displays hallucinations or delirium. That means that the person sees, hears or lives situations that do not exist
As the condition progresses, the person cannot perform basic everyday and as a result is entirely dependent on others.
At this stage the person:
- does not recognize familiar faces
- cannot understand what is happening
- is unable to look after himself
- loses orientation within the home
- has difficulty in walking
- loses sphincters control
- may be bedridden or need a wheelchair for moving
Older people often need time to remember and learn new information. These difficulties are becoming worrying when they significantly affect everyday life activities.
- If someone forgets things more often than in the past, e.g. important aspects of his work, as scheduled meetings
- If he has difficulty doing everyday life activities, like tying his tie
- If he places things in inappropriate places
- If he forgets common words or using wrong words
- If he shows a change in his personality, such as confusion, suspicion or fear
- If he does not understand very well what day is and where he is
- If he is not interested in doing things quickly, or loses interest
- If he suddenly changes his mood or behaviour
- If he does things that have absolutely no sense
Early diagnosis of Dementia and early intervention do not benefit only person with Dementia, but also his family, the community and NHS. Early diagnosis of Alzheimer’s ensures on time implementation of various preventive and therapeutic interventions, increases efficiency of interventions applied, and therefore ensures a smoother transition from one stage to another.
Age is the most important known risk factor for Alzheimer’s condition, considering that the incidence increases as age increases. Several studies conclude that the condition occurs more frequently in the females. However, these findings should be interpreted with caution and researchers should investigate the influence of biological parameters between the two sexes. Genetic factors are another known risk factor. Researchers have identified pre-disposing genes that contribute to the onset of Alzheimer’s. The most widely studied gene that has been confirmed by a large amount of researches is the Apolipoprotein E (ApoE). This gene is located on chromosome 19 and specifically the form 4 is found in 40-80% of all patients with Alzheimer’s.
The factors mentioned above cannot be controlled nor changed, as have a genetic basis. However there are factors that depend on lifestyle of the individual, which we can control and as a result we can reduce the risk of the condition. The vascular risk factors such as diabetes, hypertension, high cholesterol, are associated with Dementia. Studies show that hyperglycaemia, cholesterol and blood pressure are associated with dementia in later life. The depression, anxiety disorders and an unbalanced diet are also risk factors, as indicated by the findings of surveys.
The behavioural and psychological symptoms of dementia refer to people suffering from Dementia and they include disorders of perception, thought, mood and behaviour.
Because of their frequency and severity, BPSD are part of the clinical form of all types of dementia. Both, frequency and severity of BPSD increase as the condition progresses.
A percentage of 80-90% of people with dementia have at least one of these symptoms during condition progression, while 64% of the people that appeal to a specialist for their first assessment report at least one such symptom. Any of those symptoms can occur at any stage of the condition progression and is not necessary for all the patients to present all the symptoms.
Psychological symptoms, as depression and apathy, are more likely to occur in the early stages of Dementia, while behavioural disorders, like aggressiveness, anxiety and wandering are more common in people suffering from medium severity dementia. Most BPSD reach their peak before the final stage of the condition. What is more, some of BPSD in Dementia are more persistent than others such as anxiety, restlessness and wandering. Their presence is associated with faster condition progression and early hospitalisation.
The care of people suffering from BPSD leads to increased psychological and financial burden of caring, affecting negatively the quality of life of both the carer and the care recipient.
Which are the BPSD?
The most common behavioural problems seen in people suffering from Dementia are:
- Wandering- Hyperactivity
- Agitation- Anxiety
- Inappropriate social behaviour
- Verbal or physical aggressiveness
- Sleep disorders
- Sexual disorders
- Disorders of appetite
The psychological symptoms include the following:
- Delusions- Delirium
- Euphoric mood
- Apathy/ indifference
Management of the BPSD
The management of behavioural and psychological symptoms includes both non-pharmacological interventions and under conditions pharmacological therapy. Behavioural and environmental changes can reduce and even eliminate symptoms, without using any medication.
The best management requires observation and good assessment of the situation. Before adopting any intervention, you should seek for any other possible causes that could lead to the appearance of the symptoms:
- a general medical condition (infection, dehydration, angina, constipation, etc.),
- a physical condition (hypothyroidism, vitamin B12 deficiency),
- the medication’s side effects or the combination of different medications,
- basic needs that have not been satisfied (hunger, thirst, rest),
- mood disorders (anxiety, depression, etc.),
- any inappropriate environmental condition (a new paid carer, a change in routine, excessively rich or poor stimuli, etc.) may be hidden behind such symptoms. In these cases, if you manage in time and successfully the causes, the symptoms will be eliminated.
In order to have an accurate and detailed opinion, observe the followings:
- When did the undesirable behaviour started?
- When does it appear?
- Which is its progression?
- When has the highest intensity and duration? When has the smallest?
- What are the conditions before, after and during the behaviour?
Once you define and explain his behaviour, you will be able to plan your management method and change the undesirable symptoms, changing first of all the factors that caused them.
People with Dementia need a personalized approach, as a specific method used to manage the BPSD can be effective for someone, but it can have the opposite effects to someone else.
The treatment of Alzheimer’s
In recent years there has been significant progress in prevention, diagnosis, and treatment of Alzheimer’s symptoms. We can distinguish 3 main intervention categories:
- Pharmacological treatment
- Non-pharmacological interventions
- Carer’s counselling
The available medications (cholinesterase inhibitors and meantime) deal with the symptoms of the condition, can slow down the course of the condition and improve quality of life of people with dementia and carers. To date there isn’t any treatment that prevents or stops completely the condition progression. However, delaying the development significantly benefits quality of life of people with dementia and their families and is also cost-effective for the national health system.
In recent years, interest has been focused on non-pharmacological interventions for the treatment of Dementia. Non-pharmacological interventions support the effectiveness of pharmacological treatments, are tailored on individual needs, abilities and have no adverse effects.
Non-pharmacological interventions include:
- Memory training, aiming at the exercise of cognitive functions. Memory exercises ban be performed either with pencil and paper or can be computerised
- Speech and Language Therapy, which aims at restoring the capacity both of understanding the speech and of articulation, in order to maintain a good level of communication
- Occupational therapy, which focuses on motivating individual and on relearning skills that will help autonomous everyday living as long as possible in the course of the condition
- Reminiscence therapy, according to which the person is encouraged to recall memories and feelings from the past and share them with other group members, often using as reference objects, tastes, smells, sounds
- Physiotherapy, through which movement, balance, stiffness and muscle atrophy are dealt
- Physical exercise, to ensure a good physical condition
- Art therapy, which gives the opportunity to individuals to express themselves using nonverbal communication, in order to improve their emotional function.
Carers of people with Dementia are experiencing physical, psychosocial and financial burden. As the condition progresses, carers are in need of support programs and are advised to attend non-pharmacological interventions for them. People who take care of a person suffering from some form of Dementia, can attend seminars, participate in stress management groups, receive counselling or seek some form of psychotherapeutic intervention.
The objectives of these interventions are that the carers:
- will get informed and will gain a sense of control of the situation
- will manage their negative emotions such as anxiety, anger, sadness, guilt, which are caused by the care
- will get in touch with other carers and may create a network to continue supporting each other even after the end of the program
- will improve the quality of their life
A holistic therapeutic approach results to the most efficient management of the condition and highlights, that the combination of pharmacological and non-pharmacological interventions including both the person suffering and the carer, is the best way to cope with Dementia.
If we know the factors that increase the risk of the condition and how to control them, we may prevent dementia.
Specifically the following factors decrease the risk of the condition:
- The Mediterranean diet with fish, nuts, fruits and vegetables
- The mental and physical exercise
- Socialisation and stress management
Do … protect us against the condition!
Here’s a useful list of tips. Remember though that the “general information for carers tab” contains lots of pages of information, some of which are referred to below.
Supporting your relative
We used mobile phones to photograph the contents of cupboards so that we could talk mum through cooking in the early days, i.e. “in the cupboard under the sink you’ll see the frying pan” and “the tins of tuna are in the cupboard below the radio”. We quickly stopped using “left” and “right” as directions because this was confusing, so knowing the layout of cupboards was very useful. We did the same thing with the controls on the washing machine, the cooker, the radio, microwave and the central heating. It meant we could always refer to those in conversations with our mum on the phone. And we labelled the phone with our numbers on speed dial, along with a card on the wall containing our pictures and lined that up to the speed dial buttons so mum could see a picture of her son and press the key alongside to speak to him.
Skype is a great resource when you’re caring from afar, provided you introduce it to your relative in the early stages. Later on, if there are willing neighbours or friends who can help with it, you will still be able to engage with your relative when they are no longer able to communicate using the phone – this often happens as some people with dementia rely on visual prompts when communicating. If you’ve not used Skype, here’s some information which may help you: about.skype.com/
We realised mum was no longer able to cook for herself, so to begin with at each visit we’d stock up the fridge and the freezer. This worked for some time as she was still confident with using the microwave but later on, even with the purchase of an easier to use microwave, this became impossible. With the introduction of many online delivery services for everything from a Chinese take away to a full roast dinner, this may be a short term solution for you – I’d ask the delivery driver to call you when they are at your relative’s door so that you could call your relative and ask them to open it. A note of caution though – you naturally don’t want to make strangers aware that your relative may be vulnerable so this may not work for you. Another solution may be to use a local care home – ask them if they could deliver meals a few times a week and set up an account to pay for them. This was well received in our case because it meant some additional income for the care home and I also got a quick health check update from them after each delivery via a quick text.
After some time we realised mum needed prompting to take her medication and at first we were able to do this by phone. After a while this no longer worked so I asked her pharmacy to pre-fill and provide a dossette box. There are lots of different types – basically these store all the medication for the day in a named compartment so that the person taking the medications can see what to take and when.
It’s now very easy to order groceries online – we found this very useful as mum didn’t keep much food in the house and it meant we could stock up before our visits and were there to take receipt of the deliveries.
Safety and security
A trusted neighbour was given a key to mum’s home and we took photos of mum to the local police station, in case she ever went wandering. We also gave them our contact details and the phone number of the local neighbour.
We installed some telecare equipment – there is lots of information about technology on a different page of the website. The most useful device was a “door enunciator”. This is a piece of kit which plays a message at designated times. So, if mum opened the front door after dark, a message with my voice would say “don’t go outside please mum, it’s still dark”.
Laundry and general domestic tasks
Mum was finding it difficult to use the washing machine and getting muddled up with doing general housework. At first we managed this by doing it for her when we visited but this wasn’t practical in the long term. If it’s affordable and practical, there are many agencies who would provide this type of service – check with them though that their staff have been vetted. A local domiciliary care provider may be able to help (contact your Local Authority to find them) and this may be a good solution if you later want to use them to provide care as well. There is a page on the website dedicated to finding care. You could also ask a local care home whether they would be able to collect, launder and deliver items for you (this will incur a cost and is only practical if there is a neighbour nearby who can facilitate this for your relative).