Diagnostics always before therapy
Only after a meticulous examination, including all of the mentioned elements, it is possible to undertake a specific therapeutic procedure and treatment.
Active care in the patient's home - this is the basic element of therapy
In spite of the significant progress of pharmacology, the rules of conduct in the case of stating the patient's dementia are not so much about pharmacotherapy but about proper care. The main purpose of this care should be to keep the patient at home for as long as possible. Among geriatricians there is a perception that non-pharmacological treatment gives better senile dementia (regardless of its etiology) better long-term results than pharmacotherapy. That is why one of the most important factors, allowing to maintain the patient's efficiency at the current level, without the risk of sudden deterioration, is to ensure him continuity in the existing environment and the best care possible. Appropriately trained care should take into account appropriate planning of the patient's course, control of meals, physiological needs, etc. Usually the main burden of caring for a patient with dementia lies with families and, as mentioned before, despite numerous shortcomings, this form seems to be the best and most effective.
The patient with dementia should stay home for as long as possible
Home, family, friends are in his case the best environment. However, the severity of the disease, and especially the behavioral disorders and psychotic symptoms that accompany it, may prevent home care, leading to the institutionalization of an older person.
By. statistics about 80% of patients with dementia remain under the care of families.
Worse and worse contact with the patient, lack of criticism of the disease and behavioral disorders, and sometimes aggression, unfortunately, constitute a huge emotional burden on the family. This, in turn, is often the reason for the development of a reactive depression at the closest guardian.
Factors that increase the risk of a demented patient in his home are:
• death of a spouse or his hospitalization
• poor health carer
• formalized care without emotional involvement
• a larger number of people who take care (they shift responsibilities, can not reasonably communicate)
A problem for caregivers may be the patient's tendency to become alcohol-dull
Alcoholism may increase the development of dementia through direct neurotoxic action or indirectly, contributing to the reduction of material status, increased injury or worse nutrition. Conversely - the tendency to a small daily dose of alcohol, e.g. in the form of red wine - can act healthily! The authors investigated the effect of the amount and type of alcohol consumed on the development of the two most common types of dementia, which in the West of Europe are Alzheimer's disease and vascular dementia. Out of 1709 subjects, a group of 83 people with dementia was selected. Men were slightly more than half. They assessed a one-off alcohol intake in small amounts per day. The subjects were classified according to the amount of alcohol consumed within one week. No relationship was found between the total weekly dose of alcohol and the development of dementia, both in women and in men. The study confirmed lower inclination to dementia syndromes, especially vascular etiology, among those who drink moderate amounts of wine, especially red, compared with those who prefer other alcoholic beverages and abstainers. The authors associate this with flavonoids having an antioxidant effect in red wine.
The patient's carer also requires special care ...
In order for the patient to stay at home, it is often necessary to help his guardian or family. This is a task for field social caregivers, community nurses and other institutions dealing with old people. The simplest, very necessary and effective in such situations is moral support. It costs nothing and can breathe new energy into tormented caregivers. The interest in the fate of the patient, the explanation of the details of his ailments, and the provision of small, practical advice can change the pessimism of a worried spouse. Material support can be multiple, it does not always have to be reduced to direct allocation of money. Sometimes it may be an aid in reimbursement of expensive medicines or nappies, handling of meal vouchers or other forms of material support for the patient and his family. The patient - Leszek writing the best in our language a monograph on Alzheimer's disease, clearly underlines the need for psychotherapeutic care also for the patient's caregivers. Caregivers who are emotionally involved and receive psychological support (eg from the support group) are less prone to depression. This support may also have various dimensions and institutional forms (eg houses of daily stays for patients).
The critical level of dementia disorders requires shospitalization
However, when mental disorders of a person in dementia become so significant and the strengths and abilities of caregivers decrease (as a result of illness or disability), institutional help becomes necessary. In the case of significant mental disorders associated with anxiety and aggression, psychiatric hospitalization will sometimes be necessary.
Whenger gives the following criteria for admitting an elderly patient to a psychogeriatric ward, and these recommendations consistently adhere to:
• behavior that threatens oneself or others
• organic bands with repeated behaviors such as: arson, escape from home, attacking people
• severe reactions to stress in the form of severe anxiety or agitation in elderly people with the organic syndrome
• an organic complex where there is a probability of improvement by active treatment under close supervision
• functional psychosis, whose outpatient management is impossible
• Chronic psychosis to determine appropriate treatment when this is not possible on an outpatient basis
• detoxification in the event of drug or alcohol abuse
• somatic diseases with such severe mental disorders (reversible) that patients who do not suffer are not admitted to the general hospital
A patient with dementia in a specialized care facility
About 20% of dementia patients living in social care facilities are there not because of their health condition but for other reasons. The author believes that patients rarely go to this type of bet due to deep dementia, and usually the direct cause is the inability of the caregiver to look after the patient. The author is even of the opinion that the selected stadium never breaks down due to the dullness of one of the spouses. Usually, a healthy spouse of a successful relationship, a woman or a man, finds in this situation the raison d'être and activity in caring for a sick partner.
A separate, difficult and sometimes very complicated matter is help in explaining the property matters of the patient.
Sometimes the only trustworthy way to solve them will be the appointment by the court of a superintendent who will supervise the patient's income and expenses.
Doctor of Medicine Janusz Krzyżowski
Psychiatrist
Private office tel. 22 833 18 68
00-774Warszawa, Dolna 4 lok. 15
