MHM Magazine

10 | MENTALHEALTHMATTERS | Issue 5 | 2021 MHM with dementia struggle to regain balance, they wobble, they take shorter steps. When memory loss starts to affect daily functioning, the thread that links experiences to information retrieval is broken. Dementia destroys every part of the brain it reaches. Alzheimer’s affects the Hippocampus 10 to 12 years before symptoms are markedly noticeable. People with dementia will retell the same stories because that is the information that is stored. Everyone learns ‘social graces’ growing up like not urinating in a public garden or not blowing your nose on the tablecloth. We all learn to read body language, gestures, and facial expressions. As the dementia penetrates the Amygdala, people lose their ability to reason and appropriately react. There is no longer a social behaviour control mechanism. It’s essential for carers to understand that someone with Alzheimer’s Disease doesn’t have the same reality as they do. Their world is very different. Someone with dementia may be living in a past memory, for example one that was created when they were 25. A mother may not remember her daughter because in her reality, that daughter was three- years-old. When carers remember this, they can better cope with the lack of recognition and the ‘hallucinations’ that comes with the Disease. The role of emotion in memory can’t be understated. I may not remember the exact smell of a rose but I feel the emotions that came with that rose garden. This emotional reaction is especially true for people with Alzheimer’s and dementia. A smell or sound can trigger an emotional reaction that carers may not understand. It’s important to get a patient history to gain better insight into these emotion-memory connections. Bear in mind that until the very end, emotion is there even if memory isn’t. Some points to consider: • People with dementia lose the ability to read signals – they’re in a constant state of fight or flight and how you behave triggers emotions you may not grasp • Combative behaviour is a form of communication – keep your body and facial expressions calm, step away and give them space • Repeating the same questions like “What’s the time” may be frustrating – what is it they need to do, did they have a routine? • No amount of arguing, correcting or reasoning will make a difference • Always ask yourself “Does it matter?” REABLEMENT FOR THE PERSON LIVING WITH DEMENTIA BY SYLVIA BIRKHEAD (OCCUPATIONAL THERAPIST) Any person who has spent significant time in hospital after an illness or injury may fear being discharged. They often worry they have lost the confidence or skill to remain healthy and stay independent at home. Reablement (intermediate care or aftercare) is a short-term service to assist people learn, or re-learn the skills necessary for daily living. For people with dementia – and their carers – recognising individual needs, abilities and focusing on what the person can do rather than what they can’t, promotes confidence. Medical professionals still generally work in silos, each treating a different and separate need. Families of people with dementia are often unsure of their role - how much and what sort of input to give. More integrated services assist not only the patient but also their carer’s and loved ones. Reablement supports the carer’s well-being, helps improve quality of life, reduces dependency and ensures early intervention for vulnerable people. Dedicated training of carers specifically for dementia would facilitate an integrated response between hospitals, physicians, and social organisations. Supporting evidence for reablement: • 90% experienced increased confidence • 30% claimed improved health • 21% of people had increased ability to handle personal hygiene • 19% were better able to dress and undress • Up to 68% required no further homecare two years later STIMULATE. ACTIVATE. INSPIRE – IDEAS AND STRATEGIES FOR CAREGIVERS AND INDIVIDUALS WITH DEMENTIA BY KIM LEWITTE (OCCUPATIONAL THERAPIST) The World Health Organisation’s Active Aging Policy (2002) rec- ognises that successful aging is a complex and multi-faceted concept. All people need to feel valued, productive, and actively engage with life. Social and pro- ductive activities have a positive effect on happiness, function and mortality. Activity is a way to express identity, organise time, connect, and give people something to look forward to. It’s important to take into consideration a person’s individual skills, needs, interests, strengths and weaknesses. The loss of independence and control is distressing. Allowing people to hold your hand to guide you while feeding, blaming the product rather than the person, and asking for assistance are useful strategies. Aging and disease often affects language ability and communication. This is especially