Practical tips for caretakers of elderly dementia patients
The first point to note is that dementia comes suddenly, that is, we realize someone whom we love is not normal at times only very late. We may be living with our elderly parents or visiting with them periodically, may be once a week — still we would realize the onset late. However, there is a starting point and there are always signals. How do we spot them?
They may exhibit the following symptoms:
1. Speak to self loudly about things past.
2. Forget things, places and persons ‘momentarily’ and quickly recollect when pointed out. This is where we may miss to notice because they get back to normal and we assume it is normal forgetfulness.
3. Imagine past events happening now, unknown or known persons in the room, etc. For instance, she may imagine cooking and hands will move imaginary utensils.
4. Face difficulties in performing daily chores.
5. Lose spatial orientation. For instance, she may not be able to take food from the plate and take it to the mouth, not able to sip water from the glass as it is properly kept in the lower lip, things are nearer than they are (it is not a visual problem), etc.
I will not go into the medical diagnostic process with psychiatrist, medicines and palliative care centers.
I am keen to share practices that I have experienced to provide better care.
1. Maintain a tight and regular schedule for the patient. This includes time for wakeup, regular hours to sit idle in the forenoon and evening, time to sleep in the afternoon and night.
2. Often the patient will have imaginations leading to movement of hands, legs and speech, at least few times a day. At other times, she will not remember why she did that and she would be normal at those times. How to handle such a situation and bring to the normal world? When this happens, ask her to show things, objects in the room and ask what it is, etc. Also ask what is happening in the room, according to her. If she tells she is cutting vegetables, ask her to show the vegetables. If she agrees that it is not there, whisper in her ears not to think of objects, events when it is not there, not happening, etc. Essentially, make efforts to bring her to the present. This exercise is not guaranteed to reduce the imaginations, but this may reduce the occurrence of specific imagination. For instance, an imagination of a person in the room may stop or reduce after the logic of questioning.
3. A physical exercise without movement, involving brain and an organ, helps in coordination of the brain and improves focus and reduces distraction. For instance, writing is a good exercise. An analysis of the handwriting over a period gives clues about
the mental faculty. We may notice that the handwriting is ineligible. Close observation will reveal that the letters are really small, letters superimposed over one another and the lines are not linear. This may tell about the spatial orientation of the brain mentioned earlier. A regular writing exercise seems to relax the agitation in the brain, keeps it calm during and after the exercise. Any other exercise like drawing may be considered.
4. Regular exposure to fresh air, sunlight, natural light (after evening) relaxes the brain and calms down the agitation. Any violent behavior, incoherent talks, inability to sleep may be controlled.
5. Massage on the scalp, temple (especially between the brows) gently with fingers seems to control the violent behavior. This also makes the patient still immediately. I am not sure if it is hypnotic, but it has an immediate effect.
Psychiatry may explain that this mental condition is age-related and occurs because of chemical imbalance in the brain. However, this doesn’t mean give up. Close care with proper exercise will certainly recovery to some degree. Above all, human touch, consoling words, religious songs may work miracles.
