Apr 02
Many of the physical and behavioural problems that occur during a dementing illness make it impossible for a member of the family to carry on caring right up until the end. Under these circumstances, some sufferers will be admitted to a long-term-care ward in one of their local hospitals. Others may instead move to a [...] [...more]
Posted: under General health.
Tags: General health
Many of the physical and behavioural problems that occur during a dementing illness make it impossible for a member of the family to carry on caring right up until the end. Under these circumstances, some sufferers will be admitted to a long-term-care ward in one of their local hospitals. Others may instead move to a private nursing home. There are advantages and disadvantages to both options. A hospital has doctors and nurses on site to deal with any complicated medical problems, but they often have to look after too many patients at one time and are really very stretched. In addition, few people in the terminal stages of dementia have medical problems that require a doctor on site.
Nursing homes on the other hand tend to have a more relaxed atmosphere and better staffing ratios. ‘Quality control’ of the care that your relative receives will have to be mainly your responsibility. In a hospital, although it is important that you keep an eye on what is happening, there are many in-built quality control procedures that may not operate in a private nursing home or similar institution.
Many nursing homes won’t wish to take on people with dementia, for various reasons, and the fees for those that will may seem very high. The same is often true for private residential homes. Nevertheless there are a number of statutory grants available, some of which are means-tested, to help families meet the costs of such care. The social worker attached to your local general practice or to the hospital – if the sufferer is attending as an in-patient or day-patient — will be able to give advice on sources of funding and provide you with a list of nursing homes. It is unlikely that social workers will be prepared to recommend one against another and this is only fair as different aspects of different homes will appeal to different people.
Before making the decision that you can no longer cope, do make sure that all possible community resources have been made available to you. Many carers are unaware of the support that they can call upon locally. Many of these services have been described elsewhere, but it is important to realize that even if available in theory, some of them may be very thin on the ground, especially as the number of older people with dementia is rapidly increasing.
Making a decision like this is very much a matter for the family and it is important to discuss it with the other relatives who are involved. You can also take professional advice from the general practitioner, or a member of his or her team, or from an appropriate member of the hospital staff if your relative is a hospital patient.
The difference between nursing homes and residential home needs to be stressed. In the latter, whether provided by the social services, a voluntary body, or privately run, nursing care is not usually available. Each resident has to be fairly independent and more than a minor degree of confusion is unacceptable unless it is a home specifically for the elderly, mentally infirm.
Some homes are dual registered which means that they can take reasonably independent people in the early stages of an illness and continue to care for them when they need the sort of help that is usually only available in a nursing home.
All homes are overseen by either the local authority or the health service, at least in principle. The degree of supervision, however, varies significantly from region to region.
It is very difficult to know which home is most appropriate for a particular individual. What seems best for one person may not suit another at all. Close relatives and carers are often best placed to make this decision, as they will often get a ‘feel’ for the home and for how their relative will fit in there. Don’t accept a place simply because it is the first empty bed that you come across. Visit a number of homes, ask to see around, and inquire about the points listed at the end of this section, as well as any other matters that you think are particularly important.
As you go round the home, try to establish whether it feels homely, whether the residents are sitting around doing nothing; if you see a member of staff talking to or helping a resident, try to assess their attitude. It is also important to look carefully in the bathroom areas for adequate safety features such as rails and non-slip surfaces. Also make sure that it is clean. Above all, try to imagine how happy your relative would be there.
Ask whether it is possible for your relative to be admitted for a fortnight or so in the first instance to see how he or she gets on. This will give everyone an opportunity to assess at first hand how things will go. If a sudden transition is likely to cause a major degree of upset, some homes will allow potential residents to attend on a daily basis several times a week, rather like going to a day centre or a day hospital. This manoeuvre can sometimes be used to ease a person with dementia gently from one environment to another.
Finally, beware of brochures. These can be very helpful, but they can also be extremely misleading. It is better to use your own eyes, to listen carefully, and to try to pick up the general atmosphere. No matter how splendid the surroundings and the fitments may appear to be, don’t forget that the most important aspect of a nursing home is probably the attitude of the staff, both to those that they are looking after and also to their relatives.
Points to Consider When Choosing a Nursing Home
Are rooms shared or single?
Are personal possessions and furniture allowed?
What are the visiting arrangements?
What activities are encouraged, other than watching the television?
What is the menu for a typical week?
Can residents keep their existing general practitioner?
How many trained nursing staff are available during the day and at night?
Have they ever had to ask residents to leave – if so why?
Do residents have their own washing and toilet facilities?
How large are the bedrooms and sitting rooms?
Is there a smell of urine?
How flexible is the daily routine, e.g. mealtimes?
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Apr 02
People who cannot think properly for themselves are far more likely to have accidents that the rest of us would be able to avoid. It is important to lock away poisons and medicines, to be wary of gas stoves and fires, and to take care over hot objects or those containing boiling water or other [...] [...more]
Posted: under General health.
Tags: General health
People who cannot think properly for themselves are far more likely to have accidents that the rest of us would be able to avoid. It is important to lock away poisons and medicines, to be wary of gas stoves and fires, and to take care over hot objects or those containing boiling water or other fluids. Trailing flexes, loose mats, and other hazards of this type should be tidied up and it may be necessary to put locks on certain doors and windows. Take particular care if a person with dementia is a smoker – never leave him or her alone with cigarettes, pipe tobacco, and matches. Make sure that the hot water in your system isn’t so hot that it can burn skin, if hands are unwarily plunged into a basinful or a person steps into a bathful.
If the stairs are a potential hazard, especially at night, consider installing a gate at the top, possibly with an attached alarm that will let you know when it is being opened. A similar gate may also be helpful at the bottom of the stairs. Make sure that the handrails on the stairs are adequate and if there aren’t any, you should think of installing some, as they can often be grabbed at the last moment if a person becomes unsteady.
Most accidents happen in the kitchen, with the stairs and the bathroom following closely behind. Think carefully about your own and ask relatives of other people with dementia about their experiences. It is better to take precautions to prevent an accident rather than have to cope with the consequences of one. Both the gas and electricity boards are aware of the problems posed by people with dementia and will advise and help in making cookers, fires, and other equipment safe. Rails around the toilet and near the handbasin, and non-slip mats in the bath or shower are also a good investment.
Lastly, don’t forget that you too will be more prone to accidents. It is well established that people who are living under additional stress and strain, constantly rushing to get things done and often exhausted from lack of sleep, are much more likely to have an accident. It is very important to take care of yourself.
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Apr 02
The general practitioner is usually the key person involved in organizing the care for anybody living at home with a chronic degenerative condition. It is essential that both patient and carers have confidence in and get on with their family doctor. Unfortunately there are always going to be some people who feel that the relationship [...] [...more]
Posted: under General health.
Tags: General health
The general practitioner is usually the key person involved in organizing the care for anybody living at home with a chronic degenerative condition. It is essential that both patient and carers have confidence in and get on with their family doctor. Unfortunately there are always going to be some people who feel that the relationship with their general practitioner is unsatisfactory. This is, however, often as much the fault of the patient and the patient’s family as it is the doctor’s.
Many patients visit their doctor and for a host of reasons fail to get across why they have really made the appointment. It is easy to describe a simple physical problem that can be demonstrated such as a rash or a swollen joint, but often much more difficult to describe adequately less tangible conditions, particularly those associated with stress. Before visiting your doctor therefore it is important to get quite clear in your own mind what the problem really is and how it has affected your day to day life. This means, whether the problem is affecting you or someone else, deciding in your own mind what is really wrong. You also need to have an idea beforehand of what sort of action you hope the doctor will take. If you are worried about forgetting things, jot down a few points on a piece of paper, more in the form of notes to jog your own memory rather than as a lengthy account for the doctor to read.
If you wish to tell the doctor that you are worried about an elderly relative’s mental condition, rather than just saying that the person in question is becoming more forgetful, be prepared to describe what is happening and how seriously you regard the problem. Have examples ready of how the forgetfulness or muddled thinking is having an important impact on the life of the person concerned and those around them. If you want a careful analysis made of the forgetfulness or confusion, make sure that the doctor is aware that you want a proper assessment of whether the condition is the result simply of old age or of an early form of dementia. You must also be ready to tell him that if it is dementia, you want the underlying cause diagnosed, just in case it is one of the treatable conditions. Try not to make it appear as if you are demanding action, but rather let the doctor know that you are concerned and are seeking his support and advice.
If, despite this, the matter doesn’t appear to be taken seriously, particularly if the doctor hasn’t examined the patient and has not requested a second opinion, tell him that you realize that blood and other tests are probably necessary to rule out conditions such as glandular disorders and nutritional deficiencies, and that you would be prepared to go to hospital for a second opinion if he would prefer that. Above all, don’t be put off; but at the same time try to handle the situation tactfully if you think your problems are being treated with disinterest.
It is very important that you listen carefully to what the doctor says. Most people, including myself, feel anxious when seeking medical advice for themselves or their family. This results in a tendency to want to make sure that the doctor has heard all that you wish to say, often in the way in which you want to say it, which may result in your not answering his questions accurately; more importantly you may not take in what he says to you. If at the end of the consultation you are not quite clear about what has been decided, ask your doctor to summarize the action that he is going to take.
There are all sorts of doctors just as there are all sorts of people. If you don’t get on with your doctor you must change to somebody else. This often seems an incredibly difficult obstacle to overcome, but it really is very important. If you are looking after somebody with dementia, you are going to need help, increasingly so, over many years. Doctors realize that they won’t always relate well to every patient or relative. If you feel you have this type of problem, summon up the courage to discuss it with your doctor and explain the reasons in a friendly and tactful manner. He will probably understand and a discussion of this nature can often lead to a better understanding, making a change unnecessary. An alternative approach is to arrange to see a different member of the practice on a subsequent occasion. One of the benefits of large group practices is that there is a greater likelihood of most people’s needs being met by at least one of the partners.
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Apr 02
Alzheimer’s disease is probably the most difficult of the dementing illnesses to distinguish from the changes of normal ageing. As mentioned before, there is indeed some degree of memory impairment in many people as they grow older although this may not be as great as was once imagined. As the earliest sign of Alzheimer’s disease [...] [...more]
Posted: under General health.
Tags: General health
Alzheimer’s disease is probably the most difficult of the dementing illnesses to distinguish from the changes of normal ageing. As mentioned before, there is indeed some degree of memory impairment in many people as they grow older although this may not be as great as was once imagined. As the earliest sign of Alzheimer’s disease is often exaggerated memory loss, there is often a grey area in the interpretation of tests of memory function. It is therefore often necessary to test memory function on successive occasions over several months before one can be certain whether or not Alzheimer’s disease is present.
There are many tests of intellectual function; some are very long and complicated and others are simple and quick. As one might expect, the shorter and simpler the test, the more likely it is that the information will be unhelpful or inaccurate. Nevertheless because of the time involved, the initial tests often have to be the short and simple ones. Many of these are employed by district nurses, health visitors, and doctors when they first meet a person with suspected dementia. The tests usually involve a few questions that are designed to gauge different types of memory function — the ability to use language correctly and parietal lobe function. The performance of more complicated tasks such as the ability to carry out simple calculations may also be examined. In many ways these are most useful if the results are normal. An abnormal result will not diagnose dementia; on the contrary, it will indicate that something is wrong and that further assessment is required. In difficult cases the patient will need to be referred to a qualified psychologist who will perform the more extensive and sensitive tests. These will usually go a long way towards determining whether or not dementia is present, and may also provide information that will help in deciding which condition may be causing the dementia.
Nowadays many of these tests have been put on to computer; colourful images on a television screen help to keep the attention of the person being tested and reduce the opportunity for inaccurate responses to creep in because of adverse interactions between the patient and the person doing the testing.
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Apr 02
The most important cells in the brain, the neurones which make up the grey matter, consist of a cell body and the nerve fibres passing from it. The cell body is the powerhouse of the neurone and contains a structure called the nucleus, from which emanate all the instructions for the biochemical processes that occur [...] [...more]
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Tags: General health
The most important cells in the brain, the neurones which make up the grey matter, consist of a cell body and the nerve fibres passing from it. The cell body is the powerhouse of the neurone and contains a structure called the nucleus, from which emanate all the instructions for the biochemical processes that occur within the rest of the cell. There is one major nerve fibre called the axon and this can be very long. The end of the axon usually breaks up into many branches, each of which makes contact with the cell body or branches of nerve fibres from other cells. Those that leave the brain either make contact with other nerve cells, in the spinal cord for example, or with other structures such as sensory organs or muscles. There are also numerous shorter nerve fibres attached to each cell body, and these are called dendrites. These make contact with parts of many other neurones. It is thought that some nerve cells die as people grow older, but that the branching of the remaining nerve fibres increases to make up the connections that are lost because cells have died. It seems as if in some types of dementia this compensatory increase in the branching is abnormal or reduced.
As well as neurones there are many other types of cell in the brain. These are usually described collectively as neuroglia. There are several different types of neuroglia, and the function of some of them is uncertain. It used to be considered that they had a principally supportive function but we now know about some of their other functions too. As far as the dementias are concerned, it is possible that one of the more important things neuroglia do is to produce chemicals that other brain cells need, and that this process may become disturbed, leading to a malfunction of neurones which results in their death or prevents them from working properly.
Inside each neurone lies a complicated structure of little fibrils and tubules. This is sometimes referred to as the skeleton of the cell but it is also important in the passage of substances from one end of a nerve fibre to the other. In some types of dementia, including that caused by Alzheimer’s disease, it may well be that a disturbance of these structures and their transport function affects the way the nerve cells work.
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