Understanding the Challenges of Dementia

Dr. Robert Figlerski, Director of Psychological Services at IPC Healthcare, Inc. gave a presentation on the Challenges of Managing Dementia to Osborn residents and their families, community members and staff at The Osborn on Wednesday evening, September 16.

Dr. “Bob” spoke about the science behind dementia, how it affects brain functioning and its impact on patients and their caregivers. “Just as a person might have kidney or heart disease, Alzheimer’s is literally a disease of the brain,” he explained.

He presented diagrams to illustrate different regions of the brain in a normal functioning brain compared to the brain of a person with dementia.

Dr. Bob cautioned people against overreacting to the occasional lost keys or inability to remember names. “Many people experience ‘benign forgetfulness’,” he said. “This is not to be confused with dementia.”

“Sometimes dementia is caused by stroke or other instances where blood enters the brain,” he said. While blood provides necessary nutrition to the brain, it is also toxic when it comes in contact with brain tissue. “As the brain structure is compromised, so is its functioning.”

The period from clinical diagnosis of mild cognitive impairment to late stage Alzheimer’s can last 10-12 years with some plateaus along the way. “Of course any catastrophic health event can accelerate this process,” he cautioned.

According to statistics, sixty-five percent of dementia diagnoses are actually Alzheimer’s. However, the only scientific means of confirming the diagnosis of Alzheimer’s is post-mortem, through an autopsy of the brain.

While there are medications that can manage some of the symptoms of the disease, there is no cure at this time. Dr. Bob advised caregivers against over-sedating patients and encouraged them to use redirection strategies, calming activities or walking to reduce agitation. “The key is to maintain a balance,” he said.

IMPACT: MEMORY, LANGUAGE, AND EMOTION

Dr. Bob talked about role played by the section of the brain called the hippocampus. “This is the part of the brain that helps consolidate memories. Even people with mild dementia experience difficulty remembering simple tasks and may need frequent reminders, causing frustration for both the caregiver and the patient.”

“Likewise, transitions are very difficult,” he explained. “Patients feel safe with their routines and any changes can be very unsettling, often causing emotional outbursts.”

While short-term memory is usually compromised, patients may have vivid memories of events in the distant past. According to Dr. Bob, these memories are a great tool for family members and caregivers. “Tapping into a happy memory by sharing photo albums or stories can have a calming effect.”

In the mid-stages of dementia, language becomes more difficult. Patients may not remember object names or word sequences, or may not be able to effectively process what they are told -- another source of frustration. Caregivers are encouraged to use other means for communicating: “Talk less, guide more,” is Dr. Bob’s mantra for these situations.

“At The Osborn, we talk with family members a lot to try to get a deeper knowing about who their parent really is,” said Chris Ferreri, Vice President of Health Care Services at The Osborn. “This understanding helps our staff relate to patients in a more meaningful way.”

Another area of the brain that is impacted by dementia is the limbic system, a center of strong emotions and instinct. Dementia patients have difficulty controlling these reactions and are often less inhibited. Patients may become verbally or physically aggressive – often threatening other patients or caregivers. It is critical to redirect patients in these situations, remembering that this flash of emotion is temporary and not meant to be personal. When patients appear aggravated, Dr. Bob recommends re-directing that energy by walking or changing scenes.

HEALTH AND SAFETY

When the brain is no longer working effectively, patients may not realize their physical limitations and are at a greater risk for accidents and illnesses. Natural sleep disturbances and forgetting to eat or hydrate cause people to be dizzy or frail. “Weight loss is a red flag,” said Dr. Bob.

Managing pain in someone who can no longer recognize or articulate their discomfort is a real issue for caregivers. “It’s important to know your patients well and watch them closely to measure their reaction to situations that might cause pain,” he explained. Lack of effective pain management can lead to an increase in symptoms, including disorientation, restlessness, depression, and increased risk of falls.

Fall prevention is a major topic for anyone involved in the care of the elderly – whether or not the person has dementia. Dr. Bob shared strategies for preventing falls, including proper foot care and well-fitting shoes, good lighting, removal of clutter and other trip hazards, bathroom safety, and medication management.

HOPE FOR FAMILIES

Despite the disheartening facts of the disease, Dr. Bob’s presentation ended on a positive note. “The good news is that we are lucky to be living such long lives. In the past, our parents might have succumbed to disease at an earlier age. Now the incidence of dementia is rising along with the average life expectancy,” he said. “We have to accept dementia as part of our journey together.”

He continued: “Family members need to understand that they will feel ineffective sometimes: you simply cannot stop the progression of this disease.”

“These patients with advanced stage dementia live in the present moment. It is best to join your loved one in that moment. The true measure of love is that you keep coming back!”

Dr. Figlerski and his staff are an integral part of the clinical team at The Osborn Pavilion. He has worked to train our Certified Nurse Assistants in the skilled nursing facility, the Patient Care Coordinators in assisted living and helped to develop problem solving techniques. In addition, he has provided training to our home care aides for years as part of their orientation program.

Established in 1908, The Osborn is a continuum of care community for seniors, offering a wide range of programs including independent living, assisted living, dementia care in the award-winning H.O.P.E. Center, short-term rehabilitation and long-term skilled nursing care, as well as home care – available on campus and throughout Westchester and lower Fairfield Counties. Individuals and families interested in learning more about The Osborn and its services are invited to call 914-925-8000 or visit www.theosborn.org