Dr. P.V.

Bhandary
Consultant Psychiatrist & Director
Dr. A.V. Baliga Memorial Hospital
Udupi
 When you become senile,
you won't know it.

Old age comes on suddenly, and

not gradually as is thought.
Dementia is a disorder of forgetfulness
which may impair normal activities of
daily living.
 Alzheimer's Disease
• A condition that damages several parts of the
brain
• Accounts for the majority of dementia cases
– Alzheimer’s Type Dementia (50-75 % of cases)
– Vascular dementia (10 to 20 %)
– Dementia with Levy bodies (10 to 15 %)
– Frontotemporal dementia (5 to 15 %)
 Worldwide Prevalence of Dementia

1 New case every 7 seconds

 Alzheimer Myths
• Memory loss is a natural part of aging.

• Alzheimer’s disease is not fatal

• Only older people can get Alzheimer's

• Flu shots increase risk of Alzheimer’s disease

• Silver dental fillings increase risk of Alzheimer's disease

• Early diagnosis is the best tool to manage
AD effectively
• Management of AD: -
1. With Medications
2. Without medication (Adult day care,
Respite care, Nursing homes etc)
Medications for Alzheimer’s
disease can slow decline

©2002 Pfizer Inc. All rights reserved.

The following suggestions are taken from the experiences of
carers.
You may find some difficult to carry out. Remember, nobody is
perfect.

You the care can only do your best.

• If the person refuses to bathe, try again a little later, when the
mood may have changed

• Check if teeth are being cleaned regularly

• Allow the person to do as much as possible unaided
• If the person appears embarrassed, keeping portions of the
body covered while bathing may be helpful
• Think about safety. Something firm to hold on to, such as
support rails, a non-slip mat or an extra chair all help
• If bathing always leads to conflict, a stand-up wash might be
better
• If you constantly have problems helping with this, get
someone else to do it
Dressing
The person with dementia will often forget how to dress and may
not recognise the need to change clothes. People with
dementia sometimes appear in public with inappropriate
clothing.

Suggestions:
• Lay out clothes in the order they are to be put on
• Avoid clothes with complicated fastenings
• Encourage independence in dressing as long as possible
• Use repetition if necessary
• Use non-skid rubber-soled shoes
Toileting and incontinence
The person with dementia may lose the ability to recognise
when to go to the toilet, where the toilet is or what to do
when in the toilet.
Suggestions:
• Create a schedule for going to the toilet
• Make the toilet door more obvious by using bright
colours and large letters
• Leave the toilet door open so it is easy to find
• Make sure clothing can be easily removed
• Limit drinks within reason before bed time
• Providing a chamber pot or commode by the bedside may
be helpful
• Get professional advice
Cooking
For the person with dementia, the ability to cook may be
lost in the middle stages.
This poses severe problems if the person lives alone, with
an increased risk of injury.
Poor physical coordination can lead to burns and cuts.
Suggestions:
• Assess how well the person can do their own cooking
• Enjoy cooking as a shared activity
• Install safety devices, for example change from gas to
electricity
• Remove sharp utensils
• Provide meals, or meal service, and try to see that enough
nutritious food is eaten
Eating
People with dementia often forget if they have eaten,
or how to use utensils. In the later stages of dementia
the person may need to be fed.
Some physical problems will arise such as not being able
to chew properly or swallow.
Suggestions:
• You may have to remind the person how to eat
• Use finger food – it can be easier to manage and not as
messy
• Cut up food in small pieces to prevent choking. In the late
stages of the disease, it may be necessary to mash or
liquidise all food
• Remind the person to eat slowly
• Be aware that the person may not be able to sense hot or
cold, and may burn their mouth on hot foods or liquids
• When the person has difficulty swallowing, consult your
physician to learn a technique to stimulate swallowing
• Serve one portion of food at a time
Driving
It could be dangerous for the person with dementia to
drive, since judgment is impaired and reactions are
slowed.
Suggestions:
• Discuss the subject with the person gently
• Suggest using public transportation, as appropriate
• If you cannot dissuade the person from driving, it may
be necessary to consult with your doctor or the
driver’s licensing authority
Alcohol and cigarettes
• drinking alcohol may cause complications with
medication.
Cigarettes introduce a greater danger because of the
risk of fire and damage to health.
Suggestions:
• Supervise the person when smoking; or discourage
smoking altogether– perhaps with a physician’s
prescription
• Check alcohol and medication with your doctor
Difficulty sleeping
• The person with dementia may be restless at night
and disturb the family.
• This can be your most exhausting problem as a carer.
Suggestions:
• Try to discourage sleeping during the day
• Try daily long walks, and add more physical activity
during the day
• Try to make the person as comfortable as possible at
bed time
Repetitive behaviour
• A person with dementia may forget what they
have said from one moment to the next, leading
to repetitive questioning and actions
Suggestions:
• Try to distract the person with dementia, offering
something else to see, hear or do
• Write down the answer to commonly asked
questions
• Give hugs and reassure with affection, if
appropriate for the person
Clinging
• The person with dementia may become extremely
dependent on you and follow you everywhere.
This can be frustrating, difficult to handle, and rob
you of your privacy. The person may act this way
as a result of feeling insecure and fear that when
you leave, you will not return.
Suggestions:
• Provide something to occupy his/her attention
while you step away
• You may want to call on a sitter to give yourself
some privacy
Losing things and accusations of theft
 The person with dementia may often forget where
objects were placed. In some cases they will accuse you
and others of taking missing objects.
 These behaviours are caused by insecurity combined
with a sense of loss of control and of memory.
Suggestions:
• Discover if the person has a favorite hiding place
• Keep replacements of important items, eg keys
• Check waste baskets before emptying them
• Respond to the person’s accusations gently – not
defensively
• Agree with the person that the item is lost and help find it
Delusions and haIIucinations
It is not uncommon for the person with dementia to experience
delusions and hallucinations.

A delusion is a fixed false belief.

For example, the person may hold the false belief of being under
threat of harm from the carer.
To the person with dementia the delusion is very real and causes
fear, and may result in distressing self-protective behaviours.

If the person is experiencing an hallucination, he/she might see or

hear things that are not there; for instance, figures at the foot
of the bed, or people talking in the room.
Suggestions:
• Do not argue with the person about the validity of what was
seen or Heard

• When the person is frightened try to give comfort. Your calm

voice and gently holding a hand can be comforting

• Distract the person by drawing attention to something real in

the room

• Check with your doctor about medications that are being used,
these may contribute to the problem
Sexual relationships
 Alzheimer’s disease does not usually affect sexual
relationships, but the person’s attitude may alter.
 Gentle cuddling and holding may be mutually
satisfying, and will let you know if the person is able or
inclined to engage in further intimacy. It is wise to be
patient.
 The person may not respond in the same way as
before, or may seem to lose interest.
 For some couples, sexual intimacy continues to be a
satisfying part of their relationship.
 The opposite may occur, too. The person may make
excessive demands for sex, or behave in a manner that
makes you feel uncomfortable.
 You may feel guilty about needing or wanting to sleep
separately.
Suggestions:
• Seek help from other carers or professionals you trust
• In some countries there are people with special skills
in this area, such as psychologists, social workers or
counsellors who can provide advice and guidance
• Don’t be afraid to discuss these and related issues
with a professional who is trained to understand and
help you manage them
Inappropriate sexual behaviour
The person with dementia may display inappropriate sexual
behaviour, but it is rare.
Behaviour may include undressing in public, fondling the
genitals, or touching someone in an inappropriate way.
Suggestions:
• Try not to over-react to the behaviour – remember it is
the disease taking effect
• Try to distract the person to another activity
• If the person removes clothing, gently discourage the
behaviour, and try to distract the person
• If it persists and is troubling, seek help from a professional
Wandering
This can be a worrying problem which you may need to
manage.
People with dementia may wander around the home or
leave the house and wander around the neighborhood.
They may get lost.
Safety is a primary concern when the person with
dementia is out in public alone.
Suggestions:
• Make sure the person carries some form of
identification
• Make sure your home is secure and that the
person is safe in your home and cannot leave
without your knowing
• When the person is found, avoid showing anger –
speak calmly, with acceptance and love
• It is helpful to keep an up-to-date photograph in
case the person gets lost and you must ask for
help from others
Violence and aggression
From time to time, the person may become angry,
aggressive or violent.
This can happen for a variety of reasons such as
sense of loss of social control and judgment, loss
of the ability to express negative feelings safely,
and loss of the ability to understand the actions
and abilities of others. This is one of the most
difficult things to cope with as a carer.
Suggestions:
• Keep calm, try not to show fear or alarm
• Try to draw the person’s attention to a calming activity
• Give the person more space
• Find out what caused the reaction – and try to avoid it
in the future
• If violence occurs often, you will need to seek help. Talk
to someone for support, and speak with your doctor
about help in managing the person
Depression and anxiety
The person with dementia may experience depression
and be withdrawn and unhappy, and will speak, act
and think slowly. This can affect the daily routine and
interest in food.
Suggestions:
• Speak with your doctor, who may be able to help or
offer a referral to a counsellor, psychologist or
psychiatrist
• Give more love and support to the person
• Don’t expect the person to snap out of the
depression
 The personal and emotional stress of caring

• Dementia not only affects the person with dementia, it

affects the entire family. The greatest burden is placed
on you, the carer. The personal and emotional stresses
of caring for a person with dementia are enormous and
you need to plan ways of coping with the disease for the
future.
• Some of the emotions that you may experience include
grief, guilt, anger, embarrassment and
loneliness.
Grief
• This is a natural response for someone who has
experienced a loss.
Because of dementia you may feel that you have lost a
companion, friend, or parent, and grieve for the way the
person used to be. Just when you think you have adjusted,
the person changes again. It maybe devastating when the
person no longer recognizes you.
Many carers have found that joining a support group is the
best way to get help to keep going.
Guilt
It is common to feel guilty for being embarrassed at the
person’s behaviour, for feeling anger at the person,
or for feeling that you cannot carry on.
You might be feeling guilty about considering placing
the person in a nursing home.
You may find it helpful to talk to other carers and
friends about the feelings.
Anger
 Your anger may be mixed. It may be directed at the person,
yourself, the doctor or the situation, all depending on the
circumstances.
 It is important to distinguish between your anger at the
person’s behaviour – which is a result of the disease – and
your anger with the person. Seek advice from friends, family,
or a support group. Sometimes people feel so angry that they
are in danger of hurting the person they care for.
 If you feel like this, you must seek professional help.
 You may find yourself taking on the person’s responsibilities,
such as
 paying the bills, housekeeping, cooking.
 This increase of responsibilities can be very stressful. It may
be helpful to talk over your feelings with other family
members or a professional.
Embarrassment
You may feel embarrassed when the person displays
inappropriate behaviour in public.
The embarrassment may fade if you share these feelings with
other carers who are experiencing similar occurrences.
It also helps to give explanations about the illness to friends and
neighbours, so that they will better understand the person’s
behaviours.
Loneliness
Many carers withdraw from society and are confined in and
around their homes with the person with dementia.

Being a carer can be lonely – you may have lost companionship

with the person and lost other social contacts due to the
demands of being a carer.

Loneliness makes it hard to cope with the problems of caring.

It is helpful to make it a priority to maintain friendships and
keep social contacts.
 How to get diagnosed early
• You must consult to your Doctor and have your proper
checkup of memory and other memory related
aspects.
• Self screening of Memory and other related aspects by
specially designed and scientifically proven
questionnaires.
• If you tick any of the question asked in the self
screening tool, you may need to consult the Doctor.
Whom to contact?
• Memory clinic
Dr. [Link] Memorial Hospital
Doddanagudde, Udupi
 ADD LIFE TO YEARS

ALONG WITH

ADDING YEARS TO LIFE