SPONSORED FEATURE
FORGET-ME-NOT ...
PEOPLE WITH DEMENTIA
ementia is a syndrome , characterised by a significant cognitive decline ,
D severe enough to interfere with independence in everyday activities . The impairment must be acquired and represent a significant decline from a previous level of functioning . There are various forms of dementia i . e . Alzheimer ’ s disease ( most common form of dementia ), vascular dementia , Parkinson ’ s disease dementia etc , and mixed forms often co-exist .
♦ PREVALENCE OF DEMENTIA
Around 50 million people have dementia worldwide , with nearly 10 million new cases per annum ( World Health Organization ), and the number is expected to increase due to aging of the population . The global prevalence of dementia ( of all causes ) is 5-7 % for adults age 60 and above , and the risk is doubled every 5 years after the age of 65 . By the age of 85 or older , 25-50 percent of people will exhibit signs of dementia . The future projections of number of people with dementia ( PWD ) may be influenced by preventive interventions ( lowering incidence ), improvements in treatment and dementia care ( prolonging survival ), and disease-modifying interventions ( preventing and slowing the disease progression ).
♦ MANAGEMENT OF DEMENTIA
Mr Andrew , 58 , has vascular dementia ( post-stroke dementia ). He is well educated and used to work as a sales manager . His wife described his premorbid status as a very polite person , good in talking with excellent job performance and sociable with his colleagues . His memory began to decline in 2016 , whereby he became less talkative , forgetful and often misplaced things , forgot his ATM card PIN number , and frequently missed appointments with clients . He stopped working a year later due to poor performance and being unable to manage his job routine . His wife noticed he had word-finding difficulties and became quiet during family gatherings as he had trouble expressing what he wanted to say . He has three children , but he couldn ' t remember their age . He is independent on basic activities of daily living and personal care , helps in simple household chores , but he stopped managing his banking and household bills since 4 years ago . He is still able to drive ( only when his wife is around ), but occasionally needs his wife to assist with navigation . He started Qi Gong group exercise 2 years ago , which has become part of his routine every morning . He is able to follow the exercise instructions and steps but sometimes has left-right disorientation .
Dr Lam Ngee Wei ,
Consultant Physician ( Internal Medicine ) and Geriatrician
♦ CARING FOR THOSE WITH DEMENTIA
Caring for PWD poses many challenges for the family and carers . Progressive deterioration of the memory makes PWD more difficult to make decisions , remember things , communicate with others and even deal with their own personal care . Furthermore , their mood swings and ( for some of them ) change in personality and behaviour , make the caring more difficult and complicated .
Caregiving for PWD represents not only the contribution of time and energy , but also the potential loss of income when carers have to change work schedules , take a leave of absence , or even give up their job to accommodate their role . It is not an easy task to provide care and assistance to a loved one with dementia , especially when most carers are aging adults themselves , in their 50s and 60s ( or older ), who increasingly find themselves disabled and in need of medical assistance and help from others . They frequently need to provide support to both the younger and older family members , while at the same time dealing with competitive employment and other activities .
Being diagnosed with dementia is not a death sentence , although no treatment is currently available to cure dementia . However , medications are available to slow down the disease progression , and lots can be offered to support and improve the lives of PWD and their families and carers .
The legal and ethical issue in this case is that Mr Andrew is still actively driving around with cognitive impairment . Research suggests that PWD tend to overestimate their driving abilities . As the disease progresses , their attention and concentration , visuospatial skills , judgement and decision- making skills , and quick reaction time needed for safe driving tend to decline . These put them at higher risk of unsafe driving , even in those with mild dementia .
Early conversation with PWD and families perhaps helps to address the issue early with better outcome . Early discussion on the plan for retirement from driving and its alternative ( alternative transportation and delivery ). Driving test by an occupational therapy rehabilitation specialist is valuable ; even if they pass the test , they should be retested regularly in 6 months . Carers need to be educated and aware of signs of unsafe driving such as difficulty navigating to familiar places , poor lane control and inappropriate driving speed , confusion with the brake and gas pedals , failure to observe traffic signs , making slow or poor decisions , becoming easily angry or confused while driving , etc . Consider ways to limit and distract PWD from driving as the disease progresses , and if they still insist on driving , do consider these last-resort preventive strategies : control key access , disable the vehicle or sell off the vehicle .
Appropriate acknowledgement , support , respites and rewards should be given to reduce carer stress and exhaustion . Sometimes , they just need a good listener and to find a balance point among competing demands to enable them to sustain their role and contribution . Indisputably , caregiving does provide much personal satisfaction and many positive aspects , including a feeling of being needed and of being useful , feeling appreciated by family members , a sense of accomplishment , having the opportunity to express love for the disabled loved one , and many more ...