Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Wednesday, March 15, 2017

Society's Dementia Dilemma

In the city of Ottawa alone calls came in to the Ottawa Police Services to report that 1,600 adults were missing, in the last year. "After 30 years of being here, I can tell you without a doubt that those numbers are higher than they were even five years ago", stated Sgt.Reno Rushford of the Missing Persons Unit.
"It used to be, I could go to a house on a street and say, 'Have you seen Mr. Jones?' and everybody on the street would know who he was. Today, it would be 'I didn't know there was a man living there'. There's a neighbourhood disconnect that wasn't there twenty years ago."
"If everyone with Alzheimer's was physically fit, then there would come a time where everyone would have a period of [wandering]."
"As the disease progresses, physically you're still very well, but cognitively you don't remember. And if you don't recognize that you've been to this place before, then your mind map starts breaking down."
Dr. Frank Knoefel, Bruyere Research Institute Memory Program
Memory complaints are common within the elderly population, and their frequency usually increases with age. Decline of memory function is a normal process of aging, but they also may be the result of a pathological condition such as Alzheimer's disease.

When a search situation is mounted, it doesn't take long before the matter is resolved for the most part; roughly 95 percent of wanderers are discovered to be within a half-kilometre of where they started out. On occasion, however, they have been gone for a substantial period of time and are found quite a distance away from home. In winter, when it's extremely cold and windy, the loss of "executive function" where clear cognition has been disrupted because of Alzheimer's the situation can turn deadly.

When police open a missing persons file for an adult wanderer suffering from Alzheimer's they look for some quick answers to give them directional opportunity: Is the person on medication? Do they have mental-health issues? Is this the first time they've wandered? Does a pattern relating to their wandering exist with respect to visiting old neighbourhoods or former places of employment? This narrowing down of options can help lead searchers as directly as possible to the wanderer, preventing disaster.

The most common cause of dementia is Alzheimer's disease, accounting for about two-thirds of cases. A progressive, eventually fatal disease that destroys brain cells, Alzheimer's has a strong correlation to aging albeit with a defined genetic link. In its early stage, symptoms may include forgetfulness, mood changes or problems with communication, which are common enough issues faced by many people, not necessarily, nor confined to those with Alzheimer's onset. And as such, those symptoms are easily overlooked and misidentified.

Memory and communication problems increase by the time the person reaches the middle stage, and assistance will be required to function. It is at this point in the progression of the disease that the tendency to wander begins to manifest, even though Alzheimer's may not yet have been diagnosed. This also happens to be the longest stage in the trajectory from onset to death. When late stage Alzheimer's arrives, 24-hour care is required and mental capacity will have been stringently reduced.

By this time the sufferer has become quite ill and frail and consideration among family members as to whether to continue home care or seek long-term facilities that are capable of housing and caring for the patient becomes a primary concern. The final, end-of-life stage represents a situation of awaiting death while giving comfort to the patient along with the specialized care required.

Many in the field of health care with a special emphasis on care for the elderly predict that Alzheimer's disease and other dementias will be more prevalent in an aging society, that within the next fifteen years the number of those with dementia will double, with up to 1.5 million Canadian sufferers. With no cure in sight, let alone ameliorating protocol to prolong the quality of life, Dr. Knoefel and others in the field begin to think in unexplored directions.
"Maybe we just need to think differently about the brain. I'm not as fast as I was in my 20s. I know I can't run the 100 metres in ten seconds for the rest of my life. Why do I expect my brain to do that? Why can't we just say, 'Hey, this is good news. We're living longer, but you know what? When you get out to that end, we're going to have to think about how we take care of ourselves differently."
We're going to have to think differently about how we design our spaces so that people who need more clues about where they are, are given that chance. Rather than think of it as the 'war on Alzheimer's', we need to say, 'This is a reality. How do we live with that? How do we minimize its impact'?"
So at the Bruyere, where quality of life linked to palliative care is the goal, research has been launched on how to make homes 'smarter', with perhaps an additional set of 'eyes and ears' to remove a portion of the burden from the caregiver. For example, if the sound of an Alzheimer's patient rising from bed, approaching a kitchen stove or a front door is heard, have a voice recording speaking familiarly to the person: "It could send a voice message; 'Honey, why don't you come back to bed'; like a substitute spouse."

At the Acute Care of the Elderly unit of the Queensway Carleton Hospital, rooms are colour-coded for the ease of visual hints when a confused patient attempts to find their way around, back to their room. Flooring is uniformly the same light colour, as those with dementia feel more comfortable with a light floor, misinterpreting dark areas for holes they could stumble through. Dark flooring as a consequence is used where patients are excluded from wandering.

The Alzheimer's Society has a host of coping strategies, such as painting or wallpapering doors to give them less of an appearance of being a door, of moving the locks on doors to make them less accessible, to placing hats and coats out of direct sight so no reminder of exiting the house can be triggered. Furniture arranged differently, to alter the movement flow in a room, away from exits. iPhones programmed to track a person; GPS devices worn like a wristwatch.
Unfortunately, there is no vaccine against dementia. Yet lifestyle and other factors play a role in the risk of developing a disease that may cause dementia. So, healthy lifestyle choices regarding diet, nutrition...exercise is recommended.

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