Understanding Dementia and Functional Limitations within the Elderly

Dementia within the elderly can produce significant deficits in functional abilities, which could affect their 'independence' and 'safety' living in your own home, particularly if living alone. This may include: difficulty maintaining basic self-care needs for example hygiene, bathing, dressing, etc.; difficulty with taking medications on schedule everyday; preparing and eating adequate meals; increased risk for falling because of incoordination, weakness and poor safety awareness; difficulty with communicating skills, etc. Dementia may also result in a alternation in personality, psychosis and delusional thinking; along with a host of other issues, both subtle and obvious.

Although most people are familiar with Alzheimer's Dementia (AD), there are also other forms of dementia that can affect older adults. This includes vascular dementia, multi-infarct dementia, Lewey body dementia, and Frontotemporal dementia. Individuals with other primary disorders, for example Parkinson's or stroke, could also develop some type of dementia at some time. Dementia is generally classified as mild, moderate or severe. When AD is diagnosed in someone who is younger, say 65 years of age, the progression tends to be quicker and more severe than in someone who is 80 years old and only recently diagnosed with the disorder. A CT scan can often reveal if there are any significant areas of atrophy in the brain, sometimes related to multi-infarct or vascular dementia.

It is important to know what type of dementia the person has and when they must be taking any medications for that disorder. Often, older adults in your own home won't look for a physician or neurologist to get an accurate diagnosis and receive the proper medication, which can make living at home more difficult; both for the person and the caregiver, if there is one.

Among the hallmarks of AD may be the difficulty with language and communication skills. Individuals with AD might have difficulty expressing themselves and communicating with other people. Withdrawal and decreased socialization may occur. They may become depressed due to a recognition that their mental abilities have diminished. Sometimes the physician will prescribe an anti-depressant that may also alleviate some of the symptoms of their dementia.

Some of the cognitive components required to perform functional tasks include: adequate long and short term memory, appropriate insight and safety awareness, sequencing skills, ability to stay focused on a task, sufficient judgment and problem solving abilities, and higher level 'executive function' abilities. Executive function refers to our ability to plan and execute a series of tasks in order to produce a desired outcome. It is a complex mental ability which integrates the various cognitive skills; which people with dementia have difficulty with. For example, baking a cake requires the ability to preheat the oven, gather and mix all the ingredients in the proper amount, know when the oven is hot enough, know when the cake is done, and safely removing it from the oven at the correct time. Someone with dementia may have difficulty with many of the functional components required to do all of these steps in the correct order to produce the desired outcome.

When mental abilities have diminished, seniors are at a greater risk for declining physical health. Declining physical health related to cognitive deficits can occur due to poor eating habits and malnutrition, poor hygiene and self care skills, a greater risk for falling, not taking prescribed medications daily, not monitoring blood sugar levels - if diabetic, along with a host of other health-related problems.

Some fundamental home adaptations for safety range from: hand rails about the stairs, well light rooms and stairwells, grab bars within the tub/shower, keeping toxic items unrealistic or locked up, no throw rugs, low profile carpeting, no clutter within the walking paths of the house, limit carrying of things down and up stairs - for example laundry, removing car secrets of prevent them from driving in the event that is a problem (this is sometimes a difficult issue to deal with for all those with dementia), obtaining an ID bracelet when they are vulnerable to wandering, a gate to avoid them from heading down to the basement, along with other adaptations when needed.

For all those with mild to moderate dementia who live in your own home, below are great tips which may be ideal for the person and also the family / caregiver (the amount of care is going to be dictated through the harshness of the dementia):

It is necessary how the individual get a proper diagnosis, which may be obtained from a neurologist, and that sufficient medication is provided. It is vital that a caregiver look after them and insure that medications are taken daily. If there is no family who are able to help, then maybe someone using their church or local senior center could be entrusted to assist. Also, the neighborhood Agency On Aging might have someone consider their wellness if there is no member of the family who's accountable for them.
Have medications dispensed from the daily pill organizer. By doing this a caregiver could make sure each day's medications are taken. Daily phone calls from someone familiar with the person can then check up on them and remind them, if they live alone.
Have meals-on-wheels provide at least one hot meal each day. This may not always be sufficient, but it can help insure that some nutrition is provided.
A local home care agency can provide a 'house sitter' to stay with the person each day and help with daily chores. They are offered as several hours when needed. This may sometimes be costly, but a lower rate can sometimes be given when they are employed for a certain amount of hours each week.
If the person is becoming incontinent, have them wear snug fitting disposable briefs with elastic leg bands. This will prevent accidents from ruining clothing. Have them on a toileting schedule of every two to three hours during the day. At night, a wet alarm about the mattress may be used to remind the individual to alter from wet clothing.
Provide lots of activities, for example daily walks. This is not merely for his or her physical wellness, however it has been confirmed that daily walks provide mental stimulation as well.
Have the person participate in mentally stimulating activities daily, such as games, games, etc.; tasks that need interaction along with a little bit of problem solving. Watching tv may be the least stimulating for all those with dementia, but sometimes that's all they would like to do. The issue with television can there be isn't any interaction or response required in the viewer, that is exactly the same problem with young children. The person needs to be engaged with the environment in order for it to be sufficient as mental stimulation.
Allow the person to do as much of their own self-care, as possible; such as washing, grooming, etc. Some people with dementia enjoy using their hands and holding items; things that can be manipulated, etc. For a retired mechanic, maybe nuts and bolts could be used, for a housewife who enjoyed sewing or knitting, maybe a ball of yarn could be used. There is no limit to what can be tried; as long as the items are not sharp, could be swallowed easily, breakable, etc.
Be aware that those with moderate dementia often be agitated within the late afternoon, plus they shouldn't be over-stimulated during this period frame. Sometimes a nap can help calm them. A change in medication intervals may help keep them calm in late afternoon.
Be aware that medications can affect their level of arousal. Let the physician know about any side affects which are affecting the person's ability to function. Cognitive medications need to be at a certain level (titrated) in order to be effective. Too little medication will not help them and too much may produce undesired side affects.
Consider joining the neighborhood chapter from the Alzheimer's Association. They're an excellent resource for that client and family/caregiver.