Escolar Documentos
Profissional Documentos
Cultura Documentos
What is Dementia?
Dementia is the loss of mental abilities and most commonly occurs late in life. Of all
persons over age 65, 5-8% are demented. This percentage increases considerably
with age. Twenty-five to 50% of people over 85 are affected (Table1).
The most common form of dementia, Alzheimer’s disease, accounts for 50-75% of
all cases of dementia. Another 20-30% is due to blood vessel disease ("multi-infarct
dementia" or "mini-strokes"). The remaining cases result from a variety of less
common disorders.
-Losing items
-Missing Appointments
Loss of Ability For Abstract Thought, Planning And Doing Complex Tasks
As the dementia progresses, the person may require increasing care by friends,
family members or institutions
In the past, Harry had been a very competent driver. Recently, He has become lost several times while
driving, and has had several accidents because he can’t keep track of traffic patterns. Despite this Harry
becomes irate when his wife tells him he can’t drive. He demands to use his car, insisting that it is his
right to drive it.
After washing her hands, Kathy left the water running in the bathroom and flooded the house. Lately,
she has stopped doing any cooking since she finds that she can’t remember how to cook favorite
recipes that she has prepared for years. Last week the police called her daughter after Kathy became
lost while walking to the neighborhood market.
Unfortunately these problems are often quite frustrating for the afflicted person and
alarming to her family. The frustrations can lead to her becoming irritable or
demanding, particularly if she doesn’t remember that she has a problem. She may
resent being told that she can’t do things she has "always" done.
At times dementia can produce a degree of paranoia, since the affected individual
sees those whom she relies on "taking over" her control. She may attribute the
disappearance of mislaid items to her care provider stealing her possessions or
money.
Despite these changes, people with moderately severe dementia can often engage
in many usual activities, particularly if they are not expected to function at a very
high level. Readily manageable activities might include attending a backyard
barbecue or picnic; helping to repot houseplants, drying the dishes or being taken
for a ride in the country.
Many people retain a considerable degree of social skills. For example laughing at
a joke (often because everyone else is laughing, not because she understands it).
She may carry on a conversation, but respond in stereotyped and vague ways with
empty phrases ("My, my! Isn’t that something! You know, it’s just like that.")
While some rare forms of dementia don’t progress (e.g. dementia resulting from a
head injury), the course is usually a relentless decline in functioning. When
dementia becomes severe, a person may require much help with personal care,
such as toileting, bathing, dressing and feeding. Finally the person becomes totally
dependent on his caregivers, loses the use of language and is largely unaware of
his bodily functioning or his environment.
Meals on Wheels
Case Manager and Service Coordinator
The decision to move a person into a nursing home is often wrenching. The
demented person may not wish to go into a nursing home and may become
outraged or frightened when the decision is mentioned. Or he may agree with the
decision when the reasons are explained to him, only to oppose it later, when he
has forgotten the reasons.
Unfortunately, the cost of living in a nursing home is quite high. In general, the
better staffed nursing homes cost more, Another consideration is that once a
person uses up their money, they are eligible for Medical Assistance (Medicaid) to
pay for their nursing home expenses. This requires that if the person has no
spouse, most of their assets must be liquidated and used to pay nursing home
expenses before they can receive Medical Assistance. This leaves nothing to
reimburse relatives who may have undergone the expense of caring for that person
previously. Even if the resident’s spouse is still alive, Medicaid qualification will
leave only their home (if they have one) and a limited amount of the commonly
owned assets. Naturally this may alter considerably the financial means of the non-
institutionalized spouse. Some families consider "sheltering asset" by transferring
the demented person’s property to another family member prior to the move to a
nursing home. The ethics of circumventing the law must be considered, as well as
the legal requirement that this be done at least 3 years before application for
Medical Assistance.
Summary
Dementia is a serious illness that requires much help from a person’s friends,
family and society to manage. The eldest segment of our population is now the
fastest growing group in the United States. As people live longer, and as the "baby
boom" generation ages, dementia is increasingly likely to affect us directly or
indirectly at some point in our lives. The purpose of this article is to help provide an
introduction to some common aspects of dementia. While research is progressing
to understand the causes of dementia and to develop more effective treatments, it
remains a significant challenge for us to deal with.