Clifford Singer is worried about a tsunami. Not the oceanic event but one potentially as devastating. He anticipates a tsunami of dementia that is inevitable as coming-of-age Baby Boomers begin entering their at-risk years.
“We are struggling to provide needed services now and the numbers of people with dementia is increasing quickly,” said Dr. Singer, adjunct professor at UMaine, and chief of the Division of Geriatric Mental Health and Neuropsychiatry at Acadia Hospital and Eastern Maine Medical Center. “There are just too few professionals with expertise in dementia care and too few resources to provide the care.”
Often, families find themselves in crisis when something happens that breaks the already fragile safety net they have established. The life-altering event could involve the elder wandering from home, a tragic driving accident, paranoid and aggressive behavior, or family caregiver illness from stress, to name a few, said Singer.
“When [crisis] occurs, people with dementia will sit in emergency departments, acute care hospitals or just try to hang on at home until treatment or alternate care can be found,” he added.
By working with families and caregivers in the clinic and in long-term care facilities, admissions to hospital or emergency departments can be avoided. This is what Acadia Hospital is attempting to do. But even with expert dementia care, emergencies will happen and we need more alternatives to hospitals in time of crisis. Until that happens, emergency departments and hospitals will continue to be the default system.
Singer outlines the different stages of dementia what constitutes good dementia care:
1. Pre-dementia phase: Focus on prevention and slowing of dementia-causing disease. This would basically include everything in most public-health and wellness guidelines since everything that’s good for mental health and cardiovascular fitness preserves brain function.
2. Mild cognitive impairment phase: Assessment of symptoms related to memory and cognitive decline to rule-out “reversible” causes and plan for the future if a progressive disease is suspected. Attention to physical and mental activities, diet and weight loss is key at this stage.
3. Early dementia: Make a diagnosis, initiate treatment if desired, attend to other conditions such as alcohol abuse, depression, sleep disorders, general medical conditions especially diabetes. Assess driving, financial decision-making, safety at home. Engage in cognitive rehabilitation activities to preserve function as long as possible.
4. Middle dementia: Focus on safety in the home, nutrition and hydration, depression, anxiety, paranoia, sleep, mobility and fall prevention. Maybe start considering a residential or assisted living facility. Become involved in appropriate activities such as those in adult day programs.
5. Late stage: Extensive caregiver support if at home or involvement in dementia-care programs and facilities, treatment of pain and neuropsychiatric symptoms, transition to palliative/hospice care and avoidance of emergency department and hospital care for anything but surgical emergencies.
Singer has ideas for change.
“One step in the process of preparing is to lift general awareness of the problem, educate policy makers of the needs of people with dementia and their families and implement systems and programs that meet those needs,” he said. “There’s a new State Plan for Healthy Aging and Alzheimer’s Disease, which provides broad guidelines. But we need specific actions that approach dementia care as chronic disease care with active, engaged multi-disciplinary teams who provide help in the home and help make transitions when necessary to respite care and appropriate long- term care facilities, while reducing ER visits and hospital admissions. We need dementia-care educators to increase skills of health care providers at all levels. And we need many, many more hands-on caregivers who can provide compassionate, enlightened care.”
Indeed we do. To learn more, come to the next Acadia Hospital Open Mind community educational session, Excellence in Dementia Care, Thursday, Oct. 18, 5:00 – 6:30, at Acadia Hospital, Penobscot Room. Dr. Singer is the speaker. Call 973-5055 to reserve your materials.
Carol Higgins Taylor is director of communications at Eastern Area Agency on Aging.