Understanding Dementia and Functional Limitations in the Elderly

Dementia in the elderly can produce significant deficits in functional abilities, which can affect their ‘independence’ and ‘safety’ living at home, especially if living alone. This can include: difficulty tending to basic self-care needs such as hygiene, bathing, dressing, etc.; difficulty with taking medications on schedule everyday; preparing and eating adequate meals; increased risk for falling due to incoordination, weakness and poor safety awareness; difficulty with communicating skills, etc. Dementia can also cause a change in personality, psychosis and delusional thinking; and a host of other problems, 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. People with other primary disorders, such as Parkinson’s or stroke, may also develop some form of dementia at some point. Dementia is usually 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 if they should be taking any medications for the disorder. Often, older adults at home will not seek out 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.

One of the hallmarks of AD is the difficulty with language and communication skills. Those with AD may have difficulty expressing themselves and communicating with others. 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, and a host of other health-related problems.

Some basic home adaptations for safety can include: hand rails on the stairs, well light rooms and stairwells, grab bars in the tub/shower, keeping toxic items out of reach or locked up, no throw rugs, low profile carpeting, no clutter in the walking paths of the home, limit carrying of items up and down stairs – such as laundry, taking away car keys to prevent them from driving if that is an issue (this is often a difficult issue to address for those with dementia), obtaining an ID bracelet if they are prone to wandering, a gate to prevent them from going down into the basement, and other adaptations as needed.

For those with mild to moderate dementia who live at home, here are some tips that may be helpful for the individual and the family / caregiver (the level of care will be dictated by the severity of the dementia):

  • It is important that the individual receive a proper diagnosis, which can 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 can help, then maybe someone from their church or local senior center can be entrusted to help. Also, the local Agency On Aging can have someone look into their well being if there is no family member who is responsible for them.
  • Have medications dispensed from a daily pill organizer. This way a caregiver can make sure that 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 out with daily chores. They are available for as many hours as needed. This can sometimes be expensive, 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 on the mattress can be used to remind the person to change out of wet clothing.
  • Provide plenty of physical activities, such as daily walks. This is not only for their physical well being, but it has been shown that daily walks provide mental stimulation as well.
  • Have the person participate in mentally stimulating activities daily, such as board games, card games, etc.; tasks that require interaction and a bit of problem solving. Watching television is the least stimulating for those with dementia, but sometimes that is all they wish to do. The problem with television is there is no interaction or response required from the viewer, which is the same issue 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 become more agitated in the late afternoon, and they should not be over-stimulated during this time frame. Sometimes a nap will help calm them. Even 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 local chapter of the Alzheimer’s Association. They are a great resource for the client and family/caregiver.

Article Writer: Tim Mancino

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