Providing nursing care to elderly and senile patients

Dementia is a general decline in mental abilities. It is more common in older people diagnosed with Alzheimer's disease over the age of 70.

Brain injuries, infections, and addiction to alcoholic beverages also contribute to the manifestation of dementia, chronic and progressive.

There are different types and three stages of the disease, vascular dementia or with the formation of Lewy bodies. The speed and depth of degradation depends on the individual characteristics of the individual and the causes of the disease.

Features of people with senile dementia or post-stroke dementia

The main feature of sick people with senile dementia is that they have no control over their own lives, cannot carry out daily routines, run a household without danger to life, communicate adequately with loved ones, or live alone without care. Here are just a few signs of dementia to look out for:

• Impairment of both short-term and long-term memory. An elderly person may not remember what they ate for breakfast or may forget important events from many years ago.
• Disturbance in the sense of space and time. An elderly person “falls out of reality”, wanders in an area familiar from childhood, gets lost in supermarkets, etc.
• A person with dementia becomes unresponsive to new things and declares that “it was better before.” His brain loses the ability to process, analyze and synthesize any information.
• Loss of self-criticism. Such a person cannot be told that he is wrong (sloppy, inadequate, unable to cope) - he believes that they are slandering him. The patient realizes the need for medical intervention only at the initial stage of the disease.

Contrary to the stereotype, senile dementia is not divided by gender, race, IQ level or occupation. Both a factory worker and a doctor of science with numerous credentials can get sick.

Sleep with dementia

Sleep with dementia is often disrupted, and a person may not sleep all night long. This is often the most difficult thing when caring for a patient, because after being exhausted from the day, the caring relative also needs rest. In order for these situations to happen as rarely as possible, it is worth not allowing the patient to sleep a lot during the day, but it is better to engage him in physical labor as much as possible. Before going to bed, you can go for a long walk with the patient.

Providing a cozy and comfortable sleeping place is the key to ensuring that the patient sleeps long and soundly. To do this, you need to choose a mattress that suits the person’s preferences, pleasant bedding, and the bedroom needs to be ventilated for a long time to enrich the air with oxygen.

How to prolong the life of someone suffering from senile dementia?

On average, patients who have been diagnosed by a specialist live with senile dementia for 8-10 years. Relatives are wondering: how to extend the life of a loved one while maintaining its quality. If you follow the doctor’s recommendations and establish proper care with medication, the patient with dementia will live a relatively comfortable and interesting life, even if “in his own world.” To do this you should:

1. “Train your brain” with the help of chess, crosswords, intellectual games, construction sets, and creative handicrafts. If an elderly person had a hobby that was dear to their heart, they should maintain interest in it.
2. Do exercise therapy with simple movements that are not burdensome for a person with dementia.
3. Walk in the fresh air with an escort.
4. Provide the patient with interesting and varied leisure time with friendly communication. Adequate interaction with other people is possible only at the initial stage of dementia; it is important not to miss this moment. The patient should not be locked in an apartment or protected from friends - this will accelerate neurodegradation.
5. Fight depression and low mood. Patients with dementia, who are not susceptible to paranoia and aggression, blame themselves for becoming dependent. If possible, you should create a positive atmosphere in the house and please your loved one with good news, good films and cartoons, beautiful outfits, and family photographs.
6. Organize the patient’s life - change linen daily, fight bedsores, bathe the patient regularly, ventilate the room, spoon feed.
7. To see in your loved one the person you knew and loved before. Respect the patient and remember that it is not he who “speaks”, but his illness.

There is no effective way to cope with dementia, but it is possible to slow down the progression of the disease and the onset of the final stage.

“By following the recommendations of doctors, you can extend the active phase.” Vladimir, 57 years old

“We noticed symptoms in March 2011, but in hindsight we realized that dementia had started to develop earlier. Six months before, she was bad at sewing, knitting, and cooking. But we didn't attach any importance to this. Then she began to get confused more than usual, making mistakes in the simplest things. Mom, of course, is an elderly person, but it became obvious to both me and my sister that something was wrong.

We didn't understand what was happening and took her to a neurologist. The doctor immediately said that my mother had dementia, possibly Alzheimer’s disease. She prescribed medications, injections and suggested specialists who deal with this problem in Moscow. The Scientific Center for Mental Health of the Russian Academy of Medical Sciences sounded. Department for the Study of Alzheimer's Disease and Associated Disorders. I found it. In the first months we managed to get an appointment. For the first five or six years we visited there regularly. They told me how to behave with my mother in everyday life, what to do with her.

The first years we lived actively. We did Nordic walking and played chess. We did everything together: shopping, eating, cleaning, even doing laundry together. We tried to communicate: we went to visit, we invited friends.

But this time quickly passed. Three years ago, my mother began to fall into delusional states, sleep poorly, and behave aggressively. She has required continuous monitoring for the last two years. We had to put locks on all the doors and windows and remove the handles from the stove. If I’m doing something, I look back at her every two or three minutes. Now my mother is bedridden. He speaks poorly and doesn't understand anything.

All the concern lies with me. At first I went to work, but then I had to leave everything. The situation was depressing. But over time, we got used to each other and managed. My sister is a visitor and comes when she can. I can do some things at this time. But since my sister, unlike me, is not constantly looming before my eyes, my mother does not perceive her well: she does not listen, she contradicts her.

My mother’s character changed a lot during her illness. She doesn't react well to all people, so we haven't thought about a caregiver. We did not consider boarding houses either. She is very restless, energetic, and difficult to keep track of. And a change of scenery wouldn't do any good.

Mom, of course, doesn’t realize much, but her native walls work better on her. Even when we first went to a relative’s dacha, she always asked to come back home. As we were told at the “School of Caring” and as I myself understood through experience, caring for such patients is still the business of relatives. Nothing can replace their help and care.

On the recommendation of the center’s specialists, we registered at the neuropsychiatric dispensary at our place of residence. The doctors sent me, saying that they could give me free medicine. But the necessary drugs were not available. We buy everything ourselves. We spend 5-7 thousand a month.

In my opinion, the most important thing is to notice in time, give importance to the changes and turn to specialists. Nothing good will happen if you leave things to chance. By following doctors’ recommendations, you can extend the active phase.”

How to maintain your sanity while caring for someone with dementia

If you decide that an elderly relative would be better off at home than in a special institution, remember: both he and you need you to be mentally healthy. Therefore it is not recommended:

• Arguing with a person with dementia costs you more. The affected brain dictates to the old man ideas and decisions that have no relation to reality, but he sincerely believes them. You need to suppress your instinctive desire to prove that you are right, to correct, to dissuade. It is difficult to argue with a person with impaired logical thinking.
• Ignore the first symptoms, attributing them to old age. You are not a specialist, and therefore you may miss the “first signs” and mistake a change in symptoms for improvement or recovery. There are also many treatable diseases that “masquerade” as dementia. A psychiatrist can identify them using special techniques, tests and questionnaires.
• Prescribe medication to the patient independently. Even medications prescribed by a doctor can have side effects and disorient the patient. Dosage and regularity of administration also play an important role. The psychiatrist also selects alternative drug options.
• Respond to aggression with aggression and accusation to accusation. Your loved one does not control or decide anything: his lifestyle is determined by his illness. Nothing said to the patient should be taken personally, even if it is accusations of robbery, poisoning, etc.
• “Pull” a person out of his fictional world. Experts recommend white lies. The caregiver will have to come to terms with any reality. Some patients believe that the deceased spouse is still alive, while others consider themselves to be small children. Attempts to argue “shatter” the old man’s inner world and lead to aggression, screaming, and anger. By expressing his feelings and thoughts, the elderly person quickly calms down.
• Deal with it yourself. Caring for someone with dementia is exhausting work. It is necessary to look for those who can and are ready to help: specialists, volunteers, a nurse, specialized institutions, a “support group”.
• Entrust the care of the old man to younger family members. A minor may overlook the patient.
• Getting hung up on caring for the old man, ignoring rest, your desires and needs. This will increase the risk of emotional burnout.
• It is impossible to believe those who promise to completely cure and restore your patient using alternative medicine.

Practical recommendations for drawing up a plan

An accurate plan for organizing the nursing process for elderly dementia should be drawn up only after the specialist hired to supervise the patient is fully familiar with the characteristics of this person, his character, preferences and anamnesis.

The most detailed information about the patient will be provided by his relatives.

If you are not going to hire a person to look after your relative, then it will be even easier for you to make a plan: you need to describe in detail his routine, wake-up/bedtime, meals and medications, as well as entertainment activities (if the relative is not bedridden and exists such opportunity).

What else you need to know about dementia:

• what are the reasons for its development, can it be a consequence of other diseases;
• what is acquired and congenital dementia;
• why dementia develops at an early age, as well as in children and adolescents, and how it can be prevented;
• what methods of diagnosing the disease exist, what are its symptoms and signs;
• how dementia manifests itself in older people, what are the features of treatment in old age;
• is there a difference in symptoms between men and women;
• what is the life expectancy of a sick person, is it possible to apply for disability and how?

Home care or nursing home?

How to care for an elderly person with dementia whose brain is affected by degenerative processes is up to the family to decide. It is worth considering that the patient, once wise and independent, turns into a child - rude, harsh, capricious and manipulative. But children develop, acquiring skills and abilities, and old people over 60 with dementia lose them. In this case, thoughts about a boarding house where an elderly relative will be surrounded with attention and care are not a betrayal. People in Russia, following Europe and America, are increasingly abandoning home care without specialized knowledge and skills, and are deciding in favor of specialized medical institutions.

“If you take care of your health, it becomes easier.” Olga, 29 years old

“We live with my husband’s grandmother. She is 87 years old. She worked as a doctor. Five years ago she retired and the very next day she fell ill, saying that she could not do anything. She developed various fears. She began to fear that there was no money. I tried not to go to the toilet, fearing that the toilet would clog, and refused to eat, fearing that the food would run out. She didn't want to take the pills.

We took her to a mental health center. Doctors made a diagnosis and prescribed medications. Although her fears have become less pronounced, she still refuses to go outside, has lost a lot of weight, and her cognitive impairment is progressing.

This is the first time we have found ourselves in such a situation. And at first they didn’t understand what to do, how to behave. When she refused to eat, we tried to convince, give some arguments and only got annoyed.

When I went to the School of Caring, it turned out that fears are classic symptoms of dementia. Experts explained how to communicate with your grandmother: in an imperative form, in short sentences, say, for example, “eat”, “take the spoon in your hand”; They told us which government services could help and how they could help. It never occurred to me that I could get diapers at a discount or call an assistant.

Sometimes I think there is a point in boarding houses if they are good. But my husband is categorically against boarding schools. This is his beloved grandmother. In addition, she has become so attached to the house that it would be difficult for her to move to a new place.

The costs of care have not been calculated, but the amount is quite burdensome. In addition to medications, we need diapers, visits from doctors, now mainly a traumatologist. There were no critical situations.

We have a small child, so I am at home and take care of my grandmother. Her condition is changing. When I get very tired, I give up. Sometimes it comes down to me: how stupid we are, that we moved in with our grandmother, we should have hired a nurse. But this goes away quickly if you talk to someone. If you take care of your health, it becomes easier. In the morning I do exercises and dance. Sometimes you need to leave home. For several days my husband takes care of my grandmother, and I go for a walk, trying not to think about my grandmother. When, for example, she refuses to eat, and I feel irritation coming on, my emotions go off the charts, I lock myself in the kitchen or room and yell. Helps."