How Help Caregivers and Social Environment of People Living with Dementia: Dr Tatiana Galako

This is informal translation of the Russian original that can be found through this link at the Kaktus Media site 

The period from 10 October through the 10th of November is known in Kyrgyzstan as a month-long series of public activities that focus on mental health. Senile dementia is a serious sickness, its prevalence is growing globally. It causes person’s inability to take care of themselves and be responsible for what they do. The Kaktus Media interviewed Dr Tatiana Galako who told of the nature of dementia and gave advise to potential client’s relatives.

– What is senile dementia?

– Probably better to call it not a senile dementia but the Alzheimer’s dementia – this is how it is categorized in international protocols. First of all, it is a sickness that causes significant decrease of intellectual capacity, memory and other critically important functions of a person. It means that the person is not able to assess what they are doing and cannot plan and forecast their activities.

Globally, the Alzheimer’s prevalence is growing. It’s considered a serious issue for the 21st century. This issue is mostly specific to elderly population.

Patients with dementia often cause discomfort to people around, to their relatives and neighbors. It is true that it’s hard to live with them, because their disorder can have different and unexpected symptoms. For instance, they gather trash in the street and bring it to their apartment. Or, they can unfairly blame their relatives in stealing their property. These patients can also be aggressive.

– What to do if there are relatives like that?

– According to the current Law on Psychiatric Assistance, there are several conditions that would allow to hospitalize people even if they don’t want to, and people with dementia are potential subjects to these regulations. They can be hospitalized if they demonstrate aggressiveness. Some of them are totally disabled, and psychiatrists screen them for more accurate diagnosis.

If relatives are leaving for let say a business trip and are not able to take care of their family member with dementia, one of the options would be to send them to a private care center for a shorter period. Long-term residence at a medical or a caregiving institution is not mentioned in the current regulations.

If patients live alone, lets say in their apartment at a house where other people live, and their sickness causes discomfort or danger to other residents (for instance, they gather trash in their apartments, bring too many pets and either don’t give them food or don’t walk with them), that means that they do need medical and social help which is often missing, and people who suffer from their behaviors must apply not just for mental health professionals’ help but for other’s too. They should involve public officers responsible for order in their neighborhood, and maybe police, because forced hospitalization is a complicated procedure that can harm primarily medical professionals if later someone assesses their intervention as unlawful or unjustified. It would be correct to initiate kind of a collective petition signed by neighbors and verified by a local police officer where the evidence of the ongoing troubles are well documented and described as a threat to normal living conditions.

– But later the person will get back from the mental center – how efficient would be the treatment there?

– Unfortunately, the Alzheimer’s dementia usually progresses, and nowadays there is no treatment approach that would cure it in full. However, even now there is evidence-based medication that should be used for longer time – but they just slow down the process.

– Having geriatric services can be a solution, but it is missing in Kyrgyzstan, is it?

This system should be a multi-player structure that will function so that people live in peace with patients with dementia, and not just because of help from psychiatrists.

– Can you give any advice to people who have relatives suffering from dementia?

– Care and oversight are very important.

There are many brochures and resources that describe approaches for improving memory – for instance, doing crosswords, managing quizzes, reading. While a person is applying certain intellectual efforts, the memory loss slows down. Relatives may want to remind these patients on regular basis of their location, tell them of their personality, of current time, so that their brains actively function. Ask them to retell what they see on TV or share their opinions on what they read. These approaches are effective enough.

Memory sticks can be used for reminding the patients of turning off the gas or electricity. We advise try to avoid putting these people in an unfamiliar environment where they can get lost, lose control and experience mental disbalance. It’s better to keep these people in the places where they get used to be in.

– What to do for protecting relatives of such patients against unfair blaming? For example, I know an old woman who uses to regular complain to the neighbors about her grandchildren who – according to her – starve her, which is not true.

– Talking to people in neighborhood on regular basis can be a solution. People around must identify the status of such people as a mental disorder. Unfortunately, when people get older, certain features of their personality get more obvious. In other words, if a person was economical in younger age, they have a risk of becoming curmudgeon while getting older. The ones who were incredulous or skeptical, have a risk of becoming over suspicious and hard to communicate with because they suspect everyone around in bad things against themselves.

These patients often live with an expectation of something negative from people around, like stealing or deprivation. These are all symptoms of dementia, they are – unfortunately – beyond our control. Their relatives have to understand it and consider such signs as sickness. They don’t have to feel offended – their relatives demonstrate not their own feeling and attitude but the features that are caused by their sickness.

We recommend trying to demonstrate calmness and neutrality. It can be very unsafe to ignore actions or talks of patients with dementia, they can become very aggressive. However, it is all possible to not argue with them. Their thoughts and talks often have nature of ravings or delirium, and it’s better to understand that it’s impossible to re-assure patients in what they say. One of the delirium criteria is its irresponsiveness to re-assuring. If you try to re-assure patients with dementia, it can only make them more aggressive. Better try to be neutral – sometime nod, sometimes agree, sometimes don’t answer but rather try to re-orientate the conversation to another topic. But don’t try to argue or re-assure, it’s so much useless and can also be counter-productive.


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