Geriatric Mental Health: Snippets on World Mental Health week 2020

Every year, the second week of October is observed worldwide as World Mental Health week, seeking to spread awareness for mental health illnesses and promote appropriate care for those suffering.

As humans with advancing age, we face a plethora of physical, financial, social and emotional difficulties.

While most people prepare for the later innings of life, some find it difficult to cope with the same, especially in face of growing dependency on younger generations. Memory loss in old age or dementia is a significant adversity that affects nearly 40 lac citizens of our country today.

Dementia results from degeneration of brain cells and commonly presents with forgetfulness.

Other symptoms can be difficulty with calculation, language, conceptual understanding, decision making or activities of daily living and self-care. Sometimes disturbances of emotions, personality traits and social behaviors too are seen. It is a progressive illness wherein symptoms worsen over time.

The most common risk factor for developing dementia is advancing age. People aged above 65 years are particularly at risk, more so if they have a family history of dementia. Hypertension or a significant brain injury also increases the risk. However, not all memory loss is dementia. Some causes are reversible in nature and can be treated; for example, smoking, obesity, diabetes, hypothyroidism, poor nutrition, bodily infections, exposure to certain medications and vitamin B12 deficiency.

These contributory factors can be reversed with appropriate medications or lifestyle changes such as regular physical exercise, proper nutrition and abstinence from smoking.

The initial symptoms of dementia can be subtle and seen as occasional memory deficits, misplacing objects, difficulty multi-tasking, planning or finding names or keeping a track of time. A person truly suffering from dementia will not be aware of this and deny the symptoms.

Dr Bhakti Murkey Sisodia Asst.Professor of Pacific Medical College and Hospital said the nearest family members will first notice the onset of these changes. As the disease progresses, the person may have difficulty recalling recent events or personal information or identifying familiar faces. They may lose their way back home and wander on the streets. Sometimes aggression, suspiciousness or emotional disturbances can also occur as behavioral symptoms of dementia.

Later, they may need assistance with self-care activities such as dressing, grooming or eating. The dependency on caregivers can increase as they eventually lose orientation to time, place or person. Finding it difficult to communicate, they often become agitated or hopeless and prefer to stay aloof from loved ones.

Till date, there is no medication available that can stop or reverse the damage in dementia.

However, we have effective medicines which can slow down the progression of illness and provide relief in behavioral symptoms of the patient. Treatment of medical co-morbidities and educating the family members about what to expect of the illness over time, also plays an important role.

Providing constant care for someone with Alzheimer’s can be both rewarding and challenging for the caregiver. With progression of disease, some patients may require round-the-clock assistance and monitoring, which often impinges upon the routine lives of the caregivers. The behavioral symptoms can especially be quite upsetting and disrupt the sanctity of a home.

In such times, it is prudent to provide proper education and training to family members about assisting the patient with activities of daily living, handling their emotional outbursts, finding opportunities to communicate with them, planning for the future and encouraging participation in activities that are personally meaningful to them, in order to bring purpose to their remaining life years.

It is helpful when caregivers are kind and reassuring, and make use of small and simple instructions while directing the patient. They may even need to repeat themselves frequently.

A non-confrontational approach to interacting with the patient is advocated in order to prevent a catastrophic realization of self-degradation by the patient. Role of reminiscence therapy in dementia is highly talked about, wherein the patient can recall and relive their good old days.

Better preparedness for future and having a support plan in place can help the caregiver cope with the stress of watching a loved one slip away.

Sharing of emotional responses and participating in support groups in the community can also provide strength and motivation to the families.

Let us remember those who do not remember themselves and strive for minimizing the illness burden of dementia, through early detection, treatment and supportive care for those affected.

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