Reflections on dementia

As an Emergency Physician, we deal with patients of all ages. One of the groups that repeatedly evoke deep thoughts about life and death, the Evolution of Medicine and what it truly means to be healthy is the group of elderly patients I see every day.

Furthermore, I had the unfortunate personal experience of seeing a love one being diagnosed with dementia and going through the process of helping my family understand what dementia is. Dementia is a word we so commonly use in our workplace that sometimes we forget that most of the world may not truly understand what it means... and the impact it can have on ones life. I learnt that:

• What may seem so obvious to us from the medical world may not be so obvious to the rest

The signs and symptoms of dementia in my aunt was obvious. But to the rest of my family it wasn't. For many years, my aunt would claim that people were entering her house and stealing her belongings. And at times, she would call us to her house as she 'Felt unwell' and when we arrive, we would find her looking perfectly well. I realise that she was making these accusations as she couldn't remember where she left her things... and was in denial that she was becoming increasingly forgetful. Hence her defence mechanism was to make these accusations. She also forgot how to express herself especially when she was ill such as when she was having a fever. Hence, though she looked well.... she was usually brewing an infection when she told us she wasn't feeling well.

• Denial and lack of insight makes it challenging

• A sense of purpose keeps them mentally active and appears to slow down the cognitive decline (the slowing of the mental state)

• People who do not understand dementia or the process of an illness can get frustrated, angry and can lead to misunderstandings and disgruntlement within the family

• People can understand illnesses like stroke, heart attack and cancer but not conditions like dementia, depression or anxiety. If someone said they had chest pain, one would take it seriously. But if one became increasingly forgetful or depressed, we get frustrated with them, without realising this is a symptom of their illness

• One has to look out for signs of stress in the caregiver as they can burn out easily.

I saw this when my mother first understood learnt about the diagnosis of dementia (through the youtube videos I showed her and through the nurses from Touch Home Services)... it took her a while to understand, during which, the stress of her sister's condition was taking a toil on her wellbeing. It was after many conversations, videos and sessions with the Touch nurses that she learnt how to handle her sister's dementia. After which, she came up with innovative ways to help her sister remember things and function independently.

• It is hard to find help for the in-betweeners (eg: those who do not have severe dementia and with no insight; hence still appearing normal but slowly deteriorating) Help in the form of resources for equipment and services for the elderly is equally challenging. What is most challenging is finding for activities and events to engage these group of people to keep them active as well as prevent mental deterioration

• Medicine, especially doctors can be a hindrance to healthy and happy aging... by wanting to find an answer and treat everything without taking into account what the psychosocial environment and the personal desires of the individual. 

For example, giving multiple appointment for minor ailments, which may be natural in the aging process. This 'medicalises' normal aging changes and creates a "I have to see the doctor; hence I am sick" mindset. Furthermore, each clinic appointment involves the waiting time for registration, to see the doctor and obtain medications, which means spending half a day in the hospital, which can take a toil on the individual and their caregiver.
Another example is wanting to investigate everything because the protocol or guidelines dictate as such. This is inevitable in today's climate, where there is a fear of legal actions in the healthcare industry or the fear of 'missing something'. However, the solution for this can be a hear-to-heart honest discussion with the inividual and family rather than subjecting them to every possible tests. Sometimes it is not the answer that matters... but the reassurance and a discussion on the implications on one's life may be what is needed.

There are many challenges and they are going to get worse with our ageing population. Perhaps we have to think out of the box for new solutions....