Molly wakes up in the morning and can hear her husband making breakfast. She gets out of bed and makes her way into the kitchen, where she sees a stranger in the place of her husband. “Who is that?” she says. “What are they doing here? Where is my husband?” This sounds like the script for a murder mystery movie; instead it is dementia, and 342,000 people live with this disease in Australia every day.
Dementia is the umbrella term for a variety of diseases that affect the brain and cause a decline in an individual’s level of function, their thinking and behaviour. The risk of getting dementia increases with age, but it is not a normal part of ageing. This is quite concerning as our global population is ageing and dementia is one of the leading contributors to disability and dependence in this generation. As nurses, we may be caring for more elderly people with severe disability secondary to dementia dementia, so we must ask ourselves: are we, and our health services, equipped to do this?
The journey of dementia is a different story for everyone. Molly believes she is only 25 years old instead of 75, that she has two children under the age of six and is a school teacher. Another person with dementia might think they still live with their wife at home when in reality they live in a nursing home and their wife passed away five years ago. Someone else might be aware of who and where they are, but struggle to remember what they did an hour ago.
Alzheimer’s disease is the most common type of dementia. Other types include vascular dementia, Lewy body disease, frontotemporal dementia, alcohol-related dementia and dementia caused by Huntingtons disease or HIV.
Dementia is a progressive disease and affects each individual differently. However, all will have similar areas of function that may be affected, including:
The sheer range of areas affected offers some indication of how big the impact of dementia is, not only for the person with the disease, but also for those around them. Dementia also raises many challenges for the health professionals caring for these people. If we look at Molly again, we can see that she is having difficulties with her memory, her orientation and her information processing. It is also easy to see in this case that she is most likely experiencing emotional changes, not only from the dementia but also from the stress of her beliefs versus her reality.
There is no cure for most forms of dementia. Medications can be used to help with symptoms such as anxiety and sleeping disturbance which can be a big part of dementia, but these must be used with caution due to their side effects and potential interactions with other medications. The most important form of treatment for someone with dementia is support from their loved ones, but we must remember that our support should extend to those caring for someone with dementia too.
Support is an essential part of the care of someone with dementia. Nurses need to ensure the individual and their loved ones are aware of the potential support available to them. There are various community services and support groups for the person with dementia and also for the carer. Carer education sessions, resources such as books and videos, day centres, respite care, home care and telephone support groups are also available. In Molly’s story, we can see how much pressure and stress her husband must be under if he goes through this scenario on a daily basis. As nurses, we need to include him in our treatment plans for Molly and look at how we can support him, and make him aware of the aforementioned services.
It can be difficult to care for an individual with dementia in an acute care setting. Often we prioritise their acute care over their dementia-based needs, which causes a variety of negative consequences for the individual. This also increases the stress on their loved ones because they see the symptoms of the dementia worsening. When caring for someone with dementia, nurses need to ensure they are providing person-centred care. There needs to be a balance between caring for their acute needs and looking at the care needs of dementia. How would you care for Molly and her husband if she was one of your patients?