2023-06-07 15:12:44
June 7, 2023 at 3:05 p.m
VEENENDAL Dementia is a major brain disease. Many clients of Zorggroep Charim also have to deal with this. It turns the world of not only the client upside down, the consequences can also be far-reaching for family and friends. How do you deal with this?
Dementia is the name for a combination of symptoms (a syndrome), in which the brain can no longer process information properly. The most common form of dementia is Alzheimer’s disease. In addition, vascular dementia and frontotemporal dementia are common. Although the course is variable, the different forms of dementia eventually become very similar.
SIGNALS OF DEMENTIA
The insidious thing about Alzheimer’s is that it creeps in slowly. The disease starts with memory problems. Subsequently, one also has difficulty with daily skills. Alzheimer’s disease destroys the nerve cells in the brain. This is because certain proteins and/or fibers accumulate in the nerve cells. These accumulations disrupt the mutual communication in the brain cells.
Problems in the blood flow to the brain cause vascular dementia. Individuals with vascular dementia may suddenly deteriorate from a stroke or series of small strokes (TIAs). Frontotemporal dementia (FTD) often occurs at a younger age. Changes in behavior are usually the first to notice. This is due to the death of brain cells in the frontal lobe (the behavioral area).
Psychologist Irene Verhage works at Zorggroep Charim and has a lot to do with people who have dementia. The choice for Irene to study psychology has always been an obvious one: ,,Friends always came to me because of my ability to listen well. I soon thought that I should make it my profession.”
NEW PHASE OF LIFE
For many psychology students, a hospital has a great attraction in terms of dynamics, including Irene. Somewhat timidly: ,,I came into contact with outpatient care for the elderly through a forced internship. I struggled with my own preconceptions that elder care would be a gray and dusty area.”
Every person of age has its own history and is shaped by experience
Nothing turned out to be less true. ,,The life phase problems are often dramatic, but nevertheless also very interesting, purely reasoning from my position. Older people say goodbye to their working lives, loved ones are disappearing, physical disabilities are increasing and cognitive problems also come into play.” The GZ psychologist has now been working at Zorggroep Charim for four years. “I haven’t looked at elderly care for a long time. Every person of age has its own history and is shaped by experience.”
DIAGNOSIS HAS IMPACT
When diagnosed with ‘dementia’, the patient is confronted with a confrontational message. He knows that he is going to lose himself, as it were, and slowly but surely sink into a dense fog. ,,For example, I am now guiding a man who has just been diagnosed. You see the struggle with the future perspective.”
In the near future it will be possible to continue living at home, but it must be healthy and responsible. A fixed point of contact is important for coordinating care. In many cases this is a case manager. As informal carers, the partner and close relatives have a lot on their plate. “As a partner you also lose your buddy. You can’t be away from home for long and it’s difficult to find distraction. All these factors create a feeling of loneliness. We look at whether the partner can be relieved and offer support so that they can also persevere.”
By expressing incomprehension, one ignores the agony that has already been traveled
The roles within a family can also change dramatically. In frontotemporal dementia (FTD), the patient is usually still relatively young. As a result, there is a chance that children still live at home. “Uninhibited behavior and inappropriate comments can disrupt a family, especially when the diagnosis has not yet been made. Sometimes this process takes years. People often think of a form of burnout rather than dementia.”
SERIOUSNESS NOT ALWAYS CLEAR
The environment can also play a negative role. The severity of the dementia is not always clear to the outside world. At first glance, the patient may be able to maintain himself well. “When an admission to the nursing home is imminent, the environment reacts with surprise and disbelief. One does not realize that the decision is never easy. By expressing incomprehension, one ignores the agony that has already been traveled.”
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An employee of care group Charim talking to a resident. – Care group Charim
When the signals of misunderstood behavior cannot be interpreted and symptoms are not picked up, adequate help is not provided. Usually, the client comes to live in the care institution when the complexity of the behavior has already increased considerably. The fact that care institutions are receiving more and more clients with complex care needs is partly due to government policy aimed at allowing people to live at home for as long as possible. Only when it is no longer possible does living in a care center come into the picture.
Experience shows that if you work calmly in the morning with the personal care of clients with dementia, you can prevent a lot of unrest later in the day
WELFARE IS CENTRAL
The shortage of personnel in healthcare is a national phenomenon. “I have a lot of respect for my fellow healthcare providers. The complexity is increasing and the workload is as high as ever. We also ask them not to work in a hurry. Experience shows that if you work calmly in the morning with the personal care of clients with dementia, you can prevent a lot of unrest later in the day. The feeling of well-being of the client is at the top of the list of priorities of the healthcare staff.”
Collaboration with the family is also very important. She can give an insight into the life of the person with dementia when he or she is no longer able to do so. “If you know that someone has experienced the war, images on the news can leave a deep impression and come in hard. With this knowledge, the healthcare provider can respond to this. When I see how much patience, dedication and care our staff shows, I am proud. You want everyone to see how beautiful elderly care is.”
TIPS No person is the same. Although dementia can be erratic, according to GZ psychologist Verhage, general tips can be given on how best to approach people with dementia. “As tempting as it is, make sure you don’t test people with dementia. Don’t ask about the events that appeal to memory. It brings fear, sadness and stress when someone has to forcibly remember a name, event or activity.”
Irene Verhage herself leaves it mainly to the client herself: ,,I notice quickly enough whether a nod of agreement is sufficient or whether people like to start a conversation. My advice is to respond and not to start a conversation. Not all silences need to be filled by talking. Sometimes it can be enough just to be there.”
Another tip is not to be in a hurry and to watch your own facial expressions: “When dementia progresses, people usually respond positively to a happy face. This has to do with the fact that the ‘feel-brain’ will play a greater role. People are slowly but surely using the ‘thinking brain’ less.”
The psychologist compares the experience of stimuli such as hearing, seeing and feeling with practicing top sport: “It demands a lot from older people with dementia. We cannot remove all incentives. We do have to deal with it consciously and continue to monitor how much one can tolerate. Restlessness and tension are the signals we should be suspicious of. It is up to us as healthcare providers to adapt. The resident can no longer do that. Also give the right stimulus at the right time, don’t set the table an hour in advance. And also try to encourage as long as possible whether the client wants to help.”
TEAMWORK THROUGH AGT
Based on the idea of appropriate care, we look at whether people with dementia can continue to live at home for as long as possible. Charim Vitaal, part of Zorggroep Charim, recently started an Outpatient Geriatric Team (AGT). This team focuses on diagnosis, support and treatment at home of elderly people with complex problems.
The work of the AGT is a welcome addition to the regular care provided by the general practitioner, who, incidentally, retains control. Each care provider in the AGT provides help with and treatment of complex physical complaints, psychosocial problems from his own discipline and also helps with dementia. The care that is otherwise provided in a nursing home can therefore largely also be provided at home. “In its work, the AGT mainly looks at the quality of life. It is essential to look at the needs of the client on a daily basis. Next week could be very different. As a team, we can anticipate and respond to that.”
For more information, go to www.zorggroepcharim.nl
by Diana Kervel
This article is brought to you by Zorggroep Charim.
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