Dr. Cheryl Woodson

Woodsonian Informational Thoughts on Thursday: How to Treat Dementia? Treat the Caregiver

Sorry I’m late posting today. Had to get my turkey in the oven..

The advertised dementia medicines manipulate proteins manage communication between brain cells. New research focuses on drugs that might change production of the abnormal proteins found in people with Alzheimer’s disease. Some of the available medicines can improve symptoms and behavior, and modifying risk factors for heart disease (blood pressure, cholesterol, Diabetes, obesity, and smoking) may affect dementia, related to stroke, but NO AVAILABLE MEDICINE stops, slows, reverses, or prevents dementia.

The typical two-drug regimen can cost as much as $480 per month (without insurance.) In my community, that would pay for about 8 days of adult day care. If the medicine makes a senior call a caregiver 2000 times a day instead of 3000 times, by using adult day care, for at least two entire days every week, the caregiver wouldn’t hear anything. Caregivers can use that time to rest, have fun, and work with doctors to protect their own health. If a family has only enough money for either medicine, or care resources, I believe that money is better spent, giving the caregiver regular breaks.

In dementia care, it is often more important to treat the caregiver. One of my caregiving warriors. Mrs. G., had finally agreed to take a vacation and use a dementia-specific assisted-living facility for his wife. On the first night, Mrs. G. refused to get dressed for bed. A nurse called to report that the patient was “having a nervous breakdown;” she requested an order for a powerful sedative and planned to call the husband.  I refused to subject my patient to the potential side effects of sedation (falls, fractures, death,) but I resisted the urge to tell the nurse to take the sedative herself.

Dementia sufferers often become disoriented in a new environment; excellent lighting, distraction, and calm redirection can help.  The nurse should have expected the agitation and developed a proactive plan, but she did not have the right training. I gave instructions about the best ways to help Mrs. G. and said, “WE are the professionals, right?” I refused to let the nurse make poor Mr. G. guilty, forcing him to cut short a well- deserved and much needed vacation. The next day, I spoke to the administrator and offered to “treat” the staff to more training.

Without dementia education, family caregivers can have unrealistic expectations. Patients may be unable to change certain behaviors, but thinking that their loved one intends to get on their nerves, many caregivers fight with the senior, making the situation worse. There’s less frustration when families learn about the natural history of dementia and understand what their loved ones can and cannot do. These families also realize that you can’t force loved ones into your reality; you have to accept theirs. I took my mother to a restaurant where she put hot sauce on pancakes. I didn’t correct her. Mother was wolfing them down with such gusto; I was just grateful that Mother was eating and not losing weight.

The best treatment for dementia is a team of well-informed, calm, rested, and healthy caregivers.)  Information leads to more realistic expectations, more useful responses, and less stress for everyone. This will be available only when professional caregivers have better training, and family caregivers have information about the illnesses and resources, and they commit to taking excellent care of themselves.

Professionals, schedule a workshop with me. Families, find a Geriatrics team, which may include a neuropsychologist (See Dr. Neil Pliskin’s guest blog on November 5, 2014.) I am also available to review and translate medical records, help you formulate questions for your care team and suggest resources.

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