Handbook for successful ageing - 9.5

9.5 Handle housemates who suffer from dementia sensitively!
    

When writing this section, I again assumed that you live alone with your housemate requiring care. If this is not the case, then my recommendations here are also valid for everyone who are involved in care-giving.
  

If your housemate is forgetful, tired, unable to concentrate or restless, convince him to visit a geriatrician a geriatric center or a clinic for the aged. If his family doctor is already aware of these symptoms, but thinks that these are due to the age of your housemate and should be borne with or will be treated by him with medication, do not rely exclusively on this, but rather, ask for a transfer if it is available in your country.
  

The geriatrician will first perform an intelligence test ( http://en.wikipedia.org/wiki/Mini-mental_state_examination; Dem Tect: http://ageing.oxfordjournals.org/cgi/content/full/36/3/326; Clock Drawing Test: http://alzheimers.about.com/od/diagnosisissues/a/clock_test.htm ). He perhaps deduces from the result that it is only a "Mild cognitive impairment" (MCI). This is an age-related slackening of attention and retentiveness, which goes beyond a certain "age-related" decrease in performance, but does not mean dimentia. You can console yourself with the fact that only about 10 % of patients in whom such an MCI is determined, actually become demented later.
 

If the geriatrician determines the beginning of dementia, he will not only try to halt the progress medically, but will also advice you about how to keep your housemate fit as long as possible.
 

If your housemate wants that, but loses his short-term memory more and more, at least try to keep the past alive in his memory as long as possible.
  

Additionally, urge your housemate to do everything he can do himself, and be patient with him if he takes longer to perform a task than if you do it yourself. Try to get him interested in as many household activities as possible, even if he had previously left all the household activities to you. Play simple games with him and think about what you could further do, both in the Internet as well as in terms of exchanging experience with persons giving care to people with dementia. Ask for such groups in your church, the charity, and whoever else is worthy of consideration in your town. If your housemate sometimes refuses to do something although he can do it, remind him of his resolve to remain fit. If this does not help and if he seems to be in no hurry, remind him of the same again after a short while. Otherwise do it yourself.
 

If your housemate does not wish to make an effort to remain fit, respect his wishes. The decisive factor here is only the well-being of your housemate, even if this quickens the intellectual decline and death occurs earlier than otherwise. Allow your housemate to get up, go to bed, watch television, eat and drink, etc., whenever he wishes to. Do not prevent him from doing whatever he wishes to do, for this could harm him.
 

Be there for him as far as possible whenever he needs you and listen to him patiently. If he asks you for the xth time as to from where or whom something is, do not respond: "I brought it for you!", but rather pleasantly: ""I brought it for you". Don’t reproach him for just having said or asked something (the same). This will only remind him of his disability unnecessarily.
  

Respond to questions which do not make sense in a manner that your response does not hurt your housemate. Do not correct him if he says something wrong, mixes up names or something like it is so and it cannot be different as someone’s wife wrote me: "I generally leave him in his own world. But that does not always work. If I am asked to call his wife so that she can finally take him home, or when I should allow his mother who is calling him, then I should explain to him that I am his wife or that he could not have heard the voice of his mother. I must tell him that his father, mother and siblings are no more."
  

If your housemate talks about going home, he is probably referring to his parents' home. Perhaps console him that you live far away from home and that you will take him there some day soon.
   

If others are present, correct a falsehood only if absolutely necessary.
  

Ensure that visitors also behave in the same manner with your housemate. If they do not do so despite prior instructions, do not invite them home.
 

To begin with, it is certainly a success for you to have done something correctly. You will gradually accuse yourself less and less of having done something wrong.
  

If your housemate is not happy with the meals, be patient with him: "I am sorry. I am sure you will find it tastier tomorrow."
  

Urge him to undergo massages and physiotherapy, so that he does not become stiff.
 

If someone offers you help, request him to help you with tasks outside the house, so that you can remain as a reference person with your housemate. It is possible that the offer comes from someone whom your housemate knows well and likes.
 

Provided it is available in your country, have his doctor prescribe him an emergency calling system (refer to 9.3.1 and 9.3.2) and attach it to him if you have to leave home. Attach the signal transmitter to his neck.
  

If your housemate threatens to run away, lock the house door. In situations where the door is accidentally left unlocked, ensure that your housemate always carries a slip of paper with your address and telephone number with him. If he does not object to it, attach a mini-transmitter to his neck or to the talus, depending on what is most comfortable and secure during the day, so that he can be found via a locating system.
 

Identify the way to the toilet, if he is unable to find it, with a tape that glows at night if it has absorbed light during the day.
 

If you are still working, you can bring your housemate to a day care for elderly people (for example: www.barchester.com/Our-Services ) on your way to work, if and as long as you can move him to go there, or you can have him picked up and brought back in the afternoon if you can’t do that yourself. But you can also bring your housemate to a day care if you don’t work anymore, and then you can probably even stay there with your housemate if he wouldn’t go alone.
  

If your housemate has a driving license, ask his geriatrician if he can continue driving. If this is not the case but your housemate doesn’t want to give up driving, you should try to explain to him that he puts himself and others in danger, and that you are greatly worried about him. If this doesn’t work, you should call the police when he starts driving, inform them where he wants to go and ask them to follow him discreetly in order to detect a possible mistake. If your housemate gets lost and is looking for the way disorientedly, if he ignores a traffic light and drives even though it’s red or if he stops even though it’s green, obstructs other drivers or even drives in a zig-zag, the police has a good reason to withdraw his driving license. If your housemate doesn’t make any mistakes during this drive, you should discuss the next step with his specialist. If the reservations of the geriatrician with regard to the ability to drive of your housemate are so strong that you now have to arrange for the Road Traffic Licensing Department to step in on the basis of the written report of the geriatrician, you should do that. By writing this report, the geriatrician does not make himself liable for prosecution due to breach of secrecy because the protection of the public is a more precious commodity/ good than the right of your housemate of informational self-determination. You don’t have to tell your housemate that you have called in the Road Traffic Licensing Department, so that it wouldn’t even burden your relationship.
 

If he is unable to eat warm meals on his own using cutlery or perhaps with his hand, you could either use chopsticks or feed him. If he is unable to hold a glass or cup and drink from it, you hold it for him, but allow him to direct with his hand as far as possible, so that he determines the speed at which he takes in the contents of the cup. If this does not work, provide him a straw.
  

If your housemate no longer wishes to eat or drink and no longer understands your query about the reason for this, or if food runs out of the mouth, he could have difficulties swallowing. In such a case, consult an ENT specialist. If this turns out to be a swallowing disorder, attach a PEG by consulting his family doctor, but now through such a PEG you can deliver nutrition from the chemist's.
  

On the contrary, if his swallowing reflexes are not damaged, offer him food and drink again, but do not force him. The body then no longer needs any food. Life will fade away. Do not try to prevent this. Do everything possible to ease the situation when your housemate is dying of emaciation. Discuss with his family doctor as to how this is possible.
  

If your housemate suffers from an ailment which, if left untreated, could result in death, ask him as to whether he wishes to receive treatment for it. If he is not in a position to comprehend your query, consult his family doctor as to whether you should allow his ailment to be treated.
  

If the emaciation of your housemate has progressed to such an extent that his demise appears inevitable, transfer your responsibilities to a hospis (see above, at the end of section 9.4)

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