Tuesday, March 8, 2011

One Day Sensitization Programme for Family caregiver of Demented Elderly

I am giving below some details of the one day program on sensitization
of care givers of the demented elderly. I found the summary so useful
that I thought all of us will benefit too.

Dr P Vyasamoorthy
MINUTES of  National Institute of Social Defence (NISD), Ministry of
Social Justice and Empowerment,  "One Day Sensitization program for
the Family care giver of the Demented Elderly."

Alzheimer's and Related Disorders Society of India (ARDSI) – Hyderabad
Deccan and Memory Clinic, NIMS  organized "One Day Sensitization
program for the Family Care Giver of the Demented Elderly  "  on
February 26,2011 Saturday, 9:30 AM –5PM, at Conference Hall, 1st
floor, Millennium Block,NIMS.

The session, attended by 35, commenced with a warm welcome from
Dr.Suvarna Alladi, Additional Professor, Dept of Neurology NIMS and
President, ARDSI Hyd Deccan who wished all the participants and
explained the aim of this program which is to sensitize the community
and to take best care of Demented elderly.

What is Dementia: She emphasized the need for training family members
apart from diagnosis and prescription, as the family plays a vital
role in dealing with the Disease. The topics covered in her
presentation were -  Dementia, Symptoms and types of Dementia,
different stages of Dementia, effects and prevalence rate of Dementia.

Communication: Ms. Santhoshi Kumari, Psychologist, Memory Clinic, NIMS
took the session on communicating with people with dementia. She
differences between verbal and non verbal communication. Common
communication problems faced included naming, recall, slowness in
speech e.t.c. People with dementia have an insight in to the problems
they face and to avoid affecting their sense of self-worth and
self-respect, we should provide them the environment and support to
communicate effectively .

Some of the tips  for better communication included use simple and
short sentences, providing choices, taking consent from patient,
informing  the patient prior to any activity, refrain from talking  in
front of the patient about their condition , avoiding arguments and
confrontation, avoiding  baby-talk  while encouraging them for any
task.  She summarized the session saying that we should show courtesy
and concern to the patients and actively engage in supportive

Ms. Sonal Chitnis, Speech pathologist, Yashoda Hospital explained
about the aim of speech therapy in Dementia.
Her talk highlighted the following. Speech therapy in Dementia aims
not only at SPEECH but also at Verbal and nonverbal Communication
Facilitation, safe Swallowing , Linguistic and extra-linguistic
skills, cognition of persons with dementia,therapy with both
individual and care giver through direct and indirect intervention
mode. Direct intervention can be one to one or in a group therapy
where motor, sensory, social, cognitive skills based activities can be
carried out to restore and facilitate Speech, language, communication
and Swallowing in general, indirect intervention includes counseling
reg environment modification, training caregiver, giving memory aids,
communication board, signs, Augmentative alternative communication

She also explained about oral mortor therapy and activities on
symptoms based. Precautions while feeding to be monitored are  avoid
fast feeding, difficult to chew, sticky –spicy and too cold/ hot
eatables and beverages and explained the chin tuck method to avoid
aspiration pneumonia and swallowing impairment in the patients.

Understanding Behaviour: Dr K Chandrasekhar (Vice- President, ARDSI
Hyderabad Deccan and Director, Division of Neuropsychiatry and
Geriatric Psychiatry at Asha Hospitals, Hyderabad), gave a
presentation on Understanding Behavior of Dementia patient.

He said that  persons with dementia typically lose logical thinking
and also lose  track of  the conversation after a while.  He explained
differences between normal forgetfulness and told that the symptoms of
Dementia do not happen overnight but it is a progression and sequence
of the disorder.
There is a continuous change in behavior, where the patient will lose
reasoning and face lots of stress and may withdraw himself from
others. He explained the reasons for sleep disturbance , wandering and
provided practical solutions to deal with those problems

A question and answer session followed.

Geriatric problems: Dr. Rukmini Mridula, Assistant professor, Dept. of
Neurology NIMS gave a  presentation on Common Geriatric Problems. The
normal problems with elderly people are decrease in retention of new
information, decrease in blood pumping capacity to heart, urinary
bladder disturbances , decrease in muscle strength etc. Common
disorders in elderly people are Hypertension and Diabetics.
Neurological disorders are Brain attack, Slowness in activities,
Confusion state, Metabolic abnormalities etc.

Sharing of carer experience: Mr. Guru Raj, family caregiver narrated
his experience with his mother who was affected with dementia and have
been taken care of by the family for 10 years. He explained that
special care needs to be taken with respect to basic hygiene and
toileting.  To reduce caregiver stress, it is essential to have an
alternate caregiver who can share the responsibilities. It is
important to spend quality time with patient and include outings in
the daily/weeklyschedule such as visits to the park, temple etc.
Patients shouldn't be coerced into doing anything as this will
increase their frustration. Rather a loving and supportive environment
should be provided to persuade them. He concluded by asking carers to
not focus on the tragic nature of the disease but to develop the
courage to accept the circumstances and work towards improving the
quality of life.

Physiotherapy: Dr. Naveen, Lecturer, Dept of Physiotherapy NIMS gave a
presentation on Physiotherapy for Dementia Patients. His talk included
the role of a physiotherapist in dementia care, interventions
appropriate for the different stages, postural deviations and
corrective exercises, gait training, toileting, bowel and bladder
training. He showed pictures of different assistive devices available
for Dementia Patients.

Caregiver experience:
Ms. Shobha Caregiver, shared her experience as a caregiver whose
husband, former Chief Engineer,  is in the advanced stage of
Alzheimer's. Earlier she had no awareness about the Disease but after
coming to know about the Disease, she worked towards  providing a
better care to her husband. She explained about the behavior problems
of the patients such as halluncinations and inability to recognize
relatives, blaming others. She emphasized  the importance of the
support to be given to them in the best way possible.

Ms. Safiya Fathima, Psychologist and coordinator, ARDSI Hyd Deccan
took a session on the importance of activities for Dementia patients
and said that the family is the best source to determine the activties
appropriate for the patient.  Activities need to account for
preferences of the patient and stage of dementia.  She highlighted the
point saying that Activities are as important as medicines. Activities
should suit the person's preferences, their level of Dementia and also
their interest and abilities and should give them a sense of happiness
and confidence. She shared her experience with the patients at the
Rehabilitation centre [run by ARDSI Hyd Deccan twice week ] using
different pictures and videos of the patients.

Functional Rehabilitation of  Persons with Dementia:
Ms. Rukhsana Ansari, Secretary of ARDSI Hyd Deccan gave a presentation
on Functional Rehabilitation for Patients with dementia.She gave
practical tips on how to manage different problems faced by the
Dementia patients. Functional decline in patients creates
Helplessness, frustration, dependency on others, loss of role in their
families etc. The goal of functional rehab is to retain functional
abilities and allow for a  normal life as much as possible. One needs
to recognize the process of reverse ontogeny that starts of by loss of
declarative memory,  followed by loss of procedural memory and finally
primitive skills. Instrumental Activities of Daily Living (IADLSs) are
affected first followed by Basic ADLS and with this knowledge, carers
can setup milestones to help patients maximize their functional

Caregivers should think from the perspective of the patient and extend
their support to lead normal life as much as possible without
effecting their routine and day to day activities. Especially care
should be more extended in the basic but very important activities of
the life i.e., Feeding, dressing and Toiletries. Special feeding
devices, comfort dressing and toiletries, and walking devices need to
be arranged for rehabilitation purpose.

Environmental modifications, assistive devices, can be used to reduce
incontinence, improve feeding, walking etc.  Simple changes such as
proper night lighting, labelling, removing clutter, cueing,
maintaining an activity schedule, timed voiding help in making
significant improvements in patient's daily life.

The programme concluded with felicitation of 5 volunteers who have
been helping in the Rehabilitation centre and Home-visits.

Warm regards

Konduri Kotibabu
Project Manager
ARDSI Hyderabad Deccan Chapter

Mobile: +91 99517 52077
Email:   kotibabu76@gmail.com
ARDSI, Hyderabad-Deccan Chapter
Room no. 3, Memory Clinic,  Millenium Block, Ground Floor,
NIMS, Punjagutta,  Hyderabad – 500 082 (A.P), INDIA
Ph: +91-40-6610-3413 /
Email: ardsihyd@gmail.com
Website: http://www.ardsihyd.org

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