National Dementia Strategies and Guidelines

My recent posts have concentrated on what I can do to support Maureen.   That is one aspect of having a life after diagnosis. The other is the importance of positive National Strategies as Kate Swaffer outlines in the Blog that follows.

Kate Swaffer (she/her) Kaurna Country's avatar

brain treeAustralia, and many other countries have until recently had no national guidelines for the post diagnostic support of people with dementia, which I see as more than a failing, but as unethical. However it is encouraging to be able to report that the national clinical guidelines recently drafted went out to the public for comment before they are to be finalised, hopefully by October later this year. They are, disappointingly, I believe, still lacking in the prescription of authentic and comprehensive brain injury style rehabilitation and other proactive interventions and disability supports for people with dementia.

Many countries do have national dementia strategies, including Australia. Scotland of course has a National Dementia Strategy, and is often ahead of the rest of us. And talking of things Scottish, I refer you to an interesting article written by a Psychiatrist in Scotland, Dr Peter Gordon, Early detection of dementia: RCPsych result, for further reading. The UK of course, also has a

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Dementia: The Importance of Good Support

I am always impressed by the level of support offered in this town when you mention the word dementia.  This morning has been another example of dementia friendly staff in a local Superstore.  Once I mentioned my dilemma and produced a sample of what was needed, help soon arrived.  A lovely woman guided me around areas of the shop that are not familiar to men and assisted me to make suitable purchases. I am optimistic that there will be positive results from this morning’s mission.

I have returned from Grimsby with several purchases and need to manage the Fashion Show that is pending.  My approach will be to encourage Maureen to try on one pair of joggers today.  This will mean minimum disruption from her current pursuits and will not involve the removal of clothing that is already in place.  It is easy to forget my mantra of KISSS  is vital with clothing. Keeping it Simple Stupid and Short raises the prospects of  one of the options being deemed suitable. If I go for a Fashion Show, all the new gear faces being ditched in one fell swoop.

The real bonus from today’s mission is the positive atmosphere it has generated in the house.  Maureen feels good that i am trying to help.  I fell better that I have tried to do something positive to sole the clothing crisis.  As I have said before sitting around witnessing decline is not our approach to living with dementia.

Dementia: Compassionate Confrontation

Yesterday I posted about my plans to embark on a period of Tough Love rather than continuing an indulgent approach to Maureen’s dementia.  You will note from revisions to my About page that I see little point in avoiding using our names from now on.  So it’s Paul here – attempting to find  the most the most appropriate focus for the next few days.

It seems to me that sorting out the clothes issue is a useful starting point.  It takes Maureen so long to get dressed each morning.  The whole searching exercise is often so exhausting that she often goes to bed before the day has started.  This will not be a simple matter as many, including myself, have tried and failed on this front.

Just to get us off on positive footing this morning I have washed her favourite pair of joggers.  She lives in her ‘Blueis’, as we call them, and they will be needed as it is cool this morning.  I am fairly confident that I will be able to find a t shirt and jumper to complete her outfit for today.  None of this is easy as: ‘nothing fits, belongs to her or it smells of perfume’.

If things go well this morning we will search the stores in Grimsby for a few more additions to her extensive wardrobe.     With luck several garments, deemed unsuitable, that have never been worn and still have labels attached will be returned. Finding suitable underwear is a real priority: Maureen is really low on on things that fit and provide support.  It will be a real bonus if we are successful in that area.

There is no doubt that we cannot carry on like this.  So much time is being wasted in the daily search for suitable clothing to wear.  I will just have to tough it out and confront Maureen with her dilemma of either putting up with what she has or looking for something that is better.  The endless rigmarole that takes place every morning has to end.

Dementia: Tough Love

I think I need to engage in a bit of tough love.  Indulgence is not helping and we are wasting lost of time as dementia is progressing.  It is time to dig in a little and take any hostility that comes my way.

Clothes are a real issue for my wife: nothing fits or feels comfortable.  Lots of the clothes in her wardrobe ‘belong to to other people or they smell of perfume’. This state of mind has continued since stroke and shows no sign of abating.  I simply have to bite the bullet or this scenario will continue.

Tomorrow I plan to take action and steel myself for a possible hostile reaction.  I will put out new clothing that has the potential to fit.  I will hide, even throw away, the old scruffy gear that  would not be accepted by a second hand shop.

I have no idea whether this will work.  However, seeing my wife trawl through clothing every day and getting so upset has to come to an end.  She often gets so worn out by her routines that she goes back to bed totally exhausted.  This reduces the time for activity that could help reduce the impact of her dementia,  She is currently in tears with her frustration following today’s ongoing search for any clothing that is comfortable or suitable to wear.

Watch this space: interesting times are ahead.

Dementia: Dealing With Denial

I am pretty tired at the moment and early morning wakening is once again a feature of my life.  It is difficult to switch off when I wake early in the morning and if I mange to stay in bed then I am generally thinking.  My thoughts stray to what can be done to improve our lives.  Yes  I know staying in bed and sleeping longer would be a help.

We have moved on from a difficult phase over the last few weeks.  It appears we now have some continuity of care with our ‘adopted daughter’ on duty two mornings a week.  Strange faces waking you up in the morning are not a good start to anyone’s day; particularly when you have dementia. I am hoping that continuity will give us a helpful pattern to our lives in the coming weeks.  One issue that continues to nag away at me is the whole business of denial.  My wife would at best admit that she has some problems with her memory she does not appear to accept she has dementia.  Despite the loss of 50% of peripheral vision she often talks about getting her licence back.

In previous posts I have already alluded to reluctance of the Memory Service to use the word DEMENTIA.  They have not done us any favours in their misguided approach to M’s condition and I have outlined their shortcomings in a previous post..  It would be far more sensible for dementia to be treated as brain injury.   Kate Swaffer makes this point in her Blog today:

‘If I had been referred to the brain injury unit (in the early stages, dementia is not that different), I would have been proactively treated to live the very best life possible with the injury I have. Suggesting I disengage from my meaningful life, and take up activities other people thought might sustain my soul, was not only illogical, it was insulting. Initially it seemed I should join in, I should be grateful for the services people are trying so hard to provide, often with limited funding and resources. But I have found mostly I get no enjoyment from engaging in things that I was not interested in before (doh!!).’

I have to admit I am unsure how to deal with denial.  When M talks of getting her driving licence back it is easy to listen to her plans and eventually change the subject.  I fully understand, like my fellow Blogger, her reluctance to attend  activities put on for people with dementia.

What I need to consider is how to sustain my efforts to encourage her to take up those things that might just make a difference.  There may be no need to spell out the likely prospects for her condition.  However, it would be sensible to try to find a few more ways to ease her out of her comfort zone:  procrastination is particularly the thief of time where dementia is concerned.  Cunning plans are pending and I make no secret of the fact that I will be following Kate’s path even though it is based on the ‘anecdotal evidence’ of one.

Three Tips When Helping a Parent Who Has Dementia

Three helpful tips from Kay Bransford’s Blog for helping anyone who has dementia:

Kay H. Bransford's avatarDealing with Dementia

If you are finding it difficult to adapt to and visit a loved one who has any form of dementia (Alzheimer’s, multi-infarct, vascular, lewy-body, and Parkinson’s) here are three tips that helped me to manage through my visit, while helping my loved ones navigate the changes happening around them:

1) Always smile and patiently answer questions. I realized that the emotion of the moment was more of a factor in any interaction with my mom. I would take a deep breath, smile, and answer the question. You can use some simple tactics to redirect the questions by suggesting a new activity (walk, snack break, craft) or excuse yourself for a few minutes (go wash your hands, empty the dishwasher).

2) Don’t say “Remember.” Unfortunately, short-term memory is usually the first to go so recognize that they can’t remember, and reminding them of it may only increase their anxiety and suspicion…

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Dementia: The ‘D’ Word?

After my sister’s visit yesterday I suddenly thought how dementia has almost become my life.  On reflection it is an unhelpful approach to life.  My thought pattern goes something like this:  as we age things happen in our lives; illness, death and divorce to mention just a few.  Everyone has their share of misfortune.  There is now a great danger that I present a ‘poor me’ to visitors and that can’t be my fun when they spend time here.

I can recall one of my daughter’s saying following a visit: ‘I thought we would have some quality time’.  She makes a fair point.   Why does she want to here grief from her dad when she has been kind enough to visit?  Particularly when M is not even her birth mother.  The same with my sister yesterday – she hasn’t come here to listen to my trials and tribulations: she has plenty to deal with in her own life.

Must tie a knot in my handkerchief and remember the positives.  Stroke can lead to drastic outcomes: M has been relatively lucky.  We are both still here and we can think of lots of others who wish they had the same good fortune.

Dementia: Fears and Nightmares

Maureen showed her fears about a man, or men, in her bed again last night.  She went to bed early on and I joined her a couple of hours later after watching T V.  As I slipped into bed beside her she let out an almighty scream and shouted out: ‘Who’s that?’  I tried to reassure who I was and console her as she sobbed for quite some time.  She also mentioned that she had: ‘told them before about strange men trying to get into her bed’.  Having this experience once gain left me shaken and wondering about a number of things.

I am wondering what is the source of these fears; even nightmares? It was something that surfaced during her six weeks in hospital, where she became very anxious about men coming into her room when she was in the Independent Care Facility.  She was clearly constantly anxious about the strange behaviour of some of the male patients in that facility.  Therefore, it is understandable that in a confused state she misread incidents.  On the other hand something may have happened that may add substance to her fears.  There is another puzzling incident that she often refers to when recalling the period following stroke.

Maureen often tells of being shifted from one hospital to another in what she describes as a cattle truck.  There is little doubt that being moved from one hospital to another late at night shook her up. Her behaviour  when she arrived at the receiving hospital was extraordinary, claiming she had been: ‘transported by crooks and none of them were to be trusted’.

I suppose I will never get to the bottom of  these anxieties about men: they will remain for the rest of her life.  It is unlikely if the detail of the cattle truck and the crooks will ever be forthcoming.  What I can do to prevent the screams in the night is to take to the spare bed when my wife has decided on an early night.  Hearing her scream out and sob is no way for either of us to get a decent night’s sleep.

Dementia: Rising to the Occasion

We have had a lovely afternoon with my sister and her son.  Things got off to a dodgy start today with M reluctant to get out of bed until after noon.  In fact she came down stairs for the first time as our visitors arrived.  M was both pleased, and nervous, about seeing  her nephew and his mother for the first time in ages.

Things did not go well for the first hour or so as M struggled to find any clothes that felt comfortable and indicated that she had nothing to wear.  She ate a late lunch in her dressing gown and P J’s.

Gradually she began to enjoy having other folk in the house and changed her mind about a walk towards the beach.  Although it took her a time to find suitable clothing she eventually joined us for a short stroll.

Once outside we saw a different woman: keen to give a commentary as we showed our guests around.  She enjoyed her walk; particularly taking her nephew in hand and guiding him along our sea front walk.  My sister has had close involvement with dementia supporting our mother.   She responded well to M’s questions that would have puzzled an innocent onlooker.  Her sensitive demeanor, and her sons willingness to be led by the hand, made for a pleasant afternoon for M.

It was clear that M was nervous about the prospect of our visitors: particularly as she had not seen them for some time.  I suppose she didn’t know what to expect.  Once she saw that empathy in abundance was on offer she rose to the occasion. It makes such a difference when visitors have direct experience of dementia and their behaviour is  supportive.

Dementia: Dump the Risky Drugs

More on the dangers on using risky drugs for dementia from an article by Irving Kirsch in New Scientist. I make no apologies for continuing to use Irving as a resource on this Blog.  I am pretty certain if I had not read his book: The Emperors New Drug I would have remained on mirtazapine for life.