Living well with dementia

Although dementia mainly affects older people, it is not a normal part of aging. Dementia is a syndrome caused by a variety of brain illnesses that affect memory, thinking, behavior and the ability to perform everyday activities.¹ Alzheimer’s disease is the most common type of dementia, accounting for 60 to 80 percent of cases, and nearly one in every five dollars spent by Medicare is on people with Alzheimer’s or another dementia.²

New research suggests that people are often correct when they think their memory is declining. Individuals may pick up on subtle signs before they are obvious to others. Normal memory problems do not affect everyday life. If someone forgets where they put their keys, it may be because that individual is not well organized. However, if someone forgets what keys are used for or how to unlock doors, it may be a more serious matter.³

A diagnosis of dementia can be emotionally overwhelming for the individual as well as the family. Individuals with dementia require more intensive care and assistance as the dementia worsens. Though there may not be a way to completely alleviate symptoms of dementia, maintaining sleep patterns, a healthy diet, regular exercise, cognitive stimulation and socialization can help people with dementia maintain a normal level of functioning for as long as possible.

Psychologists work to assess, diagnose, treat and support individuals with dementia and to lighten the burden on the families that care for them.⁴ Psychologists have developed methods for measuring memory capabilities to assess what is likely normal aging versus the first signs of dementia. They can also help sort out when memory loss might be associated with treatable causes like depression or sleep disturbance.

Psychologists help minimize the changes in mood and behavior associated with dementia and work with the family to design living environments, provide tools and put procedures in place that allow a person with dementia to function well. Psychologists also facilitate communication among family members to help identify preferences for things like support services, such as home health aides; financial and legal planning; and day-to-day activities early on. Once the person with dementia is no longer able to make decisions on their own, the psychologist can help families implement these plans.

In the earliest stages, individuals with dementia as well as their family members may experience anxiety, sadness and even depression. Psychologists can provide strategies to manage these emotions. As the dementia progresses, psychologists can assist caregivers and families by helping them maintain their loved one’s quality of life.

In long-term care settings, like nursing homes, psychologists may be called upon to help develop and implement treatment plans that use approaches to manage behavioral changes without medication because of the high risks associated with dementia and antipsychotic medications.

Psychologists may work with individuals with dementia and their families independently through a private practice or as part of a health care team. Psychologists will work with the individual and family to develop strategies to improve quality of life and manage emotions related to the dementia diagnosis.

In working with a psychologist, an individual with dementia and those who provide care for them may discuss what is already being done well to manage the dementia and which behaviors may be improved. The psychologist may ask the individual or caregiver to do homework like practicing memory tools. Memory tools can help individuals become more organized to better manage their symptoms of memory loss. These tools might include:

• Using an alarm as a reminder to take medicine
• Using a calendar, to-do list, and journal combo as a memory substitute
• Establishing routines to identify, plan, and carry out pleasant activities that are within the capacity of the care recipient

Caring for a loved one with dementia is a big job. Nearly 60 percent of Alzheimer’s and dementia caregivers rate the emotional stress of caregiving as high or very high, and more than one-third of them report symptoms of depression.⁵ The demands of physical caregiving and constant supervision combined with the emotional toll of seeing a loved one so altered by dementia can be a lot to handle. However, the best thing a caregiver can do for their loved one is to stay mentally and physically strong.

The good news is that psychologists can encourage and assist caregivers to improve well-being in a number of ways:

• Actively manage stress by taking time to exercise, meditate, or talk to a friend. Finding positive, healthy ways to manage stress can lower the risk for negative health consequences.
• Accept the changes that the person with dementia is facing. Even if they can’t remember a name, they may still recognize and have feelings for their friends and family.
• Understand that no one can do this alone. Seek support from friends, family or a support group. For many this support may be enough. But if a caregiver finds himself or herself overwhelmed, a psychologist may be able to help.

Living well with dementia

• Remember that people diagnosed with dementia are not completely helpless. Dementia progression is usually fairly gradual. Live one day at a time and cope with things as they come.
• Involve the person with the diagnosis as much as possible in future plans for their care. Plan as many things in advance as possible when it comes to future care so that later on, family members will be able to follow their loved one’s plan.
• Set up the environment for success. Design the space where the individual with dementia lives to enable him or her to function well. For example, the caregiver might use a piece of paper to draw an outline for a place setting so their loved one can set the table, or label shelves so they can put groceries away on their own.
• Use memory tools. Just like when vision starts to decline and people wear glasses to read, those with dementia use memory tools like alarms and to-do lists to remember things like birthdays, doctor appointments, and to take their medicine.
• Emphasize remaining strengths. It is possible for a person with mild or moderate dementia to continue to learn using remaining learning and memory systems. Try to facilitate daily successes by:

• Providing visual and verbal cues for everyday activities
• Simplifying tasks and routines
• Breaking larger tasks into small steps
• Identifying and engaging in activities that are pleasant and meaningful to the person with dementia