A guide for caregivers. Recommendations for relatives of a person with dementia Toileting and incontinence
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Caring for loved ones with dementia comes with many pitfalls for family members and caregivers. People who have dementia caused by diseases such as Alzheimer's disease and similar diseases have progressive degenerative changes in the structures of the brain, which over time increasingly complicate the processes of remembering, reasoning, communicating, and self-care. It should be added that dementia can cause frequent mood swings and even changes in personality and behavior. All this requires a special attitude towards these patients, improving skills for communicating with them.
1. Have a positive attitude towards interaction with the patient. Your behavior and body language communicate your feelings and thoughts more powerfully than words. Set a positive tone by speaking to your sick relative in a pleasant and polite tone. Use facial expressions, voice timbre and tactile contacts to convey information and tender feelings.
2. Communicate with the patient in a caring, but at the same time confident and clear tone.
3. When talking with the patient, limit exposure to distractions and extraneous noise. Before speaking, attract the patient's attention: address him by name, identify your personality and relationship (degree of relationship) with the patient, use non-verbal cues and touches to keep his attention.
4. State your message clearly. Use simple words and sentences. Speak slowly, clearly, in an encouraging tone.
5. Ask simple questions that are easy to answer. Ask one question at a time; the best one is one that can be answered “yes” or “no.” Refrain from asking difficult questions or providing too many choices. If he's working on an answer, it's natural to give him a hint.
6. Be patient with the patient and give him time (perhaps a few minutes) to react or answer the question.
7. If necessary, repeat important information, possibly more than once.
8. Try to help the patient remember specific data (time, place, names of friends and relatives).
9. Be understanding, even if sometimes it is difficult, and try not to get angry with the patient if he cannot do something or behaves incorrectly, since his behavior, like memory impairment, is a manifestation of his illness.
10. Try not to react to reproaches and reproaches.
11. You can achieve more with praise than with criticism. When the patient behaves correctly, praise can be expressed in words, touch or a smile.
12. Respond with love and encouragement in your voice. People with dementia often feel embarrassed, anxious, and lacking in self-confidence. In addition, they often have a distorted view of the reality around them, in particular, they can remember things that never happened in real life. Avoid convincing them that you are wrong. Often nothing helps to establish rapport as effectively as touch, handshake, hug and praise.
13. Break the action into a chain of sequential steps. You can encourage a person to complete a task that they can by gently reminding them of what they need to do in the sequence of actions required to complete the task. In this way, you help him do things that, due to his condition, he can no longer cope with on his own. Using visual cues, such as pointing with your hand where to put the soup bowl, can be very helpful with this.
14. If achieving a goal becomes difficult, distract the patient and set him another goal. If the patient is upset, try changing your occupation. For example, ask him for help or suggest going for a walk.
15. Remember the good old days. Reminiscing about the past is often a calming and life-affirming activity. Many people with dementia cannot remember what happened 45 minutes ago, but they clearly recall events from 45 years ago.
16. The patient needs incentives for mental activity that do not require excessive effort from him, and he especially needs an interlocutor.
17. Take care of the consistency of the patient’s daily routine.
18. Simple rules and strong habits are very helpful for all older people, and especially for those with dementia.
19. Concomitant diseases (high blood pressure, diabetes mellitus, thyroid pathology and others) must be promptly diagnosed and treated - this is also the task of those caring for the patient.
20. Very important for older people: good nutrition and sufficient fluid intake, as well as regular exercise.
Alzheimer's disease: how to provide care for the patient at home
The disease is named after the German scientist A. Alzheimer, who in 1906 described changes in the brain tissue of a 55-year-old woman who died, as was then believed, from an unusual mental illness. It is known that the disease is based on the gradual destruction of brain cells and tissues, especially those parts of the brain that are responsible for memory and thinking. Symptoms usually progress slowly but steadily. The disease usually lasts 5 - 10 years. Cognitive functions (memory, judgment, abstract thinking, mathematical abilities) are gradually lost. The emotional sphere and the personality as a whole collapse, motor skills and, especially, speech are lost. The patient ceases to recognize even his family and friends, he is bedridden, and cannot take care of himself. The disease affects representatives of all social groups and is not associated with belonging to a certain class of society, gender, nationality or residence in a certain geographical area. Although the disease is most common in older people, it also occurs among younger people.
Alzheimer's disease affects different people differently. This largely depends on what the person was like before the illness, i.e. on his personality, physical condition, lifestyle. The disease creeps up unnoticed; it is very difficult to determine its onset and distinguish it from the so-called senile forgetfulness that affects a huge number of elderly people. Who among us has not witnessed people looking for keys or watches that just a second ago were lying before our eyes and suddenly disappeared into the ground, or engaged in such searches ourselves? It is well known that human memory weakens with age, but it is important to understand that Alzheimer's disease is not simply an age-related change in memory or the manifestation of signs of aging. Alzheimer's disease is an insidious and as yet incurable disease in which memory fails completely.
People around you need to be attentive to any signs of dementia and behavioral disorders in the elderly. The first signs of the disease can be noticed by the patient’s relatives and family members when he has problems finding words in a conversation, when he has difficulty remembering recent events (what he did last night, what he ate for breakfast, etc.), and loses interest in favorite activities, loses habitual skills. Timely contact with medical specialists at an early stage of the disease can help establish an accurate diagnosis, increase the effectiveness of treatment, properly organize patient care, improve the quality of his life, and preserve his labor, professional and creative potential for as long as possible.
Main symptoms and signs of Alzheimer's disease
Early stage
The early stage usually goes unnoticed. Relatives, friends and often specialists incorrectly attribute symptoms to a patient's old age, believing them to be a normal part of the aging process. Because the disease develops gradually, it is often difficult to determine the exact time of its onset. Gradually a person:
- difficulties arise when choosing words in a conversation;
- short-term memory deteriorates;
- serious difficulties arise when making independent decisions;
- the perception of the environment, recognition of objects is impaired, a person is easily lost, especially in an unusual environment;
- there is disorientation in time;
- understanding of complex and abstract thoughts is impaired;
- initiative and motivation to act disappear, indifference and isolation are noted;
- depression may develop, signs of aggression appear;
- having difficulty doing complex housework (for example, cooking);
- Loss of interest in your hobbies and other previously favorite activities.
Middle stage
As the disease progresses, the problems become more obvious and significantly limit the patient’s activities. The patient experiences difficulties in everyday life, for example:
- becomes extremely forgetful, especially often forgetting recent events and names of people;
- may become lost in familiar surroundings, at home or in society;
- cannot continue to live alone without assistance;
- cannot cook food, do house cleaning, or go to the store;
- needs help when going to the toilet, washing, dressing, etc.;
- ceases to be aware of his illness;
- experiences increasing difficulties in communication;
- exhibits abnormal behavior (eg, wandering);
- may suffer from visual hallucinations.
Late stage
But at this stage the patient is completely dependent on those caring for him. Memory impairment is extremely serious, and the physical side of the disease becomes noticeable.
- loses the ability to speak and understand speech;
- loses the ability to move, his limbs become rigid;
- has difficulty eating and has to be fed;
- does not recognize relatives, acquaintances, friends and familiar objects;
- unable to control natural functions;
- behaves inappropriately in the presence of other persons;
- bedridden or wheelchair bound.
When the disease begins to progress, every opportunity must be used to support the patient’s ability to self-care, reduce his internal discomfort and isolation from others. New, better-fitting glasses, better hearing aids, an easy-to-use radio, and books with pictures and large letters can help. It is necessary to find a useful and accessible activity for the patient, taking into account his needs and the capabilities of the caring staff. A sick person constantly needs consolation and encouragement; you cannot scold him or make offensive remarks.
Factors that increase symptoms of dementia
When providing care, it is necessary to know the factors that worsen the patient’s functional abilities and, if possible, eliminate them. Factors known to increase symptoms of dementia include:
- unfamiliar places;
- being alone for a long time;
- an excessive amount of external stimuli and irritants (for example, meeting a large number of strangers);
- darkness (suitable lighting is necessary even at night);
- all infectious diseases (most often urinary tract infections);
- surgical interventions and anesthesia are used only for absolute indications;
- hot weather (overheating, loss of fluid);
- taking a large number of medications.
Activities for caring for the patient at home deserve special attention. It is important for families and others involved in caring for the person to know the basic signs and symptoms of Alzheimer's disease, understand how the disease progresses, be aware of factors that increase symptoms of dementia, and be familiar with basic caregiving techniques.
Hospitalization for Alzheimer's disease is an expensive undertaking, which sometimes only has a negative effect (accelerates the progression of the disease). With any change in the environment, caring personnel, or changes in drug treatment, the course of the disease usually becomes more severe. Hospitalization is indicated for the selection of therapy, which is dangerous to carry out on an outpatient basis, in the absence of careful medical supervision of the patient, as well as in cases of confusion, psychotic manifestations and antisocial behavior.
Caring for patients with Alzheimer's disease can be very challenging. At home, caring for such patients, as a rule, falls on relatives who are subjected to severe emotional stress, constantly watching how their loved one is deteriorating. The unpreparedness and helplessness of relatives in a situation of chronic stress will not only not help the patient, but can also have a very negative impact on their own health. Nurses and doctors need to provide psychological support to those caring for patients at home, teaching them special techniques that can help cope with problems. Thus, medical personnel are given important tasks in training and counseling the patient’s relatives and providing them with effective psychological support.
Below are various teaching materials that we hope will be useful not only to professional nurses, but also to those simply caring for sick people.
How to provide care for the sick at home
First of all, it is necessary to establish a certain daily routine for the patient, which will allow him to organize and streamline his confusing life and help him get rid of the need to make difficult decisions. The patient's daily routine should include his usual activities, this will help him maintain a feeling of confidence and security. It is important to try to help the patient maintain a sense of self-worth. In the presence of a patient, you should refrain from discussing his condition, as the words and actions of others can cause anxiety and resentment.
In many cases, physical exercises allow you to maintain the patient’s functional abilities for some time, although it is better to consult a specialist for recommendations on the nature and complexity of the exercises. If before illness a person liked to work in the garden or in the country, he may enjoy using the remaining skills. However, we must not forget that as the disease progresses, the abilities and interests of a dementia patient may change. Therefore, when providing care, it is important to carefully monitor the patient and make the necessary changes in the nature and content of his activities.
It is unacceptable to draw the patient's attention to his failures. Any conflict only leads to unnecessary stress for both the patient and those caring for him. Showing anger, bitterness, or resentment will only make the situation worse and make the problem worse. Try to remain calm, try to laugh with (but not at) the patient. Humor is often a great stress reliever!
Provide a safe environment
Memory loss and poor coordination of movements in the patient increase the risk of injury. Try to make your home as safe as possible.
- Remove piercing and cutting objects, household poisons and medicines.
- Hide dangerous electrical devices away.
- Shut off the gas supply when the patient is alone.
- Install patient safety devices (for example, a microwave oven for cooking).
- Check the operation of door locks, install locks on windows.
- Use locks that cannot be opened by a sick person.
- Keep a close eye on smokers.
- Do not change the patient’s usual arrangement of furniture.
- Provide adequate general lighting, staircase lights, and nightlights in the bedroom and closet.
- Control the temperature in the room, avoid drafts, hypothermia or overheating, help select and wear clothes that suit the temperature conditions.
- Monitor the quality of food, do not eat poor quality or spoiled food.
- Install grab bars in the bathtub and toilet, the bathtub bottom and floors should not be slippery, and door locks should also open from the outside.
- The material underfoot in all areas must be non-slip.
- Furniture should be stable, chairs and bed should be high enough.
Keep in touch
As the disease progresses, communication between caregivers and the patient may become increasingly difficult. The patient's vision and hearing should be checked, if necessary, order stronger glasses, and replace the hearing aid. When communicating, it is recommended:
- respectfully address the patient by name (patronymic);
- speak clearly, slowly, face to face with the patient, while keeping your head at eye level;
- show love and warmth by hugging the patient, if this does not bother him;
- listen carefully to the patient;
- pay attention to non-verbal means of communication;
- try to establish what gestures and combinations of words, cue words are necessary to effectively maintain communication with the patient;
- avoid negative criticism, disputes, conflicts;
- Before speaking, check whether the patient is listening to you.
Bathing and personal hygiene
The patient may forget to wash, not see the need to wash, or not remember how to do it. When offering your help to the patient, try to preserve his personal dignity.
- When washing, try to adhere to the patient’s previous habits.
- Try to make washing as pleasant as possible and help the patient relax.
- Taking a shower may be easier than taking a bath, but if a person is not used to showering, it may bother them.
- If the patient refuses to bathe or shower, wait a while - the mood may change.
- Let the patient do everything possible himself.
- If the patient is embarrassed when bathing or showering, certain areas of the body can be left covered.
- Don't forget about safety - securely fastened objects, handles or railings that you can grab onto, a mat that you can't slip on, and an extra stable chair.
- If, while helping a sick person wash, you encounter problems every time, ask someone to help you.
Dressing
The patient may forget the dressing procedure and may not see the need to change clothes. Sometimes patients appear inappropriately dressed in the presence of people.
- Place the patient's clothes in the order in which they need to be worn.
- Avoid clothing with complex fasteners; use clothing with elastic bands, Velcro, zippers, etc.
- Do not rush the patient when dressing; encourage him to act independently.
- Shoes should be comfortable, non-slip, with rubber soles, loose, but not slipping off the foot.
Toileting and incontinence
Patients may forget where the toilet is and what to do in it, and they stop feeling when to go to the toilet.
- Encourage the patient to go to the toilet.
- Establish a specific visiting routine.
- Mark the door to the restroom with large, colored letters.
- Leave the toilet door open to make it easier to find.
- Make sure the patient's clothing is easy to remove.
- Within reason, limit your fluid intake before bed.
- You can place a chamber pot next to the bed.
- Use diapers if necessary.
Nutrition and cooking
People with dementia often forget to eat and may not remember how to use a fork or spoon. In the later stages of the disease, the patient needs to be fed. Physical problems may also appear - lack of ability to chew and swallow food normally.
- Remind the patient to eat.
- Give him food that he can eat with his hands.
- Cut food into small pieces to prevent the patient from choking.
- In the later stages of the disease, prepare pureed and liquid foods.
- Remind them to eat slowly.
- Do not forget that the patient may lose the sensation of cold and hot and get burned, so the food should be warm.
- Do not give the patient more than one serving at once.
- If you have problems with swallowing, seek advice from your doctor, he will introduce you to techniques that stimulate swallowing.
- Make sure the patient gets enough nutrients.
In the later stages of the disease, the patient may lose the ability to prepare food. This can be a serious problem if a person lives alone. Poor motor coordination leads to an increased risk of injury, such as burns and cuts when preparing food. Try to provide the patient with ready-made food.
The patient does not sleep well
The patient may stay awake at night and disturb the entire family's sleep. For caregivers, this can be the most debilitating problem. What can be done?
- Try not to let the patient sleep during the day.
- Taking a long walk every day may help. Give more physical activity during the daytime.
- Make sure that the patient can feel comfortable and comfortable when going to bed.
The patient often loses things and accuses you of stealing
The patient may often forget where he put this or that object. Often he accuses you or other people of stealing lost items.
- Find out if the patient has a secluded place where he hides things.
- Keep replacements of important items with you, such as a spare set of keys or glasses.
- Check trash cans and baskets before emptying them.
- Answer the patient’s accusations calmly, do not get irritated.
- Agree that the item is lost and help find it.
Vagrancy
Sometimes patients show a tendency to wander, which causes a lot of anxiety and worry to relatives and caring staff. The patient may leave home and wander around the surrounding area, go to an unknown direction and get lost, or even end up in another city. If the patient leaves home alone, care must be taken to ensure his safety.
- Make sure that he always has some form of identification document with him,
- Make sure that the person with dementia has a note in their pocket with an address and telephone number where they can contact the person's next of kin or caregivers.
- Make sure that all exits from the house are well locked, that the patient is safe in the house/apartment and cannot leave the house without your knowledge.
- If the patient gets lost, control your emotions, speak calmly, do not scold the patient, try to express your support to him when he is found.
- It is useful to have a recent photograph of the patient in case he gets lost and you need help from others in finding him.
- To combat vagrancy, you can attach unbreakable mirrors to all doors: your own reflection in the mirror distracts the patient from the intention of opening the door.
Delusions and hallucinations
Patients may experience delusions and hallucinations. Delusional ideas are characterized by the appearance of false beliefs in the patient. For example, the patient thinks that they are persecuting him, want to poison him, cause harm, etc. Delusional ideas are perceived by him as a reality that causes fear. The patient may have visual and auditory hallucinations; he may see or hear things that do not actually exist, for example, figures or voices of people talking in the room.
- Do not argue with the patient about the reality of what he saw or heard, since if he feels that he must defend his own views, this may lead to increased delusion.
- If the patient is frightened, try to calm him down: take him gently by the hand, speak in a soft, calm voice.
- Distract the patient's attention from the hallucination by drawing his attention to a real object in the room.
- Consult a doctor: the patient’s condition may be due to the use of medications.
Aggressive behavior
A serious problem for caregivers can be the manifestation of aggressiveness and violence on the part of the patient. In such cases, the following tips may be helpful:
- Try to remain calm and do not show your own fear or anxiety.
- Retaliatory aggressiveness should be avoided by all possible means; An accusing, threatening or judgmental tone of voice can increase the patient's aggression.
- You should not be too close to the patient, he may perceive this as a threat.
- Try to switch the patient's attention to a calmer activity.
- Try to determine what caused the patient’s reaction and make sure that these conditions are not repeated.
- If the patient’s aggressive behavior is repeated frequently, it is necessary to seek help from a specialist.
How to cope with the stress of caring for a patient
Alzheimer's disease affects not only the patient, but also the entire family. The heaviest burden is borne by those who directly care for the sick. Constantly exposed to stress, these people need to know how to help themselves.
Family
For some people caring for a sick person, the family is the best helper, for others it brings only grief. Do not reject the help of other family members if they have enough time, and do not try to shoulder the entire burden of caring for the patient. Contact special services for help.
Don't keep your problems to yourself
You need to share your experiences caring for the patient with others. Keeping them with you makes your job more difficult. Feeling that your emotions are a natural reaction in your situation, it will be easier for you to cope with your problems. Do not reject the help and support of others, even if it seems to you that you are burdening them with it.
Leave time for yourself
You need to have time for yourself too. This way you can see others, do what you love, and most importantly, enjoy life. If you need to be away for a while, try to find someone who can replace you so that you can take a break.
Consider your limits
How much can you endure before the work becomes too much for you? Most people are able to set their own limits before caring becomes overwhelming. If you feel that you are overworked and that work is beyond your strength, seek help to prevent a crisis.
Don't blame yourself
Don't blame yourself or the patient for the difficulties you have to face. Remember, it is only their illness that is to blame. If you feel like you are losing touch with family and friends, don’t blame them or yourself. Try to determine what exactly is disconnecting you and discuss this problem with them. Don't forget that your relationships with other people can be an irreplaceable source of support for you, which is beneficial for both you and the patient.
It can be very useful for you to seek advice from a specialist about the changes occurring with the patient.
Don't forget how important you are
Your condition is extremely important both for you and for the patient. You are irreplaceable in his life; the patient could not live without you. This is an additional reason to take care of yourself.
Professor Perfilyeva G.M.
Nurse, 2002, No. 1.
The article is published with abbreviations.
Care for dementia caused by cerebrovascular disease
With this condition, patients suffer from memory loss, and their mental disorders worsen. Unlike people with Alzheimer's disease, they are aware of their situation, their personality remains relatively intact. Caring for patients is difficult, but there are techniques that can make the situation easier:
- establish a routine that makes the patient’s life more organized;
- When following the regime, try to maintain the previously established habitual routine for as long as possible;
- maintain the patient’s independence for as long as possible;
- help the patient maintain self-esteem;
- refrain from discussing his condition with other people in his presence;
- avoid conflicts; remember: the disease is to blame, not the person;
- take care to create conditions for the maximum manifestation of the patient’s capabilities;
- monitor changes in vision and hearing, determine whether the patient needs to change glasses or purchase a hearing aid;
- speak to him clearly, slowly, do not shout, communicate face to face;
- watch the patient’s facial expressions, gestures, and postures; all this serves as a means of communication for him.
T.G.Dasko, O.P.Ivanova.
Nurse, 2000, No. 6.
Printed with abbreviations.
“I am sick with schizophrenia, or - I suffered from it. I live with this disease, I beat it. Of course, at times it was hell. But I want and can continue to live, despite the illness. Look, this is my life. I can present it to you. I'm worth as much as each of you."
Asmus Finzen “Psychosis and stigma”, 2000
You have had your first acquaintance with psychiatric services. The following information will serve as a brief introduction to the features of providing psychiatric care at the Republican Clinical Psychiatric Hospital of the Ministry of Health of the Udmurt Republic (RCPB).
The goal of the entire hospital team is to achieve the maximum level of adaptation of a patient suffering from a mental disorder in the family, society, and professional sphere. In the structure of the Republican Clinical Hospital, medical care is provided by an outpatient service on a local basis, a day hospital department, a rehabilitation department, a department for the treatment of borderline conditions, childhood and adolescence, and departments with round-the-clock supervision (women's and men's).
Due to the need for isolation from the usual environment, conditions, social circle, and changes in the daily routine, hospitalization in a hospital can be tolerated differently by the patient and his family. The concern of relatives is also due to the presence of uncertainty about the mental disorder itself, the unusualness of its manifestations, the outcome and characteristics of treatment. A psychiatric hospital differs in many ways from other medical institutions where somatic diseases are treated.
Often, before being hospitalized in a psychiatric hospital, his loved ones recall fragments that flood the screens of films, the directors of which, for commercial interests, use the theme of mental disorders in the characters in the plot. However, these “opuses” are usually extremely far from reality. In addition, among ordinary people it is generally accepted that a person who has undergone treatment in a psychiatric hospital will no longer be able to live as before, since everyone will know about it, and he will be “issued a certificate” and will not be hired. Intimidated by “rumors” and “horror stories,” the patient’s relatives put off seeking specialized help, use “traditional methods” of treatment, expect that “everything will pass,” and turn to “magicians” and “psychics.”
The fear of being diagnosed with a mental disorder is psychologically quite understandable, since in our society, unfortunately, prejudices about mental illness and psychiatry are very tenacious. But an honest and reasonable analysis shows that only timely treatment can be used to prevent negative social manifestations of the disease, such as aggression towards oneself and others, and the commission of illegal actions. In addition, it should be remembered that information about a citizen’s mental disorder is a medical secret and can only be transferred to judicial and investigative authorities upon their written request.
Mental disorders are not something invented by psychiatrists; they are diseases of the brain that occur with certain anatomical changes and biochemical disturbances. The latter allows for therapeutic effects using various medications. It should be noted that hypnosis and suggestion, popular in the popular imagination, are ineffective and even harmful in most acute mental disorders. It must be said that the help of a psychotherapist for diseases that occur with delusions and hallucinations is effective only after the patient has been relieved of the main painful symptoms with the help of medications.
Like any disease, mental disorder has certain stages of development and course. No one expects bone to heal after a hip fracture or heart function to return after a myocardial infarction in two weeks. Everyone understands that sufficient time is required to restore the destroyed structure of organs and tissues. In addition, after any illness, including the flu, there is always a recovery period with weakness, lethargy, and lack of self-confidence. Therefore, the duration of therapy for mental disorders is justified and necessary to achieve recovery or complete long-term improvement with the restoration of lost positions in life.
A feature of the diagnosis of mental disorders is the need to monitor the patient’s behavior, which is only possible in a specialized hospital, where examination of the somatic and neurological condition and psychological research are also carried out. During the initial examination, a mandatory consultation of the patient is carried out by an employee of the Department of Psychiatry, Narcology and Medical Psychology of the Izhevsk State Medical Academy. Establishing a diagnosis of a mental disorder is not a “sentence” or the end of life, but the need to understand that in the future the quality of life largely depends on the willingness of the patient and his loved ones to cooperate with a psychiatrist and strictly follow his recommendations. There is no point in looking for the “reason” and “those responsible” for the fact that a person has a mental disorder; this is an unconstructive approach to the situation. A lot of information has been accumulated about how certain diseases arise and progress, including mental disorders, but science at this stage of development cannot give clear instructions on their primary prevention, that is, prevention. Therefore, when this happens, the patient’s family and friends should come to his aid in order to facilitate his adaptation in a difficult period of life for him, requiring care, attention, and warmth.
Taking medications and maintenance therapy is a very important condition for achieving a stable state of improvement; everything here is similar to the situation with the treatment of any chronic diseases (bronchial asthma, hypertension, diabetes mellitus). The more carefully the patient and his family follow the recommendations of the attending physician, the lower the risk of side effects and exacerbation in the future. Independent refusal to take medications often entails a change in the patient’s mental state, including a sharp deterioration, repeated hospitalizations and loss of ability to work. It is very important to note that all medications currently used to treat mental disorders have undergone clinical trials, and therapeutic regimens meet the standards used in world practice. The selection of medications in a hospital setting is carried out individually in accordance with the characteristics of the disease (clinical picture), age, concomitant diseases; this is necessary not only to achieve maximum effectiveness of pharmacotherapy, but also to minimize side effects.
The regime of a psychiatric hospital differs from the regime of somatic departments in that it aims to monitor patients around the clock. This is not done to restrict their freedom, but to obtain the most objective picture of the mental state and timely assessment of its changes and prevention of aggressive and auto-aggressive manifestations and, if necessary, correction of therapy. That is why a distinctive feature of our hospital staff is the ability to notice the most subtle deviations in the patient’s condition, and, consequently, attentiveness and sensitivity. The specificity of their work lies in their greater responsibility than in other clinics for the patient, who himself cannot always assess the severity of his condition and ask for help or help himself. Therefore, all procedures, medical procedures, even visits, meals, and washing are carried out in the presence of medical personnel and must be noted in the documentation. Clear regulation of the day in the hospital does not exist with the aim of limiting the rights of patients, but provides an optimal regime for their recovery.
Diagnosis and treatment of concomitant diseases (therapeutic, neurological, etc.), if necessary, in our hospital are carried out by medical specialists in the form of advisory work, and in the event of an acute problem (for example, surgical pathology), a doctor of the appropriate profile is called by the attending physician on an emergency basis.
Patients in a psychiatric hospital have the right to visits and correspondence with relatives, a legal representative, a lawyer, a representative of religious denominations, and to read periodicals and fiction. In the hospital, during certain hours, the opportunity to make telephone calls, watch TV shows, and provide free haircutting and shaving services for patients and storage of gear.
After discharge from the hospital, our patient (similar to how it is in any medical practice) continues to be observed by a local psychiatrist in the dispensary department of the Republican Clinical Hospital or a district psychiatrist if living in other localities of the republic. The examinations prescribed by the doctor should not be missed; you can and even preferably come to the appointment with one of your relatives, who will help you present your complaints, complement the picture of your condition, and be able to ask the doctor questions yourself, clarifying the details of interest. At the dispensary department, a social worker will provide assistance in some legal issues and explain the rights of the privileged category of citizens. A pharmacy has been opened at the Republican Clinical Hospital, which offers the largest selection of essential medicines in the city for the treatment of diseases of the nervous system, and patient care products at affordable prices.
Psychiatry is both a science and an art. Psychiatry deals with the soul, which must not only be understood, but also felt. A good doctor sets himself the task of positively influencing a sick soul. But turning to a psychiatrist is often scary, worrying and doubtful. However, only as a result of the cooperation and trust of the patient, his family and specialists is it possible to achieve significant success in treatment and return the person to his former healthy life.
6
Oct
Memory impairment is one of the manifestations of dementia.
Dementia(acquired dementia) is a disease caused by organic damage to the brain. Dementia is characterized by persistent disorders of the intellect (memory, thinking), emotional disturbances and decreased volitional qualities. The diagnosis is established based on clinical criteria and instrumental studies (CT, MRI of the brain). The causes of dementia in old age are most often vascular diseases (hypertension, strokes, cerebral atherosclerosis) and atrophic diseases (for example, Alzheimer's disease).
Alzheimer's disease– a disease that occurs due to brain damage associated with metabolic disorders. At the initial stages, memory is impaired, patients forget what was recently said, why they left the house, what they wanted to buy in the store, etc. As a result, they experience difficulties in managing the household and at the workplace. Reminders don't always help them. Often, patients attribute memory impairment to absent-mindedness or overwork and do not contact doctors, although it is at the first stage of the disease that effective drug therapy is possible. Patients may change their behavior, they may become irritable and show aggression. At this stage, patients can still perform daily self-care activities. Subsequently, the understanding of other people's speech is impaired, the person gradually forgets everything - his place of birth, the names of his children, ceases to recognize familiar people, household items, and gets lost in public places. Patients do not find the right words; they often replace them with others, sometimes close in meaning, sometimes not. Instead of words, fragments of them are often pronounced, syllables are rearranged, and the vocabulary is impoverished. An advanced stage of the disease occurs, when patients can no longer prepare their own food, do their usual housework, or do shopping. Personality traits are erased, patients differ from one another only in the severity of the disorders. Frequently encountered symptoms are aimless wandering and vagrancy, often at night (patients leaving home are often due to the fact that they are not understood). Misunderstanding of the patient by relatives can be expressed in patients in tears, anger, verbal or physical aggression. Short-term hallucinations and psychomotor agitation are possible. Patients become sloppy and unkempt. In the advanced stage, patients are inactive, completely dependent on the people caring for them. The patient cannot give his name, address, does not recognize relatives or familiar objects. Sometimes you may not even recognize yourself in the mirror. The patient experiences difficulty eating, loses the ability to move, there is a sharp limitation or virtual absence of speech, and suffers from urinary and fecal incontinence.
Vascular dementia occurs as a result of vascular damage due to atherosclerosis and hypertension. “Ischemia” occurs - the death of part of the nervous tissue (including micro-strokes, which can occur almost unnoticed and manifest themselves, for example, only in a severe headache). With vascular disorders, patients complain of dizziness, tinnitus, headaches, sensitivity to changes in atmospheric pressure. Initial manifestations can occur as early as 50 years of age, sometimes even earlier. At advanced stages, personality changes occur - distrustful people become unbearably suspicious, irritable people become openly angry, careless people become thoughtlessly frivolous. The danger comes from excessive gullibility, when they can fall under the influence of others due to their gullibility and suggestibility. Those who have been stingy and suspicious in the past may experience delusions of persecution, delusions of damage - “they want to poison me with gas,” “the neighbors are stealing,” “relatives want to take over my apartment.” Individuals with a history of anxious self-observation and depressive reactions often develop depression. The patient becomes emotionally unstable - sometimes he cries, and then laughs in conversation, often anxious, confused, and sentimental. Sleep is often disturbed - it becomes shortened, the sleep-wake rhythm is disrupted, sleep becomes intermittent at night, and during the day patients remain in a half-asleep state. Patients can easily develop fears – fear of “stroke”, “cancer”, etc. In the future, a symptom such as “confusion” may arise, when the patient cannot understand where he is or even who he is. At night, motor restlessness is possible - he gets up, wanders around the apartment, touches sleeping people, touches objects that come into his hand, mutters something. In this state, he can open gas, the front door, and water. In advanced stages, people experience almost complete loss of memory for events that are happening to them now. Patients at this stage may say that yesterday they “went to work”, that their parents are alive and “live with them”, that is, memories from the past replace the events that actually happened to them. Patients cease to recognize others, the meaning of speech is disrupted.
- Try to tune in to a positive interaction with the patient: Talk to your sick relative in a pleasant and polite tone. Use facial expressions, voice timbre and tactile contacts to convey information and tender feelings.
- Communicate with the patient in a caring, but at the same time confident and clear tone.
- When talking to the patient, limit exposure to distractions and extraneous noise. Before speaking, attract the patient's attention: address him by name, identify your personality and relationship (degree of relationship) with the patient, use non-verbal cues and touches to keep his attention.
- State your message clearly. Use simple words and sentences. Speak slowly, clearly, in an encouraging tone.
- Ask simple questions that are easy to answer. Ask one question at a time; the best one is one that can be answered “yes” or “no.” Refrain from asking difficult questions or providing too many choices. If he's working on an answer, it's natural to give him a hint.
- Be patient with the patient and give him time (perhaps a few minutes) to react or answer the question.
- If necessary, repeat important information, possibly more than once.
- Try to help the patient remember specific data (time, place, names of friends and relatives).
- Be understanding, even if sometimes it is difficult, and try not to get angry with the patient if he cannot do something or behaves incorrectly, since his behavior, like memory impairment, is a manifestation of his illness.
- Try not to react to reproaches and reproaches.
- Praise can achieve more than criticism. When the patient behaves correctly, praise can be expressed in words, touch or a smile.
- Respond with love and encouragement in your voice. People with dementia often feel embarrassed, anxious, and lacking in self-confidence. In addition, they often have a distorted view of the reality around them, in particular, they can remember things that never happened in real life. Avoid convincing them that you are wrong. Often nothing helps to establish rapport as effectively as touch, handshake, hug and praise.
- Break the action into a chain of sequential steps. You can encourage a person to complete a task that they can by gently reminding them of what they need to do in the sequence of actions required to complete the task. In this way, you help him do things that, due to his condition, he can no longer cope with on his own. Using visual cues, such as pointing with your hand where to put the soup bowl, can be very helpful with this.
- If achieving a goal becomes difficult, distract the patient and set him a different goal. If the patient is upset, try changing your occupation. For example, ask him for help or suggest going for a walk.
- Remember the good old days. Reminiscing about the past is often a calming and life-affirming activity. Many people with dementia cannot remember what happened 45 minutes ago, but they clearly recall events from 45 years ago.
- The patient needs incentives for mental activity that do not require excessive effort from him, and he especially needs an interlocutor.
- Take care of the patient's daily routine.
- Simple rules and strong habits greatly help all older people, and especially those with dementia.
- Concomitant diseases (high blood pressure, diabetes, thyroid pathology and others) must be promptly diagnosed and treated - this is also the task of those caring for the patient.
- Very important for older people: good nutrition and sufficient fluid intake, as well as regular exercise.
Please note that in the early stages of a disease associated with memory impairment, for example, when a diagnosis of Alzheimer's disease is made, people may feel some discomfort due to excessive family care. Therefore, care should meet the patient's needs and be aimed at maintaining the patient's activity and independence.
Tips for loved ones of someone with Alzheimer's disease:
- Create a feeling that you are always nearby. Call, come visit - it means a lot to the patient
- Avoid situations that contribute to a decrease in self-esteem. Focus the person’s attention on those actions that he can perform independently.
- Show care in the little things. Bring something tasty, stop by the post office, etc.
- Be very clear and precise in your offers of help. Distribute responsibilities in the family, make a list with areas of responsibility for each of its members.
- Strive to know more about Alzheimer's disease, what the disease's manifestations are and how to respond to them.
- Try to get every family member involved in joint activities. Formulate feasible responsibilities for the patient when organizing joint events.
- Be an attentive listener. Try to understand and accept what the patient says.
- Encourage a healthy lifestyle. Give practical advice on following a daily routine, healthy exercises and proper nutrition.
If there are high risk factors for vascular dementia (atherosclerosis, previous strokes, hypertension), it is necessary to pay attention to following the recommendations of doctors, monitoring blood pressure levels, and conducting regular preventive courses of treatment. see also recommendations for patients with arterial hypertension.
For consultation in " Memory Center“You need to make an appointment with a psychotherapist.
All patients who apply to the “Memory Center” undergo an initial appointment with a psychotherapist, who carries out initial diagnosis, prescription, if necessary, medications and consultation with a psychologist.
Karelian Society for the Promotion of Mental Health Mental health in old age Memo for relatives and patients Petrozavodsk 2011 Compiled by: doctor Yu. A. Abramova How to take care of yourself? Learn not to reject the help of others, even if it is unusual for you. Often, family members, friends, or neighbors want to help the caregiver, but are unsure how to help or whether the caregiver will welcome their help. A few words and advice on your part will give them the opportunity to help. Don't keep your problems to yourself. You need to share your experiences of caring with others. Feeling that your emotions are a natural reaction, it will be easier for you to cope with your problems. Don't blame yourself. Do not blame yourself or the patient for the difficulties you have to face. Remember, their only fault is illness. Don't forget how important you are. Your well-being is extremely important both to you and to the patient. You are irreplaceable in his life; without you, the patient would not know what to do. This is an additional reason to take care of yourself.
Score 1. I forget phone numbers 2. I forget what I put where 3. I look up from a book and can’t find the place I was reading 4. I need to make a to-do list so I don’t forget anything 5. I forget about appointments 6. I I forget what I planned to do on the way home 7. I forget the names of old acquaintances 8. It is difficult for me to concentrate 9. It is difficult for me to retell the content of a TV show 10. I do not recognize people I know 11. It is difficult for me to understand the meaning of what others say 12. I quickly I forget the names of people I meet 13. I forget what day of the week it is 14. When someone is talking, I can’t concentrate 15. I double-check that I have closed the door and turned off the stove 16. I write with mistakes 17. I easily I get distracted 18. Before doing something new, I need to be instructed several times 19. It’s hard for me to concentrate when I read 20. I immediately forget what I was told 21. It’s hard for me to make a decision 22. I do everything very slowly 23. My head is sometimes empty 24 I forget what date it is today. If you score more than 42 points, it is advisable to consult a doctor. In old age, a disease may develop, which may result in progressive impairment of memory, thinking and behavior, as well as changes in the patient’s personality. Causes: death of neurons (Alzheimer's disease) consequence of a stroke, damage to cerebral vessels (vascular thrombosis, cerebral atherosclerosis) One should not hide from the problem and explain forgetfulness simply by age: as with most diseases, early diagnosis is an important condition for the effectiveness of treatment. If you miss precious time, then often at the first appointment the doctor sees a person with reduced intelligence who cannot cope without the help of others. This indicates the development of a serious illness. Why is it important to see a doctor? How to test your memory? A small test will help check the state of your memory. The table lists the most typical symptoms characteristic of memory disorders. Assessment of memory impairments Note how often you notice them in yourself (or in a relative) and rate them in points. 0never, 1rarely, 2sometimes, 3often, 4very often Show your love. An important task of the patient’s relatives is to create a favorable atmosphere in the family. Positive emotions are just as important as medications. People with memory loss tend to be very vulnerable, so always try to encourage and support them. Support the patient's independence. The patient needs to remain independent for as long as possible. This helps him maintain a sense of self-respect and makes it easier for you to care for him. Refrain from hassles. Any conflict leads to inevitable stress for you and the patient. Remember, the disease is to blame, not the person. Do not argue with the patient; this will only make the situation worse. Maintain communication with the patient. Before speaking, check whether the patient is listening to you. Speak clearly and use simple words and sentences. Use names instead of pronouns in your speech; show with your hand where to put the plate. Ask simple questions. If it becomes difficult to get distracted. If the patient is upset or tired, try to redirect his attention. For example, invite him to take a walk. Remember the good old days. Good memories help you calm down and have a positive outlook. Talk to the patient more often about the past; this information is usually retained in memory much better than recent events. Don't lose your sense of humor. Show a sense of humor whenever possible (but never make fun of the patient). A person with memory loss usually has good social skills and will be happy to laugh with you.