Dr. Maissa Eid Afifi. Consultant of Psychiatry.Institute of Psychiatry Ain Shams University

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1 Dr. Maissa Eid Afifi Consultant of Psychiatry.Institute of Psychiatry Ain Shams University

2 1-History. 2-Prevalence. 3-Types of Dementia. 4-Aim of Education programs. 5-Common problems of behavior. 6-The 10/66 intervention study in Egypt.. 7-Quick tips.

3 The history of dementia is probably as old as mankind itself. Around the year 2000 BC, ancient Egyptians, were aware that age could be accompanied by a major memory disorder (Signoret and Hauw, 1991). Greco-Roman authors also frequently pointed it out and many.

4 At 1906, a specific organic dementing process of early onset, called Alzheimer disease, had been described by a German physician, Dr. Alois Alzheimer. Since its discovery, there have been many scientific breakthroughs in AD research. However, AD is still incurable. The drugs currently in use treat only the symptoms, not the cause of the disorder, and they only slow the progression of cognitive decline.

5 Intervention by education is a recent practice with positive results, needed to be applied in our culture. It has a special importance because of its central role on caregiver burden and quality of life of the person with dementia. In the absence of curative treatment for the illness importance of providing caregivers for persons with dementia with appropriate intervention to decrease the burden they have.

6 With the aging population the prevalence of Dementia is rising The global prevalence of dementia stands to double every 20 years, to 65.7 million in 2030, and million in WHO 2012

7 Alzheimer's disease (AD): is the most common cause of dementia Vascular dementia: is the second most common cause of dementia Lewy body dementia: is common and progressive Frontotemporal dementia HIV dementia - most common dementia in those under age 55. Others

8 Dementia is a Burden People who have Alzheimer s need more and more help as the disease progresses, which can be a great burden and challenge for family members.

9 There is an urgent need, in the absence of any formal services, to develop interventions designed to improve the quality of life of people with dementia, and their families. Lack of awareness of dementia as a health condition, coupled with unresponsive local health services are two of the biggest problems facing those with dementia in the developing world (Alzheimer s Disease International, 2008)

10 Aim of Education programs Teach how to assist people who have dementia to maintain their abilities as long as possible. Understand the disease Sharing experiences learn to solve practical problems

11 Understanding Memory Loss Maximizing Independence at Home Getting Connected Family caregiver

12 Personal hygiene/ dressing Aggression Agitation Resisting care Common problems of behavior Repeated questioning Hallucinations. Wandering Restlessness Sleep disturbance

13 Aggression Agitation Causes Physical discomfort, Illness such as a UTI, Medication reaction, Loud noises, Very busy environment, Unfamiliar surroundings, New places, Inability to communicate How to manage Try not to take it personally. Simplify his or her environment by reducing noise, number of people. Keep furniture and objects in the same place. Speak in a very soothing and soft tone of voice. Be positive and reassuring. Provide structured routine with simple tasks and provided step-by-step instruction. Try to distract them with a favorite snack or activity like walking or soothing music.

14 How to manage Sleep disturbance Causes Progressiveness of the dementia, Medications, Illness or Environment, Fear of the dark Overstimulation or sleeping during the day Maintain a regular routine at bedtime. Make sure the bed is comfortable, reduce noise and light, and play soothing music. Increase physical activity during the day and monitor napping. Avoid giving the person caffeine, late in the day. Keep a night light on.

15 Wandering/ restlessness Causes Boredom, Physical discomfort, Loud noisy environment, Looking for spouse or children, Looking to go home Being hungry or Need toileting How to manage Secure external doors Try to turn behavior into something productive, purposeful exercise, physical tasks such as sweeping, raking, cleaning. Attend to physical needs Reduce noise level or any confusion in their environment. Hide items that they may take with them when they go out.

16 Hallucinations Causes Result of medications Course of the illness. Impaired vision or hearing may cause a misinterpretation of sound. Violent movies, television or mirrors can contribute to the hallucination, How to manage Reassure them Do not try to convince them that it does not exist. Discuss their emotions relative to what they see.

17 Resisting care Causes People with Alzheimer do not realize that they need help with care. Bathing and dressing involve many different tasks and can be frustrating or overwhelming for the person with dementia. How to manage Connect with them gently. The proper approach (its time for your shower, lets get dressed not do you want to. ) Simplify each task If they refuse to do something, back off and go back in a while. Positive reinforcement

18 Caring of older people with Dementia may give rise to range of emotions Grief Frustration Angry and lonely Carers Guilty Embarrassed

19 It's normal for caregivers to experience these at certain times. Caregivers are constantly being told that they need to find time to themselves. But, for a person who is used to take care of someone else, finding the time to relax is often easier than actually being able to relax.

20 Make the decision that your life matters. Because they are so consumed by caring for their loved ones. Ask for help,more than once. When you have the time, do something you enjoy do it. Try to have always a care team. (Laverty ) Spiritual support causes a more positive outlook on the burden, triggering the caregivers to report lower levels of perceived burden. (Schillings )

21 Less than 1/10 of all population-based research of Dementia has been directed towards the 2/3 of all people with Dementia who live in developing parts of the world Hence 10/66 is developped (Alzheimer s Disease International,2007)

22 10/66 is a group of researchers who have linked together to try to redress this imbalance, encouraging active collaboration between research groups in different developing countries. Their representative in Egypt is prof. / Abd El Moneim Ashour. Their aim is to estimate the number of persons with Dementia,to describe care arrangements for them,study the impact of providing care on caregivers and to encourage the development of support services& show how effective they are.

23 The 10/66 group has been working on an intervention designed to educate and train caregivers to better manage people with Dementia in the community (Alzheimer s Disease International,2007) This intervention consists of three simple, mannualized modules, delivered over five half hour sessions at weekly intervals

24 1-Assessment : History Examination Interviewing the carers 2- Basic education Dementia: A general introduction to the illness. Dementia: What can I expect. What causes dementia. Care and treatment for people with dementia 3- Specific training regarding problem behaviors.

25 The study included 100 patients with dementia, and their principle caregiver, selected from Institute of Psychiatry, Ain Shams University Hospitals outpatient memory clinic Intervention modules were applied for 50 patients, and 50 patients were left as controls. Evaluation of outcome was done after three months. (Ashour. etal,2009)

26 Geriatric Mental State Arabic version QOL Arabic version Burden Interview (Zarit etal,1980) Mental Test Score (Hodkinson,1972) Revised Memory and behavior Problems Checklist(Teri etal,1992) Disability Assessment For Dementia (Gelinas etal,1999) GHQ (Goldberg and Hillier,(1979) Clinical Dementia Rating (Huges etal,1982)

27 The results show the effect of burden caregivers have in caring for their relatives with dementia, with deterioration of the illness. The results emphasize the importance of providing caregivers for persons with dementia with appropriate intervention to decrease the burden they have. After attending education programs, family members can possibly care for people who have Alzheimer s at home for a longer time.. (Ashour. etal,2009)

28 The results showed that educational intervention directed towards caregivers have an effect in alleviating caregiver burden, and improving quality of life of persons with dementia of different etiologies, within the mild to moderate severity category.

29 In the lack of sufficient formal services and economic barriers; informal services, in the form of education of the caregiver of person with dementia appears to have the most benefit in this group in developing countries.

30 Remain calm and patient; Respond to the emotion not the behaviors, Don t argue or say no, Memory aides may be helpful, Look for causes that trigger the behavior, Try not to take the behavior personally, acknowledge their feelings. Try to maintain a structured routine. Consult a physician when necessary.

31

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