New Issues in Dementia. Dr. Chris Perkins NZCCSS Conference 2012

Transcription

1 New Issues in Dementia Dr. Chris Perkins NZCCSS Conference 2012

2 Dementia is still an old white women s condition Usually Alzheimer s or vascular dementia: We now recognise unusual sorts of dementia: LBD, semantic, PSP and other acronyms -dementia-cooperative/ marya.steur@waitematadhb.govt.nz 2

3 but some groups now need special consideration Younger people (aged <65) Users and abusers of alcohol and other drugs People with intellectual disability People with long-term mental illness Non- Pakeha cultures 3

4 Are there more younger people with dementia? The rate (incidence) is not changing Age group Annual incidence per 100 M Annual incidence per 100 F Prevalence % M Prevalence % F

5 But there are more of us 5

6 Specific issues for younger people with dementia Young families- spouse, student children Still working / financial issues Physically strong More likely to be unusual type and /or familial Services unsuitable 6

7 Services for younger people with dementia Diagnosis: neurologist? psychiatrist? geriatrician? memory clinic? Support: Alzheimer s NZ may have younger people s groups Community services: Is there specific day care in some places? Residential care: Is there anywhere with care particularly for younger people? WHAT SERVICES DO YOU OFFER FOR YOUNGER PEOPLE WITH DEMENTIA? 7

8 Alcohol dementia 8

9 Alcohol poisons everything including your brain There is no convincing evidence that a glass or 2 of wine prevents dementia or anything Older brains more sensitive to alcohol, especially if taking other drugs, thus lower limit for safe drinking Alcohol causes damage to the frontal lobes especially and this reduces volition and motivation to stop drinking Alcohol causes multiple physical problems as well 9

10 Other substances? 10

11 Specific issues for people with alcohol or drug-related dementia Symptoms of early alcohol- related dementia can be reversed with treatment (abstinence) Less likely to be diagnosed (if older) Less likely to be referred for assistance once diagnosed- A &D services not always suitable for older people or those with brain damage Not motivated if frontal lobes are already damaged Not particularly liked- may have alienated family and friends 11

12 Management Mainstream aged care services often cannot provide the structure required to successfully manage.challenging behaviour arising from long-term alcohol abuse. WHAT SERVICES DO YOU OFFER FOR PEOPLE WITH ALCOHOL-RELATED COGNITIVE IMPAIRMENT? 12

13 Intellectual disability People with ID now living to old age Down s syndrome = major risk factor for Alzheimer s disease ID services are gearing up for older clients Funding issues 13

14 Dementia in ID Down s Syndrome: 44% live to > 60 years, 14% to > 68 years (10) Incidence of dementia in Down syndrome years : 3.4% years : 10.3% years: 40% (11) By age 60 approx 60% Other Causes ID: Probably slightly increased risk over general population (or up to 4x?) 14

15 Issues Diagnosis History of institutionalisation- estrangement from family-for decision-making Where can they be best supported? Sometimes no daytime staff in ID homes 15

16 What the ID providers are doing. WHAT SHOULD AGED CARE PROVIDERS BE DOING? 16

17 Long-term mental illness People with schizophrenia used to die earlier than the average (smoking, poor health care) Longstanding schizophrenia is associated with frontal lobe dysfunction Positive symptoms less prominent Recurrent depression seems to be a risk factor for dementia People with longstanding mental illness are at risk of the usual forms of dementia 17

18 Management Diagnosis can be difficult- Mood disorders complicate dementia management Fall between the cracks of general mental health and old age services Too physically frail to be with younger people May be eccentric, odd, difficult to fit in with other older people 18

19 WHAT, IF ANYTHING, SHOULD AGED-CARE PROVIDERS DO ABOUT PEOPLE AGEING WITH MENTAL ILLNESS? 19

20 Other cultures in NZ Increasing numbers of older people from other cultures About 4% of Maori and Pasifika are aged > 65 BUT general health problems such as diabetes, smoking and obesity make dementia (esp. vascular) more likely And onset is earlier ( sometimes <65) Importance of language, role of family, customs, food, understanding of dementia etc. 20

21 Maori 21

22 Whanau care = cultural norm, but may not be possible- values have changed, family is spread Memory loss may be less traumatic ( memory held by tribe), to ask of a Maori person what has happened to their memory was to make a category mistake, for their memory was understood to reside in the community and the place and not be the possession of the individual. (Allen & Coleman, p. 217) though it may be difficult if person cannot carry out expected kumatua and kuia roles Many are isolated / cut off from marae / rural Make less use of services 22

23 Pasifika 23

24 Chinese cultural traditions Traditional Chinese beliefs centre around harmony, unity, and survival of the family, not the individual. The Chinese family is an extended, interdependent social unit where children provide emotional and financial support for their aging parents. Filial duty Health decision making primarily the responsibility of the family Vs autonomy/individualism in Western culture Role of Buddhism

25 The Role of Care-giving in Chinese The maintenance of a person with dementia in the community is dependent on the degree of family support (Bergmann et al; Poulshock & Deimling) Oldest son and his wife as the dedicated caregivers for Chinese elders (Confucian ethical values) Hierarchy of expectation in the Chinese family (Heok & Li) Spouse (female), daughter, daughter-in-law, son Unmarried son or daughter Chinese caregivers relied more on family support and less on psychogeriatric services

26 There will be high demand for dementiarelated services. If we use a person / whanau centred approach will this be enough for these different groups? Can we afford to provide specific care for special groups? Should our focus remain on older people? 26