Treatment for dementia stage 2 our discussion today is a continuation of the previous discussion on What is dementia. Hopefully the discussion about treatment for dementia stage 2 can be useful.
A.2. Attempting to manage the behavioral
Principles of management of behavioral problems is to find a change in behavior as early as possible. The first step that should be performed in patients who experience changes in behavior are:
- Check the possibility of infection and dehydration.
- The evaluation of any physical changes or disease being suffered by the patient (eg, hypothyroidism).
- See the possible side effects of drugs (eg drugs that cause behavioral changes such as depression, anxiety, or sleep disorders).
- Consider replacing the currently used drugs.
- Consider stopping or reducing the dose of anticholinergic drugs and the use of benzodiazepines should be tapering off.
- Perform strict supervision to prevent accidents, drug and food poisoning.
- Avoid sensory disorders by improving the function of vision and hearing.
- Prevent excessive stimulation. Too noisy, too many people, new environments, and changes in routine activities will exacerbate behavioral disorders in elderly people with dementia.
- Identify the causes of behavioral disorders.
- Use the right approach in interacting with patients with dementia who experience a change in behavior. Behavior modification techniques greatly help to alleviate behavioral disturbances.
Behaviour Modification Techniques:
1. Approach with a calm and gentle
Violence, commands, sounds that are too loud will aggravate behavioral disorders because the patient will feel threatened and frightened. The approach to the patient should be done slowly so as not to surprise them. Moving a patient in a hurry, it will also cause them to feel uncomfortable and anxious.
2. Using sign language so as not to shock the patient
The more severe dementia, the lack of a language that can be understood more patients so that patients often use sign language. Therefore bahsa cue is the best way to communicate with them.
Always smile when meeting patients. Patients who are agitated be a bit quieter if everyone smiled at him. In this way the patient can defuse anger. If we look scared, they will be chasing us and if we look angry, they will feel resentful.
The posture should be open. If understanding nod our heads, waving hands to greet them so that they would consider us friends. In this way the patient will be quieter.
3. Speaking slowly and use simple words so that the conversation menjdai easier to understand.
4. Providing security to the patient.
Cognitive impairment makes patients less confident and are not sure of his memory. When they do something good, give praise. If the patient begins to act strangely or appear confused, reassure them by saying that they have done a great job. Do not forget to thank if the patient has done well, as this will build confidence in the patient. Basically everyone likes a compliment.
5. Giving a sense of empathy for the patient's problems.
Although the patient's mind is in turmoil, it would be better if we justify all their words and we do not need to tell the truth. If the patient is confused and said that someone had stolen his nail scissors, do not blame even though it was not true. Patients will be angry because they do not believe in us, therefore we must appease them by giving them empathy.
6. Do not give orders to the patient
The more severe dementia, patients increasingly unable to decide what they should do. Therefore, nurses often give orders to them (eg: quickly go shower! His pills or drink!). It will only make them even refused to do his job, because they are governed.
One way to convince the patient to do his job is to make them think that the work should be done on their own will and initiative. Rather than tell them to shower, it would be better if we say: "I want a shower, if you want to shower first? "Or" I'll take a shower immediately after your bath. " In this way the work done based on their own initiative and the patient would not be refused.
7. Distract patients
If the patient intends to perform work that is harmful to them such as cooking or driving, immediately divert their attention by showing a picture, asking the patient to walk to the window to see the sights, or give them to eat cake. Give something they like.
"Can you help me" is a phrase that is often successfully used to distract patients from all malicious activities because they feel more appreciated that way. Even patients who are out in the street will be back if we ask help to them.
8. Keep an eye on "utilization behavior"
"Utilization behavior" means that certain activities can still be performed even if the patient had cognitive impairment. They will perform the activity is not the time and place (misalnyan: open the door despite lightning). If it finds it, the nurse should closely monitor the things that are done out of place. Patients also may experience disorientation of time that patients often wander midnight with formal wear. Nurses have to put something on top of the patient's eye to prevent the situation or visual stimuli that can evoke such behavior.
9. "Out of sight", "out of mind"
That is something that is seen by the patient will cause strange behavior in reaction to a stimulus object or situation that is experienced by the patient. Therefore, it is important to get rid of everything from their views. For example, closing the door with a cloth so that the patient does not see the door handles, so patients are not compelled to open the door.
Keep patient of people or certain places that stimulate the emergence of behavior. Avoid too patient of the mirrors in the house if the patient does not recognize himself, as this will cause anxiety for the intruder in the house.
10. doing routine activities to prevent disorientation
Perform daily activities as usual will prevent the patient from anxiety or nervousness. Changes in the environment are the most frequent cause of the onset of disorientation and confusion in patients.
11. Adding activity during the day
Adding activity during the day can help because it will stimulate the mind of the patient remain employed. It will also reduce sleep time and produce better sleep at night, thereby reducing the symptoms of insomnia (difficulty sleeping).
12. Placing patients in a safe environment
Inviting patients for walks will help reduce anxiety among adult. The more severe dementia, the patient should be monitored to ensure patient safety.
13. Avoid overly stimulating environment.
Dementia patients who already have symptoms of restless, anxious, irritable, or just love fantasizing will always show worsening behavioral disorders if their environment is too noisy. They might want to go, hitting, or yelling. Patients should be taken to a quiet place. If patients participated visiting family consisting of many people, it would be better if the patient is placed in a quiet place in the company of one or two family members.
14. Supervise custom "hyperoral"
Common in dementia with frontotemporal lobe degeneration in which the patient chews food or other objects. Need surveillance of patients with symptoms like these to keep them to eat food that does not deserve to be eaten.
15. Reduce confusion at night
Impaired sleep at night cause the patient kept awake at night even in the dark. Confusion often occurs because patients feel floating and blurred vision. To overcome this habit could use a night light so that the room they are not too dark. Sometimes they wake up and go to the light to cool down.
Modifications to specific behavioral disturbances
I. Aggressive, agitation, and irritability acute
1. Check for infections (UTIs, skin, pneumonia, etc.).
2. Identification and care of all systemic disorders (CHF, metabolic disorders, thyroid and endocrine dysfunction).
3. Stop using unnecessary drugs.
4. Avoid forcing, scold and punish people, because it will make things worse.
5. Create a soothing atmosphere. Avoid noise, the crowd or the mood in a hurry.
6. Provide caregivers during treatment in the hospital to calm the patient.
II. Aggressive and chronic agitation
1. Create a calm atmosphere around the patient.
2. Do not give orders to the patient because it will make patients become increasingly disobedient.
3. Reactive aggression best when treated with behavior modification approach, as already mentioned above
III. Wandering (like wandering)
1. Hide the car keys and put the detector at the door, can help prevent accidents in patients.
2. Provide patients with a roadmap back, phone number and photo ID
3. Creating a secure environment to facilitate people who like to walk, like a flower garden, garden.
4. Plan a schedule of daily activities.
IV. Anxiety (anxiety)
1. Keep the home environment calm and stable. This will make the patient feel comfortable.
2. Patients respond patiently and lovingly. If the patient became angry, be calm and show compassion, show understanding of the feelings (empathy) rather than explain or confirm that he felt no sense.
3. Make constructive activities for channeling nervousness. If the patient is restless, encourage activities like walking into the yard.
4. Avoid caffeinated beverages (coffee, tea) to help reduce the symptoms of anxiety and restlessness.
5. Correction other underlying disease, such as pain, sensory disturbance, dyspnoea, etc..
V. Excessive suspiciousness, hallucinations, delusions, and psychotic
1. Avoid confrontation.
2. Reacting with calm, do not rush as this will further stimulate the patient. Reassure patients that all this will end.
3. Keeping all the routines are very important because patients would easily suspect if there is something different.
4. Avoid unfamiliar environment.
5. Correction of any sensory disturbance (hipestesi, pain, etc.).
6. Agitated and psychotic symptoms are not treated while not disturbing the patient and caregivers.
VI. Anger and violence
1. Caregivers should remain calm prevailing in the great rage.
2. Eliminate the cause of the disorder if possible. Extreme agitation can be prevented or at least reduced when the cause is eliminated permanently.
VII. Deviation sexual behavior
1. Do not overreact. If the patient to undress in public, take it to his room or to the bathroom.
2. Change the type of clothes. Wear pants instead drawstring pants with zippers. Clothes without buttons better than the open front buttons.
3. Divert the attention of the patient if he wants to take off her clothes was misplaced.
4. Consult a doctor, counselor, and other family members to help address these issues.
1. Make bedtime a calm atmosphere and comfortable. Turn the television and avoid loud noises.
2. Let the patients are active during the day with exercise and patient should not take a nap.
3. At bedtime, leave the light on for avoid disorientation.
4. 2 hours of daily light therapy may improve patients' sleep patterns.
5. Maintain a fixed sleep schedule, sleeping medication only occasionally under supervision.
6. Reduce drinking before bed and take the patient to the bathroom before bed, to avoid waking the patient from sleep.
Usually not necessary in light terapi.Lakukan fun activities.
X. Obsessive-Compulsive Disorder
1. Ask the patient to do something, such as folding clothes.
2. Create your patients happy and away from the boring activity.
A.3. Helping a family or a caregiver to provide right
· Inform the family so as not to spend time and money to action or treatment that has not been proven to be effective.
· Families of patients need to be motivated to face the situation in reality, that people need encouragement in order to function efficiently in the family and society.
· Provide exercises to families or people who care about how to deal with and treat people with dementia.
A.4. Provide support through the surrounding environment
Interact socially in most patients with dementia will be fun, as follows gatherings or parties. Music and art activities will soothe and may be beneficial for patients with dementia.
· If the patient is admitted to a nursing home, create an atmosphere like a home environment.
The authors realize that taking care of a dementia, requires an extreme patience, people who care for people with dementia is the hidden victim of dementia itself, but with great compassion, faith writers too, can beat all of them. A person with dementia, which turns any behavior not because he really is, but the brain damage that changed everything.
This article is dedicated to all those who are still with sincere caring for the elderly with dementia.
Prepared by: Dr. Yuda Turana, Neuroscience Specialist, Atma Jaya Hospital / Hospital Pantai Indah Kapuk Whai is Dementia