One Day Sensitization Program of Family Caregivers of Demented Elderly
One Day Sensitization Program of Family Caregivers of Demented Elderly was conducted on 16th February, 2013 at The ARDSI Hyderabad Deccan's activity center located at Plot No. 451, Road No. 86, Jubilee Hills, Hyderabad, from 10:00 am to 5:00 pm. This one day program was organized by Alzheimer's Related and Disorders Society of India Hyderabad Deccan in association with the Memory Clinic at Nizam's Institute of Medical Sciences and ASHA Hospitals. A total of 60 people attended the training program.
The objectives of the course were to train the caregivers of persons with dementia, professional caregivers, students and social workers to understand various aspects of dementia and to sensitize them to take needful action in caring for the demented elderly. It was attended by caregivers, professional caregivers, psychologists, psychology students and social workers.
The Session commenced with an introduction by Ms Bala Tripura Sundari explaining the need for training family members apart from diagnosis and prescription, as the family plays a vital role in dealing with the Disease.
The first speaker of the day was Dr Praveen from the Neurology department of Nizam's Institute of Medical Science. He spoke on "What is Dementia - Introduction and Stages of Disease" wherein he covered aspects such as symptoms and types of dementia, different stages of dementia, effects and prevalence rate amongst the elderly.
He explained the different causes and effects of dementia and the role of the family remembers to prevent the same. He spoke at length on memory loss, problem with language, disorientation of time and place, decision making, misplacing items, loss of initiative, behavioral changes (such as aggressiveness, irritation, serious, sometimes using abusive language etc.). Causes of dementia such as Alzheimer's Disease, Vascular Dementia, Lewy Body Dementia and Fronto Temporal Dementia and the various stages such as early, middle and advanced. Few root cause such as deficiency of Vitamin B12, Thyroid, urinary infections, brain tumor also leads to Dementia. He spoke about his clinical experiences with dementia people and the problems encountered if not diagnosed early, he stressed on importance of early detection and diagnosis. He fielded questions from the audience at the end of his session.
Functional Communication with Dementia People was presented by Ms Bala Tripura Sundari, she spoke about the communication approach towards dementia persons, where she emphasised on the ways of communication such as non verbal communication through body language, facial expression, behaviour and touch. She further explained the problems faced in communicating with people with dementia especially in the advance stages where the ability to speak and understand is often lost. She explained the vicious cycle of the communication barrier between the caregiver and the dementia person of how difficult it is for the affected person to express, and how the caregiver misunderstands the expressions / gestures / behaviors. She gave useful tips for communication like keeping sentences short and simple, say exactly what you mean, use real names, encourage the person to talk, use questions with a simple answer, repeat important bits, use touch, gestures, tone of voice. She concluded with the important aspects like avoiding misconceptions, avoid underestimating the ability of the person to understand and react and importance of attentive listening. It was followed by question answer session.
Memory rehabilitation in mild to moderate dementia was presented by Ms Farzana Mulla, Neuropsychologist, Apollo Hospitals. She spoke about why memory rehabilitation in early dementia is important and explained the memory impairment in the early manifestation of dementia, the major impact upon daily life and function, social isolation of persons with dementia and their family/caregivers. She explained that the Assessment identifies the specific aspects of cognitive and behavioural performance that are impaired (affected) and those that are preserved, focuses on persons need, function and well being, develop behaviourally based treatment that is realistic and safe for the individual and their caregivers and in an environment that is meaningful. some examples she mentioned that could be achieved in the rehabilitation were remember what happened yesterday, reduce repetitive questioning, learn to use a mobile phone, learn to use a computer to email a friend/family, remember name of people at daycare/close family members/yoga class, know who will be visiting- remember name and link with calendar entry. After the therapy goals she further explained the interventions to be given to a dementia person and the strategies used in it. She then explained the importance of memory rehabilitation and how it helps by preserving the learned memory till late in the disease process, memory strategies focuses on intact ability (strengths) and uses it to compensate for lost abilities. Memory rehabilitation appears to offer some benefits for people with early dementia and represents one possible treatment option.
Caregiving in Dementia: Ms Farzana Mulla presented caregiving in dementia as her second session where she explained about caregiving in dementia and its difficulties for caregiver to take care of an elderly person. She spoke about Caregiver Stress and Caregiver Burden and how it affects their personal life and health. She explained the vicious cycle of carer burden and guilt of the caregiver. She advised help for these caregivers and meta-analytic study of psychosocial interventions with caregivers. She also suggested changing the psychological approach of caregiver towards the dementia person. There was a very interesting interactive session at the end of the talk with the audience asking her questions.
Lunch break was announced at the end of this session.
Post Lunch Sessions:
Understanding Behaviour of Dementia Patients: Dr Arindam Chakrabarti, Psychiatrist, Asha Hospital, presented the talk on this topic. In detail he explained the behaviour changes in dementia person and their manifestation. He spoke about most of the possible behaviours such as restlessness, anxiety, hallucinations, delusions, aggressiveness, irrelevant talk, bipolar disorder, obsessive compulsive disorder, wandering, insomnia, agitation, disinhibition, apathy, night time behaviour etc. He said dementia itself does not create these behaviors, the environment, physical discomfort (pain for example), our approach and communication style are just a few things that can have a person with dementia behaving in a particular way. He gave many examples from his practice and experience to support his explanations.Towards the end of his session he took questions.
Common Geriatric problems : Dr. Ramana Rao GV of GVK Emergency Management and Research Institute presented this session. He spoke at length about importance of health in the elderly, detection and prevention of health issues, psychological problems and social/ personal issues. He spoke about the common diseases in Indian elderly population and how they are neglected. He emphasised on regular health checkups, vaccination schedules, proper medication and follow up, balanced diet, care and support, encourage physical activity, rest and relaxation, first aid, group activity – family and societal.
Safety Measures for persons with dementia: Mr Shashidhar spoke of the importance of safety and safety consciousness amongst caregivers, especially if dealing with persons with dementia. He spoke of the impact of dementia on ability to understand likely dangers, the ability to discern correctness of actions, course of action, poor balance, slower reflexes, poor sight or hearing and general mobility issues. In addition dementia may also make it hard for someone to understand that there are now limitations to their abilities.
He explained about indoor and outdoor safety measures and possible ways of implementing them. He gave a brief overview of technology which can help when outdoors or travelling, such GPS watches. He took a detail question answer session regarding safety issues from the audience.
Activities for Dementia Persons: Ms Saadiya, Psychologist and Counsellor at ARDSI Hyderabad Deccan, presented the importance of activities for dementia patients and their effect on delaying the progression of dementia, to elicit positive emotions, to foster verbal as well as non verbal communication among person with dementia, maintain their abilities and independence, to improve confidence, and to improves overall quality of life and social well-being. She said that the activities practiced may establish the old roles and bring back the household chore that would give a sense of independence to the person. She showed pictures of activities done by clients and video clips of how a client was diverted of his anxiety and restlessness with the help of his activity of interest.
Care in Advanced Dementia: It was presented by Dr D.Priya Kumari she explained what is meant by advance dementia, what are the complications and about the palliative care. She explained the statistics of constipation management of constipation and correction, defecate, Immobility and reduction in of awareness in the patients. She also explained about the assessment of pain among them and about the complete care for such patients. She spoke about the bed sores and risk factors for pressure areas due to bed sores, stages of damage and intervention and its prevention. There was a brief question answer session followed which concluded her talk.
The sessions ended for the day by a vote of thanks by Mr Shashidhar, who thanked The Memory Clinic at Nizams Institute of Medical Sciences, Asha Hospitals, EASA, GVK EMRI, Pain Relief and Palliative Care Society of India, GHMC Aasara, St Francis college for Women and all the participants, facilitators and sponsors for their support.
The participants were presented Participant Certificate.
