Sreeja V, RN,BSN, DPN, *Central Institute of Psychiatry, Ranchi, India

Outline

• Introduction
• Etiology
• Epidemiology
• Sign & Symptoms
• Types of Dementia
• Assessment & Management
• Nursing Management
• Nursing care plan
• Problems of the carer
• Pre and Post Test
• Bibliography
• Glossary

X. PROBLEMS OF THE CARER

The carer, often a spouse is likely to also be elderly and possibly with poor physical health. If the carer is a child they may have family responsibilities such as dependent children, producing divided loyalties and some times marital conflict. The carer may live a distance away and suffer financial problems from travel expenses. There may be embarrassment caused by the reversal of roles, especially if caring for the personnel hygiene of a parent of the opposite sex. Lack of insight and knowledge of the progress of dementia, which symptoms can be modified and how to obtain help, can all be remedied by introducing the carer to a support group such as Age concern and the Alzheimer’s Disease society.

Help of Carer

Carer giving is hard work and is usually considered a professional activity. Amateur careers are untrained so it is not surprising they makes mistakes such as using restrain to prevent behaviour (e.g.: locked doors or request for sedation) rather than environmental or Psychological management Brodaty (1992) Suggests that, training should be comprehensive, tailored to Individual needs, and continuing through the different phases of the illness. A joint report by the RCP (1989) suggests that for the massive issue of Dementia, the emphasis should be on support of carer. Attention should be given to “Those aspects which wear careers down such as restlessness, aggression, disturbed nights and in continence “together with complicating problems such as depression in patient of career. The report describes the role of the community

Psychiatric Nurse as monitoring and support, counseling, helping with practical, financial and emotional difficulties and advocacy on behalf of the patient and families. How ever one must beware the tendency for paternalistic control. Where a patient is in capable of consent, relatives should be consulted closely at every stage of treatment. But when a patient is capable of making certain decisions. It is both unnecessary and stigmatizing to wish to confirm the decision with a relative (Murphy 1986).

1) In the Home: - The home help service can reduce the amount of work necessary in the house, leaving the carer more time to spent with the patient. Some district run schemes where paid or voluntary carers come to the house and stay with the demented patient while the carer with the demented patient while the career goes out, or take the patient out for some hours giving the career since alone in the home.

2) Outings: Many voluntary and statutory groups are able to arrange outings, either day trips or even holidays, for the carer and patient, to give interest and stimulation to them both.

3) Day Care: - Social service department and voluntary service run day care scheme in all areas. It is usually possible for transport to collect and return the patient, although sometimes a carer may do this, if there are major problems with physically dependency or behaviour such as aggression day care may be provided by the psycho geriatric day hospital, which has a higher number of staff, including nurses to deal with such problems.

XI. CONCLUSION

Dementia is irreversible psychiatric disorder characterized by the global impairment of higher cortical function including, memory, the capacity to solve the problems of day to day living, the performance of learned percept motor skills, the correct use of social skill and control of emotional reactions, in the absence of clouding of consciousness. The condition is often irreversible and progressive.

A necessary pre-requisite for the development of dementia is a relatively wide spread cerebral dysfunction or damage or both. Psychological and psychosocial factors influence to a limited extent, the degree of severity of dementia. The diagnosis of dementia rests on clinical grounds and identification of the underlying disease process. The clinical diagnosis of dementia is arrived at by the information obtained from a detailed longitudinal history and a mental status examination, supplemented by a thorough physical examination, once the diagnosis of dementia is established the choice of investigation should be done. Basic screening test is necessary for proper diagnosis.

After diagnosis psychosocial management, institutionalization, treatment of concurrent psychiatric disorder and various medical interventions purposed to improve cognitive functions assume importance. Nursing care is also ever important for demented patient according to its cause, onset of illness and severity. The main aim of nursing care is to make the patients life easier and pleasant.  It also provides safe environment for the patient. Fulfill his basic needs and emotional needs. Demented patients can be treated in community mental health centres. The team members visit the home and teach patient and family members and educational, recreational and social activities are planned and provided.

Demented patient can also be placed in dementia centres and geriatric nursing homes. In India also emphasis is being given good care to dementia patients. There are provisions to treat these cases in the Dementia centres in India, Example Kerala, Madras, Vellor, and Bangalore etc.