Exploring care options for older adults with dementia

In movies and TV shows, it’s funny: An older adult relative cracking oneliners — and other things — for the sake of laughter.

But in real life, dealing with a loved one with dementia is no laughing matter. For some, it can be the hardest thing in the world to witness a beloved parent slowly losing their memories, identity and eventually their lives.

WHAT IS DEMENTIA?

According to the Mayo Clinic, dementia describes a group of symptoms affecting memory, thinking and social abilities severely enough to in

» “People are isolating together and may notice things about their loved ones they haven’t noticed before, such as misplacing keys and other belongings. They’re more aware of cognitive changes.” Dr. Melanie Stephens, clinical director of the UCSF Memory and Aging Center

terfere with daily life. It isn’t one specific disease, but several different diseases that can cause dementia.

Though dementia generally involves memory loss, having memory loss alone doesn’t mean you have dementia.

The UC Davis East Bay Alzheimer’s Disease Center, based in Walnut Creek, said that dementia is caused by damage to or loss of nerve cells and their connections in the brain. Depending on the area of the brain that’s affected by the damage, dementia can affect people differently and cause different symptoms.

Some diseases look like dementia, such as those caused by a reaction to medications or vitamin deficiencies, as well as bladder infections in older individuals, and they might improve with treatment.

However, the UC Davis East Bay Alzheimer’s Disease Center’s Fatima Chavez provides some insight: Alzheimer’s disease remains the most prevalent dementia in older adults, and experts suggest more than 5 million Americans suffer from the disease. It is currently ranked as the sixth leading cause of death in the U.S., but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer. And it is progressive and incurable.

There are two types of Alzheimer’s disease: Earlyonset, which usually starts between the ages of 30 and 60, and lateonset, which occurs in people 60 and older.

So what are the symptoms? It starts off with memory problems. Some people have a condition called mild cognitive impairment (MCI), in which they have more memory problems than normal for their age, but they do not interfere with their daily lives. Older people with MCI are more at a risk of developing Alzheimer’s, according to the UC Davis East Bay Alzheimer’s Disease Center, but not all of them do.

Some may even go back to normal cognition.

Dr. Melanie Stephens, clinical director of the UCSF Memory and Aging Center, said that it is “very interesting” how many more referrals her clinic has processed since the COVID19 pandemic started.

“People are isolating together and may notice things about their loved ones they haven’t noticed before, such as misplacing keys and other belongings,” she said. “They’re more aware of cognitive changes.”

It is important not to wait, and to get a doctor’s opinion on these types of changes immediately.

“If you notice more depression, misplacing items, changes in shortterm memory, see a physician as soon as you can,” she said.

Alzheimer’s is characterized by three stages, according to the UC Davis East Bay Alzheimer’s Disease Center: Mild — Increasing memory loss and other cognitive issues, such as not being able to handle money or pay bills; repeating questions; wandering; taking longer than normal to complete daily tasks and personality and behavioral changes. People are often diagnosed at this stage. Families may see more caregiving is needed, and may want to bring in outside help to avoid burnout. Moderate — As more damage occurs in the brain, Alzheimer’s patients have trouble with reasoning, sensory processing (a loss of smell is common) and conscious thought; memory loss and confusion grow worse, and they begin not to recognize family and friends; they may be unable to learn new things, carry out multistep tasks (such as using the telephone, getting dressed or cope with new situations); they also may have hallucinations, delusions and paranoia and may behave impulsively. Families may want to consider livein care with licensed vocational nurses or an assisted living community at this point. Severe —At this stage, Alzheimer’s patients can’t communicate and are completely dependent on others for care. Near the end, they may be in bed most of the time as their body shuts down. Skilled nursing at home or in a memory care center is required for upmost care.

Some of the best treatments for Alzheimer’s patients that families can do in the early stages is to socialize their patient and help them get regular exercise — even if it’s just on Zoom these days, Stephens said. Setting up online calls with family and friends can help tremendously, too. CAREGIVERS NEED CARE, TOO

Christina Irving, a licensed clinical social worker and client services director for the Family Caregiver Alliance, based in San Francisco, helps provide advice to family members and caregivers working with Alzheimer’s patients.

“When a family member is mentally or physically exhausted — and developing illnesses of their own — it is time to get help,” she said.

Her organization helps determine what that help might look like, whether it’s additional inhome care for their older adults or an assisted living community.

Many assisted living communities have memory care units attached, and it’s an easy transition from one to the other. Inhome care can usually cost $35$40 an hour in the Bay Area, while assisted living averages $6,000$9,000 per month, depending on the services needed. Often Medicare and Medicaid can help alleviate some of those costs, along with longterm care insurance.

“Families have to decide what works best for them,” she said. “There are risks involved with athome care, including supervision and insurance, if the caregiver isn’t associated with an agency. But the insurance costs may outweigh the savings from an unlicensed caregiver.”

Families must be assertive in all situations and advocate for their older adult, Irving said.

No matter what people choose, Irving and Stephens said families and caregivers must avoid burnout, and take care of themselves first. Take breaks whenever possible, and consider joining a caregiver support group online or eventually in person.

“You can’t serve anyone well if you aren’t at your best,” Stephens said.

SHUTTERSTOCK Many assisted living communities have memory care units attached, and older adults with dementia can participate in specialized activities.