HERFSAKKER OLD AGE HOME IN NELSPRUIT, MPUMALANGA

HERFSAKKER ALZHEIMERS UNIT

The Herfsakker old age home has a specialized unit that provides for the special needs of persons living with Alzheimer's disease. The unit is separate from the other facilities of the home and can accommodate 12 residents. Each resident has his or her own bedroom. The ablution facilities are shared. Although Alzheimer's is a progressive disease, it is of utmost importance to maintain their dignity at all times.

It is our aim to protect our residents from any form of harm associated with the disease. We do not only provide in their physical needs, but also engage them in various activities to optimise their functioning and emotional well-being. The unit functions under the supervision of a professional nurse and a team of dedicated health care workers.

DEMENTIA AND ALZHEIMER'S DISEASE

WHAT IS ALZHEIMER'S DISEASE?

Alzheimer's disease is a type of dementia and dementia is a medical condition in which there is a serious deterioration in a person's intellectual ability and emotional state.
Dementia is an umbrella term of which Alzheimer's is only one condition.
Dementia affects 6% of people above 65 and become more common as people get older.

FACTS ABOUT DEMENTIA

• Dementia is a physical disease of the brain
• As the disease progresses, the brain becomes more and more damaged
• Performance and judgement will deteriorate until the person is unable to lead a normal life
• Dementia can affect anyone - a former president of the United States or even you!
• Dementia is not contagious
• No one single factor has been identified as the cause of Alzheimer's
• There is NO link between Alzheimer's and witchcraft

10 WARNING SIGNS

A memory problem, which is NOT caused by alcohol abuse or head injury and which worsens with time

L anguage problems: difficulty in naming objects, find the right word to use in a sentence and often talking nonsense

Z ips and buttons are difficult to fasten. Alzheimer's sufferers find it hard to dress them selves

H ygiene: those with Alzheimer's may not care about how they look and may not want to bath

E xtreme mood swings: a change in mood for no reason, like being calm and then suddenly becoming scared, angry or aggressive, within minutes

I mpaired judgement: strange behaviour, like wearing underclothes over top clothes or taking off clothes in public

M any Alzheimer's sufferers get lost in familiar places

E ven recognition of their own family and friends becomes difficult

R ecalls memories of childhood times, but cannot remember anything that happened the same day

S uspicious of other people and may accuse them of stealing or hiding things

SIGNS AND SYMPTOMS OF DEMENTIA

Dementia progresses at different rates. How the disease starts and progresses will vary from person to person. Signs and symptoms become more persistent and serious over time. A combination of symptoms can be experienced at the same time.

Signs and symptoms in the mild and moderate phases:

• Increasing and persistent forgetfulness
• Difficulties with abstract thinking
• Disorientation
• Judgement loss
• Personality changes
• Memory loss
• Increasing dependence on others
• Urinary and faecal incontinence
• Difficulties with communication
• Depression
• Hallucinations
• Anxiety
• Sleep disturbances
• Delusions (false ideas)

SIGNS AND SYMPTOMS OF NORMAL AGEING

• Periodic memory lapses and lapses in concentration
•   Sadness or anxiety specific to the situation
•   Increasingly cautious behaviour
•   Unimpaired language skills
•   Slower reaction times

TYPES OF DEMENTIA

In South Africa the most common forms of dementia include:

• Alzheimer's disease
• Vascular/multi-infract dementia  
• Alcohol dementia  
• Post-traumatic dementia
• HIV/AIDS related dementia

It is possible to have more than one form of dementia at a time.

SCREENING AND DIAGNOSIS

No single laboratory test can confirm a diagnosis of dementia. A doctor will usually make the diagnosis of dementia only after excluding other causes such as an infection, vitamin deficiency, the side effects of drugs and many other possible causes.

TESTS

Making an early diagnosis is important because medications are available that can improve both memory and behaviour in the early stages of the disease.

A doctor must do the following before making a diagnosis of dementia:

• Take a full medical history with supporting information from the family or a caregiver
• Perform a mental status examination which includes tests of memory
• A physical examination
• Laboratory tests and, if indicated, other special investigations such as a brain scan

TREATMENTS

As there is no cure for dementia, the first goal of management remains holistic physical and emotional care.

There are drugs available, designed to treat symptoms of dementia in the early and middle stages. The available drugs are not a cure, but may stabilize and even improve some symptoms for a period of time.

WHAT IS THE PROGNOSIS?

Alzheimer's is a progressive disease, but its course can vary from 5 to 20 years. The most common cause of death in Alzheimer's disease patients is infection.

COPING WITH DEMENTIA

The key to coping with dementia is to focus on what the person can do rather than on what he or she is not able to do. Caregivers will need to be patient and understanding. A constantly creative attitude is essential.

People with Alzheimer's disease are unable to look after themselves and their activities of daily living are the responsibility of someone else.

Every person experiences the disease differently, and therefore techniques used to care for a person will vary.

Alzheimer's disease is usually very stressful for the patient's family, who frequently provides most of the care and support. However, the patient is typically unaware of his/her disorder initially.

One of the most important steps is finding a qualified physician who understands the special health needs of the elderly. A psychiatrist with special experience treating late-life mental disorders is often the first choice for an Alzheimer's patient.

CREATING A CARING AND ENABLING ENVIRONMENT

A person with dementia is more likely to have an accident because he or she forgets where things are and how to use them.

SAFETY TIPS

• Install safety devices, like child-proof locks
• Lock up cleaning fluids, firearms, medicines and alcohol
• Add extra lighting or place contrasting coloured rugs at entrances and steps
• Monitor the temperature of taps and food
• Supervise all medication
• Remove anything which might cause a fall
• Be prepared for emergencies
• Don't leave open fires and heaters unattended

Alzheimer's care takes patience and can be stressful even to the most dedicated family members. It is essential for caregivers to have a support resource for the other mental disturbances resulting from the disease. Alzheimer's care also requires help in the legal, financial and social issues that emanate for this disease.

• The person with dementia is an individual with feelings - treat them with respect and dignity
• A routine decreases the decisions you need to make and can provide security for the person with dementia
• Encouraging independence helps maintain self-respect and decreases your burden
• Don't draw attention to failure and avoid confrontation by staying calm
• Avoid confusion and stress by keeping things simple
• Make your home as safe as possible
• Keeping active helps enhance dignity, self-worth and maintains physical and mental capabilities
• People whose language becomes impaired rely more on other senses, such as touch and sight
• Use memory aids to help the person remember and avoid confusion
• Make bathing an enjoyable, relaxing and stress free activity - not a forced chore
• Make dressing an enjoyable shared activity
• Confusion is often the cause of incontinence, so limit large drinks, label the toilet door with signs and dress the person in loose clothing
• The ability to cook may be lost
• Eating is important! So get help if you are having difficulty coping
• Supervise drinking and smoking to make sure accidents don't happen
• Increasing daily activities and discouraging sleeping during the day will help the person sleep at night
• Repetitive questioning is caused by memory problems giving a general feeling of insecurity
• Don't argue about lost items, they can usually be found after a quick search
• Hallucinations and delusions are real to the person so deal with them, don't dismiss them
• When inappropriate sexual behaviour occurs, stay calm, avoid confrontation, and distract the person with another activity
• If the person is lost, seek help immediately and don't delay calling the police
• Violence and aggression are caused by the illness. Keep calm and try not to show fear or alarm. Give them more space and try to draw their attention to a calming activity
• Depression is serious but treatable, so seek help and advice on how to deal with it.
• It is important with Alzheimer's care to ensure that the patient is afforded as much independence as necessary within a safe environment for as long as possible.
• In order for the Alzheimer's caregiver to cope, the burnout can be diluted through the following actions:
• The Alzheimer's caregiver needs help from others as needed
• The Alzheimer's caregiver must take care of their own health
• Learn as much as one can about the disease when giving Alzheimer's care
• Alzheimer's care requires help from a support group

TIPS FOR CAREGIVERS

• Try to accept that feelings of grief are a natural response to the situation
•   It is common to feel guilty
•   Getting angry is normal
•   Ease any embarrassment by taking the courage to explain the situation to people around you
•   Try to maintain friendships and keep social contacts, as loneliness makes care giving harder
•   The family can be the greatest source of help
•   Share your problems
•   Make time for yourself
•   Be aware of how much you can take, and seek help if caring becomes too much for you
•   Dementia is no one's fault, the disease is the cause. Don't blame yourself
• Learning to seek and take advice can help you be a better caregiver

WHERE CAN I FIND HELP?

• The SAVF Herfsakker old age home in Nelspruit Tel: 013 7411 076
• Your local clinic
• Your area social worker - contact the Department of Health and Social Services for the name of your area social worker Tel: 013 755 4036
• Mpumalanga Mental Health - Ms Annesta Hofer Tel: 0729834021

Alzheimer's South Africa - Ms Lorna Kirsten Tel: 0832651187