Dementia & Alzheimer’s: Care Giving & Support

Excerpts from the online session conducted by Pramila Bajracharya, Founder Chairperson of Hope Hermitage Elderly Care-Senior Citizen Home, Club & Day Care, Gairidhara & Hope Hermitage Nepal on 5 May 2020 with Bihani Social Venture.

About Dementia and its Types

Alzheimer’s disease is the most common cause of dementia, a general term for loss of memory and other cognitive abilities serious enough to interfere with a person’s daily life. Alzheimer’s disease accounts for 60-80% of dementia cases. There are around 200 type of Dementia with 200 different types of symptoms.

Generally, Dementia is an umbrella term under which we can find around 50-75% Alzheimer’s Dementia, 5-10% Lewy Body Dementia, 5-10% Vascular Dementia and 5-10% Front0temporal Dementia and others – Parkinson’s and Huntington’s. Alzheimer’s is not a normal part of aging. We have started seeing Early Onset Dementia in Nepal and some other countries. Normally, symptoms of Dementia are seen in elders of 60-70 years of age but Early Onset Dementia is seen starting from the age of 50 years. Huntington’s Dementia is sometimes seen at earlier age of around 35 years as well. The greatest known risk factor is increasing age, and the majority of people with Alzheimer’s are 65 and older. But Alzheimer’s is not a disease that only affects people of older age.

Cause and Symptoms

The main cause of Alzheimer’s disease (AD) is the shrinking of blood vessels in the brain. In earlier times, the life expectancy of people was around 60 years of age. With the help of cutting edge technologies and medical health facilities, the life expectancy has increased in almost every country. With people living longer, the brain also ages accordingly which results in shrinking of the blood vessels in the brain. This leads to the most common early symptom of Alzheimer’s Dementia- difficulty in remembering newly learned information. This is because Alzheimer’s changes typically begin in the part of the brain that affects learning. As Alzheimer’s advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.

Statistic on Dementia and Alzheimer’s

In 2015, 47.5 million people were estimated to be living with dementia. About 7.7 million new cases of dementia emerge each year, implying that there is a new case of dementia somewhere in the world every four seconds. The accelerating rates of dementia are a cause for immediate action, especially in low- and middle-income countries (LAMIC) where resources are limited. The Alzheimer’s Disease International (ADI) has done a trend analysis of the disease in countries with similar social and economic structure and estimated that there were about 78,000 patients with Alzheimer’s Disease in Nepal (2015) and this number is bound to double every 20 years reaching 134,000 in 2030 and 285,000 in 2050. Recently, a study done by Alzheimer’s and Related Dementia Society, Nepal for the Ministry of Women, Children and Social Welfare has shown that the prevalence of AD among the persons living in different elderly homes in Kathmandu valley is 11.01% among males and 10.64% in females (Lamichhane, unpublished).

Care Giving and Coping Mechanisms

Care giver role is important in caring for elderly. In Nepali society, people are not aware about care giving services and its requirement. It is observed that people compare care givers with domestic workers. They think that care giving can be done by domestic helpers, but in reality, it is different in each case. Caregivers provide specific care techniques, remedy, and interventions to support the elderly.

There is no treatment of Alzheimer’s and Dementia throughout the world but we can reduce its risks by maintaining our mental and physical health with regularly exercise, taking care of the heart, and more. In some cases of heart attacks, after the treating, they developed some symptom of vascular dementia. To reduce these symptoms, patients are advised to stop smoking, consume less alcohol, have nutritious food, and maintain normal blood pressure, cholesterol and sugar level. People are recommended to follow activities that boost the functionality of the brain such as calculation and playing mind games, engaging in social gathering and social involvement.

About Hope Hermitage Elderly Care (HHEC)

Hope Hermitage Elderly Care (HHEC) was founded by Ms. Pramila Bajracharya Thapa in 2017 to meet the growing need for elderly care and services in Nepal. HHEC provides Home Care services with special focus on Alzheimer’s and Related Dementia Care, palliative care, etc. in Kathmandu.

HHEC is an elderly care home providing assistance and assuring quality living with dignity where facilities and comforts are ensured aligned to physical, mental and psychological well-being of the elderly.  Investing many years in the upbringing of your child and achieving a social status, HHEC portrays as a second home for the elderly residents, surrounded by warmth, comfort and magic of choice through socialising with like-minded residents who are enjoying old age and adding years to life in good health.

HHEC delivers care and support by team of professionals who are provided with additional care-giving training for 30 days. In 15 days’ workshop, the care-givers are trained to look after the residents’ personal hygiene, communicate with residents with Alzheimer’s and Dementia, undertake activities of daily living (ADL), learn cooking related for a healthy diet and so on. Subsequently, they are deployed in Day Care Center for practical knowledge and practice.

Some of the key skills attained after care-giving training at HHEC are as follows:

  • Importance of being polite and soft-spoken towards residents, especially with the ones with Dementia
  • Learn to internalise the situation of residents with AD along with the feeling of trust-worthiness while having to deal with unfavourable circumstances
  • The art of Reminiscence Therapy for residents with AD to rejoice memory in order to enhance memory power

Personal Experience

“According to what I have observed and experienced, people with Alzheimer’s develop one or multiple of the following signs: start forgetting things/ lose memory power, difficulty in performing Activities of Daily Living (ADL), and as far as to forget how to swallow food. Similarly, in people with Parkinson Dementia, we can see signs such as having difficulty in breathing and improper functioning of nerve cells. We can eventually notice a decrement in thinking ability and difficulty in remembering certain things. Moreover, serious memory loss, confusion and other major changes in the way that our minds work may be a sign that the brain cells are failing.” – Pramila Bajracharya Thapa, founder of Hope Hermitage Elderly Care