As the saying goes, when a person gets older, they become wiser. But aging has many consequences, when you get old, your physical and mental abilities slowly deteriorates, as well. Do you remember your grandmother says “Senior Moments”, whenever she forgot where she place the house key, but she was just holding it 5 minutes ago? One of the most common consequences of getting old is having a dementia or deterioration of a person’s cognitive function, and it is an unavoidable period of getting old.
A number of patient suffering from Dementia choose to have a House Call Treatment instead of going on to a doctor’s clinic or hospital for a treatment. House calls offer a new perspective in dealing with the patient’s health and environment. According to the Journal of the American Family Physician, the demand for house call treatment is expected to increase in the United States as the population ages.
The Benefits of House Call Treatment
There are many practical benefits of having a house call treatment, these includes:
- Getting medical treatment at the comfort and convenience of home
- Doctors are able to sit down and discuss the condition of the patient to the whole family.
- The doctor can also observe how the family attends to the needs of the patient.
- House calls involve a multidisciplinary team approach that helps lessen long-term hospital stay and readmissions.
- This approach is favorable for managing acute and chronic illness like dementia and even in the management of palliative care.
- A house call treatment allows a better doctor-patient relationship, and improves the physicians understanding of the patient’s support system and their environment per se.
What You Need to Know about Dementia?
A clinical syndrome with different causes, dementia is characterized by a decline in a patients cognitive function. It affects more than five million people in United States and it costs an annual health care cost of around $157 billion to $215 billion. Dementia can impair a person’s ability to perform his or her daily functions successfully.
Patients with dementia commonly lose their ability to recall a specific place and time of events. Patients ages 70 and above lost 10% of their cognitive function. While individuals, ages 85 and above lose 20% to 40% of their memory function.
Aside from clinically identifiable memory loss, patient with dementia also suffers deterioration in their:
- Problem-solving abilities
- Judgment
- Calculation
- Praxis or Act of Engaging, Exercising or Realizing an Activity
- Visuospatial
- Language
- And other Mental Faculties
Patients with dementia syndromes also have deficits in their social and neuropsychiatric profiles. Some patients manifest:
- Depression
- Sleep Disturbances
- Insomnia
- Compulsions
- Disinhibition
- Agitation
- Delusions
- Anxiety
- Apathy
What are the Causes of Dementia?
The strongest risk factor for dementia is increasing age. The onset of memory loss is increased when a person reaches the age of 50. Autopsy reports showed that at this age, there are associated microscopic changes in the brain particularly if a patient has Alzheimer’s disease, the most popular forms of dementia.
Even though, the role of human aging is still subject to debate and controversy considering that there are many centenarians who have intact memory function and shows no signs of clinical dementia.
Below are some of the most common causes of dementia:
- Alzheimer’s Disease
- Vascular Dementia
- Alcoholism
- Medication or Drug Intoxication
- PDD/LBD Spectrum or Parkinson Disease Dementia (PDD)/ Lewy Body Dementia (LBD) Spectrum
Other less common causes of dementia:
- Vitamin Deficiencies
- Chronic Infections
- Toxic Disorders
- Degenerative Disorders
- Psychiatric Illness
- Head Trauma
- Neoplastic or Malignant Brain Tumors
- Endocrine and other Organ Failure
- Other Metabolic Disorders
What is the Treatment of Patient with Dementia?
The main goal of managing dementia is to treat the reversible causes of the disease and to provide support and comfort to the patient and their caregivers.
If the underlying cause of the disease is vitamin deficiency, then Vitamin therapy for B12 Deficiency or Thiamine is given. If the patient is having hypothyroidism, then thyroid replacement is initiated. Removal of the offending drug is useful for patients who had dementia because of medications. The rule of the thumb is to reverse the cause or the offending agent to help improve the patient’s condition.
There many recognized treatments for dementia, these includes medications and behavioral therapy. These medications are used to address the varying symptoms of dementia. Anti-depressants may become a mainstay treatment when necessary. Anticonvulsant drugs may also be used to control the seizures.
However, patients who have behavioral problems are difficult to manage. These are the major cause why they are advised for institutionalization or home placement. These include:
- Delusions
- Confusion
- Hallucinations
- Agitations
Behavior Therapy plays an important role in managing patients with dementia. The main goal of nondrug behavior therapy is to make the patient’s life more:
- Comfortable
- Safe
- Uncomplicated
In the early stages of the illness, it is important to:
- Prepare lists, calendars, labels and schedules
- Stress familiar routines and walks
- Provide simple exercises
Demented patients perform better if they are given routine tasks than remembering events. But they can still participate in other activities like walking, dancing, golfing, singing, and playing bingo. Demented patients lose control in performing familiar tasks like handling finances, cooking and driving. Thus, it is not unusual for caregivers to be greeted with anger, hostility and complaints.
It is very important to note how important it is for dementia patients to have a supporting and loving environment. This is the reason why many patient and their families opted to have a home placement treatment for them.
Home Care Treatment for Demented Patients
A demented patient needs a proactive treatment strategy in their management plan. This strategy may include:
- Frequent Orientation
- Sleep-enhancement measures
- Vision and Hearing aids
- Cognitive Activities
- Correction of Dehydration
Safety is also an important issue that includes not only driving but also controlling other sleeping, bathroom and kitchen area environments, as well as the stairways. These areas must be supervised, monitored, and made to be as safe for the patient. Moving demented patients into a nursing home, assisted-living center or retirement complex may initially cause agitation and confusion.
Although, repeated orientation, assurance and careful introduction to a new caregiver or environment may help ease the process.
Thus, many of the patient’s family who has the capacity to provide support for their aging parents or relatives opt to have a home care treatment. Providing the patient activities that they used to enjoy offers considerable benefit.
Despite the benefits of home care treatment, family members or caregivers may feel helpless and overwhelmed. They are not immune to depression and burnout. Worst, caregivers may vent their frustrations to the patient or the health care provider. Thus, some may consider day care facilities and other services that may help them in managing the patient.
Regular counseling and education for dementia is very important. A house call doctor provides a new perspective in the entire treatment process. House calls involve:
- Observing the patient on how they perform daily activities.
- Evaluating home safety
- Reconciling drug problems or any inconsistency
Aging is an inevitable process and having a dementia is one of the many common consequences. It is important for demented patients to get all the love and support that they need from their family. As this, will help them get through to the overwhelming and helpless circumstance of losing one’s memory and cognitive function.
Bibliography
Harrison, T. (2015). Harrison’s Principle of Internal Medicine 19th Edition. Mc Graw Hill.
UNWIN, B. K. (2011). House Calls. Journal of American Family Physician , 925-931.
Vink. (2013). There is no substantial evidence to support nor discourage the use of music therapy in the care of older people with dementia. Cochrane Database of Systematic Reviews .
