Dementia, anxiety, Depression, Palliative care

If you or a friend  has a diagnosis of dementia, you will probably have questions about what it means, what to do and who can help – both in the short term and in planning for the future.

The most important thing to understand is that help is available. Whether you’re living in your own home or in an aged care home, there are aged care services that specialise in helping people with dementia.

There are a number of different types of dementia. Dementia is a condition (a group of related symptoms) that is associated with an ongoing decline of the brain and its abilities, including:

  memory;  thinking;  language; understanding; judgement

Usually, dementia occurs in people who are aged 65 or over althopugh it can occuir at a younger age and even in children. The older you get, the more likely you are to develop this condition. Around one in four people living in Australia over 85 years have dementia.

The most common type of dementia is Alzheimer’s disease. It accounts for between 50% and 70% of all types of dementia. Alzheimer’s disease is a degenerative condition that affects the brain. As brain cells die, the substance of the brain shrinks causing certain information to no longer be recalled or understood.

Many people worry that forgetting things might indicate dementia. It is normal to occasionally forget appointments or a friend’s phone number, but memory loss associated with dementia will most likely be persistent and progressive, not just occasional.

You may notice changes in the way that you communicate with your friend. For example, they may find it hard to find a word, speak fluently, understand, write, read or express emotions. They may also lose normal social conventions of conversation, for example ignoring what you’re saying or interrupting you.

When communicating with someone with dementia it’s important to:

  check their hearing and eyesight to make sure that this isn’t the source of the problem;

  remember that people retain their feelings and emotions even though they may not understand what you’re saying;

  stay calm, allow time for them to understand, use short, simple sentences and help orientate them by describing what you’re about to do, who is about to visit and their relationship with this person;

  use positive body language and touch, as this forms a large part of communication; and,

  Try not to argue, be condescending, order the person around, ask questions that rely on a good memory or talk about them in the presence of other people.

Research on both the cause and treatment of anxiety in older adults, lags behind research in other mental conditions, such as depression and Alzheimer's. Until recently, anxiety disorders were believed to decline with age. But now experts are beginning to recognize that ageing and anxiety are not mutually exclusive: anxiety is as common in the old as in the young, although how and when it appears is distinctly different in older adults.

Anxiety disorders in the elderly population are real and treatable, just as they are in younger people. Another commonality between old and young is the high incidence of depression with anxiety. Depression and anxiety go together in the elderly, as they do in the young, with almost half of those with major depression also meeting the criteria for anxiety, and about one-quarter of those with anxiety meeting criteria for major depression. As with younger persons, being a woman and having less formal education are risk factors for anxiety in older adults.

Recognizing an anxiety disorder in an older friend poses several challenges. Ageing brings with it a higher prevalence of certain medical conditions, realistic concern about physical problems, and a higher use of prescription medications. As a result, separating a medical condition from physical symptoms of an anxiety disorder is more complicated in the older adult. Diagnosing anxiety in individuals with dementia can be difficult, too: agitation typical of dementia may be difficult to separate from anxiety; impaired memory may be interpreted as a sign of anxiety or dementia, and fears may be excessive or realistic depending on the person's situation. If you are in doubt about your own observations of your friend, look at the possibilty of encouraging your friend yo seek more professional support. For example, "Have you thought of talking to your doctor about your concerns?"

Depression is a serious disorder – far more complex than simply feeling moody or blue. Older people experience similar symptoms to younger people – but these symptoms often go unrecognised, misdiagnosed or poorly treated. For example, symptoms such as loss of sleep, memory, or concentration are mistakenly regarded as being simply age-related.

Diagnosis is harder too, because older people often feel more comfortable talking about physical complaints than acknowledging depression as anything more than sadness. Also, when depression combines with dementia, there is an added complexity in diagnosis.

The word depression is often used to describe the feelings of sadness which all of us experience at some stage of our lives. It also describes a form of mental illness called 'clinical depression'.

Because depression is so common, it is important to understand the difference between unhappiness or sadness in daily life and the symptoms of clinical depression.

When we’re faced with stress – caused by the loss of a loved one, or a relationship breakdown, or great disappointment or frustration, or anything at all – most of us feel unhappy or sad. But these emotions will usually last only a limited time. They are not regarded as clinical depression, but as a part of everyday life.

Clinical depression describes not just one illness but a group of illnesses. In all of them, the person affected has an excessive or long-term depressed mood, which affects their life. Clinical depression is often accompanied by feelings of anxiety. Whatever the symptoms and causes of depression, treatment can be very effective.

People of all ages, cultures and backgrounds can experience depression. The symptoms of depression vary in severity and from person to person. They can range from feeling irritable to feeling suicidal.

If you are caring for a friend suffering from depression, the good news is that safe and effective treatments are available. But the first step to progress is in recognising the symptoms. These are many and some 17 are listed in the Handbook on page ... .

There is hardly ever just one specific cause of depression. Some people seem more likely to become depressed than others. Sometimes depression may happen without an apparent cause. At other times coping with stressful events may contribute to becoming depressed. Examples are also given in the Handbook but might include:

  the death of someone you love;

  an accident or illness;

  changing accommodation, or

  family crises.

Coping with ongoing stress can also result in depression. Examples of prolonged stress include:

  trying to make ends meet on a low income;

  being unemployed;

  being a long-term carer for a dependent person; or,

  feeling lonely.

The treatment received by older people will be the same as for any other age group. Treatment depends on symptoms, but will take one or more forms.

  Psychological interventions help people understand their thoughts, behaviour and interpersonal relationships.

  General supportive counselling assists in sorting out practical problems and conflicts and helps in the understanding of the reasons for depression.

Talking with a health professional in a structured way can help relieve depression. This therapy involves a choice of one or more psychological therapies. The therapist aims to work on the way the person reacts to circumstances and relationships.

There is a variety of circumstances in which an ill person may be diagnosed as needing palliative care. The person may wish to stay in their own home. In this case, there are specific palliative care teams who can visit their home to carry out their specific roles. The team will most likely include the medical person who is looking after for example, the pain level of the ill person. There may be a carer who looks after the day-to-day functions of the ill person – helping with medications, providing hygiene care, assisting with diet and nutrition. You, as a spiritual carer, may be invited to become part of that team.

A person may be admitted to a hospice where there is 24 hour care for the dying person. An elderly person may be in aged care, again, where 24 hour assistance is available. In each case you may be able to provide specialist emotional and spiritual support while the other members of the team carry out their specific functions. Not always will other members of the team have the expertise (or the time) to sit and listen with the dying person and ‘live’ their journey with them.

Peter Hudson provides a list of things that you may be able to do with a person in palliative care that will help provide emotional care. You might like to to look at these in the Handbook on page...

Prayer for your friend in palliative circumstances can be very helpful and lead to their peace of mind. What might you include in it?

  Praise of God, and thanks, because of the hope of salvation.

  Thanks for the many blessings of life.

  Prayer for personal help for the ill person in their specific circumstances.

  Prayer for the help of those who care for the ill person.

  Prayer for the comfort of family members who are concerned.

  Prayer for continued guidance.

  Prayer for God’s kingdom to be established.

Remember to keep your prayers short as the dying friend's attention span could be very limited.

A big section!

We do hope we haven't lost you, but these issues can be very important in older people and your older friends. Again, this pages is larfely for reference. Please remember that there are only two simple questions in the Statements work page at the end of the Module! If you would like to watch some videos that give further perspectives on these issues, please click on the titles below. The presenters are very qualified and experienced practitioners.

Dementia - Cathy Strachan

Anxiety and depression - Kylee Mingham

Palliative care - Cathy Strachan