Mental health needs of the elderly: Dementia

Chief Afolabi is a 73-year-old, retired Ambassador and a highly-respected citizen of the community. However, over the past few years, there has been some concerns over his behaviour. In one instance, he went on his usual evening stroll around the neighbourhood and ended up at the extreme end of town.

He had missed his way and could not determine how to get back home. He thus sat on a bench when he became tired. Attempts to put him in a taxi by passers-by were unsuccessful as Chief Afolabi could not remember the name of his street (which is actually named after him).

When nightfall ensued and he had not returned back home, his worried family members organised a search party and notified the police. He was eventually found after three hours and brought back home. The wife observed that he had also been missing his way, even within the house, as he sometimes ends up in the kitchen when he is actually looking for the bathroom.  In some instances, he had come out of the bedroom to attend to visitors in his underwear, as he did not realise that he was not properly clothed.

The wife initially ascribed all these symptoms to normal old age, but became worried when he started sleeping poorly and becoming aggressive when attempts are made to correct him. He now has temper tantrums and can become violent and aggressive with minimal or no provocation at all.

She has been counselled to see a psychiatrist with him, as he may be suffering from dementia, but she is now confused and worried. Does it mean her husband is running mad in his old age? What exactly is dementia?

The phases of life are such that we evolve from babies and toddlers, through childhood into adulthood. This is characterised by physical and cognitive maturity and the individual is at the peak of his/her powers. As the clock winds down gradually and we advance into old age (older than 65 years), these powers begin to wane: physical strength and agility reduces, and problems with memory such as forgetfulness begin to occur. These are normal biological changes during the different phases of life.

Dementia occurs when there is a marked and very severe deterioration in brain functions among the elderly, commonly occurring after the age of 65 years. The symptoms are not always exactly the same in different individuals, but the most consistent complaint is a gradual but progressive worsening of the ability to remember things. This is as a result of the weakening of the nerves responsible for remembering things.

Thus, the person may begin to misplace items around the house and struggle to remember where they kept them. They may also lose their way, such as going out of the house and then getting lost and unable to find their way home anymore – even though it is still the same street where they have lived for more than 20 years. Difficulty finding the right words during conversations, or struggling to remember names, forgetting events or appointments are other examples of common complaints.

The categories of problems usually experienced may therefore be classified into three groups:

Memory problems: As discussed above.

Behavioural problems: This is where the individual also has poor judgement, such as wanting to go out in the middle of the night for a stroll; or comes out of the house without dressing properly. They may become agitated when attempts are made to prevent them from performing these actions. They may also have changes in mood or personality.

Functioning:  As a result of the decline in brain functioning, they may forget their bank signature for example, and therefore have difficulties making bank transactions. They may start cooking and forget about it until a fire breaks out, for example. It is at this stage that independent living for them, may no longer be feasible, as they increasingly need more and more assistance.

Challenges with managing elderly citizens with dementia

Often times when these problems begin to occur, the children are already grown and scattered across different cities or may even be outside the country. And with the breakdown of the extended family system network and increased urbanisation, it becomes very difficult indeed. It is therefore not surprising that homes for the elderly are springing up all over the place. However, there should be adequate supervision and monitoring to prevent elder abuse in these homes, or in their personal homes.

Behavioural problems may be controlled with medication but even more importantly, it is crucial that they benefit from a comprehensive medical review to check for other health issues which may also be contributing – such as hypertension, diabetes e.t.c.