Photo Credit: Fizkes

According to the World Health Organization (WHO), 55 million people worldwide suffer from dementia. We can only expect these numbers to increase as the population ages. Dementia is a frightening disease for patients and medical teams alike. There are no cures for this disease, and many of the medications used in its treatment prove ineffective.

As doctors, we all have witnessed caregiver burnout. Often, it was a family member who bore the brunt of the responsibility, one for whom there were no vacation days or sick time available. Whatever specialty we practice, we know patients with dementia can present a significant problem. Many cannot give accurate histories or know which medications they are taking. Getting a patient to sign a consent form can be tricky if their cognition is not fully functioning.

How Can We Assist Caregivers of Patients With Dementia?

• Diagnose them early. There are now many screening tools available that we can perform when patients come in for their annual wellness exams. We can train our staff to do these tests, so they do not become time-draining on the professionals.
• Listen to the patients. We all forget things from time to time. If a patient brings up the fact that they have memory problems, explore it deeper because they are worried enough to have symptoms.
• Arrange visiting nursing service. Many patients with dementia need help with their basic ADLs, such as bathing or remembering to take their meds. Often, having someone help with these tasks takes some of the burdens from the caretaker. Also, visiting nurses know many of the local community services available for patients with dementia.
• Arrange hospice. End-stage dementia is a qualifying condition for hospice. We need to be sensitive in how we present this to patients and their families because many think hospice is only for those near death. It is only necessary that the patient is unlikely to live for more than 2 years, and they can outlive that expectation and be removed from hospice if warranted.
• Discuss options such as adult daycare and respite care. These services can do a great job with patients while giving the caretaker a much-needed break.
• Prescribe meds for behavioral issues. We all learned about sundowning in medical school but living that experience is much more difficult. Caregivers are often at a loss on how to manage these behaviors, or aggression. Several medications can help, and we should prescribe them when indicated or refer the patient to someone who can.
• Be empathetic. Caregivers are often at the end of their rope. They are watching a loved one who may not even recognize them at times. Caregivers may get little support from other family members and carry the full workload. They may lash out at us because of their stress.

Another important consideration in treating patients with dementia is determining the cause. Not all patients with dementia have Alzheimer’s. These patients tend to have other chronic medical problems as well, such as diabetes or hypertension. We need to look for clues that they may not be taking their medications and have symptoms that they are not vocalizing. Caretakers sometimes say that they “seem off.” This is a red flag that there may be an underlying problem, and we shouldn’t ignore it.

As the population ages, we can expect to see more patients with dementia. We need to use all the tools in our arsenals as we wait for better therapies to be discovered.