The Gap For Older People With Behavioural Problems

Arcare lauriston

This week I was asked to assist two sisters to find accommodation for their 67 year old mother, Doreen.  It was one of the most heart wrenching experiences I have had as an Aged Care Placement Consultant for some time. Doreen had recently been diagnosed with dementia, although the sisters were aware she had been in gradual cognitive decline for some time.

One of the daughters, Rosie, and her 3 year old had moved from Queensland 5 months ago to live with her mother and be her carer.  When I went for the initial visit I found that Rosie and her child had been sleeping in the car in the driveway for the past 2 weeks because Doreen had been screaming at them, banging doors and talking to imaginary people every night.

Doreen was not eating or sleeping and was wandering. Rosie was getting calls from local shopkeepers worried about her mother, but she was unable to stop the behaviour and could no longer cope. So the daughters spoke with Doreen’s neurologists and it was decided to initially admit Doreen to a private hospital for a medication review.

I took Rosie and her sister Kate to visit 4 aged care homes that had dementia care.  They chose a home which they felt was the best fit; flexible and in a great location for friends and family to visit.  The plan was to admit Doreen there once her medication had been sorted at the hospital.

Just as they breathed a sigh of relief they got a call from the hospital saying they could not accommodate Doreen’s behavioural needs and suggested that she be admitted to a psycho geriatric hospital.  Despite frantic calls the sisters found there were no beds available for their mother in a pyscho geriatric hospital and Doreen’s condition was worsening.

There has always been a large gap in our system for older people living with dementia and exhibiting difficult behaviours or psychosis. Aged care homes are fearful of danger to current clients and there are very few psycho geriatric hospitals, leaving very few options for an ever increasing number of people suffering this way.

Having heard the desperation in Rosie’s voice when I called to check in on Doreen I decided there might be one more avenue I could try. Drawing on my many years of experience as an Aged Care Placement Consultant and my knowledge of the aged care system, I contacted the aged care facility they had selected and explained to the manager that the hospital medication review was not going to happen and the daughters’ current circumstances.  I asked her to consider admitting Doreen to the facility in the dementia support section and, if she became unmanageable, transfer her to an appropriate hospital.  This type of transfer is easier to arrange by a manager of an aged care facility than for family.

The great news is that management did not dismiss this out of hand and agreed to Doreen moving into the facility immediately.

Exciting New Research On Dementia

Dr. Sarang Kim

Would you have thought that the number one concern facing people with dementia and their carers was social stigma? Researcher Dr. Sarang Kim from ANU conducted a national survey on people’s attitudes to dementia which showed that the general public have negative views and wish to avoid people living with dementia. Dr. Kim was the recipient of the 2016 Alzheimer’s Australia Hazel Hawke Research Grant in Dementia Care and has concentrated her research on the social effects on a person with dementia.

Following the survey Dr.Kim is developing a Dementia Stigma Reduction Program (DESeRvE), which is based on the idea that contact with people living with the condition and education is the best way to reduce stigma. She will use frequently asked questions about people living with dementia sourced from focus groups to have short video clips produced. They will feature people with dementia and their carers answering the questions. Dr. Kim is hopeful that this ‘virtual contact’ and education will help to reduce the level of stigma.

Many of my clients are people living with dementia who reach a stage where they need the level of care provided in an aged care facility. I have noticed that my services as an Aged Care Placement Consultant are being called upon more often by young people with dementia. Most of these clients are in their fifties or sixties and have been living with the condition for about ten years, so the onset was quite young.

Hope for a reduction in the effects of dementia is being offered by the research undertaken by Dr Rebecca Nisbet from the Queensland Brain Institute, who has discovered a feasible treatment. “One of the main causes of Alzheimer’s disease and frontotemporal dementia, two of the most common forms of dementia, is the aggregation of the protein tau within neurons. In our study we generated an antibody specific for tau (RN2N), and investigated its efficacy in clearing tau in a mouse model of frontotemporal dementia,” Dr Nisbet said.

Dr. Nisbet went on to explain that the presence of a blood–brain barrier has historically made delivery of treatment drugs to the brain difficult, but she had found that by using ultrasound, which transiently opens the barrier, that RN2N could be delivered resulting in improvements to memory. Alzheimer’s Australia also provided funding for this important research project, which still has several years to go before it could be offered as a treatment to humans.