Activities in Aktios
MD Nursing Partnership
Caring for Dementia
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A common dilemma:
«Should I make every effort to keep my elderly demented parent at home for as long as possible, or should I search for the best possible nursing home?»
It is understandable that due to the strong family bonds in our country and a sense of obligation towards our parents, the decision to assign their care in specialized care units is not an easy one. Yet for some of the patients and some of the families care at home within the nuclear family is not the optimal option and a solution is urgently needed.
In the dilemma of “paid caregiver at home or specialized elderly care unit” there is not a clear answer. Each incident is judged differently and important parameters that have to be considered are the existence of a supporting network of relatives and friends, the socio-economical status, the pace of daily living as well as the state of health of the elderly. The care of a demented patient is complicated, on a 24 hour basis and needs to be provided by specialized staff. The behavioral disturbances and the changes in the patient’s personality become dominant and without the proper treatment (pharmacological as well as psychosocial) the deterioration of the patient’s and the family caregiver’s psychological and physical condition is more than certain.
By examining the two “care scenarios” of a demented patient we have to note the following:
Regarding the care inside the family environment it is important to keep in mind that elderly live longer increasing the number of years they need total care. Women in the family who were the tradition informal care-givers are more likely to gain formal employment outside home in better and better jobs. Paid formal caregivers are more expensive and not always trained or reliable to do the job.
Regardless of who provides the care at home and despite the best intentions, care at home might not always be adequate. For most of the time the caregiver is physically exhausted since many demented patients do not sleep more than 2-3 hours consecutively. This makes the caregiver at time irritable, impatient and finally burned-out. Attempts to treat insomnia with sleep medication, is rarely effective and, can enhance patient’s already existing confusion (chronic delirium superimposed on dementia). In addition to the principal full-time caregiver a substitute part-time care giver is necessary to allow vacation, sick leave or emergencies for the principal caregiver.
Often the patient and the caregivers spend long hours in social isolations or, staring mindlessly, at the TV thus increasing the sense of caregiver’s irritation and patient’s apathy. Since patients do not always understand what is being done to them simple but essential activities like dressing, grooming, bathing, may end up in a struggle between a confuse patient and a willing but helpless caregiver.
As the disease progresses patients have difficulties to move and to swallow food. Good nutrition becomes a challenge and the risk for fatal food aspiration more and more real. Attempts to maintain mobility by encouraging the patient to move became more difficult and with unskilled supervision run the risk of falls and complicated fractures. Since demented patients can hardly complain concomitant illnesses such as pneumonia, acute abdominal events, can easily be missed by untrained caregivers. Furthermore, considering the large number of pills many elderly take, it is not difficult for the non-medically trained caregivers to make mistakes. Moreover, as the disease progresses patients can not recognized even the closest family members or a long-standing formal caregiver hence the family’s intention to provide one to one personalized becomes less feasible
Finally, the “free” care at home has many hidden financial costs. Payments to the formal caregiver or the lost income of the informal caregiver, cost the residency occupied by the patient and the caregiver in paid rent or lost rent, house maintenance, food, doctors and medications are only some of these hidden costs. Although, reasonable care can be provided at home in requires a costly logistic operation and the active involvement of a knowledgeable family member.
On the other hand the awareness about dementia and Alzheimer’s Disease that has characterized the last 25 years has led to the establishment of nursing home specialized in the treatment of demented patients. These high-end nursing homes for the demented elderly are more and more apt to provide good, efficient care for the demented elderly and have good incentive to do so. First they act in a competitive market and their reputation for good care is their principal asset. Second they are under the watching eye of government regulators and the patient’s families.
Many of the difficulties encountered in providing care at home have been tackled in specialized nursing homes. Since professional caregivers work in shifts physical exhaustions is lees likely. Caregivers are trained to perform grooming, bathing and feeding services in a way that it is perceived by patients and friendly and helpful. Doctors and qualified nurses who are present daily are able to recognize medical emergencies and other medical needs. Personalized physiotherapy programs, which maintain mobility and muscular strength is provided by qualified physiotherapists. Personalized occupational activities provided as in one to one sessions or in groups keep patients active.
In summary, good, personalized care can be provided both at home and in specialized, high quality nursing homes.
For most patients and families the nursing home option is the more sensible but is exceptional cases or when a specialized nursing home is not available care at home is a viable option.
Aktios’ Psychosocial Sector organizes coffee trips, walks and visits for small groups of residents aiming to bring them in touch with the community, to provide entertainment and to further develop or improve their interpersonal relationships.
Our coffee trips at the Agia Paraskeyi’s Square are truly rejuvenating for the
residents that take part in this activity and help them maintain their social skills, providing the perfect opportunity to exchange different opinions and discuss all the external stimuli experienced.
One of our organized trips was also the visit in the museum of Acropolis.
This event took place in the 16th of November 2010 and the residents that participated were highly enthusiasted both for the museum’s exhibits as well as for the bus ride across major highlights of Athens, a process that moved memories from the past.
Aktios has highly trained staff and carefully designed rules and control regulations to guarantee the quality of care and the quality of life of our residents.
Dance therapy is an innovative and alternative therapeutic method that ranks among the therapeutic approaches through art along with Dramatherapy, music therapy and art therapy.
It uses the expressive movement and dance as a mean to bring changes not just to the area of motor functioning but also in an emotional and mental level.
During this process the participants have the opportunity to socialize, to experiment through movement and get in touch with feelings that may be difficult to translate into words and finally to let the pressure go and feel more relaxed.
In Aktios there is a weekly dance therapy session that takes place in a special formed space for the last 3 years, under the guidance and supervision of the Dance Therapist Marilena Kareta, in a program that actively proves our deep conviction in the need of a holistic approach and complete health care services.
During the first two years the dance therapy program was taking place in cooperation with the Greek Association of Dance Therapists and the Niarchos Foundation whereas for the year 2010-2011 the dance therapy program continues in the context of the provided services of Aktios.
Dramatherapy offers the chance to the elderly to express thoughts and feelings under a framework of safety provided by its basic tools, the symbol and the metaphor.
Even if the elderly is confined to a wheelchair, still he remains very active mentally and psychologically and he needs to be cared and educated and to feel pleasure.
Imaginary trips using stories, fairytales and guided fantasies can make the elderly feel again the joy and the emotion of standing on his legs, walking, running, swimming, and flying.
In Aktios the program of Dramatherapy was first realized in cooperation with the University of Roehampton and the educator Vivian Gkoutzi and the second time...
The natural degeneration of the body caused by ageing affects significantly the mobility of the person to the most necessary movements.
The person’s immobilization causes many problems to the elderly such as stiffness, instability and vascular problems.
This is the main reason that the need for mobilization is imperative and necessary.
The aim of the exercise is to maintain the natural range of joints and muscles and to retain the vascular system healthy by avoiding the danger of thrombophlebitis.
In Aktios besides the individual physiotherapy sessions, there are group sessions that take place twice a week.
Through exercise the bond and connection between the residents is reinforced and the tendency to withdraw from the community that is very common in the third age is avoided.
Venetia Roubini, Physiotherapist MA.
In Aktios the proper nutrition of our residents is one of our basic priorities.
Every month the kitchen’s staff along with the head of the nurses organizes the monthly nutrition program which is strictly checked by the doctor and the Unit Director.
Apart from the nutritional value of the food served, it is important to taste good, to have enough variety and to adjust to every season that we spend.
Our menu includes among others calf pastitsada, sofrito, ntakos, club sandwich, frumenty, soufflés with ham and 4 kinds of cheese, artichokes ala polita, pizza, bird livers, pork with celery, cod with garlic, fish sauce in the oven, giouvarlakia with French fries, chicken with okra and many others.
Certainly, those who have visited Aktios in one of our many events had the opportunity to taste for themselves the delicacies that we and our residents enjoy!!
The modern design of places specialized in health services the manufactures take seriously under consideration issues such as the colors of internal spaces.
The common belief, that that has also been proved scientifically, pretends that during the period of ageing our perceptiveness decreases significantly and this is particularly true for people with cognitive impairment.
The brightness, the different shades of color and even the contrast in color are concepts very relevant to the elderly that nevertheless can help to resolve many of the usual problems encountered in places where people with dementia use to live.
Research indicates that Elderly Care Units that accommodate people suffering from dementia should use colors in a way that highlights the natural and technical lighting of space in order to make it feel more easily understandable from these individuals. Moreover scientists stress that a space becomes more easily recognizable by its coloring than by its general utility (bathroom, bedroom etc).
Finally, people working in Elderly Care Units can use the color of a particular space as an instrument to orientate demented people into space (lets go from the blue corridor). However we have to mention that as the nature of the disorder progresses, patients gradually lose their ability to recognize colors.
In our own personal spaces a room filled with color, a corridor or even a wall can move us feelings of calmness, joy or even psychological tension. Many researchers claim that this is also possible to occur with people suffering from dementia and other related disorders.
Generally, scientists believe that colors that are based in gray and also all the soft colors tend not to be perceived by the elderly. More so, they suggest that bright red, orange and yellow are colors visible from the elderly that encourage participation in activities.
Finally, the warm shades of red and yellow are colors that can help stimulate people with dementia.
Giannis Petris BSc
On the 1st of November 2010 Aktios Elderly Care unit will have completed 3 years of operation.
During these three years we encountered numerous challenges that were at the same time opportunities for us to change, improve and provide more sufficient and complete services.
Thus, the quality of the provided care has improved both from on a medical and nursing care level as well as on the level of psychosocial support.
We refurbished our facilities and equipment and we are continuously training and educating our staff, providing new services that are innovative for the usual Greek standards and match the highest European ones.
This continuous course of progress was recognised and confirmed on April of 2010 when Aktios became member of the European Association MD Nursing, a chain specialised in establishing and organising health centres for elderly people suffering from dementia.
Members in the newly formed Aktios Advisory Board are, among others, Professor Michael Davidson, Professor and Chairman, Dept. of Psychiatry, Tel Aviv University, Professor Shlomo Noy, Professor of Psychiatry and Epidemiology, Tel Aviv University, the Neurologist-Psychiatrist Dr Paraskevi Sakka, the Psychologist- Gerontologist Marina Polikarpou and the Psychologist- Gerontologist Dr. Costis Prouskas.
Although in general dementia as a disease of the Central Nervous System is best know by the cognitive deficit it produces as a result of the degeneration of brain tissue, it comes as no surprise that the person’s overall behaviour is also affected in multiple levels and gradually worsens, becoming not only dysfunctional for the demented patient but also very difficult for his environment to handle and manage to cope with it.
The behavioural symptoms of dementia, measurable through observation, may be summarised in the following:
• Delusions and hallucinations
• Depression- elation/mania
• Anxiety and irritability
• Impulsivity, apathy and resistance to care
• Aggressive behavior, either on a physical level with violent actions or on an oral level, screaming and using inappropriate words
• In the verbal communication with negativism, constant request for attention and repetitive sentences
• Aberrant motor behavior, such as pacing (walking back and forth), wandering around the facility in a repeated pattern, attempting to flee the facility and searching pretentiously for objects in unusual places
• Inappropriate sexual behaviour such as unwanted verbal/physical sexual advances, disrobing, exhibitionism and masturbation in public.
The symptoms described above become more severe as the course of the disease progresses, but tend to ameliorate in the very terminal period, when the oral communication is limited almost completely and there is exhaustion and cessation of the muscle movement.
Prof. Michael Davidson
► A common dilemma
►Coffe trips and excursions
► Visiting Hours
► Dance therapy
► The importance of exercise
► Color in the Elderly Care Units
► Building the Scientific Committee of Aktios
► Behavioral Disturbances in Dementia
► Pleasant activities for people with dementia