At home with dementia
By Richard P. Holm, MD
In the U.S., there are almost five million people with mild to moderate dementia, and studies show that about 70 percent are at home, either alone or with a caregiver, often a spouse. If people with mild to moderate dementia can stay home safely, this would save Medicare and Medicaid a great deal of taxpayer money. More importantly, this would provide those people affected with dementia their preferred environment. Indeed, it is important to allow all people the chance to stay at home whenever possible.
A 2013 Johns Hopkins report studied more than 250 people with dementia living at home and found that 99 percent of the demented and 97 percent of their caregivers had at least one unmet need. The foremost unmet need was defined by safety issues such as poor lighting in walkways which increased the risk of falling. Other needs that were not being met in this study included not performing regular exercise, poor follow-up with health care providers, not having prepared legal and estate planning and not receiving help with medications and some activities of daily living. Researchers found that those with lower income, with depression and with borderline rather than severe dysfunction had significantly more unmet needs.
When there were at-home caregivers for these folks with early dementia, the caregivers were often not aware of these deficiencies. In addition, the needs of the caregivers were often ignored or unrecognized. Remarkably, at-home caregiver stress and depression were some of the strongest predictors for an earlier move of the person with dementia to the nursing home.
Methods to enhance a person’s chance of staying at home are not difficult. Preparation for legal issues and estate planning should be done early and BEFORE the loss of memory. Other methods include providing raised toilet seats, grab bars in the bath and bedroom, properly tacked down carpets, good nighttime lighting in walkways and proper day and nighttime footwear. Researchers also advise providing enhanced support for caregivers with education about community support available such as social services, occupational therapy and caregiver support groups. In addition, screening and treatment of any caregivers’ depression, should be provided. This would go a long way in helping people stay at home as they age.
Bottom line: Most of us, and our families, are not prepared for the possibility of dementia as we age. If we prepare, we greatly improve our chances for staying at home.
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