Driving
Driving is a complex task that requires much concentration, split-second decision-making and good judgment. It also represents one's autonomy and independence. A diagnosis of dementia, however, does not necessarily imply the person is incapable of driving. Your doctor can arrange for a driving assessment with a healthcare professional who specialises in testing drivers with cognitive impairment.
Eventually, a person with dementia will need to stop driving if it is no longer safe.
What are some signs that suggest a person with dementia may not be able to drive safely anymore?
• Getting lost while driving in a familiar location
• Violating traffic rules
• Driving at an inappropriate speed
• Taking too long to reach a destination
• Slow responses and reaction
• Repeated accidents or near accidents
Other important considerations
With time, people with dementia will lose their ability to make good decisions due to deficits in judgment and problem solving. In the later stages of the disease, the person is likely to lose the ability to make sound financial and healthcare decisions. Therefore, it is important for them to discuss such issues with their family or trusted associates
Lasting Power of Attorney
The Lasting Power of Attorney (LPA) is a legal document that a person who is at least 21 years of age can make to voluntarily appoint one or more persons to make decisions and act on his behalf should he lose the capacity to make his own decisions.
The LPA allows one to indicate a personal choice of trusted person(s) who can automatically step forward to act on one's behalf if one should lose mental capacity.
It is necessary to see a certified issuer to sign as witness and to certify that the person is aware of the implications of making an LPA. A certificate issuer can be a psychiatrist, a practicing lawyer or an accredited medical practitioner.
Advance Care Planning
Advance Care Planning (ACP) entails careful discussion on a person's future care preferences in the light of disease progression with careful consideration of the person's goals and values.
It includes identification of a substitute decision-maker in the event the person is no longer able to make his / her own decisions. ACP also helps in planning of care discussions which includes the Preferred Plan of Care (PPC) at the end of life.
ACP helps family members by easing the stress of making difficult decisions. The wishes of the person with dementia can be made known to them earlier so that family members can act in accordance to the expressed wishes. Ideally, discussions about end-of-life care should take place while the person with the dementia still has mental capacity to make informed choices and decisions.
LATE-STAGE DEMENTIA
Care for late-stage dementia
Making end-of-life decisions can be tough. Such decisions should respect the person's values and wishes while maintaining his comfort and dignity. Caring for persons with advanced dementia at home can be demanding. Planning ahead and knowing what to expect can make it easier.
When is a person at end-stage of dementia?
• Not being able to move on their own
• Not being able to speak or make oneself understood
• Needing help with all activities of daily living
• Progressive issues in eating / swallowing problems
• Loss of appetite
• Significant weight loss
• Sleeping excessively
• Recurrent infections often with hospitalisations
Palliative care
Palliative care is the overriding principle of care in advanced dementia. As dementia is a terminal disease, death can be expected at some time during the advanced stages. During this time, the role of a caregiver focuses on upholding dignity and quality of life for the person with dementia.
The World Health Organization (WHO), 2002 has defined palliative care as: "An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual."
The goal of palliative care is to provide the best possible quality life for the last phase of a person's life. As such, palliative care focuses on relieving symptoms such as pain, agitation, anxiety and poor oral intake, and family caregivers can play an active role in the care.
Communication
Communication is difficult for a person with advanced dementia due to their reduced ability to interact with their surroundings. Verbal expression becomes increasingly difficult and sentences tend to be shorter. Incomprehensible words may be added to the conversation.
In order to make communication easier, it is important for caregivers to understand that the person with dementia may have trouble understanding what is being said. Hence, non-verbal ways of relating through touch and one's loving presence becomes important.
Tips for effective communication:
• Always make eye contact with the person
• Call them by their preferred names.
• Use of gestures or touch whenever appropriate
• Use of pictures may be helpful
• Patient listening with interest and a cheerful disposition
Dysphagia
It is the term used to describe someone with swallowing problems. It is not uncommon for persons to have dysphagia in the later stages of dementia due to their impaired swallowing reflexes. A possible consequence of dysphagia is aspiration. Aspiration occurs when food or fluids go from the mouth into the person's windpipe (trachea) rather than the food tube (oesophagus). This can lead to choking or chest infection especially if recurrent and persistent. Some important advice includes:
• Do not feed a person who is sleepy or lying down.
• The person should be in an upright, sitting position during feeding
• Sit upright for at least 20 minutes after a meal.
• Observe closely for signs
Next Chapter: LATE-STAGE DEMENTIA
