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Vital Signs

Spring 2006

Family Caregivers Need Support with Dementia Patients

One of the sad realities for people with dementia- a progressive and disabling decline in memory and other cognitive functions sufficient to affect daily life-is the gradual loss of independence. This increasing reliance on others for daily living can place great stress on the family member or members who assume caregiving responsibilities; it is often complicated by the lack of judgment that characterizes individuals with dementia, who may not always see the need for, or want, assistance. "If family members have concerns about their loved one's cognitive impairment, it's very important that they raise these concerns with the patient's doctor to see if that person might benefit from additional evaluation," says Jeffrey Mariano, M.D., UCLA geriatrician.

Problems with short-term memory, typically the first sign of dementia, begin to expand to include other cognitive symptoms that require that the patient receive help. Family members may initially meet with resistance from their loved one when they attempt to intervene. "One of the hallmarks of dementia is that individuals who have it lack the insight to realize they are unable to care for themselves," says Dr. Mariano.

When there is only mild dementia, assistance may be needed only to help the family member take medications, and with chores such as cooking, shopping and cleaning. But as the dementia progresses, basic activities such as bathing, using the toilet, and even feeding become part of the routine. Along the way, behaviors such as aggression and wandering, as well as functional losses including incontinence, place increasing demands on family members, who are placed in the position of preventing their loved one from harming themselves or others. "The caregiver burden is something that a lot of people tend to underestimate," says Dr. Mariano.

He urges family caregivers to take advantage of the resources offered by their community, from adult day care and respite care services to support groups. Sometimes medications can be prescribed that can decrease dementiarelated behavioral problems. "This is a problem that a lot of people are experiencing," he says, "No one should have to go through it alone."

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