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Jane Cayley from Canada: Hello from Kelowna BC Can you pls tell us - what are the key indicators that an elderly person is suffering from dementia?
Dr. David Conn: Hi Jane, The Key indicators include:
a) Some kind of memory impairment (usually short-term memory loss initially).
b) Language impairment e.g. difficulty finding words or understanding certain words.
c) Trouble recognizing certain things such as people's faces.
d) Difficultly carrying out certain basic actions such as trouble dressing oneself (called apraxia).
e) difficulty with certain high level ("executive") functions such as planning or organizing activities.
In addition these changes must represent a distinct change over time and result in problems with functioning socially or occupationally.
Other changes can include personality or behaviour changes which can result in socially inappropriate actions. These changes are common in a disorder called Frontotemporal Dementia.
Brenda Dunn from Canada: When our Aunt had a breakdown 13 years ago at 77 her Dr put her in a nursing home with no anti-depressants. They told the family just to leave her there, she'll get used to it.
It took me months to get her proper treatment. She has been at home with her daughter now for 12 years. She has had a few relapses, again they want to put her in a nursing home. She lives with her developmentally delayed daughter and as long as they can manage she will stay home.
We have to fight to keep her on her anti-depressants, they figure at her age she doesn't need them. How many more people are in nursing homes because people think Drs know best?
Dr. David Dunn: First of all I agree that the decision to enter a nursing home should be carefully considered. For many people staying in their own home for as long as possible with maximum family and community supports is ideal.
On the other hand for some individuals nursing homes offer a good alternative.
When the person is very isolated and has few supports and multiple problems (mental health and physical) the care and support offered in LTC can be very beneficial.
I agree that the role of the physician or health care professional should be to assist in the decision-making process not to impose their views. The issue of risk must also be considered and carefully weighed.
You also note that you had to battle to keep your aunt on antidepressants. For individuals with chronic severe depression staying on antidepressants (often for life) is vitally important and can allow them to live full and productive lives.
Alan McRoberts from Canada:My mother recently had surgery and since returning home has been often confused, angry and depressed. She seems to be doing OK physically but mentally she is acting very strangely.
Dr. David Conn: Hi Alan, As I mentioned previously delirium is very common after surgery. It has multiple possible causes including infections, drugs, anesthetic, changes of blood levels of glucose or electrolytes (like sodium and potassium) or a variety of other illnesses which may be co-existing.
It is important to have your mother assessed to ensure that she doesn't have an underlying illness or complication that needs treatment.
Depression can occur during delirium as well as other mood swings. One common symptom of delirium is day night reversal (insomnia plus day time drowsiness).
It is also important to rule out depression as the primary problem BUT I would start with asking the physician to rule out causes of delirium.
Christine Diemert, globeandmail.com: Thanks for joining us today Dr. Conn, and thanks to Kim Wilson, executive director of the Canadian Coalition for Seniors' Mental Health, for adding her voice. Before we conclude, is there anything either of you would like to add?
Dr. David Conn: Hi Christine, I would like to thank you and The Globe and Mail for your outstanding advocacy work in creating and developing this series on Mental Health challenges in Canada.
Seniors are particularly vulnerable to developing mental illnesses including mood and anxiety disorders, psychotic illnesses and the complications of many brain disorders such as Alzheimer's Disease and other dementias.
Our health and social services in Canada vary in terms of availability with huge discrepancies across the country.
Many organizations, including the Canadian Coalition for Seniors' Mental Health and the key organizations on our Steering Committee, are trying to advocate for improved services and best clinical practices.
Hopefully we will be able to care for our aging population with excellent care and compassion in the years ahead.