What is your advice for elder care, particularly taking care of dementia patients?

post by RasmusHB (JohannWolfgang) · 2022-04-12T11:33:49.209Z · LW · GW · No comments

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I think I already have a good sense of what lifestyle changes can slow down aging and the progression of dementia and to what extent, but I don't know how to implement these changes. There is lots of advice here on how to change your life, which I appreciate, but not that much on how to change another person's life (please do correct me if I'm wrong), particularly if they are older and set in their ways or even suffering from dementia and find it difficult to learn new things while not quite comprehending the urgency of change. In this case, I couldn't even convince the primary caregiver (which is not, or at least should not be me) of the importance of diet and exercise.

How did/would you deal with these problems or any other problems in elder care in general? (Since my model of average rationalist told me that someone would bring up cryonics, I asked and they don't want that.)

As a side note, I feel like this topic does not receive enough attention on LessWrong, for instance it does not have a tag, unlike e.g. parenting [? · GW].

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answer by cranberry_bear · 2022-04-12T13:25:40.991Z · LW(p) · GW(p)

Dementia patients become increasingly dependent on their caregivers, and as a caregiver, it isn't a great strategy to rely on giving the dementia patient advice and trying to convince them of something. Instead, you can model your role as trying to maximize the happiness of the patient's remaining lifespan, primarily through interventions that don't rely on the patient being agent-y. Some things that I have done for relatives with dementia that seem net positive:

  • Making sure there is always accessible water in the rooms they hang out in so they are less likely to forget to drink
  • Provide brightly colored everyday items, such as cups and plates
  • Play music that evokes pleasant emotions in them
  • Allow them to talk freely about the past / their long term memories
  • Hold their hand, brush their hair, massage - loving touch is a great way to communicate with dementia patients
  • (Not for everyone) Provide means for the person to express themselves creatively, especially if they enjoyed that in the past (eg: art materials, musical instruments)
  • Eat with them, encourage them gently to eat and drink regularly
  • Don't get angry if they are confused/wrong about things, validate their emotions and give generic words of reassurance
  • Enable the person to head outside as much as possible and get natural light and fresh air - take them to the park or garden

Ultimately, communicating with and helping a dementia patient is extremely far removed from dealing with a rationalist. Instead, communication is primarily based on emotion and senses. In my experience, looking after dementia patients well, by providing the company, emotional support, and physical things that they need, slows down the progression of the disease as much as possible. Without this, dementia can progress extremely quickly, however in the presence of effective help, I believe dementia patients can experience net-positive lives for many years, as well as enrich the lives of their friends and relatives. 

↑ comment by PeterMcCluskey · 2022-04-12T15:36:08.847Z · LW(p) · GW(p)

I agree with most of this advice. I probably couldn't do any better than that. But it seems unlikely to be the best that's possible. Dementia can probably be stopped in early stages if there's a way to persuade the patient to make larger lifestyle changes. It's frustrating that such persuasion is unusually hard.

Replies from: cranberry_bear
↑ comment by cranberry_bear · 2022-04-12T21:19:52.977Z · LW(p) · GW(p)

Ah yes it's a separate question when we have someone who does not yet suffer from dementia but is at risk and who can plausibly take some actions to reduce the risk / delay the onset of dementia. I am definitely no expert on this but I would assume promoting better physical and psychological health reduces dementia risk alongside other bad side-effects of aging. The psychological part is key. I think if you know someone at risk of dementia, making sure they have a supportive family and/or friends and they don't feel lonely goes a long way to promoting better psychological health and reducing dementia risk, even if, for example, their diet and exercise regime is not optimal. 

↑ comment by Dirichlet-to-Neumann · 2022-04-12T17:07:19.653Z · LW(p) · GW(p)

This is a great answer, thank you !

↑ comment by RasmusHB (JohannWolfgang) · 2022-04-12T17:00:37.565Z · LW(p) · GW(p)

Thank you so much for your thoughtful comment! Specific pieces of advice like these are exactly what I am looking for. One question: what is the rationale behind the brightly colored items?

Replies from: cranberry_bear
↑ comment by cranberry_bear · 2022-04-12T21:13:32.916Z · LW(p) · GW(p)

I have heard this recommended by others but never looked into the research. Anecdotally I have found that very elderly patients/people with dementia react positively to colorful things. However, a casual googling of this revealed that "colorful stuff for dementia patients" is more of a "folk wisdom" being passed around as opposed to something with a rigorous backing (there are articles about the phenomenon like this: https://www.enablingenvironments.com.au/colour-perception-and-contrast.html). My theory of why it might be good is a) more sensory stimulation which keeps the brain active, especially in more severe cases b) helps them distinguish and remember the locations of different items more easily c) association with positive emotions (bright -> happy) d) as eyesight declines, brighter colors are required to elicit the same amount of attention / visual stimulation 

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