Nam’s old also battling dementia

By Kaula Nhongo
September 2012
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Out of the recorded 35.6 million cases of dementia (loss of memory in old people) worldwide, 8000 cases emanate from Namibia while a staggering 25 000 originate from South Africa; a recent World Health Organisation (WHO) study shows.

Dementia is a scientific term for the progressive deterioration in cognitive function, meaning that, one loses the ability to process thought and it usually occurs in old people but it can also be found in young people.

This depressing and lonesome chronic illness has not spared Namibian elderly people and efforts to find a cure continue from different medical experts worldwide.

The most common cause of this condition is Alzheimer’s disease, though it may also result from the destruction of brain tissues by a series of small strokes.

The second most common cause is Vascular Dementia, which results from hardening of the arteries in the brain. Deposits of fats form on the inside of the arteries, blocking blood flow. These blockages cause multiple strokes or interfere with blood flow to the brain.

According to the chief executive officer of Michelle Group Trust/Dementia Namibia, Berrie Holthausen, this condition is indeed a reality in Namibia.

“It is common for people with dementia to experience some difficulty in undertaking everyday tasks such as cooking, cleaning, and organising or even making a cup of tea. It is frequently reported by both care-givers and people with dementia that what happened five minutes ago is forgotten, yet events from decades ago can be remembered quite easily,” says Holthausen.

He adds that statistics from WHO also show that there are an estimated 35.6 million people with dementia worldwide; a number expected to double after every 20 years, to an estimated 65.7 million in 2030 and 115.4 million in 2050.

This will mean people aged 60 and over will account for 22% of the world’s population of people with dementia.

Studies continue to show that people with irreversible or untreated dementia present a slow, gradual decline in mental functions and movements over several years. Total dependence and death, often from infections, occur at the last stages.

Holthausen states that the symptoms of dementia may be obvious or very restrained overtime; difficulties with everyday tasks, short-term memory losses, recognition and perception, are some of the most common symptoms associated with dementia.

According to him, people with dementia get very confused, especially when they are in unfamiliar surroundings. They may even roam trying to return to familiar surroundings.

Dementia patients find it difficult to learn and communicate, which in the end makes it difficult for them to take care of themselves. Not being able to remember daily occurrences makes them moody and aggressive.

“As time passes by and the disease progresses, disruptive behaviour and other unpredictable behavioural problems may start showing. These include wetting the bed, waking up in the middle of the night screaming and forgetting that they have eaten; that they keep complaining of hunger,” he says.

Among the symptoms, the most severe of them all are paranoia and suspiciousness.

“There have been some weird cases we have come across from people with this condition; instead of seeing a blue carpet in their house, they see a river or they see a hole on the ground where their rug should be. Their bin turns into a barking dog and flowers on the wallpaper turn into a swarm of bugs,” he explains.

People with this condition may often be completely unaware of these behavioural changes that it makes it very difficult for their loved ones to deal with their situation. Society is not really aware of this condition thus most of the time, they view it as a form of mental illness.

“Because of ignorance by the State, churches and communities, dementia patients are still viewed by society as people who have been bewitched or zombies and that they are of no benefit to the society anymore,” he says.

They are chained to trees, locked up in small rooms and sometimes tied up in chairs and beds because of their behavioural psychological symptoms of dementia (BPSDs) - mostly caused by the attitude and misunderstanding of their illness by families, their beloved and society, Holthausen states.

Those caring for dementia patients are encouraged to be friendly and helpful, to demonstrate kindness and respect through their non-verbal communication and to use language and phrases that are familiar to the patients.

“It’s very important to rethink how we communicate with dementia patients, to ensure we do not create any additional problems. Even when our own communication is clear and helpful, a person with dementia might still struggle to understand us (receptive communication difficulties),” he says.

Listening to the patient attentively is also very important despite the fact that it is hard to understand the precise meaning of many of the words and sounds that are used.

A case study by Dementia Namibia of a dementia patient states him saying that “Our behaviour is normal, considering what happens inside our heads. Try to enter into our distorted reality, because if you make us fit in with your reality, it causes us extra stress.”

To date, Dementia Namibia is the only organisation in Namibia that provides training for care-workers, old-age homes, hospitals and families of dementia patients.. PF

Closed in a bubble hoping to come out

For the past five years, a senior citizen at Oude-Rust-Oord old-age home in Windhoek West, Ans Lottering, has been living with this incurable condition; dementia.

Eighty-year-old Lottering cannot look after herself. Her family found it very challenging to look after her, so they took her to the home five years ago. The condition has worsened and all doctors and nurses can do is give her medication to calm her down and help her sleep better.

Seeing her at the home sitting on a chair looking down on the ground as if her whole life was reflecting right in front of her, makes one notice that her body and mind are in two different places. She looks at me closely, trying to place me; to figure out from where she could have met me but the emptiness in her eyes shows otherwise.

Her caregiver explains that she does not even remember her own name, let alone her family; to her, everyone is someone she knows from her past. She stares up at me with watery eyes, extends her greetings and smiles.

A registered nurse who works at the home, Sister Hilde Nguvauve, says that most families do not know how to deal with dementia patients, so they end up bringing them to the home where they can get professional care.

“Family members don’t have anyone to look after them while they are away at work, so they find it better to bring them to a place with professional care-givers,” she explains.

Lottering’s story is that of many senior citizens in Namibia who live with this condition. Efforts to get a comment from her to find out how she feels were fruitless as she was confused as to what was happening and why we wanted to speak to her.

“Dementia patients are usually unaware of their mood swings; they will be nice to you at one point then be very aggressive the next. It is very important for care-givers to know how to treat them and avoid retaliating,” she says.

Her son, Jerry Lottering, remembers his mother back in the day and how active she used to be.

“There are days when she goes back to the way she once was and usually, seeing her like that is a joy. She likes listening to soft music, so we always play that for her whenever we visit. As she closes her eyes to enjoy the music, you can see she is where she would like to be in her consciousness but unfortunately, she cannot express that in words,” he says.

Nguvauve explains that since dementia is incurable, “patients are given Risperdol tablets whenever they become restless to calm them down and Zolpidem at night to help them sleep better.”

Lottering’s caregiver, Johanna Kahuika, says some of her behaviour is often on a daily basis.

“She can start calling out people’s names and look for things she has never had. Other times, she starts calling a dog she might have owned at some point in her life,” Kahuika says.

With her whole life’s memories ripped from her head and spending the last golden days of her life with total strangers, Lottering’s life is now nothing but a sad and empty tale.

Nguvauve encourages those looking after dementia patients to be patient with them, “They need someone to listen to them no matter how confusing their stories may be.” PF