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Practical Dementia For Families and Caregivers
By Doug Wornell
ISBN: 978-1-84991-269-3
Published: 2010
Pages: 127
Key Themes: dementia, Alzheimer’s, pharmacy, psychiatry
Description
Wandering Explorers is a guide for families who are making the lengthy and agonizing journey through the course of a loved one’s dementia. The title itself reminds us of the devastation that occurs in the brain – leading to wandering and confusion. And yet, there remains a curious human drive to explore and find purpose of life. Understanding this duality in dementia patients turns what is otherwise an apathetic family tragedy into a meaningful terminal event. This book is written in easy to understand terms and describes a multitude of aspects of brain disease including the many types of dementia, medical issues, drugs, behavioral management and the severe social consequences of this disease.
This book is unique not only because of its concise nature but that it is essentially a compilation of all the common questions our practice has been asked over the years. It provides answers about what to expect in the various stages of dementia, how the diagnosis is made, and proper treatments relative to the stage of disease. Wandering Explorers does not provide any false hope. It is made clear that this is a fatal neurologic disease where end of life preparation needs to be dealt with head on.
But Wandering Explorers takes a family to another level by providing information about realities of elder care you will not find in any other book. Dispelled, is the myth propagated by “Big Pharma” and the academic community over emphasizing the prevalence of Alzheimer’s disease in the face of the normal aging process. This has side tracked the geriatric medicine community onto CNN waiting for a cure that will never come just as sure as people will keep getting old. Meanwhile companies get rich and professors who don’t actually treat dementia patients get famous. And there’s the popular and inappropriate use of anxiety drugs to calm agitation in confused patients or the appropriate use of antipsychotics in the elderly despite the FDA warning against them. These are some of the eye openers you will find in this book. With this knowledge a family can better understand actual mechanisms of disease, make proper treatment decisions, and even begin their own personal brain health programs.
About the Author
Douglas Wornell, MD is a geriatric psychiatrist with a large practice in the Seattle-Tacoma area of Washington State, USA. He was born in 1955 in Tacoma and has lived throughout the United States. Dr. Wornell got his bachelor’s degree in chemistry at the University of Puget Sound and his medical degree at the University of Miami. He did his internship in general surgery at the Albert Einstein College of Medicine and his residency in psychiatry at St. Luke’s Roosevelt Hospital Center in New York City.
Dr. Wornell lived in New York City for 13 years, eventually becoming the Director of Psychiatric Emergency Services for St. Luke’s Roosevelt Hospital Center and Assistant Clinical Professor of Psychiatry at Columbia University College of Physicians and Surgeons.
He is now back home in Washington State and is the Medical Director of the Behavioral Wellness Center at Auburn Regional Medical Center. He has participated in the treatment of over twenty thousand dementia patients in the past ten years. Additionally he is the Medical Director of Wornell Psychiatry and Associates, a geriatric and neurological psychiatry consultative service covering over 2000 long term care patients. He has given over 200 presentations on geriatric psychiatry.
Dr. Wornell does prefer to be called Doug. He lives on a small farm on Fox Island in the Puget Sound where he, his wife Michelle, and two daughters raise their own organic beef and poultry. He is an eagle scout, an avid skier, plays jazz piano, paints and has written 6 screenplays. Dr. Wornell is a commercial flight instructor and floatplane charter pilot….when he finds the time.
Book Extract
Forward
The wandering explorers
Dementia is a term used to denote deterioration of the brain. The disease process is generally slow and progressive but may vary. While many consider the classic dementia to be Alzheimer’s disease, there are many disorders that fall into the broad classification of dementia. The impact of dementia on both the patient and the family is enormous and devastating. This is true not only because of the loss of brain function but also because of the slow and agonizing nature of the disease process itself.
As we age many aspects of our body begin to deteriorate. It is not a surprise therefore that a deteriorative illness such as dementia would most commonly occur in the elderly. It is interesting however that this common aspect of aging is so rarely seen as normal, particularly considering that one sees an uncanny reversal of the developmental milestones seen in youth – infants change into toddlers and then into adolescents in much the same but opposite way that dementia progresses. It is as though the demented brain is falling apart just as it was glued together. One by one, each life experience becomes erased from short-term memory leaving the patient more and more dependent upon the past. Eventually there are no more memories to erase. And then the person we once knew seems gone.
How perfect then for the pharmaceutical industry and research centers to have an illness that will ultimately occur in all of us – if we live long enough. Is it an accident that the dreaded Alzheimer’s disease and senile dementia are virtually synonymous terms? If you look at the average age of patients in drug studies for Alzheimer’s medications one finds no shortage of very old people represented yet if you compare a 50 year old with this disease and a 90 year old with “Alzheimer’s Disease” it appears to be two completely different circumstances. Of course a 50 year old with dementia is clearly abnormal and deserves all the notoriety and research available but, are we being somewhat misguided into being overly concerned about a disease state when we should be more focused upon healthy aging? The somewhat preventable small blood vessel disease component, commonly known as hardening of the arteries and so prevalent in the aging brain, has been left out of the Alzheimer’s equation. Yet we sit and watch Erectile Dysfunction commercials on television on a daily basis that clearly show the relationship of small vessel disease from hypertension or diabetes to ED. It would seem we have all wandered and explored ourselves into strange territory. Perhaps the idea of an incurable disease of the penis is just too unacceptable.
Regardless, we are left to ask the question, what must it be like to possess only limited cognitive skills and distant memories of childhood? It’s hard to say. Some with dementia seem quite pleasant while others live in misery. This actually doesn’t sound too much different than the general population and reminds us that the psychology of dementia is highly influenced by the pre-dementia psychological nature of the patient. But to be sure, the frequency of psychiatric symptoms such as anxiety, depression and psychosis are much more common in the demented population than the general population.
Again I return to the parallel of dementia to developing children. They too seem to exhibit a higher than usual amount of psychiatric symptoms although we don’t usually think of it that way. We see it as normal that infants are impulsive, talk to themselves, and are tearful at least three to four times a day. Of course it is normal but what about dementia? Is there a baseline behavioral description that could be considered “normal” for dementia? This question is important because of the longevity of the illness. The process is slow and painful. It can tear people up. Wouldn’t it be easier to metabolize some of the emotion involved by accepting the patient at any given point in time for who and where they are, just as we would a child?
I have heard countless family members refer to their demented father or wife as someone who is not the same person they once were. I would argue otherwise. Would you say that your 14 year old was not the same person when they were an infant? Disease or not, dementia is a condition that needs to be contended with as there is a general process of brain deterioration that occurs in all of us as we age. Sooner or later we are less able to react, concentrate and remember as clearly as in years past. We may lose our driving privileges. We are offered help in the home or suggestions to sell the home and move to assisted living. We need reminders. The fact is that one third of all people over the age of 85 have dementia. Ninety percent of all those over age 100 are demented. Are they gone? Are they not the same people? If not, why don’t we be honest with ourselves and eliminate them. It would save billions and limit grief. The reason is simple. We know they are the same people. It is, however difficult to witness the drama of deterioration. We defend ourselves by seeing them as someone else.
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