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  • Q&A with Australian Health Practitioners

    At what stage of Dementia should a person be put into a care?

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    Dementia Geriatrics & Ageing Well
    My elderly Aunt has been like a mother to me, providing my childhood with entertainment and little indulgences I wasn't afforded by my parents. I lived abroad for 13 years but would visit Sydney regularly until I moved back nearly 2 years ago.

    Sadly, the relationship my Aunt was in had turned into a situation of elder abuse. I was only able to remove her from it when she was officially diagnosed with Dementia as I was her enduring guardian. My family are doing our best to care for her and for a time this involved us taking turns taking care of her in her own home. Unfortunately she became rude to my mother & her carers & so it has become untenable. I recently put her into a secure unit (to prevent her escaping! argh) & feel so awful about this as she is desperately unhappy, insisting on going home, saying that she's fine. I really struggle with the power I have over her life & morality of my actions. Given the choice, I suspect she would rather be back in the abusive relationship :(
    • 2 answers
    • Tina Garrett
    • A/Prof Tuly Rosenfeld
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    Tina Garrett

    Occupational Therapist (OT)

    Well Now Health Solutions offers high quality occupational therapy services to the adult population in Gympie and the surrounding regions. Our occupational therapy services aim … View Profile

    This is a common but no less distressing situation that many families face.  If the person with dementia is not safe to live at home, and is unable to be adequately cared for at home, then you have very few options available.  It is not so much that stage as the circumstance that is specific to the individual.

    I am not sure what the arrangements are with the residential aged care facility, ie respite vs long term care, emergency care, but considerations that may help you with your decision are: is your aunt now receiving specialist dementia care and is she safe?  If you answer yes to these questions, you can feel placement in RACF is an appropriate decision.

    There are some RACF that have specialist dementia programs that aim to help the person to keep orientated as long as possible.  Ask at the RACF about there programs and see if there are some available.  Remember you can make it homely by putting familiar items in place in her room.  You and your family can visit or take your aunt on outings to favourite places.  All these things will be helpful to her and will show her you still care.  Talk to her when she is more lucid and discuss how she is now receiving the best and most appropriate care available.  There a number of strategies that can be put in place to help her to adjust to her new environment - ask at the facility or contact the national dementia association.

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    A/Prof Tuly Rosenfeld

    Geriatrician (Aged Care Specialist)

    Assoc. Prof Rosenfeld has over 30 years of experience practicing as a Geriatrician. He has expertise in a range of medical problems including dementia and … View Profile

    The situation is often more complex than can be decsribed in a number of paragraphs and similarly the answers or at least an apporach to a reasonable solution is also complex. A carer/guardian has the task of making a call on the best options available. In order to do so the guardian relies on the best information available about the way that the situation can be best managed. It is often challenging even for health professionals to be able to ensure that the best advice is provided and they rely on objective information and their own experience and knowledge in being able to do so. It is important however that patients, families and carers seek out and are provided with the best advice so that they can make informed decisions that they are comfortable with. In my view this is the real challenge. In these situations the advice of trained and expert health professionals advocating on behalf of the patient and family/carers, should be sought. Specialist nurses, geriatricians and other health professionals in aged care should be inolved where possible working with the patient, family  and GP. It is also important in my view to take a holistic appraoach to the needs of the individual patient. This includes taking into account their long term prognosis and weighing the risks against the benefits of interventions or changing accommodation. A range of strategies may need to be considered. The biggest challenge that I have seen in the Australian health care setting is that of accessing proper advice and support when it is needed.

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