Dementia affects 20% of people by the time they are 80 and more than 40% by the age of 90. We talked to Dr. Ron Keren, Medical Director, Geriatric Rehab at Toronto Rehab, on how we can help our loved ones feel comfortable aging at home.

Dr Ron Keren.jpgWhat is the biggest challenge for informal caregivers?
The biggest challenge is that people with dementia do not recognize they have a problem. They may resist help, claiming that they don't need it. For example, it is difficult to convince an older person with dementia to stop driving or using the stove if they believe that they are not forgetful.

How can we help people with dementia living at home?
The goal of managing any patient with dementia is to allow them to live in the least restrictive environment while ensuring their safety and quality of life. A good starting point is to have a home safety and functional assessment completed by a community occupational therapist. This is done through a physician's referral to the local Community Care Access Centre (CCAC). The CCAC can also provide the assistance of a personal support worker. Pharmacies can deliver medications in blister packs to minimize medication errors. Meals-on-wheels can be delivered to the home.

Are there medications for people with dementia that may help them stay at home longer?
In Canada, there are three medications for the treatment of mild-moderate Alzheimer's disease: Aricept (donepezil), Reminyl (galantamine) and Exelon (rivastigmine). They provide symptomatic relief and are paid for by The Ontario Drug Benefit Plan. Medication for moderate-to-severe Alzheimer's disease is called Ebixa (memantine). It also offers symptomatic relief and is often combined with one of the three formerly mentioned treatments. It is not included in the Ontario Drug Benefit Plan and is less widely prescribed.

When will I know when my loved one with dementia can no longer live at home?
There is no simple answer to this question. There are a number of factors that come into play, including: the degree of cognitive impairment, difficult behaviours such as wandering and sleep disturbances, the presence of a healthy caregiver, utilization of community resources and the ability to provide private care.

It is rare to find a caregiver who wants to move their loved one into a long-term care facility, however, despite the best of intentions and substantial supports, almost all patients with dementia who survive into the severe stage of the disease will need to move into a long-term care facility.

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