May 25, 2024 • 23 mins
Have you noticed your parent becoming increasingly repetitive, forgetful, or acting out of character? While these can be signs of normal cognitive decline and part of the natural aging process, they could also be symptoms of dementia.
A dementia diagnosis is scary, but early intervention is key, and there are a number of simple things your parent can do to maintain their wellbeing and independence for as long as possible.
Senior geriatric expert Professor Peter Gonski has a wealth of experience in managing older people’s conditions and progressing models of care. He joins performer, author and host of ‘Parenting Up with Australian Unity’, Jean Kittson AM, to explain how to recognise the signs of declining cognitive health, when to raise your concerns, and what to do after a dementia diagnosis.
To learn more about parenting up, visit: https://www.australianunity.com.au/wellbeing/community-and-relationships/recognising-cognitive-decline-in-your-parent
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jean Kittson (00:00):
This is Parenting Up with Australian Unity, a podcast where
we're talking about ageing, and we're looking at some of
those essential conversations that we need to have with our
loved ones as they get older. I'm Jean Kittson, and
(00:21):
this is a subject that is particularly close to my heart.
Having been through this process with my own parents. My
mum is 99 almost and dad is 96. I've even
written a book about it to help us all, but
mainly to help me. We need to talk about mum
and dad. A guide to parenting our ageing parents. Each episode,
(00:44):
I'm going to be joined by expert guests who can
help us navigate these challenging conversations with care and compassion
and empathy and respect. This episode is about cognitive wellbeing.
Most people experience memory loss later in life, but at
what point is forgetfulness a cause for concern? You know,
(01:05):
if we notice our parents having increased memory loss, taking
longer to find the right word, losing things, forgetting appointments,
staring into the fridge, wondering why they went to the
fridge in the first place. Are these things cause for
concern or are they just a normal part of life?
This episode we will talk about when it might be
time to talk about the cognitive health of our elders,
(01:28):
and whether it's appropriate and how to do it, and
to help us with this particularly difficult conversation. We have
our brilliant expert to give us information and courage. I'd
like to welcome Professor Peter Gonski, who is a specialist
geriatrician with more than 25 years of experience in care
for elders and has done plenty of research on this topic. Welcome, Peter. Hi.
Peter Gonski (01:52):
Thanks for inviting me.
Jean Kittson (01:54):
Oh, thank you for being here with us. So I
think we'll just start by asking, you know, what is cognition?
Peter Gonski (02:01):
People think about it as short term memory loss, which
is really a major part of what we're talking about.
But cognition itself goes well beyond that, and it can
affect the whole of the brain. And that is people
personality can change their behavior can change, their ability to
function and do tasks can change. And that all adds
(02:23):
up to what our brains do. So cognition really defined
as all the tasks that the brain does.
Jean Kittson (02:30):
And when are changes abnormal and when are they natural?
Peter Gonski (02:34):
When we age, certainly our memories do deteriorate as a
lot of different parts of the body deteriorate. When it
starts affecting one's life or other people's lives, then we
are quite concerned, and that's where we actually move from
a position of saying this might be just ageing or
just deteriorating cognition to actually a condition called dementia.
Jean Kittson (02:56):
Dementia. Everyone's terrified of dementia and they try to cover
it up if they feel that they're perhaps suffering themselves.
I mean, it isn't a very nice thing to think of,
but no, not everyone who ages gets dementia. It's still
only a small percentage, isn't it?
Peter Gonski (03:11):
Well, this is where we talk about normality versus commonality,
And that is it's not normal to get dementia, but
it is actually quite common. And one of the major, um,
risk factors is age. So if you live longer and
to a long age, then you're much more likely to
get dementia. So we say that basically at 65 there's
(03:37):
probably a 5% chance. And if you're getting up to 85,
it's probably getting to about 2,025% chance. And when you're 90,
it's getting up to the 2,530% chance. And when you're 100,
it's getting up to the 40 to 50% chance. So
you can see that it really gallops along when you
get much, much older.
Jean Kittson (03:56):
How do you identify it in someone?
Peter Gonski (04:00):
Well, really by history is the big, uh, way of
doing it. And people, even these days, and possibly even
more these days, are starting to think, well, it's all
about doing tests. It's not about doing tests. It's about
finding out what's happening in the person's life. It's often
other people watching people that are actually realise that there's
(04:21):
something going on. They're not the person themselves. They're just
realizing that people's memories are deteriorating. They're becoming repetitive, and
they're not able to continue conversations that they used to
be able to continue. And their function around the home
is deteriorating as well. They become much less interested in
current affairs, which they may have been interested in, or
(04:44):
even just normal conversations.
Jean Kittson (04:46):
I think the civilian, like myself, thinks of dementia as
sort of a one thing, but there's different aspects or
different things that can cause dementia. Is it like Alzheimer's
or what are the different things we should know about dementia?
Peter Gonski (05:01):
Yeah. So once we made a diagnosis of dementia, we
try and work out why do people have dementia. And
the most common cause is Alzheimer's disease. It's a degeneration
of a specific part of the brain, which is made
worse when one gets older. And most people, as they
get older, they have the pathology, the abnormality that we
often see in Alzheimer's disease, even though they may not
(05:23):
be displaying the symptoms of dementia. So basically, that's the
most common one. The second most common one is what
we call vascular dementia, which is due to generally mini strokes, little,
little areas of the brain that aren't getting blood and oxygen.
Parkinson's disease is a condition where people can cognitively deteriorate,
(05:46):
and we call that Lewy body dementia. And then there's
the fourth most common, which we call frontotemporal dementia, which
often occurs in younger people. And the front of the
brain is affected. So their personality and behavior are affected
much more there than their short term memory, which is
the latter being the most common symptom in Alzheimer's disease.
And then you can have mixtures of a whole lot
(06:08):
of those. You can have Alzheimer's and vascular Alzheimer's and
Lewy body. So it's quite a complex number of diagnoses
and there's many, many more diagnoses. But they would be
the four most common.
Jean Kittson (06:20):
I have noticed we might just take a step back
and just say the other things that apart from age
that or that can be temporary, that can affect our cognition,
you know, like medications or hearing or there are other
things like that, or even illnesses like a like UTIs
and delirium. And they can affect our cognition sort of temporarily,
(06:42):
can't they.
Peter Gonski (06:43):
Yeah. So I think that's they're really, really important points.
One has to be careful that you're not missing other things.
And deafness is one of them. Because if people can't
hear you, they're not going to respond the way you
think they should, and you might start thinking they've got dementia.
On the other hand, if people do have deafness and
they don't do anything about it like we're hearing aids,
they do keep out of conversations and they sort of
(07:04):
socially isolated. And we know that that does make dementia worse.
So deafness is a real important one. Delirium you mentioned.
And that's really important. That's an acute deterioration of your cognition.
And it is often caused by other things such as
urinary infections. But it could be any other infection pneumonia,
infection of the skin. And people forget the teeth that
(07:26):
one does get. A lot of people have their own
teeth and they can get infected, and that's enough to
cause delirium. And many other things cause delirium, new medications,
stopping medications, drinking too much alcohol on one night or
something like that. It's really important to make sure people
are just not depressed because when they're very depressed, they
tend to become, um, very much, um, involved in themselves. Um,
(07:49):
they don't think about things, they don't talk to people.
And that in itself could look like dementia, but in
fact could be depression. So all these things do need
to be considered when one's actually making a diagnosis of dementia.
Once you've made that diagnosis, that's when you start thinking
about how are we going to prop people up?
Jean Kittson (08:08):
Well, I suppose this is where it gets really tricky because, um,
if you try to have a conversation with the person
themselves about you're worried about their cognition and about what's happening,
then that's unlikely to be a successful conversation.
Peter Gonski (08:24):
Well, absolutely. But I think that what one has to
be is realistic about, particularly when people are getting older,
that it is very realistic to understand that their brains
are deteriorating and their bodies are deteriorating, particularly when they
get to advanced age. And it's all part of aging.
Although there are risk factors which can prematurely make people
(08:48):
develop cognitive impairment or dementia. So it is a difficult conversation,
but I think it really should be seen as we're
trying to make your quality of life as good as possible.
We're trying to allow you to be as independent as
you want to be. We're trying to keep you at home,
which is what most people want to do. And with
(09:08):
all that, one has to say, well, look, these are
the problems. Let's not just talk about the problems. Let's
see what we can do about those problems.
Jean Kittson (09:17):
Well, that's a very good attitude to have, you know,
because when our loved ones decline physically, we're always adjusting,
adjusting their lives and, you know, bringing in frames and
they move less and they're working more and more within
their capacity, but with their cognition. Then we need to
(09:38):
make adjustments for that, I suppose, and help them to
remain autonomous and keep making decisions.
Peter Gonski (09:46):
There are aids for mobility, but there's also aids for cognition.
So whether it's putting up notices on the fridge door or,
you know, writing everything down or ringing people daily to
remind them to take their medication or have their medication
put into regular packs. I mean, all those things are
memory aids, which can be incredibly useful and increase independence.
(10:10):
So I don't think we should only think about functional Aids,
but also cognitive aids, which are really important. I also
think it's really important that people understand that if they
can keep on going and being active with exercise socially,
try and use their brains with whichever way they want to,
it does help to keep that independence just that little
(10:32):
bit longer. And once people do develop dementia, there are
some decisions that they might not be able to make,
such as financial decisions. They may not be able to
look after the accounts like they used to. Um, they
may not be able to make good decisions or reasonable
decisions about their own medical health. And finally, if things
(10:52):
get very difficult, they might find it very difficult to
make decisions about where they should be living and what
services and help they should be getting at home. If
they are going to live at home. And that's where
the word capacity comes in. And that is that when
people are not able to make decisions for themselves, then
they lack capacity. And then other people who tend to
be either family members or carers or even people outside
(11:17):
the family are need to step in and say, look,
this is where we need to help you. But one
thing I would like to say is that even though
they can be taking over those decision making questions, we
should be still involving the person who's got dementia because
there are some things that they will be able to
make decisions on. So we might say they can't make
(11:38):
their financial decisions, but maybe they can decide that they
want to give $20 here or $20 there, but they
may not be able to look after their whole wealth
or whatever.
Jean Kittson (11:48):
That's a very good point. You know, it's all about
degrees and still giving people the human right of of
making decisions about themselves when they're able to. When should
we do something about, I mean, are there particular signs
we should look out?
Peter Gonski (12:03):
So we believe that early diagnosis is important. And that's
for a number of reasons. Firstly, if you've got a diagnosis,
we actually can lead the the treatment and the management plan.
If we don't have a diagnosis, no one really knows
what they're dealing with. So if it is deafness or
delirium or depression or something, those need treatment in a
(12:25):
different way to dementia. Once we made the diagnosis of
dementia we can actually guide people through all all sorts
of management plans. And also it's explains to family members
and friends and carers why they're behaving in particular ways.
So someone may. Yeah. Um, go to the a, um,
(12:45):
family party and just sit in in the corner and
not do anything. And people will get very, very upset
about that. But they might be quite happy doing that.
And it's probably part of the dementia, because apathy is
a really big symptom of dementia. And to just explain
that to a family, like it's not affecting him or her,
it's affecting you. So you have to understand what what's
(13:08):
happening in their mind. Second thing is we do have
to plan and those planning include driving. Will they need
to stop driving or will they? Should they reduce their driving?
Or what should happen to driving? They need to start
looking at setting up things like power of attorneys and
enduring guardianships and wills, and what we call advance care directives.
(13:29):
All of those things need to be put into place
well before they start really deteriorating. We also need them
to sign up for my aged care so that in
the future, if they need some services at home to
keep them independent as long as possible, then that's all
organised at the moment. The medications that we use are
not fantastic, but they can be helpful in some people
(13:51):
and we often use those. But in the future and
it's not that far off, we are going to be
having more medications that will probably be able to help
people more and more. So that early diagnosis and then
the management plan and then following things through to help
people is just so important.
Jean Kittson (14:10):
Yes, absolutely. You would have seen a lot of families
who have had experiences in their loved ones. Can you
tell us about the ones who coped the best? Are
they the ones who who someone explains why? Why their
loved ones sitting in the corner at a party when
they understand more?
Peter Gonski (14:26):
Look, I think that really, really helps if they understand
the symptoms of dementia and the diagnosis. And so what
we have to do is not only make that diagnosis,
but we often have to support the families, the carers, um,
because they're suffering just like the dementia sufferer. In fact,
someone who's got dementia may not suffer. They might just
(14:46):
continue their life as well as they would like to, um,
to live it, whereas the people around them are really,
really starting to suffer. So what I would suggest is
that once the diagnosis is made, we really need to
support people and we need to educate them, and they
do need to understand the symptoms, the management plan, the
(15:06):
medical treatment. But most of all, the caring and the
help that they can get from other people.
Jean Kittson (15:12):
Who's the support mainly from in your experience?
Peter Gonski (15:16):
The first port of call is often the GP and
their services. Some GP practices will not have much, uh,
help to provide, but others might have a lot of
support around them. The next thing is that once the
diagnosis is made, uh, geriatric services or aged care services
need to be put into place. And that's often through
(15:38):
my aged care. And they can provide a hell of
a lot of support and service, including, um. Apart from
help around the home, Dementia Australia is extremely useful in helping, educating, counselling,
supporting and often it's community that also helps, like the. Unfortunately,
(15:59):
when people get diagnosed dementia, often friends around them actually
disappear and don't support them. But there are in some situations,
a lot of support out there within the community.
Jean Kittson (16:10):
Yes, I suppose, uh, for many people there's a lot
of fear around their loved ones getting dementia, and I
guess it's a sense of loss before they actually die.
Peter Gonski (16:22):
Often that's very much the case. But, you know, people
seem to be able to cope with watching their person,
the person they look after or the person they love
get frail, frail from a physical point of view, but
they don't seem to be able to cope with a
mental point of view, a cognitive point of view. And
that's very understandable, because the brain is such an important
(16:43):
part of our personalities. And, um, you know, without your brain,
everyone around them struggles to communicate and to be able
to cope with everything. So it is an understandable problem.
But one does have to say to people, look, this
is happening, we can help. There is lots of help
(17:04):
out there which can support people and education is a really,
really big one. Counselling is a very big one.
Jean Kittson (17:11):
When you are talking about treatments before, I mean a
lot of people might just be in denial if it's
their partner or something and decide, well, there's nothing anyone
can do anyway, so just keep putting it off. What
would you say to those people?
Peter Gonski (17:28):
Well, there is very little doubt that there's a lot
of evidence to show that if people keep active from
a physical point of view, so do exercise. They keep
active from a mental point of view, do some type
of mental exercises. Communicate people with people. If people socialise,
they get together with people and try and use their brains.
(17:50):
In that situation, there is very, very good evidence that
all those things are very beneficial, that people, if people
eat well, they will do much better. If they don't
drink too much alcohol, if they stop smoking, if they
sleep well, um, all of those things are really positive
in trying to support people and keep them as well
(18:12):
cognitively as possible and for as long as possible. And
that extends to allowing them to become independent for as
long as possible. So all those things are really important.
And when I diagnose dementia, I pushed those points. They
seem very simple, but it is incredible the number of
people who will not exercise, who will not eat well,
(18:33):
who will not look after their blood pressure and their
diabetes and all that sort of thing. It's quite incredible.
And yet there's such basic things. So that's one thing.
Then we would say you need the support. These are
the support services that we would suggest. And that's really,
really helpful for you. And then we would get on
to medications.
Jean Kittson (18:51):
In terms of treatment, I suppose the last the final
question that I would like to ask is if you,
your loved ones already been diagnosed with dementia and they
have had to go into, um, maybe residential aged care
or something like that, how do you know they're being
looked after in the right way? What? What is the
(19:14):
right way? Because in the old days there was a
lot of sedation. Yeah.
Peter Gonski (19:18):
And we try and avoid sedation. And sedation should be
really the last. The last type of treatment option. It's
dementia care is all about looking after the individual. The
best way to determine whether the aged care facility is
the right one is to find out how much time
(19:38):
the staff take to get to know the person, and
to try and do all the things to make that
person be at home. So it's as simple as, does
my mother shower in the morning or the evening? Because
if she normally at home showers in the morning, then
that's what we're going to do. And if it's normally
in the evening, then that's what we're going to help
(19:58):
her with. We're not going to do it just because
the staff go home at 7 a.m., and they like
to have everyone showered by then. So it's a real
positive way of looking at things that we if person
has to go into a facility that they are looked
after just the way they would want to be looked
after at home.
Jean Kittson (20:15):
Well thank you, that's really helpful. Is there anything else
you'd like to add that you think people should know?
Peter Gonski (20:22):
I understand the sadness when people find out that their
loved ones have dementia, but there is a lot of
help out there to help people along their way. It's
just so important. And there does seem to be this
slight optimism that we are going to in the future,
have more treatments, which we're going to help a lot.
Jean Kittson (20:43):
Oh, thank you so much. You've given us hope and
courage and information. So thank you very much, Professor Peter Gonski.
The key takeaways are the risks of cognitive decline increase
as we age. Warning signs go beyond forgetfulness, you know,
keep an eye on changes in personality, changes in interest,
(21:03):
changes in mood swings. A person is unlikely to identify
these changes in themselves, so their loved ones really need
to be on the lookout. Just as we use aides
for mobility, we need to think about introducing aides for cognition.
I thought that was great advice. Writing notes. I used
them already, writing notes, putting up signs by the door,
(21:25):
calling daily to remind about medications and appointments. And sleep
is a contributor to cognition. Good nutrition is, too. It's
not just if you, um, have a disease or you're ill,
there's sleep, new, good nutrition, exercise, physical and mental. Not
(21:45):
drinking too much or smoking too much. All these things
are important for maintaining good cognitive health for as long
as possible. If your loved one is diagnosed with dementia,
educate yourself on the symptoms. Um, what might the progression
might look like? So you're much better equipped emotionally and
physically to deal with them. And so is your family.
You'll cope a lot better. Get informed. Thank you so
(22:08):
much for joining me for this podcast series, Parenting Up
with Australian Unity. I've really enjoyed chatting to all these
wonderful experts, and I hope their knowledge and experience has
helped you to support your loved ones and make sure
they are healthy, safe, independent and most importantly, happy for
(22:28):
as long as possible. Thank you. The information provided in
this episode of Parenting Up is general in nature and
(22:49):
does not consider your personal circumstances. Australian unity accepts no
responsibility for the accuracy of any opinions, advice, representations or
information contained in this podcast. Listeners should rely on their
own independent advice and inquiries when making decisions affecting their
(23:10):
own or their loved ones finances, health, wellbeing or other interests.
This is Parenting Up with Australian Unity, a podcast where
we're talking about ageing, and we're looking at some of
those essential conversations that we need to have with our
loved ones as they get older. I'm Jean Kittson, and
(00:21):
this is a subject that is particularly close to my heart.
Having been through this process with my own parents. My
mum is 99 almost and dad is 96. I've even
written a book about it to help us all, but
mainly to help me. We need to talk about mum
and dad. A guide to parenting our ageing parents. Each episode,
(00:44):
I'm going to be joined by expert guests who can
help us navigate these challenging conversations with care and compassion
and empathy and respect. This episode is about cognitive wellbeing.
Most people experience memory loss later in life, but at
what point is forgetfulness a cause for concern? You know,
(01:05):
if we notice our parents having increased memory loss, taking
longer to find the right word, losing things, forgetting appointments,
staring into the fridge, wondering why they went to the
fridge in the first place. Are these things cause for
concern or are they just a normal part of life?
This episode we will talk about when it might be
time to talk about the cognitive health of our elders,
(01:28):
and whether it's appropriate and how to do it, and
to help us with this particularly difficult conversation. We have
our brilliant expert to give us information and courage. I'd
like to welcome Professor Peter Gonski, who is a specialist
geriatrician with more than 25 years of experience in care
for elders and has done plenty of research on this topic. Welcome, Peter. Hi.
Peter Gonski (01:52):
Thanks for inviting me.
Jean Kittson (01:54):
Oh, thank you for being here with us. So I
think we'll just start by asking, you know, what is cognition?
Peter Gonski (02:01):
People think about it as short term memory loss, which
is really a major part of what we're talking about.
But cognition itself goes well beyond that, and it can
affect the whole of the brain. And that is people
personality can change their behavior can change, their ability to
function and do tasks can change. And that all adds
(02:23):
up to what our brains do. So cognition really defined
as all the tasks that the brain does.
Jean Kittson (02:30):
And when are changes abnormal and when are they natural?
Peter Gonski (02:34):
When we age, certainly our memories do deteriorate as a
lot of different parts of the body deteriorate. When it
starts affecting one's life or other people's lives, then we
are quite concerned, and that's where we actually move from
a position of saying this might be just ageing or
just deteriorating cognition to actually a condition called dementia.
Jean Kittson (02:56):
Dementia. Everyone's terrified of dementia and they try to cover
it up if they feel that they're perhaps suffering themselves.
I mean, it isn't a very nice thing to think of,
but no, not everyone who ages gets dementia. It's still
only a small percentage, isn't it?
Peter Gonski (03:11):
Well, this is where we talk about normality versus commonality,
And that is it's not normal to get dementia, but
it is actually quite common. And one of the major, um,
risk factors is age. So if you live longer and
to a long age, then you're much more likely to
get dementia. So we say that basically at 65 there's
(03:37):
probably a 5% chance. And if you're getting up to 85,
it's probably getting to about 2,025% chance. And when you're 90,
it's getting up to the 2,530% chance. And when you're 100,
it's getting up to the 40 to 50% chance. So
you can see that it really gallops along when you
get much, much older.
Jean Kittson (03:56):
How do you identify it in someone?
Peter Gonski (04:00):
Well, really by history is the big, uh, way of
doing it. And people, even these days, and possibly even
more these days, are starting to think, well, it's all
about doing tests. It's not about doing tests. It's about
finding out what's happening in the person's life. It's often
other people watching people that are actually realise that there's
(04:21):
something going on. They're not the person themselves. They're just
realizing that people's memories are deteriorating. They're becoming repetitive, and
they're not able to continue conversations that they used to
be able to continue. And their function around the home
is deteriorating as well. They become much less interested in
current affairs, which they may have been interested in, or
(04:44):
even just normal conversations.
Jean Kittson (04:46):
I think the civilian, like myself, thinks of dementia as
sort of a one thing, but there's different aspects or
different things that can cause dementia. Is it like Alzheimer's
or what are the different things we should know about dementia?
Peter Gonski (05:01):
Yeah. So once we made a diagnosis of dementia, we
try and work out why do people have dementia. And
the most common cause is Alzheimer's disease. It's a degeneration
of a specific part of the brain, which is made
worse when one gets older. And most people, as they
get older, they have the pathology, the abnormality that we
often see in Alzheimer's disease, even though they may not
(05:23):
be displaying the symptoms of dementia. So basically, that's the
most common one. The second most common one is what
we call vascular dementia, which is due to generally mini strokes, little,
little areas of the brain that aren't getting blood and oxygen.
Parkinson's disease is a condition where people can cognitively deteriorate,
(05:46):
and we call that Lewy body dementia. And then there's
the fourth most common, which we call frontotemporal dementia, which
often occurs in younger people. And the front of the
brain is affected. So their personality and behavior are affected
much more there than their short term memory, which is
the latter being the most common symptom in Alzheimer's disease.
And then you can have mixtures of a whole lot
(06:08):
of those. You can have Alzheimer's and vascular Alzheimer's and
Lewy body. So it's quite a complex number of diagnoses
and there's many, many more diagnoses. But they would be
the four most common.
Jean Kittson (06:20):
I have noticed we might just take a step back
and just say the other things that apart from age
that or that can be temporary, that can affect our cognition,
you know, like medications or hearing or there are other
things like that, or even illnesses like a like UTIs
and delirium. And they can affect our cognition sort of temporarily,
(06:42):
can't they.
Peter Gonski (06:43):
Yeah. So I think that's they're really, really important points.
One has to be careful that you're not missing other things.
And deafness is one of them. Because if people can't
hear you, they're not going to respond the way you
think they should, and you might start thinking they've got dementia.
On the other hand, if people do have deafness and
they don't do anything about it like we're hearing aids,
they do keep out of conversations and they sort of
(07:04):
socially isolated. And we know that that does make dementia worse.
So deafness is a real important one. Delirium you mentioned.
And that's really important. That's an acute deterioration of your cognition.
And it is often caused by other things such as
urinary infections. But it could be any other infection pneumonia,
infection of the skin. And people forget the teeth that
(07:26):
one does get. A lot of people have their own
teeth and they can get infected, and that's enough to
cause delirium. And many other things cause delirium, new medications,
stopping medications, drinking too much alcohol on one night or
something like that. It's really important to make sure people
are just not depressed because when they're very depressed, they
tend to become, um, very much, um, involved in themselves. Um,
(07:49):
they don't think about things, they don't talk to people.
And that in itself could look like dementia, but in
fact could be depression. So all these things do need
to be considered when one's actually making a diagnosis of dementia.
Once you've made that diagnosis, that's when you start thinking
about how are we going to prop people up?
Jean Kittson (08:08):
Well, I suppose this is where it gets really tricky because, um,
if you try to have a conversation with the person
themselves about you're worried about their cognition and about what's happening,
then that's unlikely to be a successful conversation.
Peter Gonski (08:24):
Well, absolutely. But I think that what one has to
be is realistic about, particularly when people are getting older,
that it is very realistic to understand that their brains
are deteriorating and their bodies are deteriorating, particularly when they
get to advanced age. And it's all part of aging.
Although there are risk factors which can prematurely make people
(08:48):
develop cognitive impairment or dementia. So it is a difficult conversation,
but I think it really should be seen as we're
trying to make your quality of life as good as possible.
We're trying to allow you to be as independent as
you want to be. We're trying to keep you at home,
which is what most people want to do. And with
(09:08):
all that, one has to say, well, look, these are
the problems. Let's not just talk about the problems. Let's
see what we can do about those problems.
Jean Kittson (09:17):
Well, that's a very good attitude to have, you know,
because when our loved ones decline physically, we're always adjusting,
adjusting their lives and, you know, bringing in frames and
they move less and they're working more and more within
their capacity, but with their cognition. Then we need to
(09:38):
make adjustments for that, I suppose, and help them to
remain autonomous and keep making decisions.
Peter Gonski (09:46):
There are aids for mobility, but there's also aids for cognition.
So whether it's putting up notices on the fridge door or,
you know, writing everything down or ringing people daily to
remind them to take their medication or have their medication
put into regular packs. I mean, all those things are
memory aids, which can be incredibly useful and increase independence.
(10:10):
So I don't think we should only think about functional Aids,
but also cognitive aids, which are really important. I also
think it's really important that people understand that if they
can keep on going and being active with exercise socially,
try and use their brains with whichever way they want to,
it does help to keep that independence just that little
(10:32):
bit longer. And once people do develop dementia, there are
some decisions that they might not be able to make,
such as financial decisions. They may not be able to
look after the accounts like they used to. Um, they
may not be able to make good decisions or reasonable
decisions about their own medical health. And finally, if things
(10:52):
get very difficult, they might find it very difficult to
make decisions about where they should be living and what
services and help they should be getting at home. If
they are going to live at home. And that's where
the word capacity comes in. And that is that when
people are not able to make decisions for themselves, then
they lack capacity. And then other people who tend to
be either family members or carers or even people outside
(11:17):
the family are need to step in and say, look,
this is where we need to help you. But one
thing I would like to say is that even though
they can be taking over those decision making questions, we
should be still involving the person who's got dementia because
there are some things that they will be able to
make decisions on. So we might say they can't make
(11:38):
their financial decisions, but maybe they can decide that they
want to give $20 here or $20 there, but they
may not be able to look after their whole wealth
or whatever.
Jean Kittson (11:48):
That's a very good point. You know, it's all about
degrees and still giving people the human right of of
making decisions about themselves when they're able to. When should
we do something about, I mean, are there particular signs
we should look out?
Peter Gonski (12:03):
So we believe that early diagnosis is important. And that's
for a number of reasons. Firstly, if you've got a diagnosis,
we actually can lead the the treatment and the management plan.
If we don't have a diagnosis, no one really knows
what they're dealing with. So if it is deafness or
delirium or depression or something, those need treatment in a
(12:25):
different way to dementia. Once we made the diagnosis of
dementia we can actually guide people through all all sorts
of management plans. And also it's explains to family members
and friends and carers why they're behaving in particular ways.
So someone may. Yeah. Um, go to the a, um,
(12:45):
family party and just sit in in the corner and
not do anything. And people will get very, very upset
about that. But they might be quite happy doing that.
And it's probably part of the dementia, because apathy is
a really big symptom of dementia. And to just explain
that to a family, like it's not affecting him or her,
it's affecting you. So you have to understand what what's
(13:08):
happening in their mind. Second thing is we do have
to plan and those planning include driving. Will they need
to stop driving or will they? Should they reduce their driving?
Or what should happen to driving? They need to start
looking at setting up things like power of attorneys and
enduring guardianships and wills, and what we call advance care directives.
(13:29):
All of those things need to be put into place
well before they start really deteriorating. We also need them
to sign up for my aged care so that in
the future, if they need some services at home to
keep them independent as long as possible, then that's all
organised at the moment. The medications that we use are
not fantastic, but they can be helpful in some people
(13:51):
and we often use those. But in the future and
it's not that far off, we are going to be
having more medications that will probably be able to help
people more and more. So that early diagnosis and then
the management plan and then following things through to help
people is just so important.
Jean Kittson (14:10):
Yes, absolutely. You would have seen a lot of families
who have had experiences in their loved ones. Can you
tell us about the ones who coped the best? Are
they the ones who who someone explains why? Why their
loved ones sitting in the corner at a party when
they understand more?
Peter Gonski (14:26):
Look, I think that really, really helps if they understand
the symptoms of dementia and the diagnosis. And so what
we have to do is not only make that diagnosis,
but we often have to support the families, the carers, um,
because they're suffering just like the dementia sufferer. In fact,
someone who's got dementia may not suffer. They might just
(14:46):
continue their life as well as they would like to, um,
to live it, whereas the people around them are really,
really starting to suffer. So what I would suggest is
that once the diagnosis is made, we really need to
support people and we need to educate them, and they
do need to understand the symptoms, the management plan, the
(15:06):
medical treatment. But most of all, the caring and the
help that they can get from other people.
Jean Kittson (15:12):
Who's the support mainly from in your experience?
Peter Gonski (15:16):
The first port of call is often the GP and
their services. Some GP practices will not have much, uh,
help to provide, but others might have a lot of
support around them. The next thing is that once the
diagnosis is made, uh, geriatric services or aged care services
need to be put into place. And that's often through
(15:38):
my aged care. And they can provide a hell of
a lot of support and service, including, um. Apart from
help around the home, Dementia Australia is extremely useful in helping, educating, counselling,
supporting and often it's community that also helps, like the. Unfortunately,
(15:59):
when people get diagnosed dementia, often friends around them actually
disappear and don't support them. But there are in some situations,
a lot of support out there within the community.
Jean Kittson (16:10):
Yes, I suppose, uh, for many people there's a lot
of fear around their loved ones getting dementia, and I
guess it's a sense of loss before they actually die.
Peter Gonski (16:22):
Often that's very much the case. But, you know, people
seem to be able to cope with watching their person,
the person they look after or the person they love
get frail, frail from a physical point of view, but
they don't seem to be able to cope with a
mental point of view, a cognitive point of view. And
that's very understandable, because the brain is such an important
(16:43):
part of our personalities. And, um, you know, without your brain,
everyone around them struggles to communicate and to be able
to cope with everything. So it is an understandable problem.
But one does have to say to people, look, this
is happening, we can help. There is lots of help
(17:04):
out there which can support people and education is a really,
really big one. Counselling is a very big one.
Jean Kittson (17:11):
When you are talking about treatments before, I mean a
lot of people might just be in denial if it's
their partner or something and decide, well, there's nothing anyone
can do anyway, so just keep putting it off. What
would you say to those people?
Peter Gonski (17:28):
Well, there is very little doubt that there's a lot
of evidence to show that if people keep active from
a physical point of view, so do exercise. They keep
active from a mental point of view, do some type
of mental exercises. Communicate people with people. If people socialise,
they get together with people and try and use their brains.
(17:50):
In that situation, there is very, very good evidence that
all those things are very beneficial, that people, if people
eat well, they will do much better. If they don't
drink too much alcohol, if they stop smoking, if they
sleep well, um, all of those things are really positive
in trying to support people and keep them as well
(18:12):
cognitively as possible and for as long as possible. And
that extends to allowing them to become independent for as
long as possible. So all those things are really important.
And when I diagnose dementia, I pushed those points. They
seem very simple, but it is incredible the number of
people who will not exercise, who will not eat well,
(18:33):
who will not look after their blood pressure and their
diabetes and all that sort of thing. It's quite incredible.
And yet there's such basic things. So that's one thing.
Then we would say you need the support. These are
the support services that we would suggest. And that's really,
really helpful for you. And then we would get on
to medications.
Jean Kittson (18:51):
In terms of treatment, I suppose the last the final
question that I would like to ask is if you,
your loved ones already been diagnosed with dementia and they
have had to go into, um, maybe residential aged care
or something like that, how do you know they're being
looked after in the right way? What? What is the
(19:14):
right way? Because in the old days there was a
lot of sedation. Yeah.
Peter Gonski (19:18):
And we try and avoid sedation. And sedation should be
really the last. The last type of treatment option. It's
dementia care is all about looking after the individual. The
best way to determine whether the aged care facility is
the right one is to find out how much time
(19:38):
the staff take to get to know the person, and
to try and do all the things to make that
person be at home. So it's as simple as, does
my mother shower in the morning or the evening? Because
if she normally at home showers in the morning, then
that's what we're going to do. And if it's normally
in the evening, then that's what we're going to help
(19:58):
her with. We're not going to do it just because
the staff go home at 7 a.m., and they like
to have everyone showered by then. So it's a real
positive way of looking at things that we if person
has to go into a facility that they are looked
after just the way they would want to be looked
after at home.
Jean Kittson (20:15):
Well thank you, that's really helpful. Is there anything else
you'd like to add that you think people should know?
Peter Gonski (20:22):
I understand the sadness when people find out that their
loved ones have dementia, but there is a lot of
help out there to help people along their way. It's
just so important. And there does seem to be this
slight optimism that we are going to in the future,
have more treatments, which we're going to help a lot.
Jean Kittson (20:43):
Oh, thank you so much. You've given us hope and
courage and information. So thank you very much, Professor Peter Gonski.
The key takeaways are the risks of cognitive decline increase
as we age. Warning signs go beyond forgetfulness, you know,
keep an eye on changes in personality, changes in interest,
(21:03):
changes in mood swings. A person is unlikely to identify
these changes in themselves, so their loved ones really need
to be on the lookout. Just as we use aides
for mobility, we need to think about introducing aides for cognition.
I thought that was great advice. Writing notes. I used
them already, writing notes, putting up signs by the door,
(21:25):
calling daily to remind about medications and appointments. And sleep
is a contributor to cognition. Good nutrition is, too. It's
not just if you, um, have a disease or you're ill,
there's sleep, new, good nutrition, exercise, physical and mental. Not
(21:45):
drinking too much or smoking too much. All these things
are important for maintaining good cognitive health for as long
as possible. If your loved one is diagnosed with dementia,
educate yourself on the symptoms. Um, what might the progression
might look like? So you're much better equipped emotionally and
physically to deal with them. And so is your family.
You'll cope a lot better. Get informed. Thank you so
(22:08):
much for joining me for this podcast series, Parenting Up
with Australian Unity. I've really enjoyed chatting to all these
wonderful experts, and I hope their knowledge and experience has
helped you to support your loved ones and make sure
they are healthy, safe, independent and most importantly, happy for
(22:28):
as long as possible. Thank you. The information provided in
this episode of Parenting Up is general in nature and
(22:49):
does not consider your personal circumstances. Australian unity accepts no
responsibility for the accuracy of any opinions, advice, representations or
information contained in this podcast. Listeners should rely on their
own independent advice and inquiries when making decisions affecting their
(23:10):
own or their loved ones finances, health, wellbeing or other interests.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Crime Junkie
Does hearing about a true crime case always leave you scouring the internet for the truth behind the story? Dive into your next mystery with Crime Junkie. Every Monday, join your host Ashley Flowers as she unravels all the details of infamous and underreported true crime cases with her best friend Brit Prawat. From cold cases to missing persons and heroes in our community who seek justice, Crime Junkie is your destination for theories and stories you won’t hear anywhere else. Whether you're a seasoned true crime enthusiast or new to the genre, you'll find yourself on the edge of your seat awaiting a new episode every Monday. If you can never get enough true crime... Congratulations, you’ve found your people. Follow to join a community of Crime Junkies! Crime Junkie is presented by audiochuck Media Company.