BALTIMORE – Supportive care for patients with dementia and their caregivers is an important component of overall dementia care, Dr. Constantine G. Lyketsos said at a meeting on Alzheimer's disease and related disorders sponsored by Johns Hopkins University.
Supportive care for the patient should provide comfort and emotional support, safety, structure, activity and stimulation, planning/assistance with decision making, management of medical comorbidities, and good nursing care for advanced stages, said Dr. Lyketsos, chair of psychiatry at Johns Hopkins Bayview Medical Center in Baltimore.
In terms of safety, “many patients with dementia, in fact most of them, should stop driving,” said Dr. Lyketsos. “Most of them can't live alone entirely. That doesn't mean that there needs to be someone in the house 24 hours a day, but there needs to be some support.”
Providing structure means ensuring a safe, predictable place to live with support for activities of daily living. “Because of diminishing cognition, making sure that structure is available is critical. … The more dementia advances, the more important it is to have daily structure in place that's predictable,” he said.
Participation in activities can make a big difference. “One of the things we found in the Maryland Assisted Living Study was that the more participation there was in activities, the longer patients were able to stay in their assisted living facility,” Dr. Lyketsos said.
Support for caregivers includes emotional support and comfort, education, instruction in the skills of caregiving, problem-solving and crisis-intervention help, respite, and attention to personal needs and wants.
“The piece that we don't have a good way to deliver yet is respite. Caregivers need breaks. They can get easily overwhelmed,” he said. Caregivers tend to overlook their own health, so they need to pay attention to their personal needs and wants as well. They also need to maintain touch with social contacts, which is an important part of the support network.