Dementia on the Beach


Would you take a person with dementia to the beach?

This might not really be an idea you would think of. There are several possible constraints: difficulty with travel, for example, being one. And what if, having succeeded in getting the dementia sufferer there and back, the next day you asked if they enjoyed their day out and he or she just stared at you with a confused gaze as if to ask, ‘what are you talking about?’ If you think it makes little sense to take persons with dementia to the beach, it will surprise you that a nursing home in Amsterdam has built a Beach room.

In this room, residents can enjoy the feeling of sitting in the sun with their bare feet in the sand. The room is designed to improve the well-being of these residents. The garden room at the centre of the home has recently been converted into a true ‘beach room’, complete with sand and a ‘sun’ which can be adjusted in intensity and heat output. A summer breeze blows occasionally and the sounds of waves and seagulls can be heard. The d├ęcor on the walls is several metres high, giving those in the room the impression that they are looking out over the sea. There are five or six chairs in the room where the older residents can sit. There are also areas of wooden decking on which wheelchairs can be parked. The designers have even managed to replicate the impression of sea air.


Visits to the beach room appear to have calming and inspiring effects on residents of the nursing home. One male resident used to go to the beach often in the past and now, after initially protesting when his daughter collected him from his bedroom, feels calm and content in the beach room. His dementia hinders us from asking him whether he remembers anything from the past, but there does appear to be a moment of recognition of a familiar setting when he is in there.

Evidence is building through studies into the sensorial aspects of memorizing and reminiscing by frail older persons in nursing and residential homes. Several experimental studies have noted the positive effects of sense memories on the subjective well-being of frail older persons. For instance, one study showed that participants of a life review course including sensory materials had significantly fewer depressive complaints and felt more in control of their lives than the control group who had watched a film.

The Beach Room is an example of a multisensory room that emanates from a specific sensorial approach to dementia. The ‘Snoezelen’ approach was initiated in the Netherlands in the late 1970s. The word ‘Snoezelen’ is a combination of two Dutch words: ‘doezelen’ (to doze) and ‘snuffelen’ (to sniff ). Snoezelen takes place in a specially equipped room where the nature, quantity, arrangement, and intensity of stimulation by touch, smells, sounds and light are controlled. The aim of these multisensory interventions is to find a balance between relaxation and activity in a safe environment. Snoezelen has become very popular in nursing homes: around 75% of homes in the Netherlands, for example, have a room set aside for snoezelen activities.

On request by health care institutions, artists have taken up the challenge to design multisensory rooms or redesign the multisensory space of wards (e.g. distinguished by smells) and procedures (cooking and eating together instead of individual microwave dinners). Besides a few scientific evaluations, most evidence is actually acquired from collaborations of artists and health professionals at the moment. The senses are often a better way of communicating with people affected by deep dementia. Like the way that novelist Marcel Proust opened the joys of his childhood memories with the flavour of a Madeleine cake dipped in linden-blossom tea, these artistic health projects open windows to a variety of ways of using sensorial materials to reach unreachable people.

So, would you take a person with dementia to the beach?


Yes, take them to the beach! It can evoke Proust effects and enhance their joy and well-being. Although, we still do not know what the Proust effect does inside the minds of people with dementia, we can oftentimes observe the result as an enhanced state of calmness with perhaps a little smile on their face. People with dementia who have lost so much of their quality of life can still experience moments of joy and serenity through their sense memories.

What is Alzheimer's Disease?



This fantastic video is presented by TED-Ed and features animation by STK Films.

Alzheimer's disease is the most common cause of dementia, affecting over 40 million people worldwide. And though it was discovered over a century ago, scientists are still grappling for a cure. Ivan Seah Yu Jun describes how Alzheimer's affects the brain, shedding light on the different stages of this complicated, destructive disease.




Additional Resources for you to Explore
  • Dementia is a loss of brain function that occurs with certain diseases. Alzheimer's disease (AD), is one form of dementia that gradually gets worse over time. It affects memory, thinking, and behavior.
  • Learn more about Alzheimer’s disease here.
  • Is it possible to predict the possibility of Alzheimer’s disease? See more here.



Dementia & Driving


                       
When an individual is diagnosed with dementia, one of the first concerns that families and caregivers face is whether or not that person should drive. A diagnosis of dementia may not mean that a person can no longer drive safely. In the early stages of dementia, some – though not all – individuals may still possess skills necessary for safe driving. Most dementia, however, is progressive, meaning that symptoms such as memory loss, visual-spatial disorientation, and decreased cognitive function will worsen over time. This also means that a person’s driving skills will decrease and, eventually, he or she will have to give up driving.Many people associate driving with self-reliance and freedom; the loss of driving privileges is likely to be upsetting. Some individuals, recognizing the risks, will limit or stop driving on their own. Others may be unable to assess their own driving skills and may insist on driving even when it is no longer safe. Families and caregivers may have to intervene when an individual’s symptoms pose too great a traffic risk.

Because the progression of dementia varies from person to person, it is difficult to know at what point an individual can no longer drive safely. This fact sheet provides guidelines to help caregivers and persons with dementia decide when and how to limit or stop driving.

Deciding When to Stop

As a general rule, individuals with early stage or mild dementia who wish to continue driving should have their driving skills evaluated immediately (see “Arrange for an Independent Driving Evaluation” below). Individuals with moderate or severe dementia should not drive.


Observe Behavioral Signs

You can assess an individual’s level of functioning by observing his or her day-to-day behavior outside of a motor vehicle. Following are some signs that a person no longer has the necessary skills to drive safely. He or she:
  • Has become less coordinated.
  • Has difficulty judging distance and space.
  • Gets lost or feels disoriented in familiar places.
  • Has difficulty engaging in multiple tasks.
  • Has increased memory loss, especially for recent events.
  • Is less alert to things happening around him or her.
  • Has mood swings, confusion, irritability.
  • Needs prompting for personal care.
  • Has difficulty processing information.
  • Has difficulty with decision-making and problem solving.

It is important to compare present behavior with behavior before the onset of dementia. For example, weigh an individual’s degree of “difficulty engaging in multiple tasks” in relation to his or her prior ability. Changes in behavior will be most noticeable to family and friends who have closely interacted with the individual over time. Share and discuss your observations with other family members, friends and health care providers.


Arrange for an Independent Driving Evaluation

The safest option for assessing a person’s driving skills is to arrange for an independent driving evaluation. Prior to the evaluation, inform the examiners that the person being evaluated has dementia. Evaluations are sometimes available through driver rehabilitation programs or State Departments of Motor Vehicles (DMV).

Although laws vary from state to state, some states require physicians to notify the DMV of any patient diagnosed with dementia. The person with dementia may then be required to report to the DMV for a behind-the-wheel driver re-examination. In some states, individuals diagnosed with moderate or severe dementia may have their licenses automatically revoked. To find out about driving and dementia laws, you can call the Department of Motor Vehicles for the state in which the individual resides.

Because symptoms of dementia are likely to worsen over time, individuals who pass a driving evaluation should continue to be re-evaluated every six months. Individuals who do not pass must discontinue driving immediately.


Continue to Monitor Driving

If an individual clearly demonstrates that he or she can drive safely, it is still important for family and friends to continue monitoring the individual’s driving behavior, as the individual’s driving skills may decrease significantly in a short period of time. The objective of monitoring is to detect a problem before it becomes a crisis. If there are any doubts about safety, the person with dementia should not be driving.

It is often helpful to keep a written log of each incident of poor driving behavior. Following are some of the common warning signs.
  • Drives too slowly.
  • Stops in traffic for no reason or ignores
    traffic signs.
  • Becomes lost on a familiar route.
  • Lacks good judgment.
  • Has difficulty with turns, lane changes, or highway exits.
  • Drifts into other lanes of traffic or drives on the wrong side of the street.
  • Signals incorrectly or does not signal.
  • Has difficult seeing pedestrians, objects, or other vehicles.
  • Falls asleep while driving or gets drowsy.
  • Parks inappropriately.
  • Gets ticketed for traffic violations.
  • Is increasingly nervous or irritated
    when driving.
  • Has accidents, near misses, or “fender benders.”

Discuss any concerns you have with the individual, family members and health care providers. All involved will need to weigh potential risks and decide when the individual needs to stop.


Ask Individual to Co-pilot

You can also estimate an individual’s potential for a traffic accident by taking the person along as a passenger and asking him or her to co-pilot. Ask the person to give you specific instructions about using blinkers, changing lanes, and following the rules of the road. If he or she has difficulty or becomes frustrated easily, it may be time for another in-dependent driving evaluation.

Easing the Transition


Involve Person in Discussions

Some individuals are aware of having difficulty with driving and are relieved when others encourage them to stop. Many people, however, will find the loss of driving privileges and the inherent loss of in-dependence upsetting. Encourage the individual with dementia to talk about how this change might make him or her feel. Try to imagine what it would be like if you could no longer drive. Support groups provide a good venue for both the caregivers and the in-dividual to talk about their feelings and get advice from others in a similar situation. A person often adjusts better if he or she is involved in discussions and decisions about when to stop driving.

If the individual is reluctant to talk about driving, ask the individual’s physician or care manager to bring up the subject of driving during health care visits. A lawyer or financial planner may also be willing to discuss driving as part of the individual’s legal and financial planning.

Begin discussions early and try to establish guidelines about when and how to limit, and eventually stop, driving. Try to reach an agreement regarding which types of driving behavior would signal the need to stop driving. Each family will have to find the solutions that work best in their situation.

Limit Driving

Because the progression of dementia varies, individuals who have demonstrated the ability to drive safely should still begin gradually to modify their driving. This can reduce the risk of an accident if the individual’s driving skills decrease significantly between evaluations. Making the transition from driver to passenger over time can help ease the adjustment. Encourage individuals to try some of the following examples:
  • Drive only on familiar roads and avoid long distances.
  • Avoid heavy traffic and heavily traveled roads.
  • Avoid driving at night and in bad weather.

Reduce the Need to Drive

Individuals able to maintain an active life often adjust better to the loss of driving privileges. Following are some ways to reduce the need to drive:
  • Have groceries, meals, and prescriptions delivered to the home.
  • Arrange for a barber or hairdresser to make home visits.
  • Invite friends and family over for regular visits.
  • Arrange for family and friends to take the individual on social outings.

Make Arrangements for Alternative Transportation

It will be important to make alternative transportation arrangements so that the individual’s mobility and activity level are not unduly restricted. Commonly used transportation options are:

Family and Friends. Family members, friends, and neighbors can offer to drive the individual to social engagements and appointments.  Consider making a list with the names, phone numbers, and times of availability of those willing to provide transportation.

Public Transportation. For individuals in the early stage of dementia, public transportation may be a good alternative to driving. It works best for those who are already familiar with the public trans-portation system in their area. Persons in the later stages of dementia may not be able to figure out routes and schedules.

Taxis. For individuals in the early to middle stages of dementia who do not have behavior problems, taxis can be a good option if someone meets the individual at both ends of the taxi ride. You may be able to set up a payment account with the taxi company so that the individual with dementia does not have to handle money.

Senior and Special Needs Transportation Services. The Yellow Pages of many telephone books have a special section in the front with the names and addresses of various service organizations. Look under transportation or community services for the names of agencies that provide transportation for special needs.

Eldercare Locator at (800) 677-1116, a nationwide directory assistance service designed to help older persons and caregivers locate local support resources, including transportation, for aging Americans.


When Persuasion Fails

Ideally, an individual will limit or stop driving on his or her own. However, some individuals with dementia may forget that they should not drive or insist on driving even though it is no longer safe. While it is important to maintain respect for the individual’s feelings, you must put safety first.

As a last resort, you may have to prevent his or her access to a car. Some methods to do that include:
  • Hiding the car keys.
  • Replacing the car keys with a set that won’t start the car.
  • Disabling or selling the car.
  • Moving the car out of sight.

 

Caregiver Support


Balancing safety with respect for an individual’s desire to drive can be difficult and emotionally trying. Enlist the support of other family, friends, caregiver support groups and health professionals when making and implementing difficult decisions about driving. 


Via