While many of us greet the new year with new wishes for the future, some people are lost in time, unable to enjoy or even understand the singificance of the holiday. Their memories are not those of the present, but of a time long ago, some as far back as infancy. Senile dementia, or Alzheimer's disease, robs a person of his sense of self and his grasp on reality.
Returning to the past
"We choose books and videos that are as old as possible. That makes the elderly comfortable," said Chen Mei-yun (
PHOTO: CHEN CHENG-CHANG, TAIPEI TIMESN
"There are some Ha-jih-tsu (
A man over 90 years old, who is a faithful KMT veteran, refused food when he first started living at the center. He told workers that he daren't eat because he had no coupon for meals.
"His memory had reverted to decades ago and he thought he was still in the army," Chen said.
PHOTO: CHEN CHENG-CHANG, TAIPEI TIMES
In order to coax the man to eat, the social workers told him: "The KMT government has arranged and paid for you to stay and eat here."
"He's eaten and lived here happily ever since," Chen said with a knowing smile. "Taking care of senile dementia patients requires creativity," she added.
In a rehabilitation room at the center, several older dementia sufferers are practicing their balance. An old man sits on an exercise bicycle. He has difficulty coordinating movements of his hands and feet. He has the childlike smile and clumsy behavior of a toddler.
Another old man stands motionless in front of a desk. Time appears frozen on his stationary form. Behind him sits an old woman in a chair with a cotton belt around her waist. "She forgets that she is incapable of walking and keeps trying to take steps," one of the social workers said.
Many older dementia sufferers forget to chew, stopping abruptly as they eat. Some even forget to take a step while walking and end up falling down.
"Just consider them as children who will never make progress," said Jian Shuen's director, Liao Hui-yuan (
But differing from children, the elderly have strong self-respect and ability for social activities, Chen said. "They will tell you every day that they seem to have met you before," Chen said laughing, "But in fact they don't remember you at all."
Many even forget their own appearance. A grandmother goes along with her family to meet other patients and social workers once a month at the Catholic Sanipax Medico-Social Educational Foundation (天主教康泰醫療教育基金會), which has been providing care training for people who have family members with senile dementia.
The woman usually behaves perfectly normally and her condition was not easily diagnosed at first. But when she enters the elevator on her way to the foundation, everybody can see it clearly.
"She will say hello and chat to herself in the mirror in the elevator," said Wang Yi-min (王憶敏), senior counselor at the foundation. "She has forgotten what she looks like."
On the wall by the door of each bedroom at the Jian Shuen Care Center hangs a photograph of the patient who occupies that room. Some look younger in the photographs because they can only recognize their more youthful faces.
Dementia sufferers cannot find their rooms and beds without the help of other items. An old man identifies his bed from a steel mug on the cabinet next to it. The mug is similar to one he used in the army many years ago.
Some patients wake up in the morning in beds that do not belong to them. "They can't remember where they should sleep, so they sleep in whatever bed most resembles that of their childhood days," Chen said.
A bomb in the family
The forgetfulness and unpredictable behavior of dementia sufferers cause a lot of difficulties for their families. Most people are uneducated as to how to recognize the symptoms, and many think that the elderly behave badly on purpose.
"Ignorance of senile dementia symptoms often causes misunderstanding and family discord," Chen said. "All the families of patients in our center experienced similar distress when their loved ones were first struck by dementia."
Chen recalled the story of a young married woman.
"Her mother-in-law often told her first son that she had given money to her second son, causing distrust between the brothers. She also complained to her son that his wife, the young woman, had stolen money from her."
"Quarrels became very common in the family. The woman fought to move out and eventually packed her bags," Chen said, "But just before she started to leave, her mother-in-law said she had lost a spoon and wanted to look for it in the packed bags.
"That young woman told me she felt so dejected she almost collapsed before bursting into tears.
"It's a typical story. The family didn't know that delusions and obessive behavior are common among senile dementia sufferers," Chen said.
Senile dementia suffers exhibit symptoms such as aimless wandering, auditory and visual hallucinations, loss of memory of recent events and people, problems dealing with money, and poor interpersonal skills, according to doctors and social workers.
They might forget that they have just used the toilet or eaten a meal and complain that people are not taking care of them.
"But these symptoms are usually ignored by their families. They often say that it's because the patients are elderly or that they do it deliberately," Chen and Wang said.
"The lack of understanding and willingness to admit that their elderly relatives are affected by dementia often delays medical treatment. That is the main problem for treating patients and it places them at risk of becoming a time bomb in the family. Usually, when families understand that the strange behavior of patients results from disease, they will learn not to take patients' inconsistent words seriously," Chen said.
But families usually only consider taking relatives to care facilities when their errant behavior has developed into a serious problem. This often takes years after the first behavioral quirks are noticed. The belated realization usually comes after the emergence of family problems and the aggravation of the disease, doctors and social workers say.
"Many people also think it a sin and a shame to admit that their relative suffers from senile dementia and are reluctant to send patients to care centers," they said.
About 3 percent of families who have taken elderly dementia sufferers to the hospital once thought of abandoning the patients, 3 percent contemplated suicide because of the pressure of providing care, and 6 percent of them had otherwise "reacted emotionally" to the patient's condition, according to Chen Jui-hsing (甄瑞興), a neurologist at Kaohsiung Veterans General Hospital.
"Ninety percent of senile dementia patients are looked after by their families as far as we know," Wang said. "Lack of manpower and resources to take care of patients are the main causes of the families' pressure."
Around 50 to 60 percent of senile dementia patients are sufferers of Alzheimer's disease, and most of the rest are victims of strokes, said Liu Hsiu-chi (
As medical research points out, Alzheimer's is the most common cause of intellectual decline among the aged. It occurs in approximately 9 in every 10,000 people worldwide. The disorder affects women slightly more often than men. The causes are unknown. Several factors are suspected to be behind the disorder, but have yet to be proven.
Mystery disease
There is no known definitive cure or prevention for Alzheimer's. Treatment is aimed at relief of symptoms and protection from the effects of the debilitating condition. Nevertheless, research into treatments is progressing.
Earlier this month, US scientists said they had genetically engineered a baby rhesus monkey named ANDi in a step that could hasten the development of cures for diseases ranging from cancer to Alzheimer's. Scientists at the Oregon Regional Primate Research Center at Oregon Health Sciences University reported that they had inserted a foreign gene into a monkey egg, fertilized the egg and had produced a baby monkey with the added gene in its cells.
"If you are a mouse with Alzheimer's, there are very good vaccines available. But long before we would want to help [former US] president [Ronald] Reagan, [who suffers from Alzheimer's], we'd want know that those vaccines could be optimized," head of the scientific team, Gerald Schatten, told the news agency Reuters.
In Taiwan, there are no official national statistics about the population of senile dementia sufferers, Department of Health official Su Shu-chen (
It is estimated that between 2.5 and 5 percent of the population over the age of 65 in Taiwan suffers from senile dementia, according to the Catholic Foundation for Alzheimer's Disease and Related Dementia (
According to the latest statistics released by the Ministry of the Interior, people over the age of 65 make up around 8.56 percent of the total population, or about 1.9 million people. There are, therefore, nearly 80,000 senile dementia sufferers in Taiwan.
The prevalence of senile dementia doubles every five years. It is estimated that one in five people over 80 years old suffers from dementia, according to doctors.
Since 1993, the elderly population has increased by more than 7 percent more than the total population, which qualifies Taiwan as an "aging society" according to criteria set by the WHO.
In recognition of the fact that Taiwan's population is aging, a census which took place last month included for the first time questions about people in need of long-term care.
"Taking care of the elderly is becoming a more serious problem for society," Tan Kai-yuan (譚開元), director of medical affairs at the Department of Health, said prior to the census, adding that the government has designated the establishment of a long-term care system as a social welfare policy priority.
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