Alzheimer’s & Dementia
Recent studies show that neurological disability and dementia in the elderly can – in select cases – actually be prevented or the rate of their progression decelerated by early detection and comprehensive treatment. The cause of more than fifty per cent of functional disorders in old age involves disorder in the central and peripheral nervous system. Neurological diseases like stroke, Parkinson’s disease, Alzheimer’s disease, and other dementias are only a part of the enormous number of disorders which affect the elderly.THE DEPARTMENT OF PSYCHOGERIATRICS Herzog Hospital currently maintains a 30 bed department to treat patients who suffer from psychogeriatric disabilities. The Department of Psychogeriatrics cares for two major types of patients. The first group comprises those suffering from severe dementia, Alzheimer’s Disease and Parkinson’s Disease. These patients require a great deal of care and supervision.
The second group of patients are those who suffer from severe psychiatric diseases and therefore have been hospitalized for a long time. There they aged and they have now become a combination of a psychiatric and geriatric patient. Such patients require special long-term care combining the best of both worlds.
Needless to say, in Israel many of these patients, in both groups, are Holocaust survivors for whom these are the final years in which they can live a normal life.
The cause of more than fifty per cent of functional disorders in old age involves disorder in the central and peripheral nervous system. Neurological diseases like stroke, Parkinson’s disease, Alzheimer’s disease, and other dementias are only a part of the enormous number of disorders which affect the elderly. Improving neurological evaluation and treatment by combining diverse medical and paramedical fields, i.e. geriatric neurology, behavioral neurology, geriatrics, neuropsychology, psychiatry, psychology, social work and occupational therapy, can significantly improve the functioning level and the quality of life of the elderly, including memory, aches and pains and sleep.
Causes of failure to treat and prevent neurological disorders in the elderly are as follows:
a) Lack of multi-disciplinary approach.
In geriatric neurology, as well as in other fields of geriatric medicine, medical problems have multiple causes e.g. a walking disorder might be caused by both Parkinson’s disease and spinal cord disorder, by disease of the joints or by low blood pressure. Even if one particular cause is identified, the diagnosis does not end until all additional potential causes have been investigated. Each patient’s diagnosis must be ‘customized’.
b) Lack of experience in behavioral neurology.
A large proportion of the elderly suffer from neurobehavioral disorders, e.g. memory disturbances, lack of concentration or language and depression, all of which are caused by brain lesions which doctors have overlooked. Many neurobehavioral patients receive a diagnosis of irreversible disease like Alzheimer’s while, in fact, they suffer from remediable conditions like vitamin or thyroid deficiency, etc.
c) Underestimation of the role of non-medical support systems.
Caregivers and family members are natural support systems, as well as social and creative resources. Frequently, they are the first to notice a change in the patient, they are the most sensitive to the course of the disease and are a key resource in the treatment and rehabilitation process. Their partnership in the medical process should be encouraged and their energy should be actively exploited. The medical team should support them and be available to listen to their needs. For this reason, it is necessary to integrate social services and diverse rehabilitation professionals into the medical team.
Objectives of Department of psychogeriatrics:
Return senior patients to a normal, independent, creative life.
Coordinate treatment of neurological and behavioral psychogeriatric medical problems with paramedical and social services.
Initiate a pro-active medical approach to delay and minimize the severity of aging syndromes by intensive medical check-ups, tests, planned treatment and follow-up, in order to prolong healthy living for the elderly.
Develop and implement a framework of supportive services for the gradual transition of patients from the hospital back to their homes.
In the new Samson Pavilion, we plan to construct two new departments, each of 30 beds. The patients will be accommodated in fully equipped double rooms, designed to cope with the special needs of these patients. In the complex there will be a central block of facilities such as dining rooms, day rooms, occupational and physiotherapy as well as a day-care unit and rooms for doctors, social workers, neuro-psychologists etc. An adjacent garden will also give the patients much needed “freedom” whilst maintaining a controlled and protected environment.
The Department provides three major avenues of care:
1) Day hospitalization and Out-Patient Center. This enables the observation, care and treatment of patients who cannot manage with just a short visit to the clinic because, for example, the spouse is incapable of caring for them or the behavioural disorder appears infrequently. But, on the other hand, they do not require full hospitalization. The facility will enable the support and maintenance of the patients during the day within the day hospitalization and care center. There the patient will be evaluated by the medical, nursing and social staff so as to determine a treatment program, as well as initiate the care.
2) In-patient hospitalization. This is the full hospitalization program, which is currently within the hospital department of Psychogeriatrics.
Emergency Care Facility – this is an extension of the community care clinic and enables the family to bring an elderly relative in for evaluation and care on an emergency basis. Currently there is no such facility available anywhere in Israel. Today, if a patient requires urgent care during the evenings or weekends, the family usually have to turn to either a general emergency room, which is not geared to such cases, or to a psychiatric emergency room which is also not suitable as it is aimed at pure psychiatric patients. (The other alternative currently available is to turn to the municipal social services, which are very inadequate and have no solutions of their own).