Each patient requires different treatment, given by a team of doctors, psychiatrists and caregivers

For Radha Murthy, managing trustee, Nightingale's Medical Trust, geriatric psychiatrist Soumya Hegde and their team of doctors, psychologists, psychiatrists, researchers and in-house caregivers at the Nightingale's Centre for Ageing and Alzheimer's, a day is spent always on their toes.

They manage more than 70 patients suffering from dementia and Alzheimer's disease at their centre in Kasturinagar.

An offshoot of the Nightingale's Medical Trust, this 71-bed facility houses a memory clinic, and offers day care, short- and long-term care for patients.

Initial assessment

“An Alzheimer's patient may not be able to withstand being taken from one clinic to another for tests. That is why we began this centre,” Dr. Radha says. “There are patients here who have come from Kolkata, New Delhi, and Mumbai. So you can imagine the paucity of such centres there.”

Dr. Soumya says these patients need not just a doctor but an entire team of trained professionals and each patient requires a different mode of treatment. “Not remembering what day it is or what you had for breakfast is not as big a concern as when a patient feels that somebody is stealing his belongings or that his wife is taking over all the finances,” she explains. “Based on these behavioural issues and after careful assessment, we draw up a care plan for that particular patient.”

Caregiver training

According to the doctors at the centre, most of patient's history is gathered from the caregiver (usually the families), as the patient may not remember or even have experienced his/her problems as much as the caregiver has.

They administer memory tests to gauge which parts of the memory are affected.

Then they learn about the patient's daily living skills such as bathing and feeding, from which they also get to know to know how much stress the caregiver is undergoing as a result of the problem.

“Sometimes caregivers and family members think patients are faking it and that he or she deliberately does not want to remember things,” Dr. Soumya says. “In these cases, we need to educate the caregivers about the ailment itself. We also have a training centre for caregivers here.”

Patient negotiation

Patients at Nightingale's are kept engaged all day through non-pharmacological activities such as music, games and occupational-therapy.

Dr. Soumya says it is not possible to admit these patients in the regular wards in hospitals.

“We are talking about patients who are above 70. Where can you admit a person who is shouting, hitting you even when you want to give him a bath?” she asks.

“Our staff here get pinched and hit, but they know how to handle it. It is important to train the staff to understand that the patients are not doing it deliberately,” she adds.

Dr. Radha says that hospitals generally resort to physical restraint when patients are being difficult.

Often, the team at Nightingale's has to innovate solutions to specific patient issues.

Dr. Soumya narrates how her team once tried to see if there was non-alcoholic beer available at stores because one of the patients was asking for a glass of brandy. “I cannot give the patient alcohol. But since there is non-alcoholic beer available, I could try and bargain with the patient. We cannot take these things away from them just because they have a problem.”

No cure yet

On the dearth of such centres in the city, Dr. Radha says, “It is not a lucrative field where treatment is over with a surgery. Increasing awareness is bringing to light more cases every day but the number of psychiatrists and trained professionals is not enough to handle the number of cases.”

As the illness does not have a cure yet, people may not be willing to pay for treatment, Dr. Soumya adds.

The team has been conducting community screenings and going to old age homes to identify more patients. About 37 villages are covered in a day.

Nightingale's is also the government appointed regional resource training centre that has to enhance the capacity of other non-governmental organisations and old age homes.

The organisation also undertakes patient care at their homes.

Nightingale's Centre for Ageing and Alzheimer's is located at 8P6, 3rd A Cross, East of NGEF Layout, Kasturinagar, Bangalore 560043. Contact 080-65356535, 42426565 or log on to http://nightingaleseldercare.com.

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