Recently I’ve been reading Dementia: The One-Stop Guide. Just leaving it on the desk while I’m treating sparks conversation, and it seems that everyone is touched by dementia to some degree. Dementia may seem a bit incompatible with osteopathy, or at least unrelated, but that is not the case.
I’ve treated a couple of patients with dementia, one well enough to see me without a carer and one who needs her daughter with her. Beyond the symptoms they came with for treatment, the first suffered with the way people disregarded her since her diagnosis. This is echoed in the book with quotes like “treat us as normal people. We’re still here, just a little slower and sometimes confused.” In a more personal context, my Nanna has dementia too, so I’ve seen the disease grow from its first signs to the need to move her into assisted living.
Dementia: The One-Stop Guide is an absolutely brilliant resource. Carers, relatives, and healthcare professionals would all benefit from reading it. As a professor of dementia and with a background in nursing, she is a fountain of knowledge and presents it in a no nonsense way. She requires no previous knowledge of the condition- the first chapter explains what dementia is, from Alzheimers to Lewey Body.
June has bright ideas for “the dementia friendly home”, suggesting that the first time the electric kettle is put on the hob, to go and buy an old fashioned hob-top kettle. She also writes a lot about how to treat people with dementia. If you are involved with the care of someone with dementia, you’ll find her chapters “What you should expect from the social care system” and “What you should expect from the NHS” particularly helpful. How to get the most out of a system that isn’t completely in tune with the condition is very valuable information!
“You might be starting to wonder if I believe that exercise solves everything, but to be honest it has amazing value.”
June repeatedly emphasises the importance of exercise for delaying and managing dementia. As we get older and slow down, we spend more time sitting and much less time bringing our joints through their full range. These are prime conditions for arthritis to begin, and as it becomes more difficult and painful to move, it’s easier to just give up. But exercise has more benefits than the obvious cardiovascular one. Getting moving in the day helps reinforce the body clock and improves rest at night, vitamin D from the sun improves bone density, movement and agency improve mood. All of these are particularly important for people with dementia.
Another benefit to getting moving again that deserves its own paragraph is balance. Avoiding stays in hospital is so important that June dedicates a whole chapter to it- and it’s often falls that cause these prolonged stays. Improve balance to prevent falls and improve bone health to prevent fractures. Linking back to arthritis again, one recent patient comes to mind who had to use a stick to move around the house before her first appointment. We had very quick progress, and as her hips became more mobile, she found she could get around safely without the stick. One less thing to depend on, one less thing to trip over, and one more free hand! I can’t emphasise enough that osteoarthritis is not something that has to be lived with, and that doing so will likely lead to secondary problems.
Improving movement in a joint is one way to help with balance. For patients recovering from twisted ankles, I often prescribe an exercise to help with proprioception. Proprioception is information about where you are in space, and therefore is very important for balance. A lot of this information comes from the ligaments: ligaments get sprained if you twist an ankle, and you might feel like you can’t trust your ankle for quite a while. Exercises like standing in front of a mirror and going up onto your tiptoes while looking at your feet in the mirror, can be really useful for improving that proprioception. Find more information in the book about how to reduce the likelihood of falls by altering the environment: lighting, high contrast design, and appropriate flooring are just a start.
Dementia is not a reason in itself to avoid treatment. The consultation may be more difficult, but we’re very happy to work with that if it (indirectly) slows down the progression and secondary effects of the disease. If the patient has enough capacity to come on their own and consent to treatment, we can treat them as we always would have. If the patient is at a stage where power-of-attorney is necessary, then we just need the attorney to accompany the patient. The attorney can be very useful for filling in the gaps and sensitively correcting the reporting of symptoms. We still need consent from both parties, however.