The Problem of Alzheimer's by Jason Karlawish

Author:Jason Karlawish
Language: eng
Format: epub
Publisher: St. Martin's Publishing Group

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The class, the brochures and web pages, the visits, emails, and telephone conversations with the Memory Center collectively gave Beverly and Darren Johnson knowledge and skills, and for about three years, our prescriptions of ways of living maintained their day-to-day well-being. But in time things began to fall apart. He could no longer read the newspaper. Television programs and his wood shop were confusing. He stuck to Beverly like a pet. She found this maddening. And then he became frightening. At the end of the day, he left her side to pace up and down the stairs and close the drapes. Home wasn’t working for Mr. Johnson.

She called me panicked. “He needs something to calm him. A tranquilizer of some sort.”

I agreed. He did need a new treatment, and so I drew up a prescription: not for a tranquilizer but for adult day care.

Of all the treatments for dementia, this is the most misunderstood. The confusion starts with the name. In Pennsylvania, where I practice, the state refers to the service as “older adult daily living centers.” The trade association that represents the providers of the treatment calls it adult day services. The recipients of the care are called clients, participants, or members.

The center I prescribed, Main Line Adult Day Center, describes itself as an “adult day care center” and the twenty-six people who attend it are “members.” That center is a two-story house set along a suburban street. The front lawn leads up to a porch and a side driveway to the back entrance. It is all quite homelike, but inside is a lobby with a chest-high counter that resembles a physician’s waiting room and a room equipped with basic medical equipment. And yet the space is neither a medical nor a rehabilitation facility. The multiple names for the place, the people who attend it, and the hybridized architecture denote something distinct, a therapeutic activity program for adults with cognitive and behavioral impairments.

Families often react to my calling it a treatment as though I’m kidding them, that I’m playing with the idea of treatment. I’m insistent, however. I’m not joking. For many patients, a therapeutic activity program is a far more effective and safer treatment than the medications prescribed for agitation. It reduces agitation and stress not only in the people who attend it but also in the family members I persuade to try it.1

I insist that before they reject the idea, they at least visit a center. In these places, I explain, every activity has a purpose and the staff are mission driven to achieve that purpose. They’re typically trained in occupational or recreation therapy and how to communicate with persons with dementia, a skill that relies on listening to emotions more so than exact words. They’re not in it for the money.

The days are a scheduled succession of activities beginning with breakfast and then exercise, word games such as using the letters of a long word (“astrophysics”) to spell shorter ones (“chat,” “sit,” “spot,” etc.), singing, and trivia.

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