Liam Butler interviews Dr Chris Perkins author of Dementia: What you need to know

03 February 2015

Liam Butler

Dr Chris Perkins (FRANZCP), is the author of The New Zealand Dementia Guide and Dementia: What you need to know - a guide for people with dementia and their caregivers. Chris has worked mainly in old-age psychiatry in both the public and private sectors. She holds a Diploma of Professional Ethics, is Director of The Selwyn Centre for Ageing and Spirituality, and works part-time as a locum around New Zealand. Chris is chair of the National Dementia Cooperative www.ndc.hiirc.org.nz

Question One

Dr Chris Perkins, in Dementia what you need to know you explain that people with Dementia still have sexual needs. How can family members learn to accept this and how can rest homes accommodate this need?

With difficulty.

A common complaint of spouses is that the person with dementia is less sensitive and caring towards their partner. Furthermore the person with dementia might misinterpret signals as being sexual or forget that they have had sex and become more demanding- this can be exhausting and upsetting for the partner. People need to be ingenious in coming up with ways to still be loving and intimate in ways that suit both parties. This can often be difficult to do without hurting the feelings of the person with dementia and there is no simple formula for this.

In residential care, staff need education to understand that despite cognitive impairment, people still have emotional needs, including sexual needs. There is nothing strange about this, however, there is quite a bit of ageism around. Family member and professional caregivers, often scoff at "geriatric sex", but for holistic care, sexuality must be taken into account. Once family and caregivers are aware of this, they might be more tolerant of the liaisons that occur in care. If the rest home has a positive attitude to the wellbeing of their residents and staff are understanding, then people cane usually talk through the issues so that the person with dementia can have their needs met at the same time as being protected from unwanted approaches.

Question Two

Dr Chris Perkins, you assert that "People with Dementia are some of the most vulnerable in our community. I believe they need protection against both ‘mercy killing' and misguided attempts to prolong their lives. We need to be able to let people die naturally, but provide the best possible palliative care support to dying people and those around them"

What are three things that can be done better in New Zealand to support care givers of people receiving palliative care?

• Advance directives:if the person with dementia is able to indicate ( before the dementia is too advanced) what sort of care they would like at the end of life, then this is a guide to the people making decisions in the final stages.
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• Discussion before action:the family and other carers should be involved in decisions about managing the terminal phases of the person's life.
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• Reduce the stigma of dementia:often people with advanced dementia are not regarded as "real" people. But of course people with dementia suffer pain, other physical symptoms and anxiety like the rest of us when we are dying, from whatever cause. Good physical and emotional care needs to be available to everyone. Although it is sometimes difficult to determine the person's needs, it is not impossible and there are various tested ways to do this.
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Question Three

Chris, what can a care giver do if they are worried about a person with Dementia driving even though their licence may have been revoked?

Oh dear. There are a variety of ways that families get around this. Of course being "up-front" with the person about family concerns, including the possibility that they might kill someone on the road is a start. Having a policeman visit to inform them they have lost their licence can work (and may be remembered). Failing that, they keys could be lost, the car taken to the garage where it cannot be repaired or some vital part of the motor removed so it can't go. These latter approaches involve deception, but sometimes this is the lesser evil. It is important to ensure that there are alternative forms of transport available.

Question Four

Chris, you conclude that "it never ceases to amaze me how those closely involved in the care and support of people with dementia can continue to do the right thing by those who cannot speak for themselves" How do you think we can better honor the work of care givers in rest homes and hospitals?

Pay them properly.

Dementia: What you need to know

Penguin Random House $39.99

Thorough and compassionate information about dementia and Alzheimers for caregivers and people with early dementia.

As the population continues to age, so too the numbers of people with dementia and Alzheimers grow. Inevitably, it will affect everyone in some way . . . as sufferers, or as carers, or as part of the wide circle of family, friends, professional and voluntary workers needed to support the main caregiver. The effects of dementia spread far into the community.

Based on Dr Chris Perkins' book acclaimed book The New Zealand Dementia Guide, first published in 2004, this is a completely revised and updated edition.

This comprehensive book has been written to give people the information they need to understand and come to terms with this illness, and cope with the changes that occur as the disease takes its course. It explains what dementia is, the different forms it takes, how and where to get help, diagnostic tests, treatment and medication, and the services available. It examines the issues involved in both caring for a sufferer at home, and when the time comes to choose residential care.

It is difficult for carers to achieve the right balance of reality and hope. Dementia can be a grim condition, which progressively deprives people of the attributes they value. But in this book, old-age psychiatry specialist Dr Chris Perkins aims to help caregivers at all levels deal with it with acceptance and compassion, offering humane and respectful care to people with dementia.

To enter the competition for a copy of this book CLICK HERE

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