Module 5 · Part 4 of 5
Do not cast me away when I am old; do not forsake me when my strength is gone.
— Psalm 71:9
An explanation. While this section covers important information, it's not comprehensive — we've kept it shorter so you don't get bogged down. It's essentially a reading section, and only two True/False questions are given in the Statements page for this part of the module. If you'd like to learn more, please look up the relevant pages in the Handbook.
If you or a friend has a diagnosis of dementia, you'll probably have questions about what it means, what to do, and who can help — both short term and in planning for the future. The most important thing to understand is that help is available, whether living at home or in an aged care home.
Dementia is a condition — a group of related symptoms — associated with an ongoing decline of the brain and its abilities, including memory, thinking, language, understanding, and judgement. It usually occurs in people aged 65 or over, though it can occur younger, even in children. Around one in four people living in Australia over 85 have dementia.
What is the most common type of dementia? Alzheimer's disease, accounting for 50–70% of all dementia cases. It's a degenerative condition affecting the brain — as brain cells die, the brain's substance shrinks, and certain information can no longer be recalled or understood.
When is memory loss more likely to be associated with dementia? Many people worry that forgetting things might indicate dementia. It's normal to occasionally forget an appointment or phone number — memory loss associated with dementia is most likely to be persistent and progressive, not just occasional.
You may notice changes in how you communicate with your friend — difficulty finding words, speaking fluently, understanding, writing, reading, or expressing emotions. They may also lose normal social conventions, like ignoring what you're saying or interrupting. When communicating with someone with dementia, it's important to:
Is not wisdom found among the aged? Does not long life bring understanding?
— Job 12:12
Research on anxiety in older adults lags behind research into other conditions like depression and Alzheimer's. Until recently, anxiety disorders were believed to decline with age, but experts now recognise that ageing and anxiety aren't mutually exclusive — anxiety is as common in the old as the young, though how and when it appears differs. Anxiety disorders in older people are real and treatable, just as in younger people. Depression and anxiety commonly go together in the elderly, as in the young — almost half of those with major depression also meet the criteria for anxiety, and about a quarter of those with anxiety meet the criteria for major depression. As with younger people, being a woman and having less formal education are risk factors.
Recognising anxiety in your older friend poses several challenges. Ageing brings a higher prevalence of certain medical conditions, realistic concern about physical problems, and higher use of prescription medications, making it harder to separate a medical condition from anxiety symptoms. Diagnosing anxiety alongside dementia is difficult too — agitation typical of dementia can be hard to separate from anxiety, impaired memory may be mistaken for a sign of either, and fears may be excessive or realistic depending on the person's situation. If you're in doubt about your own observations, consider encouraging your friend to seek professional support — for example, "Have you thought of talking to your doctor about your concerns?"
Depression is a serious disorder — far more complex than simply feeling moody or blue. Older people experience similar symptoms to younger people, but these often go unrecognised, misdiagnosed, or poorly treated — symptoms like loss of sleep, memory, or concentration are mistakenly regarded as simply age-related. Diagnosis is harder too, since older people often feel more comfortable discussing physical complaints than acknowledging depression as more than sadness; when depression combines with dementia, diagnosis becomes even more complex.
Depression and anxiety explained. "Depression" is often used to describe the sadness we all experience at times, but it also describes a form of mental illness called clinical depression. Because depression is so common, it's important to understand the difference between everyday unhappiness and clinical depression's symptoms. When faced with stress — loss of a loved one, relationship breakdown, disappointment — most of us feel unhappy or sad, but these feelings usually last only a limited time and aren't clinical depression, just part of everyday life. Clinical depression describes a group of illnesses where the person has an excessive or long-term depressed mood affecting their life, often accompanied by anxiety. Whatever the symptoms and causes, treatment can be very effective.
Depression is common across all ages, cultures and backgrounds, with symptoms ranging in severity from irritability to suicidal feelings. If you're caring for a friend with depression, the good news is that safe, effective treatments are available — but the first step is recognising the symptoms, of which there are many (some 17 are listed on page 70 of the Handbook).
Causes of depression are rarely singular. Some people seem more prone than others; sometimes it happens without apparent cause; other times, coping with stressful events contributes. Examples (with more in the Handbook) might include:
Coping with ongoing stress can also cause depression, including:
Treating depression and anxiety. Treatment for older people is the same as for any other age group, depending on symptoms, and will take one or more forms:
Talking with a health professional in a structured way can help relieve depression — therapy involves a choice of one or more psychological approaches, aiming to work on how the person reacts to circumstances and relationships.
I have upheld since you were conceived, and have carried since your birth. Even to your old age and grey hairs I am he, I am he who will sustain you. I have made you and I will carry you.
— Isaiah 46:3–4
There's a variety of circumstances in which someone may be diagnosed as needing palliative care. They may wish to stay in their own home, in which case specific palliative care teams can visit — usually including a medical person managing pain levels, and a carer handling day-to-day functions like medication, hygiene, diet and nutrition. You, as a spiritual carer, may be invited to join that team.
A person may be admitted to a hospice with 24-hour care, or be in aged care with similar assistance available. In each case, you may be able to provide specialist emotional and spiritual support while others carry out their specific functions — not all team members will have the expertise or time to sit and listen with the dying person, and "live" their journey with them.
Peter Hudson provides a list of things you may be able to do with someone in palliative care to help provide emotional care — you might like to look these up in the Handbook.
Prayer for your friend in palliative circumstances can be very helpful, and lead to their peace of mind. What might you include?
Remember to keep your prayers short, as the dying friend's attention span could be very limited.
We do hope we haven't lost you, but these issues can be very important for your older friends. Again, this section is largely for reference — remember there are only two simple questions on this part in the Statements work page at the end of the module. If you'd like further perspectives, view the videos below - the presenters are qualified and experienced practitioners.
Continue to the next part of Module 5.