Care for Dementia - Mental Health Solutions

Trained to care

Mr Ravi Samuel, a trained cognitive behaviour therapist, believes in the power of care, not cure, for dementia patients, says Susan Philip For many silvers, dementia, a progressive brain dysfunction, is akin to entering a dark world of disorientation, forgetfulness and chaos. There may still be no cure for Alzheimer's disease but right care can do much to dispel the darkness. That's the conviction of Dr Ravi Samuel, a Chennai-based cognitive behaviour therapist, who is determined to bring light to the lives of countless patients suffering from the ailment. "Despite the general literacy level of 56 per cent, most people in India know little or nothing about dementia care," says the 39 year-old, trained in London and Copenhagen and the only professional in Chennai certified by the Rehabilitation Council of India to work with elderly dementia patients.

Samuel offers cognitive rehabilitation therapy (CRT) to dementia patients, especially those with Alzheimer's -he is the only practitioner of CRT in Tamil Nadu. CRT is a guided therapy to learn, or relearn, ways to concentrate, remember and solve problems. Samuel started using it in India about three years ago. He uses software called 'Brain Train' developed in the US, which comprises various puzzles, like anagrams, mathematical calculations, logic sequences and memory tests, to stimulate every part of the brain. According to Samuel, CRT has proved useful in the initial stages of dementia. "Patients who undergo cognitive difficulties stop making an effort to regain their lost skills and go into depression," says Samuel. "That worsens the problem. These exercises help them regain much of their brain function and improve language, calculation skills and concentration.

The patients grow confident and can make the best use of their skills." Dr Deepak Arjundas-one of Chennai's leading neurologists, using occupational therapy, neuro-psychology and cognitive rehabilitation therapy to handle dementia cases-finds Samuel's skills to be effective. "He interacts with both patients and caregivers and ensures that the caregiver knows enough to handle things well. He evaluates the patient, sets exercises and demonstrates to caregivers how these exercises are to be conducted."Take Waris Ali, 75, for example, a patient of Alzheimer's, who was referred to Samuel by Dr Arjundas, a noted neurologist in Chennai. Medical tests revealed an infarction of the brain (a condition in which a segment of the brain is affected) and cognitive difficulties. He suffered loss of mobility, and low bladder and bowel control. Samuel started CRT on him, prescribing exercises for him while his family continued his medical treatment. Today, Waris no longer suffers from incontinence, has regained some mobility and responds to communication better. Samuel also believes in the power of images.

In 2002, Samuel developed the Dementia Pictorial Book, an illustrated book on dementia management, which was commended by the UN, WHO and Cancer Society, and found mention in world conferences of Alzheimer's Disease International (ADI) in 2002, 2003 and 2004. "I've always loved reading comics but often avoid reading a proper book," he confesses with a smile. The Dementia Pictorial Book is a comic book with a difference. There are no superheroes or legendary kings fighting epic battles. Instead, it depicts the real story of Usha, a teacher who developed Alzheimer's after retirement and shows how her family coped with the challenges. It underlines the progressively degenerative nature of Alzheimer's-patients ultimately need care in all aspects of their lives and care giving must be a shared family responsibility. Illustrator Xavier Rajan observed Samuel's sessions with Usha and other patients of dementia and interacted with their families before finalising the storyline with Samuel.

The text is bilingual, in English and Tamil.Samuel felt the book needed to do more than make the rounds of academic circles-it needed to reach the target group. With this in mind, he approached Chennai-based Vision Age India (VAI), an organisation offering community-based services to the elderly, of which he is a founding member. The ITC group sponsored the printing and the book was officially released on 9 March 2006.In fact, VAI has provided a strong platform for Samuel to reach out to silvers. From conducting seminars on physical, emotional and financial concerns of the elderly, VAI has widened its base since its inception in 1997 and now lobbies government on issues like lack of healthcare services and insufficient pension for seniors. It is funded by contributions from individuals and corporate bodies.Samuel is also a member of 10/66 Dementia Research Group, a research wing of Alzheimer's Dementia International, a key global body involved in dementia-related work. The group is currently conducting a worldwide study of the disease. "Symptoms of Alzheimer's are difficult to spot early, even in well-informed circles," says Samuel. "Initial symptoms are too often confused with normal deterioration owing to ageing." Apart from genetic factors, Alzheimer's can also result from ailments like tuberculosis, Parkinson's disease, brain injury, tumours or infections, alcoholism, nutritional deficiency and AIDS. "Withdrawal from social communication and depression act as a catalyst to the disease," adds Samuel. His advice to the elderly: undergo a medical check-up at least once in three months (those who suffer from diabetes and hypertension should go once a month); and develop a healthy lifestyle. "Read newspapers, read a book, socialise."

To families with patients of Alzheimer's, he has this to say: "Keep talking to them even if they don't make much sense. It creates positive vibes. Encourage them to do things. The focus has to be on care, not cure." As hired help is beyond the means of many families of dementia patients, VAI has launched home care for them, with trained personnel on a part-time basis, free of charge. Staff visits their homes and provides care, giving the family a much-needed break. While Samuel is doing his best to generate awareness on dementia, he feels India has a long way to go in coming to terms with the disease and the problems of the elderly in general. "In the West, help is available on various levels," he points out. "Respite care facilities, which let patients be admitted for a short time while caregivers take a break and community nursing facilities, where trained personnel assist caregivers at home, are easy to arrange. None of these facilities are

available in India."

He also feels events like the World Elders' Day make a mockery of the elderly. "They are celebrated with inane events like fashion shows and 'Best Couple' awards," he says with evident disdain. "But their problems are not being addressed at all." For his part, Samuel is determined to change this. And with him is his wife Sunitha, 39, a lawyer. "I'm happy that my husband is able to help so many people," she says. "I don't mind the late hours. He's so cheerful and patient with those who come to him for help, and he's the same at home too." Offering him quiet support are his mother Lalitha, 69, a retired schoolteacher, and father Dhanaraj, 70, a former employee of the Integral Coach Factory. Samuel likes to think positive and believes a little care goes a long way for dementia patients. "Do not let go so easily," he says, "and let them sink into a world of darkness and oblivion."

Ravi Samuel, cognitive behavioral therapist can be contacted at The Clinic
26/1 Arcot Street, T.Nagar, Chennai - 600 017, Tamil Nadu, India
0-91-44-2433 7439
http://www.urclinic.com/

Vision Age India: NGO for the Care of the Elderly
1 - Parjwal Apartments, 1, Zacharia Colony 2nd Street, Choolaimedu, Chennai 600 094 Tamil Nadu, India
091 44 372 1418 VAI@visionageindia.org
http://www.visionageindia.org/

Featured in Harmony MagazineJuly 2006