Interviews

Interview 1: Claire Solu-Burd

Occupation: Psychotherapist, social worker

Location: New Jersey, United States of America

Interview type: doxy.me (video call)

Interview date: 28th of October 2020

Interview Duration: 40 minutes

Biography:

Claire Solu-Burd has an undergraduate degree in Psychology. She also has a degree in Political Science. She has a master’s degree in Public administration and in Social Work. During her master’s degree she specialized in ageing. During her university path, she worked at a nursing home that dealt with Alzheimer’s and Dementia patients for 5 years.

She has a social work and clinical license. She curently works in a private practice where she works with dementia/ alzheimer’s elderly, as well as their families and/or caregivers.

What are some of the most common mental problems that people with Alzheimer’s/Dementia face?

It’s hard to discern when mental health issues come up for, the dementia/ Alzheimer’s elderly, but what I saw when I worked at the nursing home are symptoms of depression and anxiety. Sometimes, almost 1 out of 10 patients would present delusion, where they could have a period of delirium or hallucinations. They hear, see, smell things that are not in the room.

What are some of the methods you provide them with to help cope with the issues they are facing?

We use a technique called validation therapy. It’s such a compassionate way to manage someone in a moment of extreme stress or sadness. It’s basically whatever they say and whatever they do is validated. If, for example, a dementia patient complains that someone is bothering them and there is no one in the room, what I would say for example is, “yeah why does she always bother us like that?” So, instead of escalating the stress what we do is contain the stress. The minute you challenge a patient with dementia or Alzheimer’s they become even more dysregulated. We also use recreational therapy, which is a whole set of staff members that provide services for dementia patients. They might do music therapy, a very healing method of therapy for dementia/alzheimer’s patients. It calms their nervous system to where they feel more alive. There’s also massage therapy and aromatherapy. Recreation staff would sometimes do hand massages. As for aromatherapy, they would use diffusers that would release different scents that would calm the nervous system of the dementia/ Alzheimer’s patient. We’ve also done pet therapy, where people bring in animals. Just because you have Alzheimer’s doesn’t mean you don’t want to connect with the things that you love. There’s also art therapy. Art therapy is not about being a good artist, it’s about connecting with paint, materials, glue, and glitter. They tend to tailor the art therapy around the time of the year and the holidays. Often dementia and Alzheimer’s patient don’t remember what time of the year it is, so stirring up their emotions by reminiscing, using reminiscence therapy helps them piece together pleasurable memories from the past. There is also at least one exercise a day that the dementia/ Alzheimer’s patients too such as chair exercises.

Do you feel like exposure to the outdoors helps the person with Alzheimer’s/ Dementia improve their mental health?

There’s a couple of things that I’ve seen that really work one is a bird feeder. Connection to nature is very important. It could just be through the window. The whole mood of the person when the sun hits their face for the first time is transformational, we really value outdoors with our patients. It’s about sitting somewhere and noticing the little things and being more mindful of your surroundings. Bringing attention to the current moment is really helpful for the dementia and Alzheimer’s elderly. It evokes it works peace within the elderly.

What are some ways caregivers can help the people with Alzheimer’s/Dementia, in terms of improving their mental state, or helping the person with Alzheimer’s/ Dementia cope with the cognitive problems, or other issues they might face?

When you provide socialization for people with dementia and Alzheimer’s, it reopens their capacities for connection. Socialization is incredibly important but certain features of dementia or Alzheimer’s isolate people. It’s extraordinarily isolating so these adult day centers are specifically for people with challenges. It’s important for caregivers to find a community of people for the person with dementia or Alzheimer’s who have similar challenges so that your loved one can go and have socialization and not feel judged. For caregivers, connecting with other people who are going through similar challenges is just as important. This helps normalize the experience instead of having a feeling of shame or embarrassment.

Would you recommend for the person with Dementia/ Alzheimer’s to stay at home with their caregivers or stay in a nursing home?

It depends on the capacity of the caregiver. Caregivers are always hypervigilant, where they’re always scanning the dementia elderly to check on their well-being. This increase of stress translates to the relationship dynamic. Considering the progressive nature of the disease, the caregiver would have to evaluate the level of care needed for the dementia elderly. There’s research that shows that the caregivers sometimes get even more sick than the person they’re caring for because they don’t prioritize themselves. It’s mostly on a case-by-case basis since every case is different.

What are some ways can Alzheimer’s/Dementia elderly do to familiarize themselves in their place of residence?

I worked in a facility that called itself a bed and breakfast. It was well decorated, but with safe furniture that wouldn’t topple over. There were lamps, instead of the industrial overhead lights. Every single month, there was a change of decorations and it was easily seen what they were trying to communicate through this change. Every month there would be a clue on what’s going on in the world outside. There was also safe access to the outdoors. There was a water feature and lots of plants. There would be gardening activities with the residents because we didn’t want them to lose their interest. We want them to heal like they are at home. They would use facility furniture, something safe but they’d also make it provide the feeling of home. There’s a lot of ways to humanize what feels clinical. When it comes to people with Alzheimer’s or dementia that stay at home, I would say always keep a photo album. A photo album that shows the image, and for example would mention (daughter) or (granddaughter). When we think about presenting the day and the time, there are huge alarm clocks the narrate the day, the date, and the weather. Making things more accessible in a safe space is very important.

If so, how can they enjoy the outdoors without exposing themselves to danger or harm?

Some facilities create a courtyard in the middle over the facilities where there’s only a certain number of entrances this can be accessed. These spaces usually have a lot of windows looking in on that space to make sure that the patients are being monitored. The facility I worked up would have sensors on the doors so we would know if someone was attempting to leave. It feels more like a punishment to lock the doors but it’s a safety measure that we have to take, just to make sure that their accompanied when they are going out. Access to outdoors has to be careful and we have to think of all the what ifs.

Do you recommend the person with Alzheimer’s/Dementia to be in the same environment as other persons with Alzheimer’s/Dementia? If yes, why? If no, why not?

I think it makes better sense to help people who are struggling with the same cognitive issues to be cared for it together. It would be hard to meet their needs if they weren’t going through the same cognitive issues. Even with dementia, it’s hard to navigate it because you don’t want someone to feel embarrassed or ashamed that they don’t know what day it is, for example. It’s sort of like if you have a school with a first grader in 9th grade and you’re trying to teach them the same thing. You would do it very differently. In an institution, it’s easier to feel comfortable when dealing with the same types of gaps because there’s stuff that are trained to deal with it. In some ways, that makes it more tolerable to have a place that caters for similar issues.

Do you think that they should be isolated to avoid harm to themselves, or more active in the society where they go out and see people?

If you think about it in stages, when you put someone in a nursing home, where they just got a dementia diagnosis, is not a good idea. Dementia or Alzheimer’s, in the first stages, isn’t as difficult. They can live by themselves and not someone to check on them. It’s hard to make generalizations since there are different stages. If they have demonstrated that they could be a danger at home, then it makes sense to have a 24-hour nature to their care. That could be through aids, nursing assistants that stay at home with them or staying in facility. Some people don’t need as much socialization but most of us benefits so greatly from other people so there would be a big benefit of being in a facility with others dealing with the same issues.

Interview 2: Dr. Mohamed Lafta Mozan

Occupation: Senior Consultant Neurologist

Location: Doha, Qatar

Interview type: in-person

Interview date: 31st of October 2020

Interview Duration: 15 minutes

Biography:

Dr. Mohamed Lafta Mozan has a bbachelor’s degree in Kufa College of Medicine in Iraq in 1999. He was part of the Neurology Board in Baghdad in 1998. He worked in BBaghdad Teaching Hospitals from 1990-1998. Then, from 1998-2007, he worked in Saddam General Hospital in Baghdad, Iraq.

He’s had training courses in Neurophysiology in the USA. He’s had 18 years in practice within the neurology field. He’s in the American board in Aniaging Medicine. He has awards and recognition for UCL Exam in neurology and Felowship of American Academy in regenerative medicine.

He currently works in Al-Emadi hospital in Qatar where he treats neurological cases for outpatient clinic and inpatient in relation with central and peripheral nervous system.

As a neurologist, what is it that you do for Dementia and Alzheimer’s patients?

Our duty in neurology clinics is to differentiate treatable causes of dementia from untreatable causes. The main treatable dementias are those associated with metabolic disorder and endocrine disorder, mainly hypothyroidism and exclude surgical cases like brain tumors and subdural hematoma and NPH. In neurology clinics, we depend on diagnosis of lab tests and MRI brain tests. Some patients are also sent as far for SPECT or PET scan. Our main tool for detection of memory brain disorder is the use of MMSE test scores. Alzheimer’s disease is a complex neurodegenerative disease considered as the most common cause of dementia. 75% of all dementia is due to Alzheimer’s disease. It is the 5th leading cause of death and effects 1/3 of people above 85 years old. Every year, 5 million new cases are added to the pool of the disease. There are now 25 million cases all over the world.

What are the biggest problems people with dementia/ Alzheimer’s face? What are the symptoms?

It depends according to the stage that the dementia elderly is at of the disease. the three stages start from mild, moderate to severe. It can go from memory to loss of insight to psychotic episodes, dehydration, loss of eating and loss of control of feces.

What are some medications that you prescribe or recommend for the diagnosed elderly?

In medical terms, we use Donepezil, Rivastigmine, Galantamine. These medicines decrease the acetylcholine levels. We also use NMDA inhibitors such as Memanine lomytab that increase the glutamate levels. There isn’t a single just one dementia test memory decline and impact on daily life function leads to the decline and inability to judge and think and plan in one’s daily life this leads to emotional liability and social life coarsening such as depression and anxiety.

Do these medications provide different side effects?

These medications do provide side effects some of the side effects are problems with urination. if the patient has a cardiac disease then some medicines are to be reconsidered since it could negatively affect them. the medicines also cause agitation where the patient has a difficulty to fall asleep.

What advice do you usually give the caregivers when you meet with them, on how to take care of the elderly?

It usually depends on the stage. It’s encouraged for the patient to do mathematical exercises, read novels and/or religious books. It’s also encouraged for them to be socially active and to meet with people, to ensure a sense of socialization. In more advanced stages, it’s recommended for them to follow a routine within their life, where they stay in the same place, follow the same activities, and see the same people.

What can be a trigger for the dementia patients, something might worsen their symptoms?

Usually, when they have other illnesses, such as just infections or previously done surgeries. This could trigger the dementia/Alzheimer’s symptoms. A big change of scenery could also negatively impact the patient, such as travel or a big change in the routine.

What are your recommendations for the people with Alzheimer’s or dementia, in terms of what can help lessen the progression of the disease?

Keeping a certain routine for the patient is very effective. Access to the outdoors is very helpful, a deeper connection with nature. Accessing these outdoor environments would obviously be only with a familiar person. Having kids around them increases their morale. Allowing them to do some simple manual work, like drawing or painting or gardening helps with the behavioral problems they might face.

In Qatar, what type of care do the families of dementia patients choose for the year diagnosed elderly?

Usually, the ones that take care of the patients are the family members. in Western countries they usually hire a carer that could be paid by the government, or the patient could be referred to a rehabilitation institution or nursing home where their retirement money is sent to the center.

What other diseases can result from dementia and Alzheimer’s?

Dementia could cause brain failure. Dementia could also result to a chest infection which could cause death. Falling is a big issue that could result to fractured bones. Dementia patients also get bed sores and septicemia. A lot of dementia patients in severe cases face difficulty in swallowing, They could also have cases of dehydration. Dr. Mohamed Lafta Mozan provided the Mini-Mental State Exam (MMSE) that they use in Al-Emadi hospital, where they test the patient’s orientation, attention, memory, language and visual-spatial skills to determine the severity of tthe cognitive issues.

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Design Considerations

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