Ageing DS population raises dementia issue
by Coen Lammers
As life expectancy of people with Down syndrome is increasing, the number of them developing dementia is also growing.
The extra chromosome that causes the developmental and health issues associated with Down syndrome also carries the Alzheimer’s genes, so people with Down syndrome often develop dementia at an earlier age.
Research shows that about one third of people with Down syndrome over 50 years develop dementia, which is creating new questions and challenges for families, support workers and health services.
Two leading Australian scientists analysed all the available research around this subject which they published last year.
Currently in New Zealand, there is no coordinated effort from the health authorities to prepare the sector for the ageing population with Down syndrome, so people on the frontline are left to come up with their own solutions, in their own community.
Hohepa Canterbury in Christchurch provides residential care and other services for people with intellectual disabilities and may be the only organisation in the country with a dedicated dementia unit for people with Down syndrome.
General manager Arnah Trelease explains that people with Down syndrome and dementia need specific care and staff need specialist training, which Hohepa originally was not able to offer.
“When the first people presented with dementia, they had to move to rest homes, where sadly they would not last very long and usually pass away within six months,” says Trelease.
Moving their clients away from Hohepa, however, was contrary to the commitment the organisation had made to its members that they could live out their days in their own environment.
“Dougie Brown was one of our original clients back in 1964 and when he started developing dementia, his mother Jendy refused to let him go to a rest home and reminded us of our commitment to our people.”
Hohepa considered its options and decided to turn Dougie’s house, Rose Cottage, into a dementia unit within Hohepa.
“We had to move Dougie’s house mates to different houses on our grounds, which got some resistance from the families, but they now tell us that we made the right decision,” says Trelease, who adds that the establishment of the dementia unit was only possible thanks to close collaboration with the Canterbury District Health Board.
“Tracey Hawkes from the CDHB has trained our staff in the Walking In Another’s Shoes programme to give them dementia related skills and helped us set up Rose Cottage.”
Juliet Nelson is the Integrated Support Manager running Rose Cottage and she says the big difference with a normal rest home are the staffing levels and the fact that people stay amongst their own people in a familiar environment.
The five clients who currently live at the cottage have two staff members, which is a significantly higher ratio than rest homes, which enables the staff to engage with the clients more one-on-one and find activities that fit the stages they are in.
“They remain part of our community and live as a family. They can watch the meals being prepared and sit around the table to have dinner,” says Nelson.
Hohepa has clients ranging from 6 to 82 years of age. “So they should not be moving out at the most vulnerable stage of their lives,” says Trelease.
“They should be able live out their lives in a familiar environment,” says Trelease who adds adds that the demand for dementia care is increasing and Hohepa are about to open a second unit.
“It feels like we’ve got a flood coming, and not just here. Other providers are contacting us because they may have one or two people getting dementia but are not able to set up their own units, so I think we will need a lot more collaboration in this space,” says Trelease.
Geraldine Whatnell on the other hand feels that the flood is more likely to be trickle.
Whatnell is part of the National Dementia and Intellectual Disabilities Steering Group and the first qualified Nurse Practitioner Dual Disabilties in New Zealand, specialising in intellectual disabilities and/or Autism Spectrum Disorder and associated mental health needs.
She says the most recent research indicates that the numbers of people with Down syndrome developing dementia may not be as high as assumed a few years ago.
Whatnell says he numbers may be inflated because many people with Down syndrome are incorrectly diagnosed as having dementia.
“Someone may present as being confused or off their food and doctors often go straight to dementia because they see someone with Down syndrome. In many cases, however, there could be other health reasons that can be easily reversed,” says Whatnell.
She says that people with Down syndrome are often diagnosed too late because they do not have the language skills that indicate any changes. “So caregivers and health providers need to look for other indicators.”
The early warning signs for dementia is often epilepsy and starts presenting itself in the late 40s.
To help the doctors with their assessment, Whatnell hopes one day soon every person with Down syndrome will complete a baseline test when they are around 30 years, the Baseline Observation of Functioning For People with Intellectual Disabilities (BOFIID).
“And once you have that baseline doctors can compare those data when that same person presents later in life,” says Whatnell, adding that early diagnosis can lead to better support, better quality of life and less anxiety for the families.
To get a clearer picture if there is any onset of dementia in their 40s, caregivers can also use another effective screening tool, the Dementia Screen Questionnaire for Individuals with Intellectual Disabilities (DSQIDD).
Unfortunately, the Ministry of Health does not have data on how many people with Down syndrome in New Zealand have dementia.
Toni Atkinson, Group Manager Disability Support Services at the Ministry of Health, says the Ministry is aware of the misdiagnosis issue, but hopes the DSQIID baseline will help health professionals and support workers to notice any earlier decline in functioning.
“New Zealand has a growing and ageing population and we recognise that people with Down syndrome and their families will also be looking to the future and what supports are available.”