Drugs not the only solution

2011-09-21 00:00

TODAY is World Alzheimer’s Day. More than 35 million people worldwide are living with Alzheimer’s disease (AD), according to the 2010 Alzheimer’s Disease International World Report.

By 2030 there will be 65,7 million and by 2050 around 115,4 million. An extrapolation of South African stats, suggests about 254 000 of us are living with this condition.

The manner in which we, as South Africans, care for those living with Alzheimer’s is one that is in dire need of change.

In many care homes across the nation we still practise conventional methods of care, including drugging Alzheimer’s patients with anti-psychotic drugs: the most common ones being Seroquel, Risperdal and Zyprexa.

These drugs have not been designed for use in those with Alzheimer’s, yet they are continuously prescribed for this “off- label” use. American pharmaceutical giant Eli Lilly and Company agreed in 2009 to plead guilty and pay U.S.$1,415 billion for promoting its drug Zyprexa for uses not approved by the FDA.

Pharmaceutical giant AstraZeneca settled a $68,5 million, multistate allegation that the company deceptively marketed its anti-psychotic drug Seroquel.

Seroquel, Risperdal and Zyprexa and other atypical anti-psychotic drugs can produce dangerous side effects, including weight gain, hyperglyceamia, diabetes, cardiovascular complications and increased risk of mortality in elderly patients with dementia.

In a 2005 British Medical Journal report it showed that Seroquel was ineffective in reducing agitation among Alzheimer’s patients, whose usage of the drug constituted 29% of sales. It was found to worsen cognitive function in those with dementia.

A 2006 study showed that for most Alzheimer’s patients, anti-psychotics resulted in no significant improvement over placebos in treating aggression and delusions.

So is there an alternative? In the United States and other countries, some nursing homes are using an approach called “Environmental Intervention”. This includes reducing boredom, providing intellectual and physical stimulation, exercising, playing calming music, bringing in pets for therapy, and improving how staff members talk to elderly patients.

In addition, another group of anti-dementia medications, including Aricept, Exalon and Menamda showed noticeable positive improvement in 10% to 20% of Alzheimer’s patients, with 40% more showing some cognitive improvement, experts say.

Some physicians say that simply paying attention to patients with dementia can help ease symptoms. In random trials of anti-psychotic medications, 30% to 60% of participants in the placebo group improved.

Person-centered care is an approach that involves tailoring a person’s care to his or her interests, abilities, history and personality. This helps people to take part in the things they enjoy and can be an effective way of preventing and managing behavioural and psychological symptoms of dementia. A detailed, social history of the person makes for an effective care plan.

In the U.S., Dr William Thomas founded the Eden Alternative. This philosophy is used successfully around the world. Yet, it is only now reaching South African shores.

Naomi Feil founded Validation Therapy, which is used with phenomenal success worldwide. Again, it’s a new concept for South Africa.

Dementia Care Australia has developed The Spark of Life approach, under the guidance and direction of Jane Verity, a leading authority on dementia care.

Here in Ixopo, there is a home that has developed a unique philosophy of its own, one that incorporates and works well with all of the above philosophies. Its most notable feature is that it is an anti-psychotic drug-free environment.

Unicorn’s Haven has been operating since 2006.

I am the owner and hands-on manager of this home. I developed the home’s philosophy around a lifestyle that I would like to have when I get old and if I were to get Alzheimer’s.

Our holistic approach, focussing on mind, body and soul, is imperative. Just because someone has Alzheimer’s, it doesn’t give us the right as carers to drug that person in order to make our lives more comfortable or to make the routine of the home easier. At Unicorn’s Haven we believe the day has to revolve around the capabilities of the person living with Alzheimer’s. This is why we keep the home small with a maximum of two to six residents. This makes meeting the five universal emotional needs easier.

While these concepts and philosophies are foreign to us, South Africa has to move with the times. We cannot be left in the dark with regards to caring for our elderly dementia population.

We need to remember those living with Alzheimer’s every day, not only today.




• Ramona Alexander is available to give talks on dementia and Alzheimer’s. She can be contacted through her website: www.unicornhaven.co. za





• Alzheimer’s is a form of dementia that causes problems with short-term memory loss and behaviour.

• It accounts for 50% to 80% of dementia cases.

• The majority of people with Alzheimer’s are 65 and older, and it is a progressive disease, getting worse over time.

• In its early stages, memory loss is mild, but with late-stage Alzheimer’s, individuals lose the ability to carry on a conversation and respond to their environment.

• Alzheimer’s has no current cure and current treatments cannot stop it from progressing. They can temporarily slow the worsening of dementia symptoms and improve quality of life for those with Alzheimer’s and their caregivers.



THE second Dementia SA Conference will take place on October 25 and October 26 at The Pavilion Conference Centre, V&A Waterfront, Cape Town.

This conference will explore some of the global methods and best practices in caring for people with dementia of which Alzheimer’s disease is the most common dementia. The all-important factor is to maintain respect and dignity for the person with the disease.

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