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Section 4
Cognitive Impairment in Old Age

Question 4 | Test | Table of Contents

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In the last section, we discussed catastrophic reactions.  With Valerie, three methods were beneficial to her as a caregiver regarding dealing with her husband Sam’s catastrophic reactions.  These three methods for dealing with catastrophic reactions are avoiding catastrophic reactions, preparing for catastrophic reactions, and managing catastrophic reactions.

In this section,s we will discuss excess disability.  Key factors regarding excess disability concerning dementia related cases are understanding excess disability and how to avoid excess disability through identifying problems and finding the right approaches.  If you believe that an understanding of excess disability may benefit the caregiver of your client, you might consider playing this section for him or her. 

3 Factors Regarding Excess Disability Concerning Dementia

♦ Factor #1 - Understanding Excess Disability
As you know, the rate of decline of an aging client with dementia may increase when certain skills are not used either due to excessive or inadequate care. Karen, age 51, did not have a working understanding of excess disability. Karen was the sole support for herself and her mother, Elaine. Elaine, age 83, was in the middle stage of vascular dementia. Karen’s determination and thoroughness often led to her not allowing Elaine to do all the things she was still able to do.

Karen stated, "My mom can still take care of herself pretty well considering how forgetful she is. But so often it is quicker and easier if I just take care of her and do things myself. For instance, the other day she got up and got dressed. She made breakfast for herself. After a while I noticed she was not eating. So I encouraged her to eat and told her we had to leave soon. About ten minutes later, I checked on her. She had only eaten a few bites. I would have been late for work at that rate, so I started feeding her."

I stated to Karen, "The incapacity a person displays which is greater than the true disability is called excess disability. Think about it.  Could Elaine do more for herself than she is currently doing?"  Karen agreed that Elaine could be more capable if allowed more time for certain tasks or if she received better guidance. Think of your aging client with dementia. Have you found that if clients do not use skills, they lose them?  Could excess disability be the reason for a rapid decline in some clients with dementia? 

♦ Factor #2 - Avoiding Excess Disability
As you are aware, a common goal regarding clients with dementia is for the client to keep functioning as well as possible given the level of impairment. If successful, this goal helps clients in avoiding excess disability. By identifying problems which may lead to excess disability, caregivers can successfully avoid unnecessary decline in clients with dementia.

Three Problems that Lead to Excess Disability
-- # 1 - The first problem Karen had in meeting the goal of avoiding excess disability was that she expected Elaine to continue to function as she always had and in the same amount of time. 
-- # 2 - The second problem Karen had was that she was not aware of Elaine’s recent decline because Karen had not been conducting regular assessments of Elaine’s condition.
-- # 3 - In addition to unreasonable functional expectations and failure to regularly assess, the third problem Karen had in meeting the goal of avoiding excess disability was that she had not figured out how to adapt tasks for Elaine without taking over completely.

I asked Karen if she felt that Elaine could feed herself. Karen stated that Elaine could feed herself. I explained to Karen that she would not create an excess disability by feeding Elaine occasionally. I stated, "However, if you start to take over all or most of the time, you will create an excess disability. Your definition of success for Elaine must change as the dementia changes her.

If you do not regularly assess your mother and adapt the amount of help you are providing accordingly, you may either not help enough or help too much. Either way you could create that excess disability." In addition to regular assessment and adapting help, I also reminded Karen that if a person with dementia does not use certain skills, he or she will lose them.

Think of your Elaine. Could your client’s skill sets be viewed as "use it or lose it?"

♦ Factor #3 - Approaches
Three general approaches that Karen used to avoid excess disability in her mother, Elaine, relate directly to identifying the problem causing the excess disability. For Karen, these three approaches concerned reversing her own behavior which was causing Elaine to have excess disability.

3 Approaches to Avoid Excess Disability
-- # 1 - In her first approach, for example, Karen accepted Elaine’s decline. Karen stated, "I need to realize that I’m not failing as a caregiver just because mom can’t do everything on her own anymore."
-- # 2 - In Karen’s second approach, she began to assess Elaine’s dementia regularly. 
-- # 3 - In addition to accepting decline and regular assessment, Karen’s third approach was adapting the amount and type of help she directed toward specific tasks.

Karen stated, "I should probably think through how to help without doing too much.  If I give her more time and guide her step by step, maybe she’ll be able to do more." Karen began to do as little as possible, but helped when she was needed.

Think of your Elaine. Is your aging client with dementia in danger of gaining excess disability due to excessive or inadequate care-giving? Would it be helpful to play this section for the caregiver of your client?

In this section, we have discussed excess disability. Key factors regarding excess disability concerning dementia related cases are understanding excess disability and how to avoid excess disability through identifying problems and finding the right approaches.

In the next section, we will discuss care for the caregiver. Two important aspects of care for the caregiver are mandatory self care and warning signs of emotional overload. We will also discuss the COPE technique. The COPE technique can be used to help remind a caregiver of his or her daily needs.
Reviewed 2023

Peer-Reviewed Journal Article References:
De Lucia, N., Grossi, D., Milan, G., & Trojano, L. (2020). The closing-in phenomenon in constructional tasks in dementia and mild cognitive impairment. Neuropsychology, 34(2), 168–175.

Di Nuovo, S., De Beni, R., Borella, E., Marková, H., Laczó, J., & Vyhnálek, M. (2020). Cognitive impairment in old age: Is the shift from healthy to pathological aging responsive to prevention? European Psychologist, 25(3), 174–185.

Wilson, R. S., Barnes, L. L., Rajan, K. B., Boyle, P. A., Sytsma, J., Weuve, J., & Evans, D. A. (2018). Antecedents and consequences of unawareness of memory impairment in dementia. Neuropsychology, 32(8), 931–940.

QUESTION 4
What are three factors regarding excess disability concerning dementia related cases? To select and enter your answer go to Test.

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