In the film The Savages (Jenkins, 2007) two siblings (Jon and Wendy Savage, the parallel to the Peter Pan characters by the same first name is not hidden) are brought together to care for their aging father who has dementia. Lenny Savage (the father) is the patriarch of the estranged Savage family. Lenny was living in Arizona with his girlfriend, whom we suspect also has dementia, but she abruptly passes away as the film begins. Lenny has had no connection with his children who both live far away on the east coast (Jon in Buffalo; Wendy in New York). Their mother is out of the picture having left their father years before and no one knows where she is. The children, left to their own devices, have grown into isolated, repressed, emotionally-stunted, self-absorbed adults (savages). The film is more about the struggles of the sister and brother to grow up and face reality than about the struggles of care giving for a demented parent. Philip Seymour Hoffman's Jon, a professor and Brechtian scholar, is unable to commit to a relationship and an emotional mess while Laura Linney's Wendy has a penchant for little white lies, is in a relationship with a slimy married man, and is wound so tight it appears as if she will break at any moment. Of course these two are not equipped to handle the task of caring for Lenny. Jon, cold and all business, secures a nursing home immediately, but his emotional aloofness leaves Wendy floundering. She attempts to brighten up the situation (artificially) in the nursing home by placing lava lamps and fluffy pillows in Lenny's room. Of course these only backfire.
The film's uses well-acted scenes of squabbling and the power struggle between brother and sister, feelings of guilt about their relationship with Lenny, and coming to grips with the reality of mortality in the midst of trying to find some meaning and relevance with life. There are no overly dramatic speeches, no social commentaries on health care, just two people finally having to deal with life, aging, death, relationships, and moving forward. It is an excellent film.
The film gives a small view as the different supports for dementia, but as the film depicts dementia in a rather soft light and somewhat inconsistently the film is not really offer a realistic view of the difficulties patients with dementia and their families suffer as a result of this condition.
Medically, dementia is addressed from a number of different perspectives. There are several different approaches that are used to formulate the diagnosis of dementia. Some dementias, particularly Alzheimer's disease, can only be definitively diagnosed via autopsy or brain biopsy (Sadock & Sadock, 2007). However, there have been significant advances in neuoimaging techniques that allow clinicians to view the brains of people with suspected dementia and assist in the diagnosis of dementia. Clinical tests such as behavioral testing, neurological examinations, medical testing and laboratory values can help distinguish a diagnosis of dementia from other potential problems (Sadock & Sadock, 2007). In particular the diagnostic criteria for dementia (e.g., American psychiatric Association [APA], 2000) allow clinicians to determine if there is enough evidence for the behavior presentation in dementia to diagnose it. There are a number of medical conditions that are associated with dementia and some of these such as severe depression or normal pressure hydrocephalus are often treatable and if treated early enough can reverse the dementia (Miller & Boeve, 2009). Therefore, it is very important to diagnose the etiology of the person's cognitive dysfunction (Sadock & Sadock, 2007).
Medically there are a number of medications that can be used to help moderate memory loss, disrupted cognition, and behavioral problems associated with dementia. For example, Aricept, a cholinesterase inhibitor, can help to delay the progression of Alzheimer's disease if it is started early enough (Miller & Boeve, 2009; Sadock & Sadock, 2007). For vascular dementia there are a number of medications and therapies that can deter the progression of vascular changes in the brain and thus halt the progression of the dementia associated with these changes (Miller & Boeve, 2009).
Other medications can address some of the behavioral issues that would dementia often exhibit such as irritability, agitation, apathy, and hallucinations or delusions. These medications are typically psychotropic in nature (Sadock & Sadock, 2007). In addition, there are ongoing studies with newer medications that can hopefully address the issues of dementia more effectively in the future (Miller & Boeve, 2009).
From the patient perspective of course medications address the cognitive issues associated with dementia. In addition, there are a number of other ways to address the issue of dementia. For example, there are a number of coping strategies that can be used by people in the early stages of dementia to deal with memory issues and other cognitive problems. Typically these strategies need to be taught to the patient by someone else (because the patient's dementia interferes with their ability to independently decide to use these strategies) or need to be implemented by a significant other or caregiver. One such strategy is the use of reminders such as posters, auditory alarms, written schedules, or other reminders to cue the patient to do things like take medications, attend appointments, etc. (de Boer et al., 2007; Miller & Boeve, 2009). These memory aides typically work better with patients who have vascular or subcortical type dementias and not with those who have cortical dementias like Alzheimer's disease (Miller & Boeve, 2009).
Another way to address the issues of dementia from the patient's perspective is to provide the person with dementia the opportunity to have the assistance of the caregiver. Caregivers can assess patients with their daily routine. In this vein services such as occupational therapy, cognitive retraining, exercise classes, and other forms of intervention that keep the patient active and practicing their routines can be useful in delaying aggression of the symptoms of dementia (Sadock & Sadock, 2007). In addition, from a prophylactic perspective maintaining a healthy lifestyle including a healthy and balanced diet, moderate exercise, keeping one's mind active, and routine physical checkups can also delay the onset and progression of many dementing disorders (Miller & Boeve, 2009).
From the perspective of the caregiver there are several ways to address dementia and the problems associated with dementia. First, adequate training for caregivers is extremely important. Caregivers need to be trained on how to interact and assist people at all levels of cognitive dysfunction associated with dementia (mild dementia, moderate dementia, severe dementia; de Boer et al., 2007). In the film The Savages (Jenkins, 2007) we get a glimpse of a caregiver who is potentially abusive. It is extremely important that people who are caregivers for persons with dementia are thoroughly screened as the potential for abuse and exploitation exists. Therefore caregivers need to be properly trained, perhaps certified, and monitored in order to assure that they are performing their duties adequately and not taking advantage of their patients (Miller & Boeve, 2009).
Caregivers are often relatives, siblings, or spouses of the person with dementia. While this is often the best way to ensure that the patient with dementia is not abused (although this is certainly not assured) such caregivers are extremely vulnerable to burnout (Schoenmakers, Buntinx, & Delepeleire, 2010). Caregivers caring for severely demented patients often do not have time for themselves and often this good-intentioned endeavor becomes a 24-hour/seven day a week undertaking. It is very important to make sure that caregivers give breaks and time off otherwise the burnout associated with care giving for patients with dementia can lead to severe breakdown in these individuals and of course this can result in poor quality of treatment for the patient with dementia, susceptibility to illness for the caregiver, and a breakdown of the relationship (Schoenmakers…