David Troxel, an internationally known expert on Alzheimer’s disease and memory care, began his Feb. 3 presentation on “The Art of Dementia Care” at the Morning Forum of Los Altos by paraphrasing Charles Dickens: “It was the best of times, it was the worst of times.”
For more than 30 years, Troxel has focused on developing best-care practices for those with dementia. His writing and teaching center on caregiver support, staff training and long-term care program development. He has co-written six books, including his latest, “The Best Friends Approach to Dementia Care.” He currently serves as the only U.S. citizen appointed to the advisory board of Alzheimer’s Disease International.
What makes this the worst of times for dementia care, Troxel said, is the increase in the number of those afflicted with Alzheimer’s, the most common type of dementia, due to longer life spans.
“It has become,” he added, “the most expensive illness in the U.S.”
Moreover, according to Troxel, the medical tools we have to treat the disease “are not much better than they were a hundred years ago,” when Dr. Alois Alz- heimer first identified the link between twisted plaques in the brain and the behavior of one of his patients who had told him before she died, “I have lost myself.”
Despite the billions of dollars the government and individual philanthropists have spent on dementia research, no new breakthrough medications have emerged in the past 17 years.
While Troxel acknowledged the disappointment in failing to find medical treatments to prevent, slow or cure Alzheimer’s, he focused most of his talk on the progress made in the way people treat those with the disease.
“Sadness,” Troxel said, “doesn’t have to be the face of Alzheimer’s.”
In the early stages of Alzheimer’s, he noted, “it’s important for family, friends and caregivers to take a creative approach. It’s essential to keep those with the disease healthy and engaged.”
Among the practical tips Troxel gives caregivers: offer compliments, go outside, encourage exercise, ask for opinions and remind patients of their past successes. Give patients a sense of purpose, he advised, whether it’s just wrapping presents or arranging flowers.
As the disease progresses, many develop delusions, as one of Troxel’s patients did when she insisted to everyone she knew that she had been born on a stagecoach. Instead of challenging the veracity of such stories, Troxel said, caretakers should “let them lie and tell you about their adventures, whether they ever happened or not.”
To illustrate the importance of providing activities that speak to patients’ interests, Troxel described a space scientist he worked with who was diagnosed with Alzheimer’s at 59. While she could no longer work as a scientist, she discovered a love for art.
Troxel also emphasized the importance of music, citing Dr. Oliver Sacks, who famously said when referring to his patients: “For them, music is not a luxury, but a necessity.” Because people’s memory of music lives in a different part of the brain than the areas affected by dementia, Troxel explained, “it can do what medicine can’t” and bring our past selves back to us.
Most important, Troxel said, is to provide empathy, as “the brain loves company.” While we don’t yet have the medicines we need, he added, “we do have communication, and we must remember that boredom and loneliness are the enemy of the brain.”
Troxel cited a British study of 69 nursing homes that showed that on average, clients received only two to three minutes of individual care other than what was provided for basic needs (for example, showering). When the staff at these homes were trained and given the resources to socialize with their patients, agitation and depression significantly decreased while quality of life greatly improved.
To exemplify why he thinks the best-friend approach is the most effective way to sustain the quality of life of those suffering from Alzheimer’s, Troxel quoted Maya Angelou: “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.”
The Morning Forum of Los Altos is a members-only lecture series that meets twice a month at Los Altos United Methodist Church, 655 Magdalena Ave. For more information, visit morningforum.org.