10 фактов о деменции, которых вы не знали

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Год от года растет число пожилых людей, страдающих дементными расстройствами. Уход за такими больными — настоящее испытание для близких. При этом у врачей нет единого представления о недуге и о том, что посоветовать родственникам. Геронтолог Лора Уэймен написала книгу «Поговорим о деменции», где рассказала, как найти общий язык с человеком, теряющим когнитивные функции.

Старшее поколение 

10 фактов о деменции, которых вы не знали

«Эта книга станет наглядным пособием для десятков тысяч родственников, которые находятся в полной растерянности в тот момент, когда обнаруживают, что у близкого деменция. Мы очень ждали эту книгу и раздадим ее всем нашим врачам и помощникам по уходу как учебный материал, — говорит Алексей Сиднев, глава частной российской сети пансионов для пожилых людей Senior Group, поддержавшей издание книги на русском языке. — Для широкой аудитории книга Лоры Уэймен — это увлекательное чтение. Автор с любовью и уважением рассказывает об иной вселенной — вселенной человека с деменцией».

Эта книга и правда — путеводитель «по вселенной, где все шиворот-навыворот, как в «Алисе в Стране чудес». Мы сформулировали топ-10 фактов, которые нужно знать о деменции — это краткий гид по книге Уэймен.

1. Забота о человеке с деменцией — тяжкий труд

По данным Американской национальной ассоциации помощи родственникам людей с деменцией, нагрузка при уходе за такими больными в три раза превышает обычную. Уход за дементным больным психологически намного сложнее, чем уход за пациентом с физиологическим заболеванием, — это невероятный стресс. Чтобы снизить эмоциональную нагрузку, ухаживающий должен осознать, что не в его власти что-либо изменить. Единственное, что он может сделать, это дать заботу и любовь.

Положительные ответы на все эмоции подопечного помогут сохранить покой и уверенность. Это пойдет на пользу обоим: пациент впитает и «зазеркалит» эмоциональное состояние ухаживающего. Причем на это способен даже больной, практически полностью расставшийся с когнитивными функциями.

2. Информированность — способ облегчить процесс ухода

Недостаток знаний о деменции и ее специфике — проблема всего мира. Это ведет к социальной стигматизации больных и их семей, задерживает постановку диагноза — а значит, мешает своевременно начать лечение.

Отрицание деменции родственниками больных из-за страха получить ярлык под стать прокаженным тормозит начало правильного лечения. Единственный способ противостоять этому — знания о деменции. И чем выше их уровень, тем выше лояльность общества и семей, тем качественнее оказание медицинской помощи. Лора Уэймен пишет: «Тот, кто действительно понимает, что такое деменция, выберет путь принятия, а не отрицания».

Расширяя знания о деменции, вы установите глубокие, наполненные смыслом отношения с больным

«Ухаживающий, который знаком со спецификой деменции, думает о будущем и заботится о собственном здоровье. Он не изменит этому принципу, даже если для этого подопечному придется переехать в пансионат для людей с нарушениями памяти или в дом сопровождаемого проживания. По мере того как вы начнете расширять знания о деменции, между вами и вашим подопечным будут устанавливаться глубокие, наполненные смыслом отношения. Это придаст вам сил и уверенности для заботы о близком человеке».

3. Деменция — это необратимая потеря определенных функций мозга

Деменция происходит от латинского de («от») и mens («ум», «разум») и означает состояние отделенности от собственного разума.

По объяснению Ассоциации болезни Альцгеймера, деменция — это «спектр симптомов, связанных с нарушениями памяти и других умственных способностей, достаточно серьезных, чтобы мешать повседневной деятельности человека». Спектр этот весьма разнообразен: прогрессирующая утрата кратковременной памяти, речевые нарушения, проблемы с выполнением привычных действий, дезориентация во времени и пространстве, трудности с обработкой информации, сложности с абстрактным мышлением, сниженная способность или полная неспособность мыслить здраво, чувство потерянности, страх, паранойя, переменчивое настроение, изменения в личности, характере.

Необратимая утрата кратковременной памяти и снижение когнитивных функций вызваны органическим поражением мозга. Самые распространенные причины — болезнь Альцгеймера (она есть у 60–80% пациентов) или ишемический инсульт. Также причинами, а всего их более ста, могут быть травмы головного мозга, болезнь Паркинсона. Существует деменция с тельцами Леви. Чаще всего диагностируют две причины и более. У разных видов деменции разные признаки, скорость и размеры регресса, особенности поведения больного. Поэтому очень важно поставить точный диагноз.

К сожалению, до сих пор не разработано быстрого и простого способа диагностирования болезни Альцгеймера и других причин, вызывающих деменцию. Новые технологии дают возможность лишь более обоснованно предполагать, что вызвало нарушения функций мозга.

10 фактов о деменции, которых вы не знали

4. Умственные способности разрушаются деменцией постепенно

Нагляднее всего это представить в виде хаотичного удаления элементов из трехмерного пазла. Когда и где пропадет очередной кусок, предсказать не может никто. Универсального алгоритма для работы с дементными больными нет, «случаи деменции уникальны, как отпечатки пальцев, … двух одинаковых историй не бывает, все советы придется модифицировать для конкретных условий».

Знание о деменции — это прежде всего осознание, что потеря функций мозга прогрессирует. Приостановить и, тем более, прекратить ее невозможно. Близкие дементного больного должны понимать: синдром может только ухудшаться. Лучшее и единственное, что можно сделать, — помочь справиться с симптомами. И в этой помощи важно быть гибким — вслед за прогрессирующей потерей функций мозга все может меняться очень быстро. «Я хочу научить вас дорожить и наслаждаться любым нетронутым кусочком пазла, пока это еще возможно».

5. Отрицание диагноза — распространенная помеха лечению

Кроме отрицания обществом и семьей, существует и отрицание со стороны самого больного — анозогнозия. Она развивается у 80% людей с болезнью Альцгеймера. Практически равнозначное количество пациентов после инсульта также страдают анозогнозией. У всех она проявляется по-разному, но есть общая черта: человек не понимает, что он болен.

Подвох в том, что не только сам больной отрицает недуг — зачастую этого не могут разглядеть и окружающие. Даже измерение уровня интеллекта не выявит ничего подозрительного. «Поймать момент» можно, только начав разговор о деменции. Кажущаяся адекватность человека может сыграть с ним злую шутку: болезнь прогрессирует, а лечения нет.

Именно так когда-то не повезло американскому экс-президенту Вудро Вильсону — анозогнозия не дала получить своевременную помощь после инсульта. Самоотрицание болезни может проявляться и у людей с очень высоким интеллектом.

6. Бесполезно пытаться взывать к разуму

Людей с деменцией невозможно повернуть лицом к реальности. Все они живут в своих причудливых мирах. Спорить, переубеждать, что-то доказывать бесполезно. Мало того, этим можно только навредить: человек станет тревожным, придет в смятение.

Чтобы наладить контакт с пациентом, придется войти в этот мир и признать его реальность. Если вы будете соглашаться с больным, подтверждать его чувства и сохранять спокойствие, связь между вами станет укрепляться. Когда вы даете положительный ответ на эмоции больного, вы оба начинаете лучше чувствовать собственную значимость и достоинство. В этом суть «положительного метода» Лоры Уэймен, позволяющего находить контакт с дементным человеком.

В трудных ситуациях действуйте так, словно вы поверили всему, что говорит подопечный

«Не стоит пытаться исправить то, как больной видит мир. Лучше тренируйтесь по-новому работать с его поведением, вызванным параноидальными мыслями. Как бы невероятно ни звучали утверждения и обвинения, прислушивайтесь к ним». В трудных ситуациях берите инициативу в свои руки и действуйте так, словно вы поверили всему, что говорит подопечный, — это метод «творческой интервенции» автора книги.

7. Слова — не главное

Больные с деменцией намного лучше реагируют не на слова, а на эмоции и невербальные знаки и сигналы: мимику, жесты. Чем больше прогрессирует болезнь, тем сильнее невербальная связь. Интонация сильнее слов. На поздних этапах прикосновения и спокойная улыбка намного эффективнее слов одобрения и поддержки, которые неоспоримо важны в начале развития недуга.

«Никогда не забывайте о невербальных сигналах. Мы все общаемся, в том числе, с помощью эмоций, мимики, прикосновений. Если во время разговора вы держите человека за руку и улыбаетесь, вы сообщаете ему гораздо больше, чем можно выразить словами».

8. Чувство вины — вечный спутник ухаживающего

Как бы ни была велика нагрузка на ухаживающих, сколько бы времени она ни отнимала, какими бы героями они на самом деле ни были, многие испытывают чувство вины. Люди мучаются, потому что не всегда успевают сделать все необходимое, иногда занимаются другими членами семьи или собой, время от времени обращаются за помощью, оставляя больного одного или с кем-то другим. Они стыдятся радоваться жизни.

Это неоправданное во всех смыслах чувство также очень разрушительно. Оно ведет к подавленности и перенапряжению — физическому, психологическому, умственному, а далее к срывам, депрессиям.

Здесь важно знать и помнить: если «врачующий» не позаботится о себе, то грош цена будет его помощи. Больные считывают, впитывают и «отзеркаливают» эмоциональное состояние ухаживающих за ними.

10 фактов о деменции, которых вы не знали

9. Ухаживающий за близким с деменцией постоянно чувствует утрату

Когда человек болен деменцией, он постепенно перестает выполнять привычную роль в жизни ухаживающего. И этот процесс травматичен, потому что он меняет все стороны жизни — бытовую и социальную. Больной будет терять физические и умственные способности, в какой-то момент он перестанет понимать, кто рядом с ним. Это коренным образом изменит отношения в семье, к прежнему положению вещей вернуться уже не получится.

«Кроме того, вам постоянно придется осознавать, что вы заботитесь о человеке, который неизлечимо болен. Как бы вы ни пытались подготовиться к тому дню, когда он испустит последний вздох, когда это случится, вы ощутите, что готовы гораздо меньше, чем думали. Возможно, вам заново придется пройти весь путь переживания утраты. После этого вам, как и другим членам семьи, предстоит привыкать к жизни без этого человека и искать себе место в мире без него».

10. Самое важное — заботиться о себе

Лора Уэймен отмечает: «Главный в отношениях между ухаживающим и больным — ухаживающий». Если он позаботится о себе, у него будет достаточно здоровья и сил, чтобы осуществлять уход за близким человеком.

Жертвовать собой не единственно верный путь, а опасная дорога к разрушению

Адвокат Тодд Ратнер, специалист в области прав пожилого населения и планирования наследования, подсчитал: «…16 млн американцев можно отнести к «поколению сэндвича»: они зажаты в тисках заботы о двух поколениях. Одновременно воспитывая детей и ухаживая за престарелыми родителями, они вынуждены также работать на полной ставке. Такое перетягивание каната одновременно во всех направлениях — серьезная причина для стресса».

Ухаживающим тяжело осознать свою ведущую роль в отношениях с больными, но необходимо. Важно научиться отпускать вину и находить моральные силы для ухода за собой, для борьбы со стрессом. Если необходимо, надо обращаться за помощью к родным, друзьям, группам поддержки. Жертвовать собой в данном случае не единственно верный путь, а опасная дорога к разрушению не только своего здоровья и личности, но и больного. Он будет чувствовать ваше состояние и уходить вглубь недуга, а вы не сможете ему помочь.

Наоборот, ваше спокойствие, уверенность, жизнерадостность создадут соответствующую эмоциональную обстановку, благотворно действующую на пациента. Физические и моральные силы помогут преодолевать препятствия, которые будет ставить болезнь.

Источник: книга Лоры Уэймен «Поговорим о деменции» (Олимп-Бизнес, 2018).

10 фактов о деменции, которых вы не знали

Об авторе

Лора Уэймен — геронтолог, лектор, ведущая тренингов и семинаров. Автор «положительного метода», позволяющего находить контакт с дементным человеком.

Источник: psychologies.ru

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