Providence center’s Dr. Ian Ferguson ensures that depression does not affect an elderly patient’s treatment
Looking more like a funky film animator then a psychiatrist, Dr Ian Ferguson appears too boyish, even at 45, to be specializing in geriatrics. With his own lively mind, he treats patient suffering from dementia. Even though many of his clients display some behaviors that are ‘disinhibited,’ he finds them ‘remarkable. There’s a lot of wit there”
Ferguson believes that our society doesn’t like people that are chronically ill. “We’re terrified of them and we’re relived when they die. That’s why we accept euthanasia.” But as a geriatric psychiatrist, Ferguson relishes his relationship with the elderly.
Ferguson has both institutional and non-institutional patients. Although his office is in Scarborough’s Providence Center, which has almost 600 residence, most of his mornings are spent in community care, visiting both private homes and small community facilities.
Ferguson finds the patronizing attitude that the elderly are, “just like little children,” disgusting. “a person has a history even someone suffering from dementia. A history distinguishes who we are, Even when there is some degree of impairment, people have episodic memory. Then can remember in detail certain scenes but the sequences is all show The linkages are gone but they can put it together like a patchwork quilt.”
Senility went out of the psychiatric vocabulary in the mid 1950s. “We now have a greater diagnosis accuracy of mental disorders. Senility is too broad a label. Today the specialists speak of primary [progressive dementia (such as Alzheimer’s), multiple strokes and major depression. The latter often accompanies the first two.
“Now we have realize depression has a larger biological base. Too often in the past we have said, ‘well; he’s bound to be down after a stroke’ and we excuse it rather then treat it. Our compassion and sympathy actually results in under treatment. Depression is a treatable illness and can have a reasonable outcome.”
Sadly when the shared memory that bonds a couple together goes, when the patient starts top lose his biogeographically history, the spouse, even while still living with that person, begins to feel painfully alone.
First Ferguson deals with the one experiencing the decline, measuring and assessing the change in order to recommend suitable treatment programs and environment.
“Later I shift to the spouse and her needs, but I don’t over-identify with the stress of the care-giver else you forget who the patient is, and slip into thinking, he is not quite deserving of our interest, he’s not quite a person.”
“We have to be very careful how we use languages. We are no less the person we were. We don’t lose our personhood as we age. It is intrinsic to our humanity. But we slip into language that is very dangerous. As a society we fail each other. We fail to accord the elderly the same respect as the young.”
Even when some memory goes, character and emotions still remain, event if they become somewhat changed or exaggerated.
“One of the most gratifying aspects of being a care-giver is to click with someone who is suffering dementia. We fail them as a family or as caregivers when we are only superficial. We forget how fragile these people are. When we give them a shower, what do they think is happening? We need to appreciate what they understand is going on.
“Some times medication can calm down those who are having terrifying delusions, without turning them into zombies. But often just shifting the environment can make a tremendous difference.”
A person who has had no visitors and has lived alone as a shut-in in an apartment looking at cars all day, may thrive when moved to the hustle and bustle of an elder-care day program or a home.
According to Ferguson, institutionalizing a patient is not necessarily a bad thing. “Some, who have been failing and who have become too isolated, recover remarkably when placed in long-term care. It is also true when placed in the past wee have built a lot of long-term care facilities at the expense of community resources.”
About eight per cent of those over 65 in Canada are in institutional are in Western Europe the figure is closer to 4% or 5%.
Even in a large facility like Providence Center the staff are trained to treat the elderly as residence living in a home or residents living in a home or community, not as patients being treated in a hospital. “We’re on their turf. We’re coming into their home” explains Bernadette DeFreitas, Dr Ferguson’s secretary. “I have a ‘Please Knock’ sign on my office door so I have to knock on their doors too, not just go barging in. Just like us they want their privacy respected.
“Above all they are human beings with feelings. We have to look them in the eye. We talk to them, not above them or about them. The need touch, hugs, and kisses. We say, ‘Good morning Mrs. So and So’ just as you would greet a neighbor on the street—for these corridors are their streets.”
Staff are trained for all personnel recently included a session wearing double gloves, goggles, and earplugs. Stave were challenged to do the ordinary: eat a tray of food and comb their hair in front of a mirror. Most found it impossible to open the milk container, Others ended up with a bad hair day. A need admiration was earned for the elderly in coping with mundane struggles.
Such physical exercises are excellent. At the same time Dr. Ferguson is reluctant to “walk in the shoes” of the sufferer to the extend that his behavior would blur or cross the personal and psychological boundaries that need to be maintained for the good of his clients.
“We need to remain empathetic yet detached, else will we not be able to offer ourselves, to be a strength. We need to come alongside and offer hope and challenge them in their suffering, not sink with them into it.”