TAUREEF MOHAMMED

I NEVER truly appreciated what managing dementia entailed until I visited a patient's home. Up until then, every patient I saw with dementia was in a hospital. I examined the patient, ordered tests, prescribed medications, warned about the worst, and hoped for the best - and that was that. In the hospital, there was not much to see or do other than the medical things.

Then, about one year ago, I spent one month with Dr Sheri-Lynn Kane, geriatrician at Western University, who practised house-to-house geriatrics in London, Ontario. I learnt there was much more to see in people's homes. And when I saw what I saw, I felt very insignificant. The doctor and the medication he prescribed were perhaps the least important.

Caregivers, with the help of community healthcare workers, had transformed homes into dementia-friendly environments. Simple, thoughtful ideas seemed more impactful than a pill.

Furniture rearrangements, good lighting, bathroom modifications prevented falls and hip fractures - people with cognitive problems were always at high risk of falling. Wearable GPS tracking devices provided a sense of safety.

One family removed paintings from their walls after realising the images were confusing their mother. Another family played music to perk up their loved one who seemed disengaged otherwise.

And in another household, specially bought Ribena drinks reminded an elderly woman of her days in the UK, where she migrated from after the Second World War - dementia had not taken away her long-term memory.

The modified homes reflected a deep understanding of dementia, and an even deeper understanding of the person with the disease.

And the opposite was true: a lack of understanding of dementia made the situation dicey, and that's when Dr Kane and her interdisciplinary team got called up.

Their first task - before all the neat, non-medical interventions - was education, dispelling myths about dementia and ageing.

Why was dementia so misunderstood? Why was it so easy to blame the person and not the disease? I asked Dr Kane how she approached these situations.

'I first explain what happens when someone has a stroke.'

Pointing to her head and then her right arm, she said, 'We can make the connection, left side of brain damaged and right arm paralysed. Nobody will tell that person to eat or pick up something with their right hand.'

But the brain damage that leads to dementia manifests differently.

'The cognitive difficulties are not physically visible like a paralysed arm. Instead they manifest as people not doing things correctly, forgetting, not being able to explain themselves the way they used to.'

Unlike a stroke which occurs when a blood vessel feeding the brain is suddenly blocked, dementia happens insidiously, as parts of the brain slowly degenerate.

'It all happens gradually. It becomes difficult to say when mom went from being a strong-willed, independent person to a person who is unable to do what she did before and won't accept help.

'So the family may say,