Coping with dementia: communicating

 

In this, the second in a three-part series based on information provided by the Associação Alzheimer’s Portugal, we look at the fundamental importance of communication between those with dementia and those closest to them.

Due to the gradual progression of dementia, communication problems can arise and lead to frustration, confusion and sometimes even anger. 

The needs and desires of the person with dementia may not be satisfied and their behaviour may be misunderstood by others. Those with dementia may begin to feel more isolated. Failure to communicate properly can cause them embarrassment, especially if those close to them draw attention to their mistakes.

It’s not uncommon for people with dementia to start using a less complex style of language. They may use shorter sentences or a limited vocabulary. They may talk less and ultimately not talk at all. 

Some ways to make verbal communication easier: 

- Try to have a positive attitude. 

- Sit facing the person with dementia and try to encourage them to talk. 

- Try to understand the feeling they express. 

- Avoid drawing too much attention to their shortcomings. 

- Give your support. 

- Adapt your language style and tone of voice without sounding artificial. 

- Make sure there are no physical problems affecting communication, such as a lack of hearing or sight. 

- Ask closed questions and give only two options (e.g. instead of, "What shirt do you want to wear?", use "Do you want to wear this shirt or this one?”) 

- Give only short, objective instructions at a time. 

 

Non-verbal communication 

and physical contact 

As verbal communication becomes more difficult, it may be easier to switch to non-verbal communication, focusing on tone of voice, eye contact, facial expression, posture, sign language and physical contact. 

If using non-verbal communication when talking to the person with dementia:

- Always try to communicate at the person's eye level.

- Try to maintain eye contact.

 - Make sure you are not giving confusing messages. 

- Try to understand the body language of the person with dementia.

- Transmit security and support through physical contact such as touching hands. 

Keep in mind that as the illness progresses, many skills are lost and some are maintained. The person with dementia may still preserve their sense of touch and hearing, as well as their ability to respond to emotion. 

Its important for a person with dementia to have something to occupy them so that their brain is stimulated. This also helps to control some symptoms of the disease, such as agitation. 

It’s also important that those with dementia, accompanied by their nearest and dearest, should be regularly checked by their specialist doctor who could be a neurologist or a psychiatrist. The medications prescribed by specialists can help to control the symptoms of the disease and slow its progress.

 

 Portugal Newswatch this Saturday:  legal help for those with Alzheimer’s and other forms of dementia

 

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Coping with dementia: overview

 

 

Dementia, the most prevalent form of which is Alzheimer’s, is a condition affecting about 50 million people worldwide, with around 10 million new cases reported each year. This, the first in a three-part series, is based on information provided by the Associação Alzheimer’s Portugal, which is devoted to helping those with the illness and those close to them.

 

Alzheimer's is a neurodegenerative disease that slowly and progressively destroys brain cells. The disease affects memory and mental functioning, such as thought and speech. It often leads to other problems such as confusion, mood swings and disorientation in time and space.

 

At first, the symptoms may be slight and go unnoticed by the family or others. As the disease progresses, however, the symptoms become more and more noticeable. Memory loss is one of the most important.

 

Especially at an early stage, a person with dementia may try to hide some of the consequences of memory loss out of embarrassment or shame. Later, they may no longer be aware of memory problems and their shortcomings. 

 

It is normal for a person with dementia to ask repetitive questions. Since their recent memory is more affected, we should try to maintain a positive attitude with much patience. Try to answer as if the person were asking us the question for the first time. When we tire of answering the same question, one strategy to adopt is to divert the person's attention to something else, or to occupy them in some other way. 

 

In coping with memory loss: 

- Try to maintain a positive attitude and foster calm. 

- Do not take the behaviour to heart. 

- Avoid drawing too much attention to mistakes and problems. 

 

Problems due to memory loss can be avoided by creating routines with things at home and then not making unnecessary changes. 

 

As the disease progresses, people with dementia need more assistance for their personal hygiene. They may lose the ability to use objects such as combs and toothbrushes.  They may also forget what these objects are, and more importantly, what their purpose is.

 

They may forget there is a task to be done, have the impression that they have already done it, or lose interest in keeping everything clean and looking good.  

 

The fact that a person needs more help does not necessarily mean that he or she will enjoy receiving it. The person may resent being dependent on you and feel that their privacy is being invaded. 

 

It is very important to encourage independence. We must support and help the person with dementia in their daily activities, but we must not replace them and do things for them unnecessarily. It is important that the person with dementia performs tasks if possible even if it takes longer. Anything that the person fails to do or practice will soon be forgotten or the ability lost. 

 

There are various ways of providing assistance depending on the level of understanding and capacity of the person with dementia. For example, you can let the person wash themselves, providing just a little help when necessary, or you can explain or demonstrate, step by step, what to do. 

 

One idea would be to prepare everything first - such as a clean change of clothes, run the bath water, preheat the bathroom, arrange the towels, shampoo and soap -  and then leave them to wash themselves if this is possible.

 

Later this week: dementia communication and legalities.

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Green light for English tourists

The Azores and Madeira along with mainland Portugal have been officially given the green light by the British government for holiday visits when England lifts its overseas travel ban on May 17. 

Only 12 countries worldwide, most of them distant, have been included in the least restrictive category on the UK’s so-called green, amber and red ‘traffic light system’.

The announcement has come as a huge relief to the vital Portuguese tourism sector that has long been at a standstill because of the COVID-19 international lockdowns.

Portugal and the autonomous regions are considered COVID ‘low risk’ and thus among the safest destinations.

The only other green list places on relative short flight routes from the UK are Gibraltar, Iceland, the Faroe Islands and Israel. The rest, including Australia and New Zealand are in the far south.

Spain, Italy, France and the United States, all hugely popular destinations, are among the many countries left off the green list. They are considered higher risk and rated amber.

As Portugal is the first Mediterranean destination to make it on to the green list, the number of flight and accommodation bookings immediately began to surge.

For now, the new arrangement only applies to England. The arrangement will be reviewed every three weeks. Decisions on overseas travel from other parts of the United Kingdom are expected soon

Travellers to green list countries will have to take two COVID tests, before leaving and one within two days of returning, but if the tests prove negative, travellers will not have to quarantine. Those returning from amber list countries will have to self-isolate.

On the downside of all this, airlines and travel agencies say the traffic light system is over-cautious and more countries should be on the green list. It has also been pointed out that holidaying prices could considerably increase and passengers are likely to face delays at airports because of extra COVID paperwork checking.

 UK transport minister Grant Shapps said on Friday: “Today marks our first step in our cautious return to international travel, with measures designed above all else to protect public health and ensure we don’t throw away the hard fought gains we’ve all strived to earn this year.”

 

 

Press freedom under pressure

The United Nations Secretary-General António Guterres promotes World Press Freedom Day annually on 3^rd May to raise awareness of the fundamental importance of press freedom and remind governments of their duty to respect and uphold the right to freedom of expression enshrined under the1948 Universal Declaration of Human Rights.

“Journalists and media workers are crucial in helping us make informed decisions,” the former Portuguese prime minister pointed out last May: “As the world fights the COVID-19 pandemic, those decisions can make the difference between life and death. On World Press Freedom Day we call on governments - and others – to guarantee that journalists can do their job throughout the COVID-19 pandemic and beyond.

Secretary-General Guterres said last week that, “during the pandemic and other crises, including the climate emergency, journalists and media workers are helping us navigate a fast-changing and often overwhelming landscape of information, while addressing dangerous inaccuracies and falsehoods. In too many countries they run too many personal risks, including new restrictions, censorship, abuse, harassment, detention and even death simply for doing their job - and the situation continues to worsen.”

The European Federation of Journalists and its members have observed clear deterioration of press freedom in Europe. It quotes a report of the Council of Europe published last week saying that the number of physical attacks on journalists and media workers as well as the cases of harassment and intimidation reached a record level in 2020.

Portugal adopted the right to freedom of expression after the ‘Carnation’ Revolution of 25th April 1974. For centuries before that freedom of expression was controlled by the Catholic Church, a succession of monarchs and the Estado Novo political dictatorship. This country’s constitution now extends freedom of expression to all media.

The Reporters Without Borders press freedom index showing the independence of the media and how safe and free it is for journalists around the world to do their job shows a continuing improvement in Portugal’s status from 2013 to 2021. Portugal is currently 9th in the world rankings, after Norway, Finland, Sweden, Denmark, Costa Rica, the Netherlands, Jamaica and New Zealand. The United Kingdom is ranked 33^rd and the United States 44^th.

The main problem facing journalists in Portugal as in Europe generally has been pandemic budget cuts that has affected even some of the biggest news companies and has resulted in job losses or reduced pay.

The Washington-based International Consortium of Investigative Journalists (ICIJ), whose global team of reporters revealed the leaked ‘Panama Papers’ in May 2016, is an example of journalistic excellence, but even it regularly seeks donations to keep going.

Important information passed on to the public by local, regional or national media may not be as well researched and accurately reported as ICIJ, a major reason being that many are understaffed with journalists who are unduly pressurise not only to meet tight deadlines, but produce too many headline stories that fit with their employers’ political and commercial leanings. This in some cases encourages ‘churnalism’ as opposed to journalism. Some papers are prepared to virtually plagiarise even ‘exclusive’ stories from other papers.

Ironically coinciding with Press Freedom Day, Madeleine McCann disappeared 14 years ago on 3^rd May. The mystery became the most reported missing person case in history. It has obsessed the media and millions of readers and viewers around the world. When reporting on the thee official suspects during the initial Portuguese investigation into the disappearance, some British tabloids published reports that were inaccurate or fake - or blatantly libellous. These papers were held to account in court and ordered to pay hundreds of thousands of pounds in damages.

On the other hand, the long libel action taken by  Madeleine’s parents, Kate and Gerry McCann, against the former Portuguese detective Gonçalo Amaral for allegations in his book The truth of the Lie, was overturned on appeal by Portugal’s Supreme Court on the grounds that the author was entitled to freedom of expression. An outcome is awaited from the European Court of Human Rights in Strasbourg on the McCann’s appeal against the judgement of Portugal’s highest court.

Meanwhile in the social media, the ethics of those commenting in any way on whoever or whatever they choose is something else. With almost unlimited freedom of expression, anonymous social media trolls don’t mind making the most despicable comments knowing they can still get away with it.

In principle, global freedom of expression is highly desirable, but it still has a long way to go.

                                                              

 

The generational climate fight

 

Greta Thunberg       Joe Biden

Elderly statesmen got together at a virtual summit on climate change last Thursday, April 22, Earth Day. At the same time, middle-aged politicians under the auspices of Portugal’s current presidency of the Council of the European Union were having discussions about a provisional EU climate law on a 2030 emissions target. Young activists are not impressed; there’s still far too much talk and far too little action, they say.

US President Joe Biden has proposed pouring trillions of dollars into clean-energy technology, research and infrastructure. He faces fierce opposition in doing so from Republicans who are sticking with Donald Trump’s extraordinary decision to pull out of the 2015 Paris climate accord. They insist that any transition to clean energy would put the jobs of American oil, gas and coal workers “into the shredder”. Republicans have also been castigating China as the world’s No. 1 greenhouse gas polluter. (America is the No.2).

As well intentioned as 78-year-old Joe Biden may be  to place the US among the most ambitious nations in curbing climate change by pledging to cut fossil fuel emissions by 52% by 2030, he may not be around to see that through, certainly not as president.

Addressing an online meeting of a US House of Representatives committee on fossil fuel subsidies that coincided with the virtual summit, 18-year-old Greta Thunberg as usual did not mince her words. “It is the year 2021. The fact that we are still having this discussion and even more that we are still subsidising fossil fuels directly or indirectly using taxpayers’ money, is a disgrace. It’s proof we have not understood the climate emergency at all,” she said.

The two-day summit briefly made the main headlines, which remain preoccupied with the COVID-19 pandemic and other current matters. To the mainstream media as well as politicians, the distant future is not as compelling as the here and now. 

Among those keeping an eye on the EU’s intentions on combating the existential threat to humanity are the four Portuguese children and two young adults who have filed a climate change lawsuit with the European Court of Human Rights against all 27 EU member states, plus Russia, the United Kingdom, Switzerland, Norway, the Ukraine and Turkey. Aged between eight and 21, they claim that all 33 countries are breaching their human rights by failing to make deep and urgent emission cuts, and not adequately addressing contributions to emissions released beyond borders.

The plaintiffs have personally experienced the ravages of heat waves and wildfires caused by climate change in their homeland. While supposedly protected by the European Convention on Human Rights, they say they fear for their future lives and livelihoods because of worsening climate change. The case they filed in September last year probably has a long way to go, but it has been granted priority and fast-tracked by the court in Strasbourg because of “the importance and urgency of the issues raised”.

This highly unusual court assurance has been greatly welcomed by the plaintiffs and the London-based barrister and international NGOs who are backing them. Their efforts are in harmony with many other court cases and public protests arranged by young climate activists around the world.

This is how Sweden’s Greta Thunberg put it to lawmakers in the US House of Representatives: “What I’m here to say is that unlike you my generation will not give up without a fight. And to be honest, I do not believe for a second that you will actually do this. The climate crisis doesn’t exist in the public debate today and since it doesn’t really exist and the general level of awareness is so absurdly low, you will still get away with continuing to contribute to the destruction of present and future living conditions. And I know I’m not the one who is supposed to ask questions here, but there is something I really do wonder. How long do you honestly believe that people in power like you will get away with it? How long do you think you can continue to ignore the climate crisis, the global aspect of equity and the historic emissions without being held accountable?

“You get away with it now, but sooner or later people are going to realise what you have been doing all this time. That’s inevitable. You still have time to do the right thing and save your legacy, but we know that time is not going to last for long. What happens then? We the young people are the ones who are going to write about you in history books. We are the ones who get to decide how you are remembered. So my advice for you is to choose wisely....

Thank you.”    

 

The Portuguese plaintiffs, from left to right and top to bottom: André Oliveira, Catarina Mota, Cláudia Agostinho, Mariana Agostinho, Martim Agostinho and Sofia Oliveira (Photos: Global Legal Action Network)

International travel still troubled

It was hoped there would be clarity by now on the reopening of leisure travel from the UK, but international airlines, British holidaymakers desperate to get away and the tourist industry in Portugal are all greatly frustrated by the continuing uncertainty.

The recent taskforce framework report did not reveal any clues and the British Government has not announced anything precise about when, to what destinations and under what conditions its current international leisure travel ban will be lifted after May 17.    

“Rather than answering questions, the framework leaves everyone asking more,” said Steve Heapy, the chief executive of Jet2, which normally flies holidaymakers from the UK to Lisbon, the Algarve and Madeira among other places. Jet2 has now suspended all its flights until the third week in June.

The Reuters agency reports that the bosses of all British airlines have “joined forces to urge the British government to ensure that all popular European destinations face the least onerous travel restrictions when holidays are permitted again”.

“The aviation industry is on its knees,” said the boss of Jet2, adding that under the present circumstances it was impossible for travel businesses to make proper plans.

The chief executive of easyJet, Johan Lundgren, said he could not see any problem with opening up on May 17, but the airline does not expect passenger numbers to really pick up until late May.

The best the UK transport secretary Grant Shapps has been able to divulge is that people could now “start to think” about booking summer holidays.

 The UK Government has proposed a traffic light system that will list destination countries as red, amber or green depending on COVID risk factors. The government is especially concerned about travellers returning to the UK with Covid infections, especially any new variants of the virus.

While Britain’s aviation minister says it’s too early to predict, Portugal is expected to be one of the few countries to be in the ‘green’ category, probably along with Malta, Israel and the United States. Green list passengers will probably not have to quarantine upon returning home, but they may have to show a negative Covid test result shortly before boarding flights to and from overseas destinations.

The cost of tests is causing concern as it may exceed the cost of some international flights. A pre-departure PCR test in the UK currently costs about £128.

Portugal has lifted its overseas flight ban, but special checks will be kept in place on the border with Spain at least until early May. Meanwhile, Portugal has joined several other European Union countries in moving towards a COVID-19 passport scheme and   Portugal’s secretary of state for tourism, Rita Marques, told an online conference that this country will try to avoid “at all costs” passengers having to quarantine or take more tests this summer.

While the UK is Portugal’s number one source of visitors from abroad there are frustrating doubts too about major sources within the EU, such as France and Germany where COVID infection rates have been surging recently. Each EU country has its own non-essential travel deadlines and rules.

Portugal now has among the lowest COVID rates in Europe. With the easing of lockdown restrictions here this month and next, local tourist services may have to rely for the time being on domestic visitors until international leisure travellers are allowed in, hopefully as early as possible, before spring has completely finished and before the start of a very busy summer.

Portugal tourism -what’s what?

 

There are still many complications, much confusion and lots of uncertainty, but here’s the nitty-gritty of what’s known about the prospects for tourism from abroad.

Foreign holidaymakers are expected to start arriving in Portugal in significant numbers in May and June.

The UK has long been Portugal’s biggest source of foreign visitors, but the British Government has made it clear that no holidaymakers from England will be allowed to go anywhere abroad before May 17.

Top easyJet, Ryanair and other airline officials have strongly urged the British Government to include Portugal on a proposed “Green List” of countries and allow flights  to resume on May 17. They have asked that they be informed well ahead of this date so they can properly prepare their aircraft and staff for takeoff.

EasyJet has already announced that in addition to its normal airport terminals in the UK it will open new routes to holiday hotspots from Birmingham.

The government authorities in Wales, Scotland and Northern Ireland have yet to announce the lifting of the May 17 travel ban.

Advice on the start of international travel is expected to be contained in a report commissioned by the UK Government and due to be delivered next Monday, April 12.  

The “Green Light” category of travellers will probably only need to be able to show that they have tested negative shortly before and after international travel. They will not be required to quarantine on arrival or returning.

For visitors from Ireland, the Portuguese Government requires the following measures effective until midnight April 15:

• Have a negative / ‘not detected’ result from a pre-departure COVID-19 RT-PCR test taken within 72 hours prior to arrival in Portugal.

• Present evidence of their negative/‘not detected’ result before boarding their flight, and to Portuguese immigration officers on arrival at points of entry.

Such a scenario is less certain regarding Portugal’s other major sources of holiday visitors, particularly Germany, France and the Netherlands, which have all been described as “high risk” areas because of recent surges in Covid infections amid the European Union’s slow rollout of vaccines. 

The agreement between Portugal and Spain on the closure of their land and river borders will run at least until April 15 by which time it will be reviewed. The transportation of essential goods is among the exemptions currently in place, but cross-border leisure travel is forbidden.

Holiday travel to Portugal from the United States and Canada has yet to be given the official go-ahead. 

 All passengers travelling to the Archipelago of the Azores must fill out a questionnaire of the Regional Health Authority within 72 hours before their departure. After completing the questionnaire, they will receive a code that they must use to identify themselves upon landing.

All passengers travelling to Madeira by air must complete the "Madeira Safe to Discover" web app registration at www.madeirasafe.com in the 12 to 48 hours before departure. If they do not complete it before the flight, they will have to do so on their mobile device after landing by using the QR codes posted at the airport or by providing their data to the staff available for that purpose.

The Portuguese Government in the weeks ahead will be systematically reviewing all its current restrictions on holiday travel. Meanwhile, throughout mainland Portugal small groups may be served on outside tables in cafes and restaurants and museums have been among the facilities recently opened after two months of lockdown. The plan is to allow the reopening of restaurants indoors as well as outdoors on May 19. All stores and shopping centres as well as auditoriums and theatres will be back in business on April 19.

All sports, gyms, indoor and outdoor physical activities and other events will be permitted with reduced capacity from May 3.  

The coronavirus is not going away anytime soon and so basic rules such as the wearing of facemasks and appropriate social distancing will remain mandatory in public places throughout Portugal at least until June 13

While many Covid uncertainties remain, one thing beyond any doubt is that all sections of the Portuguese tourist industry that is so vital for this country’s economy, want to welcome with open arms any holidaymakers frustrated by lockdowns in each of their home countries.