Many people think the first sign of dementia or Alzheimer’s is significant memory loss or that it’s a disease exclusive to the elderly. But that’s not necessarily the case — which is one of the reasons why the Alzheimer’s Society of B.C. has begun offering workshops aimed at increasing understanding of the disease and encouraging “good brain health” in the workplace.
“We’re needing to really raise the awareness,” said Jean Blake, CEO of the Alzheimer’s Society of B.C. in Vancouver.
There are employees who aren’t diagnosed and have to quit their jobs because they can’t cope or people who are fired because of their increasing decline in cognitive ability, she said.
“So, instead of being worked with as a health issue, it’s seen as a performance issue and then going back to try to get long-term disability when you finally do get a diagnosis, it’s just impossible.”
The Brain Health… It’s Your Business!presentations are meant to be an added component to wellness programs offered by employers, said Blake. Organizations should also be taking a look at their benefit plans, critical illness coverage and home care for people with dementia to help them stay in the workplace as long as possible.
“Awful things like dealing with stress and depression are very common when someone receives that diagnosis,” she said. “As you can imagine, it’s quite a difficult diagnosis to receive and accept.”
Dementia is a syndrome in which a person has acquired global cognitive impairment that interferes with function and the most common cause is Alzheimer’s, said Kenneth Rockwood, professor of geriatric medicine at Dalhousie University in Halifax.
Memory impairment is not really a convincing symptom. Instead, it’s more about lack of initiative, such as someone who usually enjoys bowling suddenly being less inclined to get involved, repetitive questioning, plausible delusions (such as a spouse having an affair) and uncharacteristic irritability (such as with grandchildren), he said.
Close co-workers are more likely to pick up on those symptoms and the classic case is when they try to cover up for a friend, he said. So HR managers need to have more than a trivial understanding of this disease.
“The number of causes of impaired effective job performance late in life are myriad so, from an HR standpoint, when do you say, ‘This now merits medical evaluation,’ when do you say, ‘This merits a bit of coaching’?” said Rockwood. “We’re going to need to sensitize a generation of managers about how to deal with this and we’re going to have to help organizations in terms of what their routines for this could be.”
All of the dementias, and Alzheimer’s in particular, are age-associated so they’re very uncommon disorders under the age of 50 but over 65 there’s a detectable increase and over 85, the chances are one in three a person will be afflicted, he said.
“As the retirement age goes up… we will see more people with this,” said Rockwood.
Even if an older person doesn’t have dementia, they could be genuinely concerned about it, said Rockwood, particularly as subjective memory impairment has a higher prevalence as people get older.
From an HR perspective, that’s very problematic because some people may have concerns about ageism if, for example, they stumble over a word and co-workers assume it’s Alzheimer’s, he said.
“It can be a bit of a morass,” said Rockwood. “If we’re going to want older workers to work, it’s indubitable we’ll encounter some people with Alzheimer’s, it’s indubitable that there will be a lot of fear about it so we need to have non-emotional routines where we can at least talk to someone about Alzheimer’s and not get sued.”
Dementia can be undetected for a long time, said Kathryn Garden, vice-president of operations at DGI Clinical in Halifax, which provides an online web-enabled tool about dementia for caregivers and care providers.
“In the workplace, the consideration really ranges from safety issues to working together to adapt the way responsibilities of the job can be carried out, right down to how to transfer the knowledge to the successor of the person as the disease progresses — the planning, the management and, most importantly, support to the employee.”
The likelihood of a person with dementia carrying on in his job depends on various factors, such as the stage of the disease, the type of work they do and work accommodations, said Blake. It’s about assessing his abilities and figuring out a transition plan.
“There are therapies with cholinesterase inhibitors that work in the early to mid-stage of the disease and they can help with memory loss and some of the decision-making issues.”
One in 13 Canadians over the age of 65 have dementia but the disease is not exclusive to seniors — out of the 70,000 people in B.C. who have Alzheimer’s, about 10,000 are under the age of 65, said Blake. There is also a long period of disability, averaging eight to 12 years, she said.
“It can create quite a severe strain and financial burden on the person’s family and caregiver.”
Heavy load for caregivers
Caregivers are often busy with children of their own and one-third of employee family caregivers report disturbances in their work due to their caregiving responsibilities, said Blake.
“Those who are caring for a person with dementia are nearly twice as likely to experience symptoms of depression than those caring for someone without dementia,” she said.
One-quarter of Canadians have family members with Alzheimer’s or dementia, said Garden, and almost one-half of informal caregivers are between the ages of 45 and 54. That can mean greater absenteeism and reduced efficiency at work as they cope with the demands on their time and any stress-induced illness.
“Consistently, caregivers of people who have dementia report greater emotional burden and they experience greater employment complications.”
In the worst-case scenario, people leave their jobs because of their role as caregivers but, on a day-to-day basis, they arrive late, leave early or have to take time off for appointments or to respond to situations, said Garden.
“The biggest concern is that there’s so many caregivers in the workplace just juggling that huge role.”
Often people have to reduce work hours, take paid or unpaid leaves of absence or forego job opportunities because of their caregiving duties, said Blake.
“Employers are bearing the cost of caregiving through absenteeism, lost productivity and if they lose somebody, (there’s) the recruitment and training costs for new personnel.”
But with greater awareness, along with early diagnosis, medication, psycho-social supports and workplace benefits, the situation can be somewhat improved, she said.
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