For older people with dementia and epilepsy:
For older people with dementia and epilepsy, seizure symptoms are more understated than in younger people. These symptoms can include:
Dementia Australia www.dementia-australia.org.au
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
Behavioural changes or issues may result from deficits in memory and higher level cognitive skills due to the older person’s epilepsy manifestation or medication. Memory lapses can often be misinterpreted as a sign of dementia, when they may actually relate to the seizure activity or epilepsy medication. Behavioural issues may also emerge as the older person responds to their loss of independence or frustration with their changing environment. The older person may fear the unknown or how people will react should they have a seizure.
People living with epilepsy, of any age, can experience:
There are a number of things that can be done to help understand and support an older person who is showing changed behaviour patterns and behavioural issues:
If an older person with epilepsy has behavioural issues it may be helpful to follow these steps:
Australian Government, My Aged Care Resources www.myagedcare.gov.au Search: Caring for someone with dementia Victorian Government
Department of Health and Human Services www.dhs.vic.gov.au Search: Behaviour intervention services
Back to topics
This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
A risk management approach should be taken to prevent falls where possible, to help increase confidence, maintain independence and to ensure that the older person can live safely in the community or in an aged care setting.
It is best to see a doctor if there are any signs of changes in balance and mobility. Home assessment, assistive aids or protective wear may be recommended by the doctor such as, medical alerts, helmets, walking supports or an Occupational Therapist home assessment.
For an older person the loss of, or reduction of, independence can be a very confronting challenge to face.
Aged care workers and carers can assist the older person to identify suitable supports which can help them to maintain a safe and active lifestyle and reduce the risk of falls where possible.
Many falls can be prevented so it is important that fall and injury prevention strategies are implemented on a person centred basis. This is especially important for the person living with epilepsy.
There are several programs and services run by trained health professionals for preventing falls which are carried out in the community, e.g. community rehabilitation centres, community health services and specialised falls clinics.
These programs and services can be accessed through the doctor, some of which may require a referral.
Exercise is also recognised as being beneficial for falls prevention, particularly functional strength and balance exercise such as yoga and Tai Chi. Studies have shown that balance can be improved, reducing the number of falls, through doing exercises that challenge the balance systems and improve strength and flexibility.
Australian Government Department of Health and Ageing www.health.gov.au Don’t fall for it. Falls can be prevented! – A guide to preventing falls for older people
Victorian Government, Department of Health and Human Services www.health.vic.gov.au Search: Falls prevention: Information for health professionals
Monash University www.monash.edu Search: No Falls Exercise Program: A program of fall reduction exercises for older people
NSW Government, Department of Health www.activeandhealthy.nsw.gov.au Search: Your active and healthy guide and Staying active and on your feet
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
Medication should always be taken in accordance with the doctor’s instructions to maximise the beneficial outcomes of the medication and to prevent unwanted side effects. Around 70% of people with epilepsy can have good seizure control if they take their medication correctly.
There are two types of medications that can be prescribed for epilepsy:
1. Anti-seizure medications (ASMs).
ASMs are the most common treatment for people. While, they will not cure epilepsy, they can control seizure activity. ASMs are usually prescribed based on:
There are many different types of ASMs available. A seizure free outcome is the optimal result sought for the older person and by the doctor.
2. Emergency Medication.
For epilepsy, emergency medication works by stopping the seizure activity if taken when a seizure occurs. Emergency medication reduces the impact of seizure activity on the person’s life. What does this mean for the older person? Commencing medication does not always mean that it must be taken forever, there are a few things that need to be considered:
It is quite common for people in their later years to have other health conditions which may require medication. This may have an impact on what type of ASM can be prescribed. People in their later years also experience differences in the way drugs are absorbed and broken down (metabolised) or cleared from the body.
It is good practice to ask the doctor to discuss the risks and benefits of all medication. The doctor will describe common side effects of the prescribed medication; however it is also good to ask the pharmacist to go through any possible side effects.
If the older person is having many seizures, or seizures which last a long time, the doctor may also prescribe emergency medication:
ASMs may interact with other medications.
Other medications may impact on the effect of ASMs. Understanding medication, their side effects and impacts can be overwhelming for many people. Support with understanding the role of medication in the person’s Epilepsy Management Plan (EMP) is important. Encourage the older person to ask for more information and discuss the options with their doctor, family, close friend or carer if concerned.
Medication continuity is essential and it can be easy to forget to take medication at the appropriate time. Encourage the older person to put strategies in place to remind them to take their medication:
Better Health Channel www.betterhealth.vic.gov.au Search: Safe medication use Australian Government
Department of Health www.health.gov.au Search: Guiding principles for medication management in residential aged care facilities
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
Memory is one of the most important functions of our brain. For most people, as we age, lapses in our memory become more common. This can be frustrating and can affect daily life. People with epilepsy are at a higher risk of developing memory problems due to abnormalities in the frontal lobe of the brain.
There are two types of memories – short-term and long-term.
Short-term memory is used to process information which needs to be remembered for just a short time after first experiencing something. An example of this is when reading a sentence, our short-term memory allows us to remember what we read at the start of the sentence when we reach the end of the sentence.
We need to use our short-term memory to complete particular tasks e.g. calculating how many hours until we need to prepare dinner or playing a game, when this information is no longer needed it is discarded by our brain.
Long-term memory is information that is stored for a long period of time. This information may include things like where our childhood home was, what we did last year or even what we did a few hours ago. It can be very distressing for people when they cannot remember their past. This can be a recurring problem for people living with epilepsy, and can be even more frequent and increasingly distressing for people in their later years.
There are three phases to the memory process.
The first phase relates to learning. To be able to remember something new we must first pay attention and learn the new information. Having epilepsy can impact a person’s ability to pay attention over a period of time and may slow the speed of information processing. For some people with epilepsy processing new information can be overwhelming which can restrict their ability to maintain attention for long enough to commit the matter to memory. Important facts may be missed and memory is affected because the information is not being properly received.
The second phase is storage of information in the brain. For some people with epilepsy they may have difficulty in consolidating new information. Epilepsy can cause structural problems in parts of the brain responsible for memory and the storage of these memories.
The third phase is retrieval or recall. This is the brain’s way of finding and using the information that has been learnt. There are a number of factors which can make it difficult to recall information such as time pressure, being put on the spot or being asked to recall information out of context. Often, later in the day when the pressure is off, the information may be remembered more easily. It is difficult to remember information in isolation but when given further information the memory may more easily be recalled.
There are a number of ways that people with epilepsy can develop memory problems. These include:
Victorian Government, Better Health Channel www.betterhealth.vic.gov.au Search: Healthy mind and older people
Epilepsy Society UK www.epilepsysociety.org.uk Search: Memory
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
Managing risk is about identifying negative seizure or medication impacts and putting in place strategies to manage them.
Depending on the seizure type there may also be a number of safety issues which need to be considered, they could include always swimming with a companion, having on-call or in-house support overnight and the need for support with commuting.
Managing risk is an important part of the epilepsy management process. The first step in managing risk is identifying the risk factors that apply to each person. Just as each person’s epilepsy presentation is different, each person’s risk assessment will determine different risks to be managed.
For the older person the level of risk and what supports they will need to manage the risk will depend on a number of factors. Does the older person:
The degree of independence and support available to the older person has a direct impact on the risk associated to an activity. Living independently and alone for example creates a higher level of risk in the home as compared with living within an aged care facility where risk is managed as a matter of course.
When managing risks it is important to look at strategies that will either remove the risk e.g. do not participate in an identified risky activity, or reduce the risk e.g. participate with appropriate protection or support.
Risk management considerations:
Bathing carries additional risks for older people with epilepsy, consider:
Kitchens can present many hazards due to flame, heat, sharp knives and wet surfaces. Consider the use of a microwave instead of the stovetop and a food processor rather than a knife to reduce risks associated with seizures that involve involuntary movements or falls.
Take care with floor surfaces in wet areas to minimise the risk of slipping or tripping.
Driving and travelling carry additional risks for older people with epilepsy. Refer Information Page – Travelling and epilepsy.
Consider the following strategies to support an older person manage the risk associated with their epilepsy and seizure activity:
Epilepsy Wellbeing Mapping Tool www.epilepsywellbeing.com.au
Victorian Government, Department of Health and Human Services, Seniors Online Victoria www.seniorsonline.vic.gov.au Search: Australia MedicAlert Foundation
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
A late-onset diagnosis of epilepsy can have a substantial impact on a person as it changes the known and understood world of the person, a world that has been built over a lifetime of experiences.
Epilepsy differs from other chronic illnesses or age related conditions in its unpredictability. The older person may have no control over the seizure events; this is something that is often very hard for them to come to terms with.
The impact of epilepsy is also different for every person. This can leave the older person living with epilepsy feeling fearful, isolated and not understood, impacting on the way they see themselves and their level of self-esteem, confidence and independence.
Older people with epilepsy experience poorer sleep, decreased mental status and can have a higher prevalence of depression and anxiety. For an older person with low self-esteem these impacts can be intensified.
Mental health is very important and an instrumental part of maintaining a healthy self-image. Talking to a doctor and family or friends about what is happening and how living with epilepsy impacts life, is the first step in looking after mental health.
It is important to remember that epilepsy is one of the most common neurological conditions experienced by people today, so an older person living with epilepsy does not have to go it alone.
Self-esteem issues can present as:
Concerns about ageing itself are recognised as having psychosocial impacts such as fears about becoming isolated, experiencing loneliness and losing independence which can be present in an older person’s thinking prior to a diagnosis of epilepsy. For older people living with epilepsy the link between concerns about health coupled with managing their epilepsy can compound these psychosocial issues.
People with low self-esteem can experience protracted negative feelings which can exascerbate depression and anxiety and lead to additional feelings of anger, shame or guilt. Understanding this impact is crucial for providing the appropriate supports to an older person.
Aged care workers and carers can provide support by encouraging the older person living with epilepsy to discuss their feelings or concerns with those around them.
If an older person with epilepsy has self-esteem issues it may be helpful to follow these steps:
Victorian Government, Better Health Channel www.betterhealth.vic.gov.au Search: Self esteem
Beyond Blue www.beyondblue.org.au
Relationships Australia www.relationshipsvictoria.com.au
Mental Health Foundation of Australia www.mhfa.org.au
Back to topics
This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
Staying active and mentally alert is good for mind and body. A healthy lifestyle also helps with the medical management of epilepsy.
A diagnosis of epilepsy does not mean an older person cannot socialise with family or friends or keep doing the recreational activities that they enjoy. People with epilepsy can continue to take an active part in leisure activities, sport and recreation with the right approach to managing risk.
An active lifestyle which includes activities that exercise the mind and the body. Activities such as walking, stretching, yoga, Tai Chi, bowls, swimming, and dance can help the older person maintain a good level of fitness.
A 20–30 minute walk every day is an ideal exercise for maintaining a good level of fitness. If this is too much to begin with it can be broken up into two or three 10 minute walks. In an aged care setting this could be a walk around the garden or participation in lifestyle and leisure activities. A good level of fitness improves the chance of maintaining independence, managing health issues and recovery from illness, as well as reducing risk related to epilepsy.
A healthy diet which includes plenty of fruits and vegetables, good quality fats such as avocado and olive oil, staying away from high sugar foods and limiting alcohol intake.
Sufficient fluid intake is an important part of living a healthy and active lifestyle. The body needs the right level of fuel and water to stay active.
The body also needs the right amount of sleep to maintain a healthy body which can engage in an active lifestyle. Older people living with epilepsy report poorer sleep patterns, generally people who exercise regularly and stay active experience better sleep. Managing poor sleep patterns is therefore an important part of achieving an active lifestyle for the older person living with epilepsy.
There are many strategies that can be tried to improve sleep, including:
As an aged care worker or carer you can support the older person with epilepsy to:
When the activity needs of an older person with epilepsy are understood and supported, an active lifestyle can be achieved, and continue to be enjoyed.
Victorian Government Better Health Channel www.betterhealth.vic.gov.au Search: Physical activity – how to get started, Physical activity for seniors and Sleep hygiene
Australian Government, Department of Health www.health.gov.au Search: Recommendations on physical activity for health for older
Australians Australian Government Quitline www.quitnow.gov.au
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.
For many older people living with epilepsy, travelling away from the familiarity of home may be a daunting prospect; however for most people, with a little planning, it will be achievable.
A person living with epilepsy or seizures may be eligible to hold a driver licence for private vehicles as long as their seizures are well-controlled.
The ability of a person with epilepsy to hold a driver licence, at any age, depends on the likelihood of them having a seizure while driving and the impact of a seizure on their ability to drive.
When travelling or going on holidays
There are a number of measures that can be taken to ensure that time away is enjoyable and safe. Here are some tips to consider before travelling:
When licensed to drive
Any person who holds a current driver licence and develops any serious or chronic medical condition or disability including epilepsy and seizures, is required by law to report their condition to the relevant state driving authority. The authority will advise whether a medical report is required, if required it must be no more than six months old.
National driving guidelines for assessing fitness to drive outline the different circumstances under which driving may or may not be permitted for people living with epilepsy.
Assessing fitness to drive is managed separately by each state driving authority.
If there have not been any seizures for 12 months since the loss of licence, it may be possible to have the licence reinstated. The frequency of periodic reviews may vary depending on the medical report and the opinion of the state driving authority’s medical advisors.
Some ways you can help include:
Australian Government, Smart traveller www.smartraveller.gov.au Search: Senior travellers
AustRoads www.austroads.com.au Search: Assessing fitness to drive
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This information is part of a suite of resources that are targeted to aged care workers and carers of older people, to assist with caring for older people living with epilepsy.
The information contained in this publication provides general information about epilepsy. It does not provide specific advice. Specific health and medical advice should always be obtained from an appropriately qualified health professional.