DEMENTIA: Dealing with patients with dementia – Part 3

11) Realistic Goal setting

When devising a program for a client, it is always a good idea to have a meeting with the family and/or friends of the client. It helps to know everyone’s expectations and goals with regards to therapy or treatment. It is also important to be aware of all the health challenges or conditions facing the client by speaking with other healthcare providers.

For example, I was once given instructions to work with a client using vigorous exercise. However, I observed lightheadedness, loss of balance and anxiety in this individual. After a moderate walk I also observed paleness and clammy skin. I was able to speak to the nurse in this case who informed me that the client suffered from fluctuating blood pressure and tachycardia. 

Although my instructions for vigorous exercise came from the client’s power of attorney, it was important for me to know the complete situation. In this case vigorous exercise was not appropriate. Sometimes family and friends remember a time in the past when their loved one was much more able-bodied. It is always advisable to make notes, keep daily reports and have open lines of communication with everyone involved in your client’s care.

This is an example of how important it is to meet the client at their level of ability each day as their status can change considerably and certain exercises that you may have planned will not be appropriate.

12) Aids for Memory and Communication

A person’s pain and energy levels are individual. If empathetic understanding is difficult, you can use pictures with faces to find out how they are feeling.

Visual cues such as posters or sticky notes are very helpful for educating and reminding clients with memory challenges.

A simple note on the door saying: “Do you have your walker?” Perhaps a drawing of a walker might remind someone to be safe when leaving the room for a walk.

Visual cues involving showing rather than telling are also helpful. As an example, you can show someone what their posture looks like using your own body. You can then work together to improve their postural issues.

13) Massage

When providing hands on treatment such as massage, it is really helpful to start with light pressure. Many Clients with dementia or the more elderly client are very sensitive. Starting out with gentle touch and then moving slowly into more effective massage tends to work best. You may find a client who becomes drowsy or even falls asleep is able to tolerate deeper tissue massage.

14) Handling an aggressive client

When a client starts getting aggressive, agitated and possibly combative, some possible ways of handling it may involve:

• Leaving the client alone and making sure others around are safe and at a distance
• Removing the client from the source of agitation to a quiet, non-stimulating environment
• Finding a family member or companion, someone they know well and trust to calm them down and help them to a quiet place.
• Using distraction to take their mind away from the reason for aggression.
• Return when the client is calmer and in a better mood.