DEMENTIA: Dealing with patients with dementia – Part 1

1) Establishing rapport – A sensitive and flexible approach

Working with clients with dementia requires a slightly different approach. Every day will be different, and therapists must be flexible with treatment to meet the unique needs of the client at each and each session.

Transitioning into a treatment session can be challenging. A sensitive approach is needed. Observe what is going on around your client. They may be busy and focused on something in their own world or space. Interruptions can be difficult to cope with and too much input or stimulation can cause anxiety, frustration and even anger.

2) Different kinds of questions

I may approach a client without dementia who is aware of their appointment like this: “Hello Olivia. I am Jane, your physiotherapist. Can we start with your treatment?” The client gives consent and you proceed.

Beginning a visit with a client with dementia or someone who is very elderly may require a different approach: “Hello Olivia. I see you are busy with your photo albums. Can I join you?”

Try to engage with your client within their present activity. Allow the client to lead the conversation and offer brief and clear comments.

Avoid questions such as “Would you like to start your exercise program now?” as the client may say “No, I do not need it”. Maybe, say something like “It’s a lovely day. Let’s walk out in the garden and look at the flowers.”

Once you have established a positive interaction with your client you can proceed to therapy or exercises.

3) Initiating the Exercise Program

Sometimes simply starting to perform an exercise yourself will prompt the client to join in. If a client is difficult to engage with you may simply try sitting quietly with them.

Given time and space, a client will often start the conversation by asking “What shall we do now?” This gives a lead in to the exercise program.  Choosing an activity that they enjoy such as kicking a ball or foam ball tennis can help with initiation.

4) Using Keywords

Over time, you may observe a word or phrase that prompts your client to begin working on their exercises. For example, I worked with a woman who was concerned about the swelling in her ankles. She had difficulty with focusing and with transitions. However, when I asked her the question: “How are your ankles today?” while starting to perform ankle pump exercises myself, she would respond by joining in with her own ankle pumps. We could then continue with the rest of her exercises. It may be that there is something specific to your client that prompts them to remember what you are there for.

5) Give them choices. Let them lead.

I have found that relationships and partnerships with clients work best when both parties are given a chance to lead. It is stimulating and affirming to offer opportunities for clients to choose the direction of their sessions. For example, you may ask them to lead you in an exercise routine once they are comfortable. Or perhaps they may say that they would like to go for a walk outside. You may have planned to start with stretching and seated exercise, but here is where your flexibility helps facilitate a positive experience. Go with the flow. Start with a walk outside and perhaps you can finish the program you planned afterwards.