DEMENTIA: Dealing with patients with dementia – Part 2

6) Establishing a Routine

Building a regular program with dementia clients can take a very long time, perhaps months or even years rather than days or weeks. Given enough time, each person will develop trust and some form of “remembering” routines that you work to build upon.

It is worth pointing out that regular adherence to an exercise program helps with maintaining cognitive health, a sense of belonging and the ability to focus on positive behaviors.

7) Respect the client’s energy levels

Remember that energy levels can fluctuate more profoundly with dementia clients and the elderly in general. As a physiotherapist, I will focus more on balance and strengthening when my client has more energy. On days when I find my client is tired or even sleepy, I will focus on massage and stretching. It is less stressful for everyone when the therapy works with the situation and client preferences rather than against them. Remember to meet your clients at the level you find them at each day and there will be less resistance. This is an example of thinking more holistically about the overall health and well-being of your client.

8) Be Patient

Clients who are challenged with dementia may ask you the same questions at every session. They may not remember why they have therapy or even why you are there. Some days they may remember their exercise routines and other days they may appear to forget. It isn’t helpful to say things like:

“We already discussed this.”

“I already told you”.

“Don’t you remember from last time?”

Simply answer their questions in the same way you did on the first day as if it was the first time you answer it. Sometimes, eventually over time, you may hear them say: “I asked you this before, didn’t I?”

When this happens, or something similar, you know that you have started to build trust with your client. They feel comfortable with you enough to admit they might not remember everything.

9) Encountering resistance – Build trust. Avoid confrontation. 

Building trust leads to positive therapeutic relationships. Avoiding confrontation is important as uncomfortable situations can escalate, resulting in a failed session or at worst the break-down of the partnership with your client.

You may come up against resistance from your client especially when they are not in the best mood. Never force anyone to do anything they don’t want to do in that moment. Treat others as you would like others to treat you.  Sometimes, all it takes is to come back another time or day when he or she is in a better mood.

A caregiver or therapist may want results, progressions and improvements that they can measure and report. However, this can only happen on your client’s timeline, not your own. It is tempting to push a client to work at the same level or better than they did at the last session. Encouragement is important but remember you cannot say: “You did this last time, you can do it now”. Because of course, there may not be any recollection of a last time.

If you do encounter resistance, stop, take a break. Ask your client how they are feeling. Ask if they have pain. Remember that they may not be able to communicate to you what is going on with them. Read body language, use eye contact and LISTEN. When given time and space I have often observed that clients will willingly restart and continue what we were working on willingly.

10) Motivation

Every person has a different motivation for doing something. Knowing what motivates your client can help you talk with them about what they want to be able to do or how they would like to feel. It is very helpful to have an outline with some simple achievable goals to work towards.

For example, a client may want to be able to get in and out of bed independently. You can then work on exercises to strengthen the muscles and movements to reach this goal. Achieving a desired goal is a wonderful motivating tool.