DEMENTIA: Struggles and Strategies
Constantly forgetting words, dates, names and misplacing keys and wallets can be confusing and distressing for seniors with dementia. They can become irritable, suspicious and paranoid, mistaking others’ intentions.
Depression, delirium, problems of sleep and changes in bowels are also possible complications. The person may lose interest in their favorite activities or food, refuse to eat or drink and have a lot of anxiety. They may repeat themselves over and over, wander off and get lost, leave the stove on, misplace keys, causing frustration and worry to family and friends. Once this happens and they are not deemed safe to be left alone, many end up in a senior home without realizing how or why they got there.
Healthcare workers who work with dementia patients find ways to be supportive and understanding and at the same time, engage cooperation for daily care, exercise and recreational activities.
The main strategies we use are:
A – Allow Time
Care of someone with dementia takes 50% more time than usual. When they are rushed, it increases anxiety and potentially agitation and aggression. A calm caregiver who takes the time can calm the person and make things go smoothly.
B – Back Off
Many times, if a person is agitated, all it takes is to back off and come back again when they are calmer. Pick your battles. To confront and insist is to add flames to a fire. Take a break and return at a later time.
C – Communicate
Start the interaction in a conversational way and tell them what you are there to do. Establish trust and rapport and use body language in a positive and supportive manner. Be encouraging and try to figure out the best approach for each person.
D – Distract
Distract with another activity the person enjoys like a favorite hobby, food, photos and memory. You can sometimes turn their attention from the source of agitation to a more pleasant subject. The person quickly forgets what they were irritated about. Offer choices so they still feel some autonomy and have control over their own decisions and lives.
E – Enter their world
Validate the client’s reality and try not to use logic to argue or explain the situation. For example, if the client says they are waiting for their parents (and their parents are dead), instead of saying their parents are not alive, perhaps an empathic response “you must really miss your parents, tell me about them”. People with dementia live in the moment and it is easier to go with the flow instead of strictly following your own agenda. If you are skillful, you can use their flow to achieve your goals for them.
A note for Physiotherapists
Physiotherapists experienced with dementia patients do not set a strict regimen of exercises e.g. 10 sets of leg lifts, especially if the person does not and cannot follow instructions. Instead, start with more functional and automatic activities such as getting from the bed to the chair, walking to the garden to look at the flowers, standing up to look at a photo in a frame, brushing hair and catching a ball. If you can go with their flow, it makes things a lot easier. Establishing trust and rapport is an important first step. Many dementia patients end up enjoying the routine of regular physio visits and get to trust the same familiar therapist over time.
Physio for Seniors provides customized online and in-person physiotherapy services in Vancouver, rehabilitation and fitness programs for seniors living at home or in senior homes.