Imagine for a moment that you’ve been robbed. You’ve walked into your house to find that many of your belongings have been taken. In this scenario, you would most likely be panicking and desperate to get your belongings back.
Now imagine that the robbery has happened within your own mind. This is one way to think about what it can feel like to have dementia. One moment your memories are there, and the next they’ve been stolen. Worse than that, the precious memories that you have left are ignored or you’re not allowed to think about them for fear that it will hurt you more.
One of the biggest mistakes that family and professional caregivers can make when caring for a person who has dementia is to assume that their personality and experiences have been wiped clean, essentially giving their life a clean slate; it has not. A senior who has dementia is still the same person at their core, even if they drift in and out of memories at times.
When caring for a person who has dementia, there are four strategies you should keep in mind:
1. Active listening to signals and signs for what a senior’s behaviour is trying to tell you.
2. Assume a reactive behaviour is a clue to something bigger going on.
3 Review each client’s case history.
4. Think outside the box for how you can keep them connected to the past they love.
Two examples below will explain why using these strategies are so important for seniors with dementia to maintain their highest quality of life.
A Story About Phyllis - Clothing Choices Can Matter
Let’s take the example of a woman, for example purposes, her name is Phyllis. For many years she was an executive secretary in a large law firm. She never went anywhere without looking professional. She dressed in business suits, pearls and high heels, and had her hair done once a week. Clothes were, in a sense, the base of her identity.
Flash forward forty years, and Phyllis is battling Alzheimer’s. She’s now in a long-term care (LTC) facility. Her attendants and PSW’s take good care of her, and they dote on her, and, she appears quite happy. However, her caregivers are puzzled by one disturbing behaviour on her part; huge rages that happen whenever they try to take her down to the dining room to eat.
The occupational therapist (OT) is consulted, and goes through her case history and discovers Phyllis’ history as a highly placed executive. After investigating further, the OT inquires what Phyllis wears when she is brought down to the dining room. The answer? Track pants, t-shirts, sweaters and sneakers.
Realizing that Phyllis was trying to communicate her frustration, the OT suggests that the LTC contact Phyllis’ family and have her collection of couture suits brought in. This was done, and every night before bed, Phyllis’ caregivers asked her what clothing she would like to wear the next day. Phyllis would go through her collection of clothes, selecting scarves and blouses, and suits with obvious pleasure, and make her choice. The next day, she would arrive in the dining room, dressed to the nines and beaming, all smiles, with not a responsive behaviour in sight.
Phyllis may not have been able to sit down and tell others who she was, but that did not mean she did not know.
A Story About Cleo - Our Profession Can Become Our Whole Identity
In another case, another woman (we’ll call her Cleo) had worked nights as a night nurse in England for many years. As a result, when she developed dementia and was moved into a long-term care (LTC) facility, she was up at all hours, late into the night, long after the other residents had gone to bed.
This might not have been an issue except that she had developed a habit of wandering into other residents’ rooms late at night and startling them out of their sleep. Concerned, the staff devised a convenient way to both keep her happy and allow them to keep an eye on her. They asked her if she would like to accompany the night nurse on her rounds as she checked on the other residents.
They gave her scrubs and she happily accompanied the night nurse on her rounds. To her way of thinking, she was still a nurse, even though she hadn’t actually practiced for years. The staff was able to keep an eye on Cleo, while allowing her to maintain an important aspect of her identity.
These stories are just two examples of common issues that can happen to a senior who is unable to communicate who they are to caregivers, and what caregivers can do in response to help remove the anxiety, confusion and frustration a person living with dementia can experience when faced with the inability to live their own identity.
The largest and perhaps most important part of the caregivers’ job is active listening. Listening to signals, to signs and to behaviours are key to understanding what is going on inside someone who is battling dementia. By talking to a client’s family, doctors, friends, and reading their files, caregivers can educate themselves on the history of their clients, when the clients cannot do it for themselves.
Responsive behaviours are often times the result of frustrations and an inability to communicate needs. Caregivers look for obvious physical signs; hunger, illness, pressure ulcers, incontinence, temperature, etc., but sometimes forget that even if a person is physically fine, their emotional discontent may arise out of our inability to understand who they were, and who on some level they still know themselves to be.