By Micha Shalev
Know what to expect. Increase the likelihood of a positive visit by setting realistic expectations. The middle stages of dementia can be difficult. Sometimes, people experience challenging behaviors such as delusions or anxiety, or they become easily upset.
They might not be able to recognize you right away, or come up with your name. Knowing that these symptoms are part of the disease and not a reflection of the person’s relationship with you can help you to respond well to them and ensure that the visit is positive.
Setting the stage for success:
•Gather as much information ahead of time from key sources about the person’s previous and current lifestyle, habits, routines, eating patterns, work life, schedule, hobbies, personality traits, living arrangements and relationships with friends and neighbors.
•Prepare for spending meaningful time together. Bring activities that can easily be shared that are of interest to the person at the level of their ability.
•Enlist support. If the person struggles with strangers coming into their home, ask a known person to introduce you.
•Wherever possible interview the person with dementia in his/her own home or room.
•Interview the person alone and then with others to gauge if they are different when with other people. This can give clues about the relationships and issues influencing the person.
•Bring information that can be helpful to caregivers in helping them communicate and spend quality time with the person who has dementia.
•Check your own problems at the door. People with dementia have heightened sensitivity to other people’s moods, feelings, body language and tone of voice. The person needs reassurance and understanding in order to communicate with you.
•Memorize the key questions you want to ask.
Enlist the following communication strategies:
•Show interest and respect by maintaining eye contact and relaxed body language.
•Be calm, patient and don’t interrupt. Be focused on the present and all of the possibilities that you have to communicate meaningfully.
•Read facial expressions and gestures, that reveal more than the person’s words. Gestures may replace forgotten words.
•Enter their world with them. Be an actor in their “play.” Remember that whatever they are expressing is actually where they are in time. Their past is their present, the present is their future and the future doesn’t exist because they can’t store memory.
•Offer comfort and reassurance, especially when the person is having difficulty expressing themselves; offer praise for success with an accomplishment.
•Offer a best guess if you don’t understand what is said and the person is becoming agitated. Try again if they say “no” to a guess.
•Avoid criticism, correcting and arguing, which can be traumatic to the person.
•Reminiscence is a key ingredient for success. Do things to initiate fond memories, such as humming a favorite song, talking about a pet or offering a familiar photo or object for a story. Smells, taste and touch are also strong memory triggers.
•Engage the person’s “body memory” to help them initiate or sustain an activity. For example, place a glass of water in their hand.
•Use a sensory connection to increase focus or attention and decrease anxiety. This could be a touch, a light guide on the elbow to steer, humming or stroking the skin with an object that has a unique surface such as satin. Be sure to ask permission before touching; tell the person what you are doing as you do it.
•Focus on feelings, not facts. Encourage non-verbal communication.
• People with dementia may make assertions that are not true to cover for memory loss. Trying to argue someone out of such beliefs is usually futile because the person is not lying.
•Refusal to cooperate may be due to sadness, anger, frustration, embarrassment or anxiety. Step back calmly to previous activity and assure the person that he/she is safe.
Micha Shalev, MHA, CDP, CDCM, is the owner of Dodge Park Rest Home and The Adult Day Club at Dodge Park located at 101 Randolph Road in Worcester. He is a graduate of the National Council of Certified Dementia Practitioners program, and a well known speaker on Alzheimer’s and Dementia training topics. He can be reached at 508-853-8180 or by e-mail at email@example.com or view more information online at www.dodgepark.com