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# 2023-06-17 - A Loving Approach To Dementia Care by Laura Wayman | |
I checked out this book from the local library. I am interested in | |
dementia care, in particular, how to do it in a loving way. This | |
book strikes me as a valuable resource. It includes many personal | |
stories about caregivers dealing with dementia-related challenges. | |
This is NOT light reading! I found myself reading much more slowly | |
than usual because of the emotional weight of the material. Below | |
are notes i took while reading. | |
# Chapter 1, Introduction | |
Providing care is an important and noble endeavor, but to be able to | |
provide the best possible care, you must also take care of yourself. | |
To complement this book, I highly recommend that all caregivers | |
connect with additional resources. Reach out to your community and | |
ask for help... | |
# Chapter 2 | |
The common tragedy of caregiver illness or death illustrates why | |
stress management is so important for caregivers. | |
If you do not take care of yourself, you will not be able to care for | |
your loved one or client. | |
My years of observations and interactions have taught me that | |
communication with the dementia-challenged person involves much more | |
than words coming out of your mouth. Most of the communication comes | |
from tone of voice, facial expression, and body language. Adults | |
with dementia communicate on the basis of emotions. | |
# Chapter 3 | |
It is human to deny what we find unpleasant or frightening. But when | |
denial prevents us from seeing facts and facing their implications, | |
it will not help us or our loved ones. | |
Here's what becoming a dementia-aware caregiver looks like. | |
Dementia-aware caregivers: | |
* access support from the medical community. | |
* remain open to continuing education about their loved one's | |
conditions. | |
* consider the bigger picture. | |
* continuously reach out to stay supported along the way. | |
Here are some additional, quality-assured dementia-awareness raising | |
community resources who are promoting ways of more successfully | |
living with dementia in communities around the world. | |
* Dementia Partnerships, Sharing Knowledge and Learning Across the | |
Well Pathway for Dementia | |
* Alzheimer's Europe, Switzerland 2013: National policies covering | |
the care and support of people with dementia and their carers | |
# Chapter 4 | |
In some cases, people with dementia will experience precisely the | |
same kind of dementia-denial their caregivers exhibit, namely that | |
understandable emotional desire to convince themselves that | |
everything is fine. However, anosognosia is an entirely different | |
problem. While anosognosia is still difficult to define, researchers | |
know it results from physical, anatomical changes or damage to the | |
part of the brain that affects perception of one's own illness. As a | |
neurological impairment, it is common following brain injuries or | |
diseases. For instance, people with a disease or illness causing | |
dementia may display anosognosia and insist they do not have a | |
problem. Naturally, the family member or professional caregiver who | |
has to deal with this can become exasperated. | |
To make the situation even more challenging, anosognosia may be | |
complete or selective, in the latter case only revealing itself in | |
certain situations that trigger the person's dementia-denial, such as | |
when he or she becomes frustrated trying to perform simple daily tasks. | |
... the most effective caregiving strategy is one of acceptance and | |
empathy toward the symptoms and subsequent behaviors, rather than | |
endlessly trying (and failing) to make the person with dementia | |
understand. | |
Here are five things to keep in mind when caring for someone with | |
dementia symptoms and anosognosia: | |
1. Use positive action statements in your communication. Be gentle, | |
encouraging, and empathetic about necessary tasks. Avoid asking | |
too many questions or giving too many options. Keep it simple! | |
* Break down activities into a series of steps. Using visual | |
cues, such as showing them with your hand where to place the | |
dinner plate, can be very helpful. Instead of "Are you hungry, | |
would you like to eat some lunch?" Change the question into a | |
simple and easily processed positive action statement such as: | |
"Come with me, let's have some lunch together." | |
* I like to call this playing "Dementia Jeopardy!" In other | |
words, give the person with dementia the answer without | |
expecting them to understand or have to respond to the question. | |
Someone with a healthy working brain enjoys considering | |
questions and options and coming up with appropriate responses; | |
they can do this on "autopilot." In people with dementia, when | |
there is loss of brain functionality in the area that processes | |
questions, options, and decision-making, this will inevitably | |
cause frustration and anxiety for the person when that | |
processing ability is no longer there. | |
2. Spend time with no pressure, no agenda, no judgment, and no | |
expectations. Allow the person to be whoever he or she is right | |
now. Downsize any responsibilities that are unnecessary. | |
3. Avoid fact- and reason-based discussions with the person who has | |
dementia symptoms and anosognosia about her or his medical | |
condition or changing care needs. The more you, the caregiver, | |
become dementia-aware, the more you will see that your loved one's | |
comments, behaviors, and changes are an expected part of the | |
disease process and out of her or his control, helping you better | |
plan and accept what is yet to come. When voicing concerns, stay | |
calm, confident, patient, and present in the moment. Articulate | |
your thoughts in a simple and positive light. Practice | |
communication that excludes discussion about what abilities he or | |
she has lost, all the while increasing the focus and attention on | |
what abilities still remain. | |
4. Allow people with dementia the dignity of experiencing whatever | |
emotions they are feeling at the time, with an understanding that | |
these feelings are real to them, even if they are difficult for | |
you to understand. | |
5. Be sure to take care of yourself. | |
# Chapter 5 | |
The word dementia comes from the Latin dis, meaning "away from," and | |
mens, meaning "mind." It describes a state of being away from your | |
mind or existing in this world while being away from the previous | |
life. Like sleepwalking. Dementia is not a specific disease. It's | |
an overall term that describes a group of symptoms associated with a | |
decline in thinking skills severe enough to reduce a person's ability | |
to perform everyday activities. The way I like to describe it is | |
that the person presenting dementia symptoms has a "broken thinker" | |
and to become "dementia-aware" is to learn to "think" for them. | |
Delirium is characterized by a sudden onset of confusion. Symptoms | |
of delirium occur rapidly--not over a long period of time, as happens | |
with dementia. | |
There are some circumstances that can cause people to develop | |
dementia-like symptoms. Depression, dehydration, malnutrition, | |
hospitalization from a severe injury or fall--all can cause a person | |
to behave abnormally. ... The most common cause of dementia is | |
Alzheimer disease, between 60 and 80% of people with dementia have | |
Alzheimer disease. There are, however, many other causes of | |
dementia, including stroke, Lewy body disease, Parkinson's disease, | |
and head trauma. Many people have a dual-diagnosis... | |
Nearly everyone with dementia has progressive short-term memory loss. | |
Dementia frequently brings about impaired judgment and a loss of | |
inhibitions, causing individuals to exhibit behaviors that may appear | |
odd and may be out of character for them. In addition, people with | |
dementia may have difficulty making decisions. The person's ability | |
to be organized and to do multiple tasks simultaneously may become | |
limited. Many people with dementia choose not to participate in | |
their usual activities if there is too much outside stimuli. | |
Being a dementia-aware caregiver involves accepting the unfortunate | |
fact that when the effects of permanent, progressive loss of normal | |
brain function are readily observable, there is no way to stop, | |
alter, or fix the escalating dementia symptoms. Instead, the | |
caregiver needs to implement a realistic care approach, with the | |
understanding that you can only do your best to manage the changes. | |
It is critical for a dementia-aware caregiver to stay fluid and | |
flexible, as the strategies for managing the symptoms will shift in | |
the blink of an eye... | |
Your day must be filled with patience, empathy, and efforts to | |
maintain your loved one's dignity. At the same time, you must manage | |
all the day-to-day activities necessary to feed, clothe, bathe, and | |
nurture the person in your care. | |
A person with Capgras syndrome, also known as Capgras delusion, | |
believes that people close to her [or him] have been replaced by | |
duplicates. The person with Capgras may doubt her [or his] own | |
identity and question whether [he or] she, in whole or in part, has | |
been replaced by an imposter. This syndrome is more prevalent in | |
women than in men. | |
The delusions center around one of the senses--most often sight--and | |
remain localized to that one sense. For example, a man afflicted | |
with Capgras may recognize his wife's voice on the phone yet believe | |
that she is an imposter when he sees her in person. | |
[How does short-term memory loss feel?] Consider this comparison: | |
almost all of us have gone to the mall, parked, shopped, and returned | |
only to realize we cannot remember where we left the car. You know | |
how uncomfortable it feels when you can't find your car? You may | |
even start to wonder if it has been stolen. Well, that unpleasant | |
blank feeling and memory deficit is what the dementia-challenged | |
adult feels every day, every hour, every minute. Can you imagine | |
how frightening and disorienting this must be? | |
# Chapter 6 | |
You will never win an argument with someone who has dementia. In | |
fact, you may already sense that the person you are caring for will | |
be much more cooperative if you acknowledge and give affirmative | |
responses to her or his feelings and subsequent behaviors--in her or | |
his reality, not in yours. This reality, from which the person who | |
has dementia may drift in and out, is very different from your | |
reality and from what your loved one's reality was before the | |
dementia became an issue. | |
The most challenging behaviors for caregivers sometimes are | |
precipitated by their attempts to bring the person who has dementia | |
into their reality. | |
... the more at peace you are, the more easily you will guide your | |
loved one or client into a place of serenity. The caregiver who | |
remains calm can gently lend the person who has dementia to | |
experience feelings of peace. | |
Even the most challenging and bizarre dementia behaviors are born | |
from past events. These behaviors are triggered by things that are | |
happening now that in some way evoke a sight, smell, sound, or | |
emotion from long ago. When you understand the root causes of these | |
behaviors, you can put on your creative thinking cap and develop | |
unique approaches that will help you redirect your loved one or | |
client into more cooperative behaviors. | |
Even if you do not know what's causing a specific behavior, you can | |
still use redirection to obtain a more tranquil reaction, as long as | |
you approach each challenge from a place of peacefulness. | |
Remaining calm while caring for the person who has dementia can be | |
very difficult. The stress that caregivers face is considered | |
chronic stress because it is long-term, constant, and unrelenting. | |
This stress can be powerful enough to damage the caregiver's health | |
and cause serious illness. Properly managing stress is vital to | |
successful caregiving. | |
This chapter's message is simple: one way to manage stress is to | |
remember that you cannot correct the dementia wonderland. All | |
attempts to being people with dementia into "reality" will only | |
create more stress for both parties. Instead of setting yourself up | |
for intense frustration, give your loved one or client affirmative | |
responses and positive action statements. Doing so will help you | |
remain in a place of calm confidence, which will in turn help the | |
person who has dementia. | |
# Chapter 7 | |
As the disease strips away their language centers, people with | |
dementia lose their ability to communicate verbally. The brain | |
attempts to compensate for these losses by using all of the remaining | |
senses to perceive, interpret, and acknowledge what is happening in | |
each person's immediate surroundings. The use of other senses | |
heightens the impact of nonverbal communication. | |
In summary, the person who has dementia will feel what you are | |
feeling and reflect those emotions back. | |
The best way to help the person who has dementia remain calm is fore | |
you to remain calm. Do your best to leave harassed or anxious | |
feelings outside of the relationship. Above all, take time away to | |
find respite and keep yourself in a less stressed place. Even if you | |
are not in a place of happiness, you can still smile and make eye | |
contact. Setting the right tone at the beginning of every | |
interaction will result in a higher level of cooperation from the | |
person who has dementia. | |
The person with dementia is hypersensitive to what you are feeling. | |
Since the person with dementia will mirror your feelings and moods, | |
you have the power to set the tone. Assuming an upbeat manner will | |
create many more positive moments for you both as you go about your | |
day. If you can do it, you will be rewarded with an enhanced | |
caregiving relationship. | |
# Chapter 8 | |
As the short-term memory fades, a person with dementia sometimes | |
becomes caught up in painful, unresolved memories and is trapped by | |
the negative feelings those memories trigger. This "rut" may be the | |
root behind unpleasant behaviors. | |
Many people who have dementia appreciate it when someone does | |
something as simple as listening with a caring ear. They may express | |
painful feelings that they are still trying to work through. When | |
you adjust your listening skills to accommodate both the pleasant and | |
the painful memories--listening without judgment or argument--you | |
will become much more effective at communicating and speaking the | |
"special dialect of dementia." This kind of listening can also | |
create an opening for the person with dementia to resolve or tie up | |
loose ends by working through the negative events, venting "emotional | |
steam" that may have been suppressed for years. It sometimes happens | |
that the person will go back in time to escape the painful present | |
reality, only to get stuck in equally painful long-ago memories. | |
When you are communicating with someone with dementia, be patient and | |
develop a trusting relationship. Always provide a dignified and | |
respectful atmosphere, even if the person is not always able to | |
provide the same for you. | |
Although those with dementia have much in common in terms of the | |
disease of dementia, each individual beings a one-of-a-kind storyline, | |
so it is up to the caregiver to listen, adjust, and change, remaining | |
flexible and fluid in addressing the ever-evolving needs as the | |
dementia progresses. | |
Sometimes the stories that the person with dementia shares will be | |
unclear, repetitive, or even dull. However, the more time you take | |
to show genuine interest--intently focusing on what the person can | |
share with you about her or his past--the better able you will be to | |
build a deep connection. This connection will, in turn, help you | |
develop care solutions that effectively meet the social and emotional | |
needs of your client or loved one. | |
Human beings, including human beings with dementia, need to be able | |
to express their feelings to someone who cares; this is especially | |
true of strong (and perhaps unpleasant) feelings from one's past. | |
The strong feelings that are directly connected to past memories do | |
not magically evaporate as we age. On the contrary, they often come | |
back late in life to haunt us... By listening for and catching an | |
emotion that may have been bottled up inside someone for years, we | |
allow the person to express those feelings and easy their minds and | |
hearts. | |
# Chapter 9 | |
If you were confused about your surroundings, could not remember who | |
the people near you were, felt disoriented and overwhelmed and could | |
only access memories and feelings from your distant past, where would | |
you go to feel the more secure and content? Of course, back in time, | |
to memories that brought you happiness, delight, and feelings of | |
self-worth and purpose. | |
In contrast, if you had frightening or unhappy feelings driven by | |
painful memories, you would naturally want to avoid those unpleasant | |
stops on your journey. ... Understanding the person's behavior helps | |
reveal whether he or she is experiencing pleasant or unpleasant | |
memories. If someone is experiencing negative feelings, we want to | |
affirm the person and yet bring comfort and peace to the situation. | |
Conversely, when the person is in a good place, we want to help | |
reinforce the positive memories and feelings. | |
Remember: you will never win an argument with a person who has | |
dementia. But whenever you affirm the emotions that the person is | |
experiencing, you will instead enjoy a magical connection! Affirming | |
emotions will provide many wonderful opportunities for you both to | |
feel appreciated. Making people with dementia feel valued helps | |
create an emotional safe place for them to land amidst their | |
confusion. | |
[Reflective action: a technique where you mirror the other person's | |
actions.] | |
Our usual way of communicating becomes less effective as the dementia | |
progresses. Communicating effectively with a person who has dementia | |
requires skill, confidence, and adaptability. Approach each | |
situation with patience. Repeat phrases that produce an affirmative | |
response. Slow down, watch, and listen--and repeat, repeat, repeat. | |
Use creativity to express both your feelings and your message. | |
Practice these new skills to convey your message when you handle each | |
different situation. | |
When you want to communicate with your loved one or client, be sure | |
to get the person's attention and make eye contact. Make certain the | |
person feels that he or she is your only focus. Look her or him | |
directly in the eye and be totally present. Speak slowly and | |
clearly, giving only one message at a time. Limit outside | |
distractions such as a TV or radio. | |
Use actions as well as words--the old saw "show and tell" skills that | |
you learned as a child in school. | |
Even when their communication abilities are failing, you can still | |
show people that you understand their unique attempts to get across | |
what they with to share. Watch facial and bodily responses. The | |
person's reaction to what you say can give you an idea of how much he | |
or she understands. Respond to her or his moods and emotions, | |
especially when the words do not make sense or are inappropriate. | |
And finally, never lose sight of the importance of nonverbal cues. | |
We all communicate by emotions, expressions, and touch. Holding a | |
hand, or smiling when talking, can convey much more than words. | |
The main focus on providing care for the elderly, especially those | |
who have dementia, is not about my agenda or even my feelings. The | |
focus is on the needs of the elderly person in front of me. If I am | |
going to be able to respond to the immediate needs of a person who | |
has dementia, I must be willing to enter her or his world | |
attentively, respectfully, and without argument. Most importantly, I | |
must treat each person with genuine loving care. | |
# Chapter 10 | |
Creative intervention: finding a clever way to meet the specific | |
needs of a person who has dementia. | |
In developing your own creative interventions, you will find they | |
work best if you have the opportunity to research and collect | |
information from the individual's past. Each person with dementia | |
has a unique and long history of joys, sorrows, pleasure, and pain. | |
Tapping into the significance of historic events that make the | |
individual feel loved, secure, valued, or safe will usually bring | |
those feelings to the present time and allow you to share in the | |
origins of the feelings attached to the memory. The better you come | |
to understand the person for whom you are caring, the better able you | |
will be to provide her or his care. | |
In the early stages, as your loved one or client how you can help her | |
or him stay independent and maintain a sense of control. It is best | |
to encourage independence as much as possible, since doing so will | |
reduce the burden on you and on the person for whom you are caring. | |
As the dementia begins to hinder the person's memory and abilities, | |
he or she will find it beneficial to contribute to self-care, even if | |
it is in a small way. | |
To a point, independence boils down to the old saw: Use it or lose it. | |
A common tip from experienced caregivers is to learn to be patient. | |
Granted, this is not always easy, but it will pay off in rich | |
rewards. Do not rush people who have dementia. Give them plenty of | |
time. Although it is often faster and easier to do things for other | |
people rather than wait as they perform tasks for themselves, | |
allowing them to complete basic tasks gives them a sense of value and | |
helps them to feel proud of even the simplest accomplishments. | |
Above all, be sure to continue your favorite activities together. | |
Listen to music. Take a walk. Talk about your favorite shoes. | |
"Gossip" about the usual suspects. Focus on the person's talents and | |
abilities. Look for common interests and use them to establish | |
community connections. | |
No matter how the disease affects the individual, it is important to | |
treat her or him with dignity and respect. Although certain | |
abilities will be lost, the person's emotions and feelings will | |
remain, as will the need for companionship and belonging. To add to | |
the person's quality of life and help her or him maintain a unique | |
ID, provide activities and interactions that bring a sense of joy and | |
celebration. | |
Never lose sight of the person who was there before dementia. | |
# Chapter 11 | |
Unfortunately, as individuals struggle to cope with dementia, | |
paranoia [is common.] The people with dementia may have | |
misperceptions or hallucinations about family members, old friends, | |
and strangers. In most cases, this is just a phase that eventually | |
subsides, but there is no way to predict how long these symptoms will | |
last. The severity of the symptoms can depend on the type of dementia. | |
The resulting behaviors are especially related to a loss of control. | |
As people with dementia come to rely on others for assistance, they | |
may feel as if the caregivers are taking over their lives or even | |
robbing them. And as the dementia progresses, they often lose the | |
ability to recognize that they themselves might be to blame for | |
missing items. It would seem to them that the misplaced items must | |
have been stolen, and they will often accuse the people closest to | |
them of stealing the items. | |
Instead of reacting to these behaviors, coping with and managing them | |
is key to making the person feel safe and supported. | |
As noted in earlier chapters, it is best not to argue with a confused | |
person. Disagreeing may only escalate and fan the fires of anger, | |
anxiety, paranoia, and fear. If you cannot win the battle, change | |
the war. No matter how outlandish the claim or accusation, listen | |
and proceed as though you believe everything the person with dementia | |
is saying. Plan to take action that will give the person a sense of | |
relief. The most frustrating response she [or he] can get from you | |
is an argument to try to convince her [or him] that the situation is | |
not real. | |
This is a big change in how we have always communicated with adults, | |
so it takes practice! I even have to remind myself to ask less and | |
do more, as this is a core component of dementia-aware communication. | |
For example, when you first greet someone you often ask, "How are | |
you?" You expect a common response such as "Fine, how are you?" I | |
have observed how this ordinary and simple question can make the | |
person with dementia uncomfortable, stopping them in their tracks as | |
they struggle to process an answer. When I began to notice this was | |
causing some difficulties, I changed this customary greeting to a | |
positive statement such as, "You look great today!" or "It is so nice | |
to meet you!" The change in their response was remarkable, so much | |
more relaxed and less confused. | |
Many of the things that people with dementia do are attempts to | |
empower themselves by hanging on to the remaining elements of control | |
and choice they still possess. As we go through life, we suffer | |
diminishing control over many things. These losses put dents in our | |
emotional armor, especially if they are caused by dementia. | |
Given all of the other losses that person's with dementia may be | |
experiencing, the last thing they want to feel is that they have lost | |
their grip on reality. When people with dementia insist that people | |
around them affirm their perception of the world, they are actually | |
asking for help in framing their own worlds. By providing | |
validation, you will help to make everything else seem less confusing | |
to them, even if the relief is only temporary. Your affirmation | |
provides a brief respite, allowing the person with dementia to rest | |
her or his mind in the midst of what must feel like constant chaos. | |
Remember that each situation and scenario is very real and true to | |
your loved one or client in her or his wonderland. It must be very | |
frightening to experience events that seem so real and not receive | |
validation from others. As you listen to and focus on every | |
complaint, accusation, or angry outburst, try to allow yourself to be | |
open to what is being said. Be a detective and discover the who, | |
what, when, where, and how of each situation. Handling your loved | |
one or client's issues is yet another way to bridge the gap between | |
the two of you... | |
As you approach each situation with an open mind, also consider the | |
possibility that a person's behavior may not be totally rooted in | |
dementia. For example, the paranoia caused by dementia may be | |
exacerbated by sensory impairment. | |
As frequently as possible, look for easy ways to lighten your load. | |
Lock the bathroom door and soak in a bubble bath. Get together with | |
your friends and play cards. Take a walk or read a book. Watch the | |
latest ballgame or a comforting movie. Choose your favorite relaxing | |
activity. You need to have a place where you can remove stress and | |
emotionally vent. | |
In addition to practicing these quick-fixes, schedule time for | |
long-term stress management and maintenance. Longer-term stress | |
busters can include regularly attending caregiver support groups (the | |
local chapter of the Alzheimer's Association can provide lists of | |
support groups in your area), seeing a counselor who is experienced | |
in caregiver issues, or learning meditation or progressive relaxation | |
exercises. There are also wonderful training programs that are | |
specific to stress management and that are suited to both family | |
caregivers and healthcare professionals. [HeartMath, hypnotherapy | |
relaxation and mood-enhancing spoken and music CDs, Snoezelen Therapy | |
for clients...] | |
# Chapter 12 | |
Research is showing that some relatively basic interventions that do | |
not involve pharmaceuticals can be used to easy behaviors. A | |
simplified approach to managing agitation can be summed up as "modify | |
the environment, modify the behavior, and medication as a last resort." | |
In our professional caregiving training sessions, we always tell the | |
care providers, "If you keep doing what you are doing, you will keep | |
getting what you are getting." And if what you are getting is not an | |
affirmative response, try a different approach. | |
All types of behavior are forms of communication. When a person with | |
dementia acts out, he or she is trying to tell you something. | |
Agitation is often the result of the inability to deal with stress, | |
pain, or fatigue. The key is to identify whether the behavior is | |
related to a specific event or whether it stems from a sudden or | |
unusual environmental stimulation that causes an emotional outburst | |
and then escalates into a combative flare-up. | |
Either of these kinds of memory stimulations--which are usually | |
innocent--can trigger unpleasant, seemingly bizarre, or even | |
dangerous actions on the part of the person with dementia. | |
Take note of patterns and subtle clues that tension is mounting. The | |
more proactive you are in redirecting the behavior before anxiety | |
escalates, the more successful the redirection will be. The tendency | |
toward aggressive behavior often increases at the end of the day as | |
stress and fatigue build. | |
I have enjoyed great success using music with which the person with | |
dementia is familiar. Playing calming music or the person's favorite | |
type of music can lead to a decrease in agitation. Use this tool | |
before meals, since it can increase food and fluid consumption. When | |
relaxing and calming music is sued during bathing, it can make the | |
person with dementia less resistant to personal care. | |
Light exercise each day can also help maintain function of limbs and | |
decrease problem behaviors. Going for a walk--preferably one or two | |
hours before dinner--several times each week may help reduce pent-up | |
agitation in a healthy, productive way, as well as stimulate the | |
appetite. And besides, exercise is good for you, the caregiver, too. | |
Activities that include social interaction are also helpful. | |
Additionally, never lose sight of the person who was there before the | |
dementia. Activities that reflect your loved one or client's | |
previous life or career are very effective. | |
Above all, a serene approach from the caregiver is the magical key to | |
successfully managing agitation. The person with dementia is | |
ultra-sensitive to your moods and feelings and will mirror back | |
whatever is felt from the person providing care. So check your | |
anxiety, agitation, and stress at the door before you spend time with | |
a person with dementia. | |
# Chapter 13 | |
Many people who have dementia resist personal care tasks like | |
bathing. ... people who have dementia travel back in time into their | |
pasts, retrieving old memories and feelings. What memories might be | |
brought to mind by a shower? [Hint: not always pleasant.] Now | |
imagine what it would be like to experience a shower in an unfamiliar | |
place with strange people around you. | |
It's no wonder that caregivers frequently face resistance to the | |
common task of bathing. A sensitive approach may make all the | |
difference. When your loved one or client resists letting you help | |
her or him with a shower, avoid the word "shower" or asking | |
questions. Instead, try simple and positive action statements: | |
* It's time to clean up now. | |
* Let's go take our bath before the water gets too cold and dirty. | |
* I am so hot; a cool bath would make me feel better. I'm going that | |
way, so some and give me a hand getting the bath ready. | |
* A warm bath sounds so good. It would warm you down to your bones. | |
* "Your daughter called and said she is on her way to take you to | |
_____ [the doctor's office, lunch, etc.]" Use whatever topic might | |
motivate this person to get ready. | |
* "It's Saturday. Time for bath night." Draw on the person's past | |
routine, if you know what it is. Use terms that are understandable | |
within the person's dialect of dementia. | |
* I picked your favorite lavender-scented soap. You smell so good | |
when you use it. Let's go use some right now. | |
If the approach is not working now, come back and try again at a time | |
when he or she is more likely to be cooperative. If Mrs. Smith is | |
not a morning person, approach her in the afternoon when she is in a | |
better mood. | |
* Make sure the setting is quiet and private, with adequate but not | |
overly glaring lights. A stark or bright light can feel cold and | |
institutional. Honor the need for modesty; hold up a towel or | |
undress and redress the person as you go. It is always appreciated | |
if you provide assistance while keeping the person's dignity in mind. | |
* Be prepared. Have everything you need at hand... If you get the | |
person ready and in a cooperative mood for bathing, you do not want | |
to miss the window of opportunity because you have to go fetch a | |
towel. Furthermore, it is not safe to leave the person alone, | |
especially if he or she is wet and soapy. | |
* Give instructions one at a time. Do not rush the task. | |
* Demonstrate the task at hand. Remember to always allow the person | |
to do whatever he or she can. | |
* Consider your own attitude and appearance. | |
* Play soft music, preferably the style that is the person's | |
favorite. Additionally, praise and compliments always help... | |
* Finally, some caregivers have found that promising care recipients | |
a bowl of ice cream can work wonders as an incentive. | |
You will probably encounter days when things go smoothly and other | |
days when they do not. The person with dementia has mood swings just | |
like everyone else. | |
You may also want to read Bathing Without a Battle by Ann Louise | |
Barrick and co-authors. | |
# Chapter 14 | |
"Life Stations" should replicate things that we see in normal, | |
everyday life. Here are some great examples of life stations that | |
you can bring to your community: | |
* Office Station with a desk, older model desk phone, typewriter, etc. | |
* Baby Station with a crib, baby dolls, baby clothes, blankets, and | |
baby bottles. | |
* Kitchen Station with dishware, pots, pans, and a counter with | |
mixing bowls and spoons. | |
* Teacher's Station with a chalkboard, desk, notebook, picture books, | |
and coloring books. | |
* The Man Cave with sanding blocks, pieces of wood, PVC pipe that | |
fits together, and paint brushes. | |
* Dressing Room Station with a vanity or table and bench stacked with | |
costume jewelry, a hall tree with hats, jackets, feather boas, and | |
scarves. | |
* Laundry Station with various sets of colorful socks, towels, a | |
laundry basket, and an ironing board. | |
It is necessary to have all staff, leadership, and family members | |
trained in a dementia-aware care approach in order to use these life | |
stations effectively. The idea that simply setting these life | |
stations up and then expecting the residents to use them on their own | |
is not what happens. [In that case, these life stations often sit | |
unused and gather dust.] | |
Helping the resident take part in life station activities can play a | |
significant part in dealing with challenging behaviors. | |
A healthy brain is so good at accessing this information, thinking, | |
and solving problems that you don't even notice it working. Tasks | |
that you've practiced many times start to seem simple; but even | |
simple tasks use many different parts of our brain in amazingly | |
complex ways. | |
Often this [progressive loss of brain function from a cause of | |
dementia symptoms] culminates in people with dementia symptoms losing | |
interest in activities they used to enjoy and being less likely to | |
take part or even try them. | |
They will need even more help and support from other people. They | |
need those caring for them to step up and proactively "think for | |
them," including helping them to engage and participate in meaningful | |
social activities. | |
A person with dementia still needs good quality of life, but without | |
some assistance from families and caregivers, it is much more | |
difficult for them to achieve purpose and pleasure. | |
Ideally, activities should: | |
* compensate for lost abilities, whether physical, emotional, and/or | |
social. | |
* promote self-esteem and provide feelings of accomplishment and value. | |
* maintain residual skills and not involve new learning. | |
* provide an opportunity for enjoyment, pleasure, and social contact. | |
* be sensitive to the person's cultural background. | |
Dementia-challenged adults often have difficulty with visual | |
perception and coordination. | |
* Ensure that surfaces are uncluttered, with few distractions and as | |
little noise as possible. | |
* Maintain good lighting without glare. | |
* Establish easy in-and-out seating and correct work heights. | |
* Use plastic containers to help avoid breakages. | |
Don't choose activities that reinforce inadequacy or increase stress. | |
To achieve the most success when carrying out activities, consider | |
the time of day when the person is at their best. | |
Understanding the person as an individual with dementia symptoms will | |
help you to plan appropriate activities for them. This means knowing | |
the person's former lifestyle, work history, hobbies, recreational | |
and social interests, past travel experience, and significant life | |
events. There are nice ways in which the person with dementia can | |
contribute to the household or community and feel useful. Encourage | |
them to have something that is their responsibility, no matter how | |
small. | |
Items of nostalgia can be used to redirect your loved one or client | |
to a sense of familiarity and security, especially if they have | |
special meaning to the person you are caring for. | |
Try not to overstimulate the person with dementia symptoms. Be | |
selective with outings. Avoid crowds, constant movement, and noise, | |
which many people with dementia symptoms find overwhelming. | |
It can be helpful to write a customized activity care plan working | |
with all of those involved in their care, including family members, | |
clergy, professional care providers, neighbors, and friends. This | |
will help make sure that the activities are consistent and are suited | |
to the individual needs of the person with dementia symptoms. | |
For many people with dementia, a sense of movement and rhythm is | |
often retained. Listening to music, dancing, or having contact with | |
babies, children, or animals provides positive feelings. People with | |
dementia often have excellent memories of past events and looking | |
through old photos, memorabilia, and books can help the person to | |
recall and enjoy earlier times. | |
Some sensory experiences that the person with dementia might like | |
include: | |
* enjoying a hand, neck, or foot massage | |
* brushing their hair | |
* smelling fresh flowers | |
* using essential oils and fragrances | |
* stroking an animal or different textured fabrics | |
* visiting an herb farm or flower show | |
* looking through a box containing things that the person has found | |
interesting in the past, such as costume jewelry, postcards, or | |
greeting cards | |
Lose your preconceived notions of how the activity should be done or | |
what the outcome is supposed to be... | |
# Chapter 17 | |
Sometimes it can feel like there's not a lot in your life to laugh | |
at. But laughter is a wonderful stress buster and has great effects | |
on your body. In fact, it increases blood flow, decreases stress | |
hormones, boosts metabolism, and helps put our problems in | |
perspective. Most importantly, it can help us keep our sanity in | |
overwhelming situations. | |
# Chapter 19 | |
It is hard to remember how important it is to be thankful for | |
everything we have in our lives, especially when we are faced with | |
the daunting task of caring for a loved one or client who has dementia. | |
It may be difficult to find something to be grateful for, but it can | |
be even small things... | |
# Chapter 20 | |
If you are a caregiver assisting someone with dementia, you are | |
losing your loved one one piece at a time. You will have to | |
continually grieve each loss as it is presented: your loved one's | |
loss of physical ability, loss of memory (including when he or she | |
forgets who you are), and loss of ability to carry out everyday | |
functions. At the same time, you will be grieving the loss of your | |
own freedom, your sleep patterns, and even your energy. The | |
normality of your everyday life is gone and will not return to the | |
way it was before you became a caregiver. | |
Grief is the conflicting feelings caused by the end or of change in a | |
familiar pattern of behavior. | |
Understanding and accepting the grief process guides you through | |
acknowledging the loss. You can then give yourself permission to | |
feel the emotions and will be aware that grief is a normal and | |
natural part of the human experience. | |
A book on the subject of grief that I recommend is The Grief Recovery | |
Handbook by John W. James and Russel Friedman. | |
For a more complete list of resources and additional dementia-aware | |
support: https://laurawayman.com/iamdementiaaware/ | |
https://laurawayman.com/wp-content/uploads/2020/04/CCMC-April-2020-WEB-final.pdf | |
https://laurawayman.com/wp-content/uploads/2020/04/compassionate-communication.… | |
[The back of the book has a relatively short section titled The | |
Dementia-Aware Guide to Caregiving.] | |
author: Wayman, Laura, 1955- | |
detail: https://laurawayman.com/product/a-loving-approach-to-dementia-care | |
LOC: RC521 .W39 | |
tags: book,non-fiction | |
title: A Loving Approach To Dementia Care | |
# Tags | |
book | |
non-fiction |