The Alzheimer’s Association estimates that in 2015, 5.1 million Americans 65 or older had Alzheimer’s Disease (AD). With this in mind, AD and other forms of dementia are some of the most common conditions professionals will encounter in an assisted living or skilled nursing facility.
“Dementia” is a generic term encompassing loss of memory and other cognitive functions severe enough to affect daily living. These deficits are caused by physical changes in the brain. Alzheimer’s is one of the most common and widely recognized forms of dementia, but other types of dementia include:
Dementia with Lewy Bodies (DLB)
Normal Pressure Hydrocephalus
Dementia is a difficult disease, not just for the resident, but for family members and even the caregivers as well. Caring for dementia residents requires a great deal of patience and empathy.
Interacting With Someone Who Has Dementia
Because dementia is physically affecting the brain, the effects are commonly seen through behavioral and cognitive changes, as well as changes in a person’s physical capabilities. As dementia advances, it can strip a person from much of the knowledge, social graces, learned behaviors, and coping mechanisms that we spend our entire lives developing.
Keep this in mind when working with residents affected by dementia. Social norms, problem-solving strategies, logic and reason will not always apply in your interactions. As you get to know your residents, you will learn their habits, challenges, comfort zones and more. Use this knowledge to your advantage; it can help you learn how to assuage their fears and potentially de-escalate a problem situation.
Professionalism, Respect & Dignity
Stress and emotions run high in the healthcare profession, making it even more imperative to keep a professional demeanor and maintain your disposition at all times. There will be days plagued with emergencies, or problem behaviors will escalate and your residents may lose control of their emotions and impulses. It is your responsibility to maintain a calm composure despite the seemingly ensuing chaos. People can also sense a poor attitude and feed off the negative energy, making interactions or routines even more difficult. Once your composure is lost, control of the situation is lost. Your residents and your coworkers are relying on you for consistency and even guidance.
Upholding respect and dignity are essential in elder care. People with dementia may do things incongruous with their chronological age: cradle a baby doll, forget how to use a fork, express things we may not understand, etc. You may also need to accommodate them in many facets of daily living (grooming, hygiene, toileting, meal time, and more). Remember, these are either symptoms of old age, or reminders that the dementia has affected those areas of their brain. Though they may have reduced capabilities, these people are still adults with a life story, and deserve to be treated as such.
Avoid talking about the resident or their condition in front of them, unless you are medically questioning or interviewing them. As much as they can seem unaware, they may understand to a certain degree, or even fully. Depending on the context, the resident might feel shame or humiliation if they are reminded about what they can no longer do.
Keep it Simple
People with dementia, especially in the advanced stages, have difficulty sequencing or following complex instructions. Keep your instructions or requests simple, and you may need to use verbal or physical cues or prompts, such as tapping on the faucet while asking them to wash their hands, or gently guiding their hands to the faucet. Their physical or occupational therapist(s) may have other instructions on verbally or physically guiding them as well.
Anger and frustration are common emotions among those with dementia, and some may resort to aggression or violence because they cannot find the appropriate way to express themselves. If you are experiencing noncompliance or aggression from your resident, trying to reason or exert control over them will often engage in a non-constructive power struggle. Discovering the root of the problem, or even redirecting the resident can help prevent escalation or de-escalate a situation.
Depending on how advanced the dementia is, the resident may have difficulty expressing their basic needs as well, and act agitated or upset. If the cause is not apparent, run through a list of needs or issues that could be the trigger:
Do they need to use the restroom?
Do they need to be changed or cleaned up?
Are they hungry/thirsty?
Are they in pain?
Are they otherwise uncomfortable? Hot? Cold?
Is it fear? Confusion? Boredom?
Assisting a resident in addressing these basic needs can help improve their mood and keep them comfortable and content.
If you experience simple noncompliance with your resident, try giving them options or choices. Remember, these once fully-functional adults have lost much of their independence and even pride. It is not always pleasant having someone else constantly making decisions for you. By giving the resident options, you afford them some control and choice in the situation. You can also try to ‘reward’ them with a preferred activity in exchange for your request. If the request is not urgent, you can always try again later.
People with dementia frequently exist in the moment because their brain has lost the capacity to account for the bigger picture or context. If they are troubled by something in that moment, they may act out or perseverate on the issue. Fear and confusion are common reasons for this, so a soothing, reassuring interaction can help calm the resident. Changing the environment or redirecting them to a different activity can help their mind switch gears. Music and singing are also incredibly therapeutic, and can serve as a great distraction as well.
Sundowning is a common phenomenon among people with Alzheimer’s and dementia. Agitation, confusion, and irritability increase as natural sunlight fades into the evening.
Keeping the residents active and engaged in activities throughout the day, and avoiding naps or overnapping can help residents sleep better through the night and help with sundowning symptoms. Avoid serving caffeine in late afternoon or evening, as it can also encourage night activity and irritation. Keeping residents on a regular schedule can help reduce confusion, and if useful, post a written schedule that can be referred to.
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Alzheimer’s, dementia, and its other related diseases or syndromes are an increasingly important topic in elderly healthcare. With Assisted Living Education, you can complete the Dementia Plan of Operation for your facility to serve the growing population of clients in this market. We also offer specific courses and continuing education in Alzheimer’s & Dementia Caregiving to help further educate you or your staff for the demands in this field. Explore our website for more information or contact us for any inquiries.