Recognize that all behaviour has meaning.
Many of the behaviours we see in dementia arise because a person's needs are left unmet. When you observe the behaviour, you need to figure out what it is telling you. Here are some examples:
Grabbing: If a person with dementia constantly reaches out and grabs people who come close it may be an indication that he/she needs something or somebody. The person may need to go to the toilet, have a question that needs to be answered, may be bored or may be lonely and seeking human connection.
Trying to Leave: Boredom and loneliness are two key reasons for "exit seeking" behaviour. When people with dementia have something meaningful to do, these behaviours often disappear. If they want to leave at the same time every day, look for things to do before the behaviour begins.
Toileting Behaviours: Many habits from the past are spared in dementia. For example, men who urinate on walls tend to be those who worked on a farm or in other outdoor jobs; people who toilet in a garbage can often had an outhouse and used a chamber pot indoors; and people who put toilet tissue on the floor often had a septic and placed toilet tissue in a garbage can. Overly learned behaviours often survive in dementia and this explains why the behavior is occurring. Memory supports can help those who have the ability to practice and learn what they should be doing in the present.
Memory supports can help those who experience memory loss.
Memory supports are well suited for those who are clearly struggling to remember important information and have enough remaining ability to respond to the use of memory aids that are familiar, visible and placed where they can be accessed and clearly seen.
People with dementia often struggle with such things as finding locations, finding things (in drawers and cupboards), doing things in the right order (such as going to the toilet or putting clothes on in the right order), remembering facts (including faces and names) and remembering details related to times, dates and locations of daily, future or past activities. This is where memory cues can help, in the form of words and/or images, depending on the past and present abilities of the person living with dementia. The best way to figure out whether a person is able to use memory supports is to test them out, one at a time. With each memory cue you will need to point to the cue and tell the person that this is what he/she needs to look for when he/she wants to find the location/item or what he/she needs to do when he/she wants to complete a task. While some will learn the details almost immediately, some do not have the ability to remember information for more than 10 seconds, and would thus not benefit from memory cues.
Examples of Memory Cues in Action:
Finding a Location: Directional arrows that point to the location of the room, such as the bedroom, bathroom or dining room, along with a sign on the door (a word, image or both), can help with finding the destination, as long as you teach, and rehearse, how to use the memory cue.
Repetitive Questioning: When memory is impaired answers to questions are often forgotten almost as quickly as you provide them. The best way to help a person with dementia remember answers is to write it down (if they can still read). You will need to create a memory cue that provides the answer to the question and teach your loved one to look at it when he/she wants the answer. Rehearse the action of looking at the paper when he/she wants the answer to a question. Consider creating a daily agenda and teaching the person to look at it when he/she wants to know all the important details about each day.
Toileting Challenges: While an arrow that points to the bathroom helps with finding the toilet, this isn't enough for those who don't know what to do when they get there. Memory cues that list each step in the toileting sequence, in words and/or images, may be needed. You will need to practice these steps, one step at a time.
Develop your own cues, according to the needs and abilities of your loved one, or you can consider using the ones created, and tested, by DementiAbility. (See: Memory Aids for Dementia available at www.dementiability.com).
People with dementia can live with meaning and purpose, if their world is adapted according to their interests, skills and abilities.
While there is no cure for dementia, there are still many things we can do to help maintain the abilities of people living with dementia.
Caregivers have the best intentions in mind when they take over routine tasks that were previously part of the daily life of the person living with dementia. The important message that needs to be emphasized is that there is still so much that the person with dementia CAN do, if each task is adapted according to the abilities that remain. Help to enhance self-esteem by adapting tasks and leisure activities according to the abilities that remain.
Make a list of all the things your loved one used to enjoy doing. Think about the chores at home and the leisure activities he/she enjoyed. Then consider how these things can be adapted to your loved one's current level of ability.
DementiAbility focuses on exposing abilities, with the aim of helping people with dementia live and work at their highest potential. The goal is to find out what people with dementia can do successfully with the objective of maintaining function and adding meaning, purpose and joy to each and every day.
Eager to learn more? Check out the book entitled, 'Helping Me, Helping You' by Gail Elliot. To learn more visit: http://www.dementiability.com/Books/other/book-memory-helping-me-helping-you
Be sure to check out our next blog coming Feb 2016: Self-care practices for the dementia caregiver.