By Susan Berg United States
Working with people living with dementia, especially those with problem behaviors, can be challenging. How can you make the best of any situation?
First, you need to have a positive attitude and be smiling and upbeat. Leave your problems at the door. A person with dementia takes cues from you so if you are smiling, happy and upbeat; there is a good chance so will she.
When you walk in the door, make sure to say hello to everyone. You never know when you will need someone's help or will be caring for a particular resident.
Studies have shown that the simple act of smiling puts you and the resident in a better mood. Thus make sure you are smiling and remind the residents to smile.
Besides saying hello and smiling, you can be complimentary. All people tend to be in a better mood if you say something nice about them. In fact, try challenging yourself to get to know what it takes to make each resident’s day. Learn what makes each resident tick and how to make her feel good about herself.
Learning about the history, background, and interests of your residents is essential.
Case Study: A Resident who worked as a Pharmacist
We had a resident who prided herself on looking good. However, towards the end, she did not look or feel good despite our best efforts. Staff, who did not know her, kept saying that she looked beautiful. This resident knew that she did not look beautiful. This made her feel bad.
Several of the activity assistants took time to learn about her history. They found out that she was a pharmacist. The staff complimented her on being able to have such an important job especially during a time when women did not pursue this type of career.
They took the conversation one step further and asked her opinion about injectable drugs for psoriasis. Not only did this resident forget about her looks and how bad she felt, but she became very animated and was thrilled that she was being asked for her opinion.
Remember it's all about feelings when interacting with a person who has dementia. In the early stages, these individuals often realize that something is wrong. Sincere compliments make them feel better. In the later stages, emotions may be the only thing that they have left because feelings are the last thing to go in a person with dementia.
Adapt and modify activities so they are success oriented and failure free.
Everyone likes to feel useful. Make sure you tell the residents that you need their help.
When dealing with problem behaviors, communication among caregivers is critical. Family members and staff need to be on the same page. All staff members need to communicate what they know about each resident so other staff do not need to discover things about the resident that were known by others.
This is especially important when dealing with problem behaviors. Everyone needs to know what the triggers are that set someone off and try to avoid doing these things if possible.
There are times when some people with dementia become agitated and display other unwanted behaviors. Try to find out what is behind the behavior: sickness, sadness, environmental factors, fatigue, depression, or provocation. Clinical staff may be able to help you. If the problem is intrusive or aggressive, separate them from other residents, because one person’s agitated behavior can easily spread to others.
Try to find out how the person is feeling and empathize and console. Remember that body language and other non-verbal forms of communication can help immensely. Be aware that if the behavior is not managed appropriately, the situation may escalate.
Despite everyone’s best efforts, you might just sense that the problem behavior is escalating. It is best to stop what you are doing. Help the person with dementia to calm down, by refocusing and redirecting his attention.
Here are some things that worked most of the time for me, my staff and others caring for the residents.
We had a higher functioning resident with dementia. She would start calling out and generally being disruptive during activities. I tried letting her be my assistant. I let her ask the trivia questions, lead the songs during a sing-a-long and help less able residents during activities. I was surprised at how well this worked.
Unfortunately, her dementia advanced so she was less and less able to help, but I continued to let her do what she could. I even gave her a name tag with, volunteer activity assistant, written on it.
For lower functioning and other residents with dementia, giving them a task which requires their attention so they are not disruptive, may help.
What comes to my mind is a resident who loved chocolates and oranges. We would give her wrapped chocolate pieces. We asked her to unwrap them so she could eat them. She really concentrated on this task so she could get to eat the chocolate candy.
She also loved oranges. I asked her to peel the oranges. This might keep her busy for an hour. Eventually, her decline made it impossible for her to do this. I tried giving her ears of corn to shuck and hard boiled eggs to peel. Sometimes it worked.
However, as I said earlier, you must know the resident to find what activity might keep them calm. Sometimes the resident may get agitated, so immediately refocus and redirect their attention.
Another must, is NEVER argue with a person who has dementia. This is one thing that will set off most. Instead enter her reality.
For example: we had a resident who always thought that it was 1985 and she was forty years old. She would worry about her kids or having to make dinner for her husband. We told her that the neighbor was picking up her children.
We sometimes had staff call her pretending that she was her neighbor. She would remind the resident that it was her (the neighbor’s) turn to pick up the kids. Most often this would calm the resident.
Another strategy was to write the resident a note stating that it was the neighbor’s turn to pick up the kids. We even signed the note with the neighbor’s name. The note was a good idea because the resident had poor short term memory. She could look at the note and was reminded over and over again.
I know there are many more ideas. It is best to use trial and error to see what works the best.
The truth is that it is not easy. There is no magic bullet. Using these strategies will provide you with the best possible outcome. However, it can be challenging every single day.
What works one day may not work the next. I hope you will find these ideas useful. If you have a question about a specific situation, please leave a comment below.