Following on from yesterday and the day before this is another post about the Dementia workshop I attended on Friday. The topic of this one is techniques that can be used to manage some of the more difficult behaviours that accompany dementia, and your caree (courtesy of @Ctrying dictionary on her blog http://constantlytrying.webnode.com/dictionary/).
The first thing we learnt in this chapter is how dementia actually works with memories in the brain. It takes two memories, forgets half of each and sort of mixes them up. It does this over and over until each memory is so diluted and confused it makes no sense.
An initial problem with dementia is the struggle to speak or write, to voice opinions or concerns. This is what can lead to the anxiety and agression that can lead to the behaviours. So it is important to recognise the lead up, and to cure the source of the anxiety before the behaviours take place and uncomfortable situations arise.For example wandering is often a sign of anxiety (I’m late for Gill’s wedding, I must get to the church), by treating this anxiety we can prevent the wandering e.g. If caree is concerned about an appointment/person they might be missing ask them if they would like to get dressed up for the special occassion, or find a present to give them. By the time they have finished get dolled up, looking round the shop etc they may well have forgotten the important occassion.
The best way to do this is to look at the non-verbal communication; pacing, grimacing, wringing hands, frequently glancing at the door etc. When signs of agitation, anxiety, confusion, discomfort are showing it is integral to intercept, either by distracting (e.g. talk about a memory in the life journal) or to root out the problem (do they need the toilet but have forgotten where it is, or how to go?). Look out for signs that let you know exactly what the problem is. It may take time to train yourself to act at small facial expressions, but once you know how to recognise them it will make life easier. The rule Home Instead told us was 30 seconds (not the food on the floor rule!). Responding to the behaviour in the first 30 seconds of a sign developing can help prevent it becoming a major problem, and keep you both safe.
I have already discussed the behaviours that can be attached to dementia, but just to refresh: delusions, wandering, refusal, aggression, repetition, agitation, sexual inappropriateness and false accusations. Some of these behaviours are easier to manage than others, and some do not require action (remember if it isn’t detrimental to anybody’s health and well being, adapt to change and DON’T POINT IT OUT). The behaviours that will require action are for example; refusing to eat/drink, not frequently washing, refusing medication, striking out, withdrawing/isolating.
If the caree is being physical; striking out, pushing, throwing objects, leave the room. Keep yourself safe and away from the “danger zone”. If you get injured/knocked out there will be no one to call for help, or look after the caree. If the worst happens and the caree injures themselves at least you know how to react to an emergency situation. It is of course slightly different if the caree already has an injury that needs seeing to urgently, and you must think on your feet of ways that calm them down (this will be different for everybody, and again may be useful to refer to the life journal) so that you can take them to hospital, or call an ambulance. When taking a caree in the car you may want to let them sit in the back, if a trigger occurs that makes them agitated they may lash out, in the front seat this puts you at extreme risk of injury (not ideal when driving). If they are in the back it is safer for them and you. I have to admit this is not something that had ever crossed my mind before, as nan does not (yet) get violent, however I will certainly think more about it now.
Just as dementia itself is very personal and affects everybody differently, every behaviour/mood swing is different. What can help the caree one minute, may not work the next. So try to have a selection of options you can use every time (Home Instead referred to this as a tool box of technique – I like that, makes it sound very organised). It was suggested by Home Instead that you try to deter a behaviour/encourage a task three times, but three different ways (e.g. start with bath/shower option, progress to now/later, then try the activity)
Try to remain calm when diffusing a situation, as just like all of us, people with dementia can pick up on agitation in your voice, and non verbal communication, and this can heighten theirs.
Some techniques that have been proven to work to help diffuse situations/behaviours are:
- Give simple choices – This helps the caree feel more in control and gives them back the independence they may feel they have lost. NEVER tell the caree to “do this/that” but assume they will be doing the task anyway, even if they are refusing, just give them two options of how/when/where they will be doing it. For example if your caree is reluctant to have a bath/shower ask “Would you like to have a bath now OR in 1 hour”? “Would you like a bath OR a shower today?”
- Apologise or take blame for the situation (This is the one I struggle with, why does everything have to be my fault? It’s easier for us to shrug off apologising for something we haven’t done than it is for the caree to have to accept they have failed)
- Redirect – Offer chocolate (or fish and chips in nans case, as long as I buy fish and chips when I have upset her everything is fine), or use the life journal (see how useful it’s becoming?)
- Physically remove items (walking stick was one that came up in our workshop, it can be easily launched in a moment of anger and can cause considerable damage to objects, surroundings and you!), the caree or yourself from the environment.
We discussed the bathing problems quite in depth during the workshop. Another way we found of easing reluctance was to turn it into a fun activity (this could be used for any situation I suppose). For example find some smelly soaps, bubble baths or shower gels, and ask your caree to decide which one smells nicest. When they have decided tell them you are going to use it in the bath you are going to run (but do not mention who it is for). Quite often the caree would decide they wanted to use the smelly and would voluntarily go up to the bath. If your caree is reluctant to get in the car, ask them to help you choose a CD to listen to in the car, then when they have found one “we should see how this sounds in the car”.
It was mentioned during the workshop that managing the behaviours of a dementia patient can be quite similar to a child. That is to say do not treat your caree like a child, they have lived just as much of an independent life as you up to the point they got dementia, and to have to revert to being treated like a naughty child is very demeaning. But the way you react/intercept should be done in the same way you would a child; don’t reward bad behaviours (if your caree becomes aggressive and you react, it becomes a memory of a way they gained your attention, if you ignore the behaviour it doesn’t have chance to form a memory). This reminded me of something the AN told me, most people who become carers for dementia have often had children previously, this experiences aides their caring process. Young carers such as myself are doing it the other way round, so the experiences I am learning from nan will help me in the future should I decide to have children.
Of course it doesn’t matter how prepared you are or how much experience you have, some days are going to be rubbish. Some days your caree will be completely uncooperative, will refuse anything, and may hit “the silence” (see previous post entitled “the silence”). These days it is best to think more about yourself, instead of getting worked up trying to solve your loved ones problems.
Feel free to leave a comment if there are any behaviours you are struggling with, as another reader may have just tackled the same thing.
Thankyou once again for reading, big hugs to you all.