In his book Contented Dementia, Clinical Psychologist Oliver James outlines a new approach to interacting with people living with dementia.
This is based on creating links between past memories and the routine activities of daily life in the present. At Good Oaks we don’t subscribe completely to this revolutionary and sometimes controversial approach, but have read the book with interest, and wanted to share some of the advice given.
Ask specific questions and give context
When we interact with people with dementia, we realise how much of our usual conversation assumes a certain level of knowledge of current events; be that the news, the weather, or what the person has done that day.
Asking questions seems to be the polite thing to do – you’re giving them an opportunity to talk about themselves and you’re showing an interest in them.
Changing the way you phrase things can help when interacting with someone who suffers from memory problems.
For a person who can’t retain new information well, questions can be scary. A question like “Did you enjoy your lunch today?” can set the person’s mind racing – have I had lunch? What did I have? Did I enjoy it? People either freeze, searching their mind for a memory, or simply guess the answer. Either way it can be unsettling for the client, and not helpful to the person asking.
James suggests a way of interacting called “verbal ping-pong” – which bans the use of questions, instead making open and leading comments about activities and interests of the individual to coax out information.
We feel that banning questions is impractical and not helpful – especially as choice and independence are so important for people with memory impairments. But being mindful of the difficulty some people may have, and either rephrasing, or providing more information in your question – “Did you enjoy that chicken pie your son bought round for lunch?” is sound advice.
Don’t contradict dementia sufferers
When faced with a person with dementia telling you something that is obviously factually incorrect you face a dilemma.
You have a split second to decide whether to gently correct them, or not. The SPECAL (Specialized Early Care for Alzheimer’s) approach argues that correcting them does not help improve their well-being. You can find out more about the SPECAL method of caring for dementia here.
The ‘temporal gradient’ of memory loss, where most recent memories are forgotten first, can explain why people say some of the things they do. When people have forgotten the last twenty years of their life, they may interpret where they are using the memories that are now most vivid – a holiday in Cornwall in the 80’s, at a wedding, or in a previous house.
Contradicting them with the jarring truth that it is actually twenty years later and they now live in sheltered accommodation may not be the most helpful thing to do.
Instead, using open sentences to agree with them, or at least not disagree, such as “How interesting”, “What a good idea”, you can join in with a reality that they are happy and content in.
Use repetition to your advantage
People with dementia can repeat questions when they are worried. This may be because the reply hasn’t been processed or stored, and hasn’t reassured them, so they ask again.
People who spend a long time with people with dementia can be stuck in a cycle of repetition, repeating the same answer to the same question, while both people get more frustrated and anxious.
By varying your answer, you can run a little experiment. Each time the person asks the question, e.g. “Where’s Jack?” (Her late husband), you change the answer:
- He’s gone shopping
- He had to go to work
- He’s visiting his sister
You may find one of these answers will elicit a more positive reaction – “Oh, he always gets called in to the factory at short notice”. This causes the worry to go away, and hopefully a decrease in the repetition.
Avoid blaming the dementia
As mentioned in the article about how to broach care with your parents, it can often be easier to use other medical problems, such as a painful hip, arthritis, failing eyesight, rather than dementia.
- “You’re having some help in the mornings because after you hurt your leg, it hasn’t been easy to wash”
- “We need to go to the Doctor’s because he needs to check on your eyesight” (when it’s really a memory test)
- “You may not be able to remember because of that nasty infection you had”
These are easier to deal with than constant reminders of your dementia. Of course, as with all these suggestions, it is only relevant for certain people at certain stages of dementia. People in early stages will remember that you told them the check-up was for their eyesight when they get to the surgery for a memory test.
You can find out more about dementia care at Good Oaks here.