dementia 

People living with Dementia may have episodes where they regress in their mind to an alternate reality.

A common example is that they could be searching for their spouse, parent or sibling who has passed away many years ago. They could experience a hallucination or think that they themselves are a different age, or that they are living in a different location to their reality.

While it may be tempting to correct this individual’s understanding of their situation in the moment, such an approach could cause unnecessary confusion and trauma to them.

That’s why we ‘step into’ the bubble which that person with Dementia has created. We enter their version of reality and affirm their beliefs, so they feel validated and listened to during these moments where their illness is pressing on their perceptions.

Dementia can affect vision and our spatial awareness. Combined with the illness’ ability to jumble the meaning of conversations, how we position ourselves when speaking to individuals with Dementia can make all the difference to how a conversation is perceived.

For example, if we talk to someone with Dementia who is sitting down, while we’re standing above their eye line, it can feel intimidating for that person. That’s why we often kneel or crouch when speaking to our residents at Briarlea, so that we can make eye contact on an equal footing and show positive body language.

While people with Dementia may start to lose the faculty of following complex conversation after their diagnosis, good understanding of body language remains for much longer.

As a residential care home in England, our care for individuals with Dementia is guided by the Mental Capacity Act 2005. The law sets out 5 principles which enshrine a series of rights for people who live with conditions that can impair their mental capacity, like Dementia.

These principles are: that we should always presume someone has capacity to make a decision until proven otherwise, that people should receive the support they need to make decisions, that people have the right to make unwise or eccentric decisions, that (if is proved they lack capacity) any decision must be made in an individual’s best interest, and finally that this decision must be the least restrictive option.

Principle two of the Mental Capacity Act details how people should be supported to make decisions. At Briarlea, we do this by offering clear choices to individuals who live with Dementia, and which are informed by our understanding of the person.

For instance, if it’s a cold day and we’re helping a resident get ready for the morning, showing them their whole wardrobe from which to choose an outfit may be an overwhelming decision. Instead, we would use our knowledge of that person to select their two favourite jumpers – perhaps a red jumper and a blue jumper – and then offer them the choice of which of the two they would prefer to wear. By doing this, we enable individuals to be involved in decisions about their day-to-day life, albeit in a way which is adapted to their condition.

Similarly, we recognise that some residents will experience greater clarity in the morning compared to in the evening where they may appear more confused. This is known as the sundowner effect. To support individuals in making their decisions, we may ask more questions in the morning, when a person feels more able to weigh up the pros and cons of their choices. 

Dementia can put the brakes on how we process information in a conversation. It can often take longer to understand what is being asked and people living with Dementia can easily become distracted and overwhelmed when a conversation moves too fast. This is known as outpacing. That’s why our care assistants ask short, direct questions – repeating the question where necessary until our service user can grasp its meaning.

The benefit of being a small residential care home here in Evesham, with no agency staff, means that we understand each of our residents implicitly – so we can tailor the style of our communication with residents to meet their understanding. 

As Dementia progresses, individuals may show greater responses to touch over the contents of a conversation. We therefore find that combining touch with speech is a good way to cement understanding in individuals living with Dementia.

For instance, our care assistants may hold someone’s hand when greeting them. Or stroke their arm to help relieve anxiety. While a resident may be confused by their surroundings, the instinct that they feel safe and amongst people who care – even if they don’t quite recall how they know them – remains true. Tactile strategies can therefore help reassure the person’s senses, when Dementia has clouded the capacity to reason.