4 things to consider when speaking to patients with Dementia
A little goes a long way.
- Your bookshelf of memories
I was once told to think of our memories as books stored in a grand oak bookshelf. This bookshelf stands tall and wide, strong and sturdy. Along the bottom shelf, you will find hefty, hardback, 1000-page volumes filled with the old, fond memories that constitute the basis of your persona. Memories of being kissed goodnight by your parents, messing around at school with your friends and playing in the streets with your siblings and neighbours. The very experiences that shape who you are today.
With time, books filled with memories are added to progressively higher shelves in a stepwise fashion. Your bookshelf is a testament to the life you have lived, filled with rich and varied content. Then dementia strikes. It shakes the ground on which your bookshelf stands. Which books fall first? Naturally, it is those on the top shelf, your most recent memories.
Use this analogy to help you set your expectations when speaking to patients with dementia. They are unlikely to recall what they had for breakfast, so reach for a book on a lower shelf and ask them about their past.
2. The devil isn’t in the detail
Objectively, being in hospital is not a pleasant experience. For a patient with dementia, this is amplified by the fact that they often forget where they are. New faces, loud sounds and long waits only add to the discomfort they experience from their original medical complaint. Attempts to engage patients in conversation at this time will largely be futile. So what can you do?
Don’t expect to walk away from an encounter with detailed answers to specific questions. Re-adjust your expectations and make your interaction more about them and their needs. After an encounter, patients with dementia recall feelings, not details. Make sure these feelings are those of safety, comfort and peace, no matter how fleeting this may be.
3. Think outside the books
The rigid framework that is applied to most aspects of medicine holds little relevance when speaking to patients with dementia. There is no pro-forma or structured questionnaire that will assist you in having a conversation. The nature of the condition simply prevents this.
Think outside of your books when engaging with dementia patients. Each patient is unique and each encounter is different. Just because you are not gaining clinical information from a patient does not mean your interaction is meaningless. Use the luxury of time to learn how to effectively hone your communication skills — these are invaluable both professionally and personally. Reassure patients that they are safe and listen to their concerns. Be patient and let them steer the conversation into familiar and comforting territory.
A practical way to help improve a patient’s experience in hospital is through the ‘This is me’ support tool started by the Alzheimer’s Society. This is a form used to record information about patients such as their cultural background, important people or places, and their routines and preferences. Look for these forms at the bedside or print one off here. This information is useful to medical professionals to ensure patients are as comfortable as possible, and can give caregivers peace of mind knowing their loved ones are looked after just as they would be at home.
4. The value of light
Patients with dementia are particularly sensitive to their environments. They struggle to adjust to new surroundings due to unfamiliarity. This is often why many patients are most settled in their homes with their primary caregivers.
Keep this in mind when engaging with patients. In particular you should be aware of a phenomenon called ‘sundowning’ that is commonly observed in individuals with dementia. It describes the increasing agitation and confusion felt in the evening (around sunset). It may be exacerbated by a loss of routine, disturbed sleep, medication timing and noisy surroundings.
Remember this and do what you can to minimise any modifiable factors. Can a lamp be switched on or can they be moved to a quieter area? If caregivers are available, ask them what techniques they use to settle them at this time. Be sure to not assume a patient is experiencing sundowning when in fact they may be communicating a care need. Assess whether patients may be in pain, if they are hungry or thirsty or if they need to go to the bathroom for example. Accounting for these factors will improve patient engagement and assure you, if they could thank you for it they would.
We all have an unwritten role in easing the pain of this cruel condition. For any length of time, be a patient’s family, hold their hand and tell them not to worry. A little goes a long way.
