Which of the following strategies is more effective when working with a patient with dementia?

Table of Contents Show

Involve family and carers
Alert all staff
Assist with activities of daily living
Change the environment
Validation therapy
Music therapy
Reminiscence
This Is Your Life book

We can improve outcomes for patients by implementing strategies that respond to their symptoms and their needs.
Strategies can include the way we communicate with patients, making small modifications to the environment they are in, and being proactive in the assistance we provide.
Involving family and carers is critical in developing and implementing effective, person-centred care plans.

There are strategies we can use to improve care for patients with dementia. These can include working with family and carers, staff and other health professionals, as well as adapting the environment.1,2,3

Involve family and carers

By involving family and carers in assessment, care planning and in delivering care we can improve outcomes for people with dementia, provide comfort, and also help family and carers understand and cope.
Use the TOP 5 initiative to draw on their knowledge and experience of the patient and their care needs. Family and carers understand what is normal for the patient with dementia and this knowledge helps us identify changes that may be indicative of delirium, pain or other treatable conditions.
Collect information from family and carers. Use forms such as the ‘This is me’, Information about ‘me’ for planning care in hospital. These forms include questions related to the patient’s social care needs and preferences, and behavioural management strategies (including mobility, toileting, medication administration, and what comforts or distresses the patient).
Inform them about what to expect during an admission and how they can work with hospital staff.
If possible, provide one contact person within the organisation for any queries.

I really got to know her and her husband. He had a lot of behaviours and caused a lot of problems on the ward. But I sat down with them both and did the Key to Me [a form similar to the ‘The information about me for planning care in hospital’] … I think that was really good. I’ve been nursing for a long, long time, and sometimes you forget …they’re not just a patient… It made me realise that he’s not a naughty patient who caused a ruckus on the ward. He was a very kind man. After that I had a lot more patience with him…he was wonderful remembering his past, he had the most amazing life… it blew me away.… You don’t get the same sense completing the form compared to when you talk to someone and fill it in with them.
- Enrolled nurse

Alert all staff

Consider a method for informing all staff that a patient has dementia, for example a discreet bed-based sign such as the Cognitive impairment Identifier.
Ensure that all staff are trained to respond appropriately to the needs of patients with dementia.

Introduce yourself and explain your role.
Make sure you have eye contact at all times.
Remain calm and talk in a matter-of-fact way.
Keep sentences short and simple.
Focus on one instruction at a time.
Give time for a response.
Repeat yourself – don’t assume you have been understood.
Do not give too many choices.
Involve family and carers.

Assist with activities of daily living

Assist the patient with toileting, eating and drinking; encourage regular movement, prompt with self-care and other activities of daily living where required. These interventions play a key role in minimising the person’s risk of under-nutrition, falls, pressure injuries and delirium.

Change the environment

Place familiar personal belongings around the patient and, where possible, follow familiar routines.
Have large faced clocks and calendars and clear signage to the toilet to assist the patient with orientation. If not available on your ward, talk to your team about purchasing them.
Normalise the surroundings and reduce environmental stimuli as much as possible.
Keep walkways clear to prevent falls.

Access the expertise of comprehensive geriatric medical services or on-site geriatricians or psychogeriatricians, or in emergency departments, dedicated aged care staff.
Where appropriate, consider alternatives to hospital admission, for example, hospital in the home or return to their residential aged care facility with Residential In-reach services.
It’s important that the person living with dementia, as well as their family and carers, maintains their social networks. Explain how this can reduce the risk of becoming socially isolated or experiencing loneliness, both of which can have a negative impact on a persons’ health. Local councils, local newspapers, neighbourhood houses and libraries can be a good place to find out what activities exist in each neighbourhood. Alzheimer’s Australia can help with information about local activities and groups. Ask a social worker for ideas.

1. Ballarat Health Services, Understanding dementia: a guide for hospital staff. [undated].

2. Joosse, L.L., D. Palmer, and N.M. Lang, Caring for elderly patients with dementia: nursing interventions. Nursing: Research and Reviews 2013 3: p. 107-117.

3. Alzheimer's Australia, Dementia care in the acute hospital setting: Issues and strategies. A report for Alzheimer's Australia. Paper 40 2014.

4.Moyle, W., U. Kellett, A. Ballantyne and N. Garcia, Dementia and loneliness: an Australian perspective. Journal of Clinical Nursing. 2011 20: p. 1445-1453.

Reviewed 05 October 2015

Working with patients who are cognitively impaired presents an ongoing communication challenge. For instance, they likely will have trouble following any instructions about their care, including how and when to take prescriptions. Make sure someone can closely monitor care management, and try to involve a care partner whenever possible.

Here are 15 tips for effectively working with and communicating with cognitively impaired patients.

Try to address the patient directly, even if his or her cognitive capacity is diminished.
Gain the person's attention. Sit in front of and at the same level as him or her and maintain eye contact.
Speak distinctly and at a natural rate of speed. Resist the temptation to speak loudly.
Help orient the patient. Explain (or re-explain) who you are and what you will be doing.
If possible, meet in surroundings familiar to the patient. Consider having a family member or other familiar person present at first.
Support and reassure the patient. Acknowledge when responses are correct.
If the patient gropes for a word, gently provide assistance.
Make it clear that the encounter is not a "test" but rather a search for information to help the patient.
Use simple, direct wording. Present one question, instruction, or statement at a time.
If the patient hears you but does not understand you, rephrase your statement.
Although open-ended questions are advisable in most interview situations, patients with cognitive impairments often have difficulty coping with them. Consider using a yes-or-no or multiple-choice format.
Remember that many older people have hearing or vision problems, which can add to their confusion.
Consider having someone call the patient to follow up on instructions after outpatient visits.
If the patient can read, provide written instructions and other background information about the problem and options for solutions.
Address potential issues of driving, getting lost, and home safety each time you see the patient. And, encourage regular physical activity, social activity, hobbies, and intellectual stimulation, as well as a healthy diet. Some studies link these approaches to the maintenance of cognitive function.

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

Content reviewed: May 17, 2017

Communicating effectively with a person who has dementia becomes an increasing challenge as the person progressively loses their memory and their ability to organise and express their thoughts. For many, the loss of recent memory means that the past begins to merge with the present resulting in additional difficulties for family and carers.

A number of alternative communication approaches have been developed which attempt to provide the trust and support so necessary to a person’s wellbeing. Many family members and carers will be instinctively using some of them without realising their formal names.

Validation therapy

Validation Therapy advocates that, rather than trying to bring the person with dementia back to our reality, it is more positive to enter their reality. In this way empathy is developed with the person, building trust and a sense of security. This in turn reduces anxiety. Many families and carers report increased benefits for themselves, as well as for the person with dementia, from a reduced number of conflicts and a less stressful environment.

Validation Therapy is based on the idea that once the person has experienced severe short term memory loss and can no longer employ intellectual thinking or make sense of the present, he or she is likely to go back to the past. This may be in order to resolve unfinished conflicts, relive past experiences or to retreat from the present over which they have little control. Some people will go in and out of the present.

Some family members and carers express concern that validation involves lying to the person with dementia about reality. However a more accurate description is that it avoids challenging their reality. For instance, if a person with dementia believes that she is waiting for her children, all now middle aged, to return from school, family members and carers who use validation would not argue the point or expect their relative to have insight into their behaviour. They would not correct their beliefs. Rather, the validating approach proposes acknowledging and empathising with the feelings behind the behaviour being expressed. In this way the person’s dignity and self-esteem is maintained.

Music therapy

Activities that involve music are another effective way of communicating with a person who has dementia. Often when other skills have gone, the person can still enjoy old familiar songs and tunes. A certain piece of music can unlock memories and feelings. It is important to be prepared to respond to the release of these feelings.

The big advantage of music is that it does not require a long attention span and it can also be a valuable trigger for reminiscing. Knowing a person’s musical likes and dislikes is vital for this to be a successful approach.

Music can be used as a formal therapy or simply for enjoyment. It can also help in the management of changed behaviours. Music therapists have extensive training in the use of music with people with dementia and can address some very complex behaviours.

Reminiscence

Reminiscence is a way of reviewing past events that is usually a very positive and rewarding activity. Even if the person with dementia cannot participate verbally it can still give them pleasure to be involved in reflections on their past. It can also be a means of distraction if the person becomes upset. While reviewing past events can provide a sense of peace and happiness, it can also stir up painful and sad memories. It is important to be sensitive to the person’s reactions if this happens. If their distress seems overwhelming then it is better to use another form of distraction to reduce anxiety.

This Is Your Life book

Making a chronological history of the person with dementia can help with reminiscence and provides information for people who may interact with them. A This Is Your Life book is a visual diary. Similar to a family photo album, it can also include letters, postcards, certificates and other memorabilia.

A large photo album with plastic protective sheets over each page will last indefinitely and can withstand a lot of use. Each photo needs to be labelled to avoid putting the person with dementia on the spot with questions such as “Who is that?” It is best to limit the information on each page to one topic, and to have a maximum of two or three items on each page.

The following list may help in getting a book started:

Full name and preferred name
Place and date of birth
Photographs and name of mother, father, brothers and sisters
Photographs of partner and wedding day
Photographs, names and birthdays of children and grandchildren
Photographs of family friends, relatives and pets
Places lived in
Schooldays
Occupation and war service
Hobbies and interests
Favourite music
Holiday snapshots and postcards
Letter, certificate, diagram of family tree and short stories about specific incidents.