Dementia care isn't rocket science, its all about helping the person feel safe

Our brain’s main function is to keep us safe, in whatever way it needs, we know that this includes the regulation of heart rate, breathing, temperature etc. But also, on the limbic level our brains are responsible for our emotions; whose aims are also to help us feel safe. These main emotions include sadness, anger, happiness, disgust and fear and they all serve a purpose in alerting us and others of our need for action, support and help.

As people struggle to communicate with others and experience multiple losses associated with dementia, (jobs, friends, family, roles, memory, money, control, physical ability, etc) the language of emotions steps in and this can lead to changes in a person’s behaviour (how they respond). It would certainly change mine!

How a person responds to an event, how they perceive their environment or how they are approached can be affected by:

•      Past experience: a memory/sensation may take them back to a time of positive emotions

•      Past experience: a memory/sensation may take them back to a time of negative emotions

•      Personality – the person may have had a disposition where one of the main emotions was dominant e.g. the person may have always appeared impatient, angry or happy. Although this can change due to the dementia.

•      Damage in the brain can cause the person to act “out of character” especially where damage is in the frontal lobe area - it is the dementia, not the person.

•      Their vision – how the person sees may change, so they may feel like Alice in Wonderland, where things may look bigger or smaller than they really are, nearer or further away than they actually are. For example, this would certainly affect how they may respond when handed a cup of tea. Coupled with possible other eye related conditions such as glaucome, cataracts, macular degeneration.

•      Hearing – if impaired, sounds are muffled, echoey, there may be a lack of clarity in hearing others speak, increased sensitivity to noise, with loud bursts of conversation can all be exhausting. This will be affected by changes in attention which we will explore in another article

•      The surroundings, if too dark, no colour contrast, shiny floors

and much more…. 

Imagine being faced with this place, how might you react?

Whilst we cannot stop the deterioration in the brain due to the disease, understanding what the person may be experiencing may help us, to help them feel less afraid, sad or angry. It all makes sense when we understand how a person may be experiencing their world, if we feel threatened and not safe, what do we do? - remember fight, fright or freeze?

It is however, important to let a person feel and express their emotions. When people feel fearful and/or angry they may appear agitated and in some cases that fear may be expressed as aggression. The first step is to be curious, ask yourself, what is this person experiencing? what is making them stressed? We need to be investigators and not take situations on face value. Its best to:

•      Stand back

•      Give the person space

•      Think about their life story (is there a pattern or an emotion that has been triggered that is associated with something that happened in their life, also is there a prop that may help them, e.g. My favourite thing, photographs, music)

•      Rule out any physical cause (infection, constipation, pain, needing toilet, hunger, low blood sugar)

•      Optimise light and quiet surroundings (take away shadows)

•      Ask yourself are there any triggers? what happened before the person became stressed, what was going on, who was there?

•      Consider using a behaviour diary to look out for possible triggers and to assess what may help soothe the person 

There is so much we need to understand in order for us to care appropriately. Evidence based training that is created in co production with people who have dementia needs to be mandatory. We have proof that some training can provide staff with the knowledge and skills to support people and reduce the potential for them to become stressed and agitated. Agitation can often lead to inappropriate use of life-threatening medications and admission to hospital, which, quite frankly is the worst environment for people who have dementia. An admission to hospital in itself can be a risk factor for delirium (of course if a person is needing acute medical treatment, then that has to be the plan). All staff need to feel more confident in their roles when in the presence of a person who has dementia and is feeling stressed, this includes not just our health and social care staff but police and fire service personnel too. It is our duty to help people feel safe.