Acute sector dementia care must improve

Clearly, significant change is necessary in how the acute healthcare sector cares for patients with dementia. Current practices mean that many such patients do not receive the best all-round care and frontline staff may waste valuable time through ineffective attempts at communicating with the patients. While dementia is understood at a neuronal level, more awareness needs to be established in caring for the individual and, in general, frontline staff need a better understanding of dementia care. Admission to a general hospital can be catastrophic for a patient with dementia. Two nurses looking after patients on, for example, a 16-bed orthopaedic ward, simply have insufficient time to spend with the dementia patient. This makes it difficult to assess what he or she is trying to communicate and provide much needed reassurance. Furthermore, it must be stressed, placing patients who have dementia as their only condition in mental healthcare units, is wholly inappropriate. The Good Care Group develop a “passport” – a one-page information sheet for each client with dementia. This allows carers and healthcare professionals to gain a rapid insight into what will assist the communication process with the client and ensure they remain feeling calm and worry free.

 The “passport” identifies themes which help to bridge the gap between the intact memories of the past and the current activities that need to be undertaken today. By using these intact memories to provide an acceptable context and state of emotional wellbeing, the person with dementia is held in a contented state, free from anxious questioning and agitation. The profile “passport” also outlines the questions that the person is most likely to ask and the answers which are most acceptable to them. It also always includes a “bargaining strategy” which would be useful in certain circumstances. While dedicated healthcare units for patients with dementia would be ideal, there is little likelihood of such care accommodation being provided in the foreseeable future. However, much can be done, at small cost, to improve the situation for dementia patients in the existing healthcare system. In building the highly important dialogue bridge with the dementia patient, some basic ground rules should be followed:

• Never contradict the patient. Informing and correcting a person with a short term memory problem is a fruitless exercise. Far better to “go with the flow” and “ join the journey that the person is on as a travelling companion”, rather than be a constant reminder of what the person has got wrong, or cannot do anymore.
• Never ask the patient direct questions, as this can heighten the patient’s level of stress. Questions, by their nature, are a direct request for information and it is information that people with dementia lack. Due to a dysfunctional working memory, new information is often not stored. Asking questions places a direct strain on the working memory and can easily highlight a person’s disability, reducing their emotional wellbeing in an instant. Asking a patient with dementia if he or she would like a cup of tea would appear on the surface of it to be innocuous. But the question could be stressful if the patient starts wondering whether they have just had tea. Is anyone else is having tea? Should they be doing something else and will the tea cost money? Soon they are searching for answers to questions which have never been stored, and panic is not far away. So, instead of a question, a statement would be better. Perhaps: “I’ve made some tea and here is a cup for you.” The person still retains total control and freedom of choice, but an option has been presented to them which they can choose to accept, decline, or ignore as they please.
• Learn from the “expert” – the “expert” being the dementia patient himself or herself. The carer or healthcare professional should look for behavioural cues to identify what generates positive and negative reactions and which phrases delivered to the dementia patient are best at building and maintaining the dialogue bridge.
• Become used to liking and making use of the dementia patient’s tendency to repeat stories and information. Once you have tapped into positive intact memories and activities that bring the person joy, these can be recycled and revisited as often as they like.
 • If a difficulty arises, opt for saying “silly me” rather than “silly you”. While blaming a dementia patient for a minor difficulty may seem harmless, the patient is likely to lose self-esteem and further retreat into him or herself. By saying “silly me”, the carer is diffusing the situation by apparently taking blame. The patient is provided with a bolster for self-esteem and retains “emotional safety”.