Key to offering good dementia care is the attitude we take towards dementia. We have only just begun to debunk the myth that if you get dementia, nothing can be done about it.
In my last piece, I explained the ground-breaking concept of rementia — the possibility for those living with dementia to regain function. Here, I want to go into greater detail on the person-centred approach which has to be at the heart of rementia.
The first thing that is critical in supporting people to live well with dementia is understanding the individual behind the diagnosis, and their specific symptoms and needs. Not everyone who has dementia will experience the same symptoms.
Secondly, simple verbal shifts can lead to big shifts in attitude. Rather than only seeing the 'disability', or difficulty in doing things, I advocate focusing on the abilities of the person and their potential for rehabilitation — regaining function.
The first step towards rehabilitation is understanding the unique experience of every individual. A popular model pioneered by Tom Kitwood and Kathy Bredin encourages carers to consider the following factors:
Personality: The unique characteristics of individuals will affect their ways of dealing with situations, events, and crucially, change – and can therefore add to or reduce the symptoms of dementia.
Biography: Life history shapes personality, and how we have learned to respond to situations. Our past experiences affect all our current behaviour and responses, regardless of brain cell damage.
Health: Physical and mental health affects how we behave. Behaviour can be mistaken by others for signs of dementia when it may simply be a sign of ill health – for example, someone may be pacing because they are in pain.
Neurological Impairment: These are the cognitive limitations resulting from damage to nerve cells in the brain. For a long time, the symptoms of dementia were thought of as only being caused by a neurological impairment.
Social Psychology: This is the way that the attitudes of others and interactions with others affect the emotional state of a person. Crucially, interactions can either enhance or limit opportunities to be a part of a social group – which is why it is so important that carers use emotional intelligence to develop supportive relationships.
While we cannot alter past life history or personality, of course, we can certainly affect all the other factors. And carers have a critical role in supporting those living with dementia to make lifestyle changes that do this, by consciously supporting nutrition, emotions, and cognition.
Leading researchers in the field have described how metabolic enhancement can help reverse cognitive decline – including through diets designed to minimise inflammation, as there is evidence of a strong relationship between inflammation within the brain and dementia. Such diets feature low-glycemic, low-grain foods and supplements to optimise the chemical balance within the brain.
We recognise the critical importance of offering the right diet at Gracewell Healthcare, and understanding each individual's culinary preferences and habits throughout the day. We were proud to be the first provider to appoint a Head of Nutrition and Hydration, Sophie Murray, whose role involves anything from providing input on menu planning to creating bespoke recipes for residents, overseeing the dining service, and setting up nutrition and hydration monitoring systems.
The interaction between a person living with dementia and their carer is a powerful determinant.
Understanding why a person who has the symptoms of dementia behaves as they do can help carers to enable rather than disable that person. In other words, the interaction between the two has the power to reduce the person’s disability – or, conversely, make the dementia worse, for example by undermining the person.
Family and friends may sometimes be bewildered or distressed by the conversations and behaviour of a person with dementia. My advice to them would be to take a step back from trying to work out what the person means and instead focus on what they are feeling. This is usually a stepping stone for developing a supportive relationship for them both.
‘Memory problems’ is a frequent but unhelpful way of describing symptoms of dementia. It is important to distinguish between the type of memory difficulty that a person has, so that you can then try to overcome that particular problem.
Three helpful techniques to aid this, which can be used easily by carers, are:
Chunking – Putting facts or steps in the process of an activity into categories or small groups. This is helpful as organising information into small, relevant, simple chunks or categories means that there is less information to remember.
Reality orientation – This is a conversational approach that uses repetition and a range of resources, such as memos, easy-to-read clocks, and calendars to help the memory. It involves regularly reminding the person of such information as the time, date, where he/she is and planned events for that day, such as a visit to see a friend.
Cognitive stimulation – This follows the ‘use it or lose it’ principle, and is achieved by supporting the person to engage through all of their senses in a range of preferred activities that will systematically target the main cognitive functions.
The key tips and strategies laid out here empower carers to help those living with dementia onto the path of rehabilitation bit by bit. They can all be brought together into a Rementia Self-Help Plan for each individual, which will be explained fully in my forthcoming book: Reducing the symptoms of Alzheimer’s disease and other dementias. And in the best cases, they are all underpinned by a deep and intimate understanding of the needs, abilities and idiosyncrasies of the individual you are helping.
You can find Jackie Pool, Head of Memory Care and Programming at Gracewell Healthcare, here.