Dementia: The careworker´s perspective
By Carole Burton
Carole Burton has lived in Spain for 38 years. In the UK she was a nursing sister specialising in kidney dialysis and then worked in Spain in a private clinic for general medical and post-operative patients. When the clinic changed hands it became a nursing home for the elderly. Despite a lot of training and seminars on dementia to adapt to the new role, she says much of what she learned was actually just being with the clients/patients. She emphasizes that, “every individual is different, dementia has over 100 different types and tailoring to that need is vast.” Below, Carole shares some of her insight into the realities of living with dementia and gives some tips from her experience as a careworker to make things just a little bit easier and are relevant both to care professionals and family carers. Carole is also a Volunteer with Age in Spain.
When a diagnosis is made
Talk to the person and their family and friends about their general lifestyle habits. Collect memories, collate pictures on a board and label them with information about who the people are. Ask the person about places they lived and worked. Make a note of their favorite flowers, perfume/after shave, foods etc. When the memory itself is gone the smell, touch or taste will still be there to stimulate a positive response.
Record their general toilet habits, - most people go to the loo for a number two at a certain time of the day. Both ladies and gents should also establish a regular toilet pattern for urinating. Ladies sometimes like to sit down stand up and down again to totally empty their bladder and men similarly like to stand and be given time for the same reason.
Alter the wardrobe hanging rail to the right height so they can access their clothes. It is a good idea to encourage choice, but don’t push the point if it confuses the person. Try to work out their favorite items and help them make the choices that they will be happy with. Comfortable well fitting shoes and slippers with easy closures and a shoe horn are all essential items.
Remember that clothes may need to be altered. For example, hems may need to be turned up as the elderly often lose height as they get older, while Velcro fastenings or skirts and trousers with an elastic waistband are a godsend.
Personal hygiene and safety
It´s a good idea to establish a regular shower routine and to wash hands, face and intimate body parts on at least a daily basis. In general, it´s better to try and assist than take over from the person. Sometimes someone with dementia may need prompting to pay attention to their personal hygiene even when they are still perfectly able physically. In this case, a good ruse is to talk about getting ready for a special occasion or perhaps to ask them to evaluate how you are doing with their personal care.
I would definitely encourage the regular use of body lotion. The elderly have particularly dry, thin skin that can easily break and using lotion to keep it supple can help to prevent tears or bruises.
If the person is bruising often, try to work out what they are falling over or into and eliminate those hazards.That may include loose rugs, door handles or furniture in their pathway but, again, it´s important that you don’t overstep - involve them with the process of making their environment safer.
Don’t be touchy about oral hygiene and false teeth and, when necessary, help someone to clean their teeth or dentures. Just think how you might feel if you were unable to clean your teeth properly. Other things to consider are shaving for men - is an electric razor needed? Ladies who wear makeup may want to continue do do so, again help them. Another thing ladies are always grateful for is plucking that stray hair from the chin.
It´s also important to pay attention to regular hairdressing, cutting finger and toe nails (although if someone needs specialist chiropody help, leave it to the professionals) and optician and hearing specialist appointments – all the things that are important to anyone who does not have dementia. If someone has a hearing aid, remember that the batteries usually need replacing about every 10 days and something as simple is cleaning someone´s eye glasses is also really important.
Try and keep up with life and pleasures, if you have a regular social life keep it up. Sex may be the great taboo as far as older people are concerned but, if you have a healthy sex life, keep it up with your partner.
Remember that family photos and histories, letters or cards can all prompt a story and a pleasurable experience. Also, just because someone has been diagnosed with dementia doesn´t mean they can´t enjoy music, books, magazines, newspapers, TV programs or films. Often a song or movie from the past gives people real pleasure. Stimulation can also be as simple as engaging people in conversations about their interests.
Other stimulating activities to consider are dancing, singing, swimming, walking, even a chair-bound exercise routine can be fun. Also try playing cards (even if it’s just snap) doing puzzles, playing bingo, or doing quiz games on topics they might know. All of these activities can bring fun into their lives.
Big no, nos
Try not to finish the conversation off for someone with dementia, give the person time collect their thoughts and to say what they want to.
Don´t argue or get annoyed if they want to wait for a bus at a chair in the house, ring mother, let the dog out or similar activities that may be based on false memories. Agree to help and leave it 10 minutes and usually it is forgotten. Sorry for the ruse again, but it often works just to say you need to go to the loo, get a drink or something similar and then come back after a few minutes.