Dementia

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Dementia
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• Provide maximum structure build into treatment
• Focus on strengths
• Focus on what might matter for a given person
• Concrete vs. abstract

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Capitalize on Automatic

• Repetition and its role in treatment
• Positive repetitive activities include
• Sanding
• Winding yarn
• Painting walls
• Brushing hair

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Memory Books

• Role in learning about patient
• Role in improving recollection of ones own life

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Improving access to ones own significant memories

• Personal timelines
• Old pictures
• Taking real pictures of real things
• Old songs from the past
• Old games from the past
• Old movies and TV shows

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Topics from the past

• What did your house look like?
• Where did you spend WWII (Vietnam)
• What was the name of your favorite doll?
• What kind of pets did you have? What were their
  names?
• What kind of games did you play?
• Who were your best friends?

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Topics from the past

• High school days
• How did you get to places?
• What were the roads like?
• Cars from the past
• How much did things cost? What did it cost to go
  to the movies?
• Who were your favorite movie stars?

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Topics from the past

• The great depression
• JFK
• After the war
• College days the GI Bill
• Etc.

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Artifacts from the past

• Dunce caps
• Snoods
• Poodle skirts
• Saddle shoes
• Flappers
• Silent movies

• Daytime baseball
• Post office, spin the bottle
• Glass milk bottles
• Outhouses
• Big bands

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What about truth?

• Whether or not a fact is actually true, in
  convrsations with individuals with dementia, if
  the experience is positive, do NOT question its
  truth value
• Accept the principle that we share truths with
  each other in normal interactions

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Speech and activity

• Activity facilitates talking (Arking, 2002,
  Tappan, 1992)
• Join in on the pacinghold a conversation
• Building labyrinths

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Uses for videotapes

• Transfer old home movies to videotapes for
  reminiscence and recollection
• Videotape special events, play and discuss
• Develop videotapes of important persons speaking
  about themselves and relationship to person with
  dementia. Can be used for identification
  quizzes, etc.

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External Aids

• If you plan to use them, teach their use
• Develop routines and practice plans with them

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Clubs and conversation groups

• Life history club
• Wheelchair aerobics
• Regular aerobics
• Grooming programs
• Dance/music
• Card clubs
• Car clubs
• Stamp clubs

• Ladies afternoon tea
• Jewelry club
• Weather and stargazing
• Babydoll clothes
• Cooking
• Furniture repair

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Doing things on purpose

• Activities that are being done just to keep
  busy are probably not worth the effort
• Define the purpose, even if its just having fun

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Modify the environment

• Shiny floors
• Intercom
• Dining room modifications
• Pictures on the door
• Dementia Friendly

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Word to the wise

• Most of the ideas come from the literatures of
  psychology, gerontology, nursing, OT, etc. Look
  beyond the confines of your disciplines
  literature

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Ways to measure change

• Direct changes in communication
• Decreases in medication
• Decreased use of phjysical restraints
• Decreased wandering
• Increased social contact and initiation
• Lessening staff turnover

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How to Talk to People with Dementia
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Creating an atmosphere conducive to communication

• Treat the individual as an adult
• Empower him or her
• Getting a message across is the goal, not
  perfection
• Forus on what can be expressed, independent of
  modality
• Accept what person wishes to share

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Creating an atomosphere conducive to communication

• Do not question truth value
• Keep background distractions to a minimum
• Really listen, give undivided attention
• Lighten up, but dont laugh at him or her
• Never talk about an individual within his or her
  earshot

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Creating an atomosphere conducive to communication

• Old times typically provide the best
  memoriesfind out what is to be re-lived and what
  is to be avoided
• Life in the old dayson a farm? A small town?
• When you were a kid, what did you like to do?
• What did you do during the war?
• Tell me about your wedding. How did you meet?
• What about when the kids were little?

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Creating an atomosphere conducive to communication

• Reiterative comments and questions
• Some reason usually underlies them
• Try to find out
• Makes it easier to cope with them
• Sometimes can be fixed-remember cue cards

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Creating an atomosphere conducive to communication

• RELAX
• Focus on the person, not the task!
• Take more than your fair share of the
  communicative burden
• In soe situations (groups?) you might be speaking
  FOR someoneshadowing
• Be prepared for failure too

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To maximize comprehension

• Look at the person you are speaking to
• Speak naturally, normally
• Speak slowly, be ready to rephrase or repeat
• Supplement speech with gestures
• Confirm understanding
• Maximize nonverbal communication
• KNOW HEARING STATUS!!

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Maximizing ability to state needs, thoughts,
wishes, etc.

• Give enough time for responding
• Really listening facilitates talking
• Allow person to complete own statements BUT
• If asked, provide help
• Respond to all communicative efforts
• Do NOT underestimate the power of yes/no
• Be patient with word finding attempts. Be
  helpful with them. Encourage circumlocution