Avoid these 4 mistakes in dementia care

December 18, 2019Mikki FiroractivitiesAging HealthAssisted Living TipsCaregiver TipsHome Care TipsMedical ArticlesProfessional TipsUsefull info Links

In my over 15 years of experience working with people with dementia, I am always inspired with new ideas. There are a lot of loving, caring, people working in this industry but their experience may be limited. If they have been in the field for a while, they may have old “bad” habits or information. The world of dementia care has evolved greatly, even in the past 5 years! There are some general mistakes I see made and there are ways to avoid them, whether you’re providing a care plan for a client, for a resident in assisted living, or someone who you’re providing care to in their home.

Mistake 1: Relying solely on a mental status exam

Mental Status Exams are commonly used when working with older adults. They’re not meant to be a diagnostic tool, yet they are used that way in many circumstances. People tend to use that score to determine a person’s abilities or challenges. People can score better on a cognitive exam than they may perform in everyday life.

We all change throughout the day as we get more tired or more energized. Our hunger or thirst level can also change our personality. And guess what, we’re all different whether we have dementia or not! So, you may see a better or worse score. Some people will refuse a mental status exam all together. So using a Gerontologist and Dementia Expert to conduct an assessment without one may be necessary. So, do not rely on the mental status exam alone.

Here is what I recommend to avoid this mistake:

My best assessments of my clients with dementia are when I don’t use a mental status exam at all! But sometimes they are necessary. So, when conducting a mental status exam, spend a minimum of 15 minutes simply connecting and chatting with the person with dementia before and after the mental status examination. These interactions will reveal a lot that may be supported by the mental status exam results.

Mistake2: Assuming every “challenging” expression is a symptom of dementia.

Wandering, pacing, verbal aggression, physical aggression, refusing medication, public masturbation, unwanted sexual behavior, refusing to eat, etc. are all examples of “challenging expressions” that I am asked to help solve. I had a client who was going to be discharged from a community because he was expressing himself with physical aggression. Before calling me, the first reaction (as it usually is) was to call the psychiatrist to treat this “mood” with medication.

When I was finally called, I started asking questions and learned he was only expressing himself this way at the community happy hour, meal times, or large community activities. I started digging deeper and learned that my client was always triggered by surprise disruptions to his personal space. If he stepped on a toy, he’d yell and throw the toy! The times he expressed himself was in crowded, loud situations when he was being bumped into or over crowded. His expression was not a symptom of dementia but a personality trait.

Here is what I recommend to avoid this mistake:

Dig deep! Ask questions about the person with dementia regarding who they are now and who they were before. Try asking the following questions (for starters):

1. What kind of challenges did the client have in the past?
2. How did the client manage these challenges in the past?
3. How would family, friends, or coworkers describe the client 20-30 (or more) years ago?
4. What sorts of things made the client sad, angry, or happy in the past?

Mistake 3: Creating a packed engagement schedule

“Cognitive stimulation is good for people with dementia!” I hear this all the time. Yes, cognitive stimulation is good for EVERYONE but overstimulation is also a very real possibility for EVERYONE. For someone with dementia, they may be unable to communicate, in the same way a cognitively health adult can, that they are feeling over stimulated or need a break. So, the communication usually looks like some of those challenging expressions described above.

This is something I find especially relevant to family members. They want the best for their loved one and there is a lot of information about cognitive stimulation for someone with dementia on the Internet. They worry that watching TV, relaxing, or sleeping too much will worsen their dementia. I understand this, but overstimulation can also make them unhappy and actually negatively impact their quality of life.

Here is what I recommend to avoid this mistake:

In order to provide the appropriate amount of cognitive stimulation or engagement for the person with dementia, I suggest learning more about the person’s previous habits and preferences around a few areas.

1. Learn about their occupation. Were they a high-powered CEO, a stay at home parent? How did they measure their productivity and value in their occupation?
2. What did they do for fun? Did they play sports, boat, garden, cook?
3. How did they perform self-care? Did they meditate, work out, paint their nails every week? Get a professional shave?
4. How did they recharge their batteries? Perhaps they spent every Sunday at church, or maybe they’d hole up in their room for a weekend and watch movies or read a book.

The final recommendation for this is to consider how much time a person spent in each of these areas. Perhaps they only worked part time but spent a lot of time on leisure activities. Or maybe they needed to recharge every single day, whereas someone else only needed a recharge once a week. Keep in mind that the time spent in each of these areas may have varied over time. So, you may have to shift the schedule regularly to accommodate their changing timeline!.

Mistake 4: Teaching new “good” techniques and failing to discuss and correct older “bad” techniques.

The best practices of dementia care have changed drastically since I started in the field. When I first started teaching people about dementia I used a pre-created education program. The number one technique taught was: Therapeutic Lying. I work with assisted living/dementia care communities to train staff, speak at caregiver conferences, collaborate with hospitals to support their doctors, nurses, social workers, etc. and home care companies to coach their caregivers, work with their families, and improve their assessments. Therapeutic lying is not the same as joining someone’s reality. But when we teach the method of joining the reality, the person immediately starts using lies to do this. Ie: “Where is my mother?” The lie “She will be here after dinner.” They assume that because the person is asking about their mother, that they believe she is alive, so therefore, they join her reality by offering a lie.

This is just one example of an old technique that was taught (and in some cases still is) that is no longer effective. It is extremely important that we course correct.

Here is what I recommend to avoid this mistake:

• Use the experiential learning cycle to correct old techniques with new techniques.
• Create an experience by using a real experience with a person with dementia and correct or reinforce the techniques the trainee uses.
• This will help the person understand the potential outcome, why it may not be beneficial, but reinforce the use of the correct techniques.
• Please avoid ignoring bad techniques all together. If you have a skilled trainer who is knowledgeable about adult learning theories, it won’t confuse your trainees. They will only benefit!
• Reinforce these skills. The repetition of correction of “bad” techniques and reinforcement of “good” techniques will help it stick!

In this field, we are all making mistakes but for the most part, we are doing things really well. As dementia care continues to evolve we will see more challenges and more strengths pop up. Just as a person with dementia is progressively changing, so is dementia care. We can start to check ourselves by avoiding some of these mistakes.

Trovato can help companies/professionals and individuals by determining what mistakes they’re making and what they’re doing well to work on maximizing the strengths and correcting the challenges.

Contact us today! [email protected] 443-510-1169