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Dementia and Behavioral Health

Communicating with Persons with Dementia

Regional Behavioral Health Center at Auburn

"Caring for Mature Minds"

What is Dementia?
Dementia is the loss of mental function in two or more areas such as language, memory, visual and spatial abilities, or judgment severe enough to interfere with daily life.
Well-known diseases that cause dementia include:

-    Alzheimer's disease
-    Parkinson's disease
-    Creutzfeldt-Jacob disease
-    Lewy Body dementia
-    Vascular dementia
-    Huntington's disease
-    Pick's disease


Other physical conditions may cause or mimic dementia such as:

-    Depression
-    Brain tumors
-    Hydrocephalus
-    Thyroid problems.
-    Head injury
-    Nutritional deficiencies
-    Drug reactions
-    Infections (AIDS, meningitis, syphilis)


Dementia  - What is it?

-    Delirium and depression may be mistaken for dementia.

-    Signs and Symptoms:
■    Memory Loss
■    Change in Personality
■    Trouble with language and judgment.
•    Inability to care for self
■    Behavior Changes:
•    Apathy
•    Depression
•    Agitation
•    Wandering
•    Anxiety
•    Sundowning
•    Paranoia


Helping someone with Dementia: Communicating takes time and patience.
-    A person with dementia has a different reality orientation.
-    Persons with dementia deserve dignity and respect; they are adults.
-    Tone of voice and facial expression matter as much as words. Be aware of your non-verbal responses.
-    Persons with dementia may take longer to respond; give them time.
-    Remember that the person may use one word when they mean another, look for other clues.
■    Clarify your guess with the person- you may be wrong.
-    Stay in eye contact - don't approach from behind.
■    Touch is important
■    Use as many senses as you can to help get your message across.



Patience, Patience, Patience
-    Present one idea at a time - don't give too much information.
■    Give one step directions.
■    Use direct statements that initiate action. (Example: "It's time to take a bath" or "Let's get dressed now.").
■    Avoid instructions that cannot be taken too literally, such as "hop into bed".
-    Discuss only concrete actions and objects.
-    Try to avoid asking questions - not being able to supply the answer may be embarrassing and lead to agitation.
■    Supply names and other information as much as possible - but avoid statements like, "You remember Mary".
-    Offer Simple Choices.
■    Persons with dementia have suffered a lot of losses; give them back some control whenever possible.


-    Accept that the person is living in a different reality.
■    Don't argue.
■    Listen to the message behind the statement, if a confused, frightened person may ask for his or her mother who died years ago. Rather than saying "Your mother is dead," which may initiate a new grief reaction, say something like "Your mother was a wonderful lady."
■    "Therapeutic Fibbing."
-    Validate what they are feeling.
-    Celebrate remaining capacity.
-    Build self esteem - allow the person to do tasks they still can.
-    Use reminiscence.


What can I do  if they become agitated or
-    Be a detective - try to find out the cause.
■    Sudden behavior change usually is the result of one, or more, of the three areas:
•    Medical
■    Infections
■    Deliriums
•    Environmental


Other Strategies:
-    Promote Security:
    Establish and maintain consistent routines and rituals so the person knows what to expect each day and can count on something familiar and meaningful.
•    Remember, most disruptive behavior comes from fear of not knowing what will happen next.
    Don't struggle to make the person behave in old, familiar ways.
•    Make pleasure in the moment: a goal in itself.
•    Do things for, instead of with the person, if he or she can no longer do them, but be discreet - protect self esteem.
   Be aware that the person may no longer be able to control impulses - use distraction and diversion.
    Watch out for situations that trigger disruptive behavior,
i.e. do not expose the person to large crowds or too many choices if these scare or upset him or her.
    If the person is in danger of wandering from the house, change locks or secure doors in other ways.
    If the person becomes paranoid, provide reassurance, avoid arguing, look for "missing" object, learn hiding places.


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