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Dementia: Tips for Visiting

By Trudi Biefeld, R.N., Family Care Program


In the first article, I talked about dementia and different types of dementia. In this article, I will give you tips and ideas for things you can do when you visit with the person.

In each stage of dementia (mild, middle and late), interacting with a client will be different. In addition, each person who has a dementia, has his or her own set of symptoms and behaviors.

When working with a client who has dementia, the most important thing to remember is that the person is an adult and should be treated with respect and dignity even if they are displaying some childlike behaviors. You cannot expect the person to have a normal reality, and it isn’t helpful to try to keep them in “our” reality. For instance, it may be helpful with some clients to remind them of a day or place, but for many, it may soon be forgotten. Instead, you can use a “reminiscence” approach by talking about things they do remember or things in their past experiences. An example of this approach would be: The person states that he/she wants to go home (they are currently living in a residential facility or a nursing home.) Instead of saying, “You are home,” you can validate their feelings by saying, “I know you want to go home. Tell me about your house.” This expands on the past and offers another conversation of ‘home’.

Reminiscence and validation are two approaches that are often used in dementia care giving. Reminiscence is a way for the individual to remember events, people, or activities in the past that should be pleasant for them. Reminiscence can be done through talking, pictures, music, etc. If this approach does bring up sad feelings, you can change to a different topic.

Validation is the acknowledgment of their feelings or statements; it keeps their dignity by not challenging their reality. For example, if the person is talking about someone who you know is deceased as if they are still alive, it’s best not to make that person experience their grief again. Instead, use the reminiscence technique of talking about that person (“Tell me about your mother. Was she a good cook?”) If the person asks the question directly whether that person is still alive, then it is important to answer truthfully and move on.

Finally, remember not to take negative remarks personally. Most likely, the person may have lost some of their social graces. For instance, if someone says, “You didn’t dress very nice to come see me,” you do not need to comment. You can just change the subject. With these suggested approaches, visits can be easier.

Tips for communication with a person who has dementia

  • Get their attention by gently touching their arm or looking directly at them
  • Speak slowly and softly.
  • Use positive facial expressions and non-threatening body language.
  • Be patient and calm.
  • Listen.
  • Touch (holding hands, touch of arms) is very important.
  • Baby talk is not respectful.
  • Don’t argue. You will never win the argument.
  • Sit with them if they are sitting. Be at their eye level.
  • Ask one question at a time, and allow extra time for them to respond.
  • Use simple explanations. Do not overwhelm the person with long statements or reasons.
  • Try to avoid explanations that could sound like you are scolding. For example: the individual states that one of his caregivers is his mother. Say, “I think she’s your nurse’s aide.” (Note: There’s no negative comment there.)

Suggested Activities

  • Music and movement. (Music should be from their generation.)
  • One-to-one attention, such as reading to the individual from the paper, short stories or poetry.
  • Reminiscence (looking at old magazines or magazine pictures of what the person did earlier in their life, such as woodworking or gardening.) Reminiscence Magazine (yes, there really is such a magazine), Fishing, Hunting, Farm Life, etc. are good magazines for this. The magazines do not have to be the latest edition for the individual to enjoy.
  • Looking at photo albums.
  • Creative activities: simple projects with simple steps to complete. Coloring is not a childish activity. It can be very calming.
  • Food (be aware if the person has any swallowing difficulties or dietary restrictions.)
  • Toss a balloon or a soft medium-sized ball, if the person is able. For some people, this will also help their range of motion. The size should depend on the member’s physical abilities.
  • Simple puzzles; you will need to assess the person for their level. A 25 or 50 piece jigsaw puzzle can be used if the individual doesn’t get frustrated with finding the pieces.
  • Simple card games such as Crazy Eights or Old Maid (games may even be made up as you go along) or large Bingo cards
  • For advanced dementia individuals: sorting of beads, folding material such as towels or wash cloths, stacking blocks or containers.
  • Animal visits (check with the facility to see if this is okay and with the client/family to see if the person likes animals.)
  • Take a walk with the individual if they are able.
  • Activities to avoid:

    • Leaving the TV and radio on all day, which can be over stimulating for them and can cause behavioral issues.
    • Noisy or busy rooms which are over stimulating for some individuals and can cause behavioral issues.
    • Lengthy programs. The programs you attend together need to be shorter in duration, as the dementia person may not be able to follow the whole program. Programs such as music, brief skits, and children singing songs keep their attention.
    • Things that require memory such as certain board games or activities that require numerous steps or instructions. Depending on the individual, these activities may frustrate them because they are unable to follow the sequence of the games.
    • Childish activities. As I said earlier, we need to remember that these persons are adults and should be treated with respect and dignity.

    In summary, remember to be flexible and patient. Try numerous activities. Some days one activity will work wonderfully, but the next time you visit, it won’t. Know that anything you do with the individual is providing that person with warmth and caring, so sometimes just holding a hand is all that is needed. It will not only benefit that person, but also give you the feeling that you have done something wonderful.

     

    If you have any questions or concerns while working with a person with dementia, please contact their Care Manager.