“I can’t stay for dinner. Daddy’s expecting me at home. Momma will miss me. I have to go.”
Laura’s agitation escalated as she squirmed in her wheelchair. A deep frown creased her face and she continued wringing her hands.
Laura lived in our TLC, an area of our home for people with dementia. But in her mind at that moment, she was a teenage girl who needed to get home for dinner. I envisioned a strong father who shouldn’t be crossed and a worried mother who peered out the door every few minutes. That was her world.
It wouldn’t have helped her for me to tell her those parents were long dead and she was elderly herself now. Saying that she didn’t need to worry wouldn’t help either.
“Would it help if I phoned your parents and got permission?” She looked at me doubtfully, but didn’t tell me not to, so I picked up the receiver of the phone on the wall and made a show of dailing. “Mr. Palmer? This is Ann at Christie Gardens. Laura has been visiting us this afternoon and we wondered if she could stay for dinner. That’s okay? Oh, wonderful. Thank you.”
I smiled at Laura. “He said you could stay.” She relaxed and happily joined us for the evening meal. After dinner, she’d forgotten about the crisis and went peacefully to bed.
Was I lying? No, I entered her reality, listened to her anxiety and helped her find a way out of it. I only used that particular solution once, but I entered a resident’s reality and tried to help them many times a day. Sometimes it worked, and sometimes not. Interventions are like that.
Learning to help with the confusing feelings and beliefs of a person with dementia can be a puzzling time of trial and error. However, there are a few principles which apply each time.
Listen
What is the real message the person is trying to convey? With Laura, it was, “I’m afraid of 
what will happen to me if I don’t get home on time. I don’t want Daddy to be mad at me.” It helped me to listen to her worries, think about how that might feel, and try to enter her reality to look for a solution.
Engage
It’s not always possible. The elder may be non-verbal, or the feelings may have ramped far beyond having a chat. But if possible, I ask people to tell me about the home they want to go to. Often, it’s the home they grew up in rather than where they lived before they came to us, as the latter had faded from memory. I’d ask what it looked like, and what they enjoyed doing there. I tried to pick up on things they said like, “What kind of cookies did your mother bake? Which were your favourite?” Often our chat and the reminiscences which came out of it would ease the anxiety and take them down a different road in their minds.
Remove
Sometimes, the cause of the problem is the over-stimulation of having other people around, or tiredness. A person with dementia often can’t pick up on these cues for themselves, so they act out. Bringing them to a quiet place, and encouraging them to relax in a chair or lie down can help. Quiet, one-on-one conversation or gentle music can lead to peace.
Knowing your elder well, and creativity are keys to helping them negotiate the confusing world of their feelings and anxieties.
Next week: What is the unmet need?