Categories: Health

Two best ways to respond to people with dementia

Managing Competing Realities in Dementia Care

Approximately one quarter of hospital beds in acute wards are occupied by someone living with dementia in the UK.

The sights, sounds, and smells of a hospital environment, and the lack of familiar carers, can be a significant challenge for people with dementia. Many healthcare staff feel that they do not have sufficient training to care well for them.

Managing Competing Realities

Dementia affects people’s abilities to use language, to understand other people’s use of language, and to remember things. One common challenge is the presence of competing realities, where the person with dementia is oriented to a different time or place. For example, they may believe a parent is coming to take them home or that they need to leave urgently to pick up their own child from school.

Responding Effectively

We found that there are four ways in which staff tend to respond, but that only two of these are effective in addressing distress.

Confronting or Challenging Reality

The first way is to confront or challenge the patient’s reality. For example, telling a person who believes they are at home that they are actually in hospital. It is understandable why staff might do this, but we found that it does not usually lead to agreement, and instead can make distress worse.

Going Along with the Patient’s Reality

The second way is to go along with the patient’s reality. For example, by agreeing that a deceased family member such as a parent or spouse will be coming to visit or collect the patient later. While this might work as a short-term strategy, it is time-limited because the promised event will never happen. This can ultimately make distress worse.

Alternative Approaches

We found that there are two alternative approaches that are more effective. The first is to find some aspect of the patient’s reality that is shareable, without fully entering into it. For example, if a patient says their (deceased) father is coming to collect them, a member of healthcare staff might ask "Do you miss your dad?" This avoids lying, but responds to the emotional tone of the patient and enables a sharing of feelings.

Diversions

The second approach is to use diversions. The topic of conversation can be shifted away from the issue that was causing distress, towards something else they could engage the person with. This sometimes drew on the immediate environment – the view out of the window, for example. Sometimes they proposed an alternative activity, such as walking to a day room, or getting a drink. When no other possibilities were available, they sometimes asked the person with dementia a question that could lead into a different conversation.

Conclusion

These approaches are relevant for carers in any setting. Even in the context of a busy, pressured environment where carers may know very little about a person, the small differences in the way they communicate can have a profound effect on the care and wellbeing of those living with dementia.

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