Ten Tips for Treatment Success with a Person with Dementia or Cognitive Impairment

Life can be a challenge for Healthcare Providers when treating clients with cognitive issues. There are many causes such as Alzheimer’s, Dementia, and other brain disorders that make it difficult for sufferers to think clearly, remember things, solve problems and live safely. Personality changes and behaviors can be problematic.  These difficulties can be magnified with new environments, pain, fatigue, emotional upset and a decline in general health, the very thing that often brings them to rehabilitation providers.

It is possible to learn new ways of communicating and dealing with a person with dementia.  Informed communication will go a long way in successful implementation of strategies to provide care and prevent or handle difficult behavior.

1. Accentuate the positive: Speak in a positive calming tone. Have eye contact and a pleasant expression. Be aware of your body language.  Begin with a pleasant greeting or compliment. Ask caregivers about things the client likes and talk about them.
2. Be aware of your approach: A person with cognitive issues and intact eye sight may have a narrowed field of vision, and may only be able to attend directly in front of them. Approaching then from the rear may be startling or irritating as you suddenly “pop” into view. Get down lower to their eye level rather than tower over them if seated.
3. Set the environment: Decrease distractions. Move to a quiet location. Soothing music can be used to create calm. Energetic music can help a person who would benefit from better arousal. Invite a trusted person to join you if the client is suspicious of you.
4. Lighten up: Face the person away from bright lights or a glaring window; they may perceive you only as a dark shadow, and will not be able to read essential cues in your facial expressions and body language if they are having trouble with receptive language.  If they are lying on a treatment table, a bright overhead light can be replaced by a softer table lamp.
5. Focus on Function: A person with dementia may not be able to complete a traditional set of therapeutic exercises, but they can still improve function. You may need to work with more familiar items.  Placing cans in a grocery bag vs lifting 2 lb weights, sweeping a floor vs traditional weight shifting techniques. Dance!  
6. Talk to the client in a way they can hear you: Identify yourself before speaking and address the person by their name- OR - There may be times when it is better to not over explain who you are but just meet the person in their reality. Make sure you have eye contact. Use touch to help maintain attention. Speak slowly and distinctly. If you haven’t been understood, wait a bit and repeat. Provide information in short chunks.
7. Distraction action: If a client becomes agitated, upset, or oppositional you will not be able to convince them of something they are sure of. Avoid trying to prove their error. Step into their world and help them be reassured. Identify and connect on a feeling level. “I can see how that is upsetting, I’m sorry you are sad. Let’s take a walk.”  
8. Listen to feelings and intent not necessarily words: you may need to probe “Tell me more about what you want” “How do you use it?”  
9. Remember the good old days: Long term memories stay intact longer than short term ones. Ask about the distant past, it’s more fun to talk about the “Glory Days” than what was for lunch.
10. Laugh with the client- be careful not to tease or laugh at their expense. Many people with dementia still have a great sense of humor!

Refer your client to a Speech Language Pathologist for assessment if you notice difficulty expressing needs, or understanding directions. Often the SLP can work with clients and their loved ones to improve function.

Leila Hee Olsen, B.S.,  OTR 
Therapy Specialists

Kelly MacNeill- Cooney M.A., CCC- SLP, CHC

Therapy Specialists

Adapted from:

10 Careful Communication Tips for Caregivers

http://www.alhambrachamber.org/files/N0000094.pdf

Keywords:

Physical Therapy dementia, Occupational therapy Dementia, Treatment tips dementia, communication dementia, Cognitive impairment and therapy

Contact Information:

Kelly MacNeill- Cooney M.A., CCC- SLP, CHC
Therapy Specialists | Vice President of Clinical Compliance & Training 
p. 858.514.0375 x304 | f. 858.514.0383 
www.therapyspecialists.net