In Dementia Action Week, Rural Doctors Foundation shares some useful tips provided by Dementia Australia for use by rural GPs or for those caring for someone with dementia.
1. Make the environment comfortable
Whether this is in the hospital or at home, the physical environment can have a huge impact on the mental wellbeing of a person with dementia.
Here are some tips to reduce confusion and create a calm and welcoming space.
Clear and simple signage
Make sure any important signage is written in a large, clear font (Helvetica or Arial, 18 point where possible) with clear backgrounds, free of unnecessary decorations. Signs should be placed at a height of 1.2 metres so they can easily be seen. Removing unnecessary signage is also helpful. In the home, using simple symbols to indicate functions of items or rooms can be helpful. For example, a symbol for a toilet on the bathroom door.
Less noise and distraction
People living with dementia can become confused or stressed by loud, competing noises or distractions such as bright lights, loud TV or radio, or loud conversations. Less distractions will help people living with dementia to focus and stay calm. Too many mirrors and reflective surfaces can also provide unhelpful stimulation.
A calendar by the bed
Something as simple as a calendar by the bed, or somewhere easily seen, can quickly orient the person and enable greater independence. Ensure that calendars and clocks are always accurate.
Keep the bathroom in view
Making sure there is a clear, unobstructed line of view from the bed to the bathroom reassures the person that they know exactly where the bathroom is if they need it.
It’s important that good lighting is in place to reduce shadowing, reflect the correct time of day and ensure that the person doesn’t become disorientated – a minimum level of 300 lux is best. Where possible, make sure the curtains are open so the person has good access to natural light. A bed next to a window is best to restore good sleep patterns.
Keep important items in sight
It helps to keep important items such as toothbrushes in a visible location, rather than hidden out of sight in a cupboard or drawer, so that the person can access them easily and independently. A glass of water should also be kept in view as a visual cue to stay hydrated.
Tip 2 – Support independence
It’s important to always be available when assistance is required, but, where possible and practical, the person should be allowed to retain their feeling of independence. This will help to improve their overall level of comfort and happiness.
Set the person’s environment up for them to succeed
As outlined in the first tip, there are some simple improvements to physical spaces that can be made to greatly improve the experience of people living with dementia.
Engage the person in everyday decision making
This inclusion in planning activities or allowing a person time to work out a problem on their own is important. When planning an activity such as a walk outside, allow the person to be involved in the planning process and let them decide where they would like to walk. If the person is trying to work something out, allow them the time to get there on their own, even if you feel impatient and want to jump in.
Tip 3 – Listen and connect
It can often be difficult for people living with dementia to communicate, particularly in hospital or care settings. If a person with dementia feels like they are not being properly listened to, this can cause them distress and may result in their care not meeting their specific needs.
Make a connection
Let the person know they have your attention by making eye contact with them. Use their name in conversation so they know you are aware of who they are and are engaged with them. Use your body language to show you are listening to what they are telling you – lean in and nod encouragingly as they speak.
Be patient and understanding
Always try to be as patient and understanding as possible when speaking to people living with dementia and listen to what they have to say. Sometimes the person may take a long time to find the right word or idea, or they might lose track of the conversation. Don’t rush them – give them the time they need to process the information and find the right answer. Try responding to the emotion that is being communicating, for example, “you sound upset about that” or “I can hear that makes you feel sad.”
For GPs – get to know the person
Getting to know a person with dementia will help them feel like they are being seen and listened to and will make them feel more comfortable communicating. Ask them what their preferred name is, about their normal routine and their likes and dislikes.
Tip 4 – Communicate clearly
It’s important for all of us – particularly healthcare professionals – to remember that people living with dementia have unique requirements when it comes to communication. Dementia makes it harder for people to concentrate and they may be unable to hold multiple ideas in their minds during conversation. Unfortunately, this can become more of an issue with visits to the GP or hospital as the distractions and stresses can make communication more difficult.
Talk with the person
Don’t assume that people living with dementia can’t understand you, and that you need to talk to their carer, family member or friend instead. This is a form of discrimination which can make the person feel excluded and isolated and may make the person less open to communicate with you.
Be calm and gentle
Always talk in a calm and gentle manner and be caring and empathetic. Don’t be patronising or get frustrated with the person – even if they have trouble understanding what you say, they will pick up on your tone of voice.
Speak clearly and avoid complicated language and jargon. It helps to use short sentences, communicating only one idea at a time. Breaking down information and providing it in smaller chunks can also help the person to process it more easily. Closed questions (with yes/no answers) with a focused context will usually be easier for the person to understand – such as “Wasn’t it nice and sunny on our walk yesterday?”
Connect with the person’s carer
It can be helpful to separately connect and communicate important information to the person’s carer. This will enable the person to clarify important medical information with someone they know and trust. Ask the person’s carer for helpful information that can support positive communication.
Minimise distractions and disruptions
It’s important to get rid of potential distractions and disruptions when speaking with people living with dementia, to make sure they can concentrate. Avoid moving around while speaking to the person – sit still and stay in their line of vision. Make sure the TV or radio is switched off and there are no competing conversations within earshot.
Tip 5 – Keep them oriented
A few simple reminders can be an effective way of keeping people living with dementia oriented when meeting with you as their GP.
Wear a name tag
Wear a clear name tag (if possible, with at least 18pt font) so that the person can easily identify you and remind themselves of who you are. It’s likely to make the person feel more relaxed if they don’t have to worry about remembering your name.
Continue to introduce yourself
Introduce yourself by name and occupation each time you enter the person’s room and explain the reason for your visit. Don’t assume the person will remember who you are and what your role is after your initial introduction. Continuing to remind them of who you are and how you are helping them will prevent them becoming confused and help them feel at ease.
Put information in writing
It’s important to put any key information the person will need in writing, so they can refer to it as a reminder when needed. This may include things like how to contact the practice, how to find the bathroom, as well as the reason for their visit.
If a hospital stay is required, allow familiar objects to be placed around the room
Placing familiar objects around the person’s room can help to make them feel more comfortable and oriented, particularly for longer hospital stays, respite or when transitioning into residential aged care. These may include things from the person’s home such as family photos, cushions, blankets or other personal items.
Use orienting names
It can be very helpful to insert orienting names into conversations to remind the person who you are talking about. For example, “Your son, Jack”, or “Your doctor, Doctor Williams”.
Tip 6 – Keep them engaged
To enable people living with dementia to live as full and active lives as possible, it’s important they stay socially, physically, and mentally engaged.
Healthy mind activities
Allow for and organise “healthy mind” activities such as crosswords, find a word, mindfulness colouring books, games, reading materials and any other activities that challenge or engage the mind. These kinds of activities can help people living with dementia stay oriented in the present and enjoy themselves. Keeping their minds active can also help people living with dementia feel better and think more clearly.
Dementia Australia offers a free app featuring a range of two player games designed to enhance communication and facilitate positive interactions between people with dementia and their visitors.
Talk to someone living with dementia as much as you can, even if communication can sometimes feel difficult. It will help to make them feel more socially engaged and included and may make them feel less lonely. Engaging in conversation is one of the best ways for people living with dementia to stay in the present moment and feel connected, which can help them feel more comfortable with their surroundings.
Dementia Australia offers the Talk with Ted program. Ted is an Artificially Intelligent (AI) Avatar with symptoms of dementia. Engage in a virtual conversation with Ted to practise your communication skills.
Encourage and support participation in activities
It can be very beneficial to encourage the person to participate in activities such as singing, gardening and games. This can help them to feel involved and included in a social community, which can contribute to a better quality of life. For acute care – sitting in the lounge area where the person can engage with others can help. For people who are non-verbal consider how they might be communicating with you in non-verbal ways. You could provide other ways for people to engage such as drawing, painting or listening to music they might recognise.
Encourage physical activities and healthy eating
Eating healthily and staying physically active will keep the person’s energy levels high and enable them to think more clearly. Encourage activities like walking and allow the person to do physical tasks on their own where practical. Always make sure the person has access to healthy and nutritious meals.
See Dementia Australia’s website for more useful information and tools.