Dementia Interactions: 5 Mistakes and 5 Tips
I have been working in this field for over 10 years. Yes, it started with zero education. So, I developed 5 top mistakes along with 5 tips for interacting with persons with dementia. These are mistakes I have made or mistakes I’ve seen other made (and thankfully I learned from their mistakes QUICKLY). Keep in mind, there are many mistakes we make but these are my TOP 5. I chose some pretty extreme, but real life, examples.
MISTAKE 1: Failing to introduce yourself!
I am going to keep it pretty simple here. We often forget to introduce ourselves to someone with dementia. We assume they know who we are if they’ve met us before. This doesn’t require a story.
TIP 1: Just introduce yourself.
“Hey Mom, it’s me Mikki!” Seriously. Giving the answer to the person with dementia can prevent a lot of distress.
MISTAKE 2: REDIRECTION without validation
A person with dementia may notice memory or cognitive changes. Sometimes, they begin to cry or just mention they have a poor memory.
Typical responses include: Trying to make the person smile immediately, or telling them “it’s ok you don’t remember.”
Now let me ask you a question: Have you heard of the resorts in Mexico where people had one or two drinks and then woke up dirty, missing their phone and wallet and had no recollection of how they got into this position? Imagine that happened to you and someone said to you “It’s OK that you don’t remember!”
TIP 2: Use redirection WITH validation
First, validate the person’s feelings by saying something like “It must be so frustrating when you can’t remember.” Give the person a chance to talk about it, then redirect them to something they love such as a warm cup of coffee, their favorite scarf, their favorite song, a story, or a video that makes them happy!
Always use redirection with another skill, and also use validation with another skill. The feeling will linger. So if someone is angry, validate then redirect. If someone is sad? Validate then redirect! If they’re anxious? Validate then redirect! You get my drift….
MISTAKE 3: Assuming that someone with dementia will forget the lie you told them.
Guess what! Not ALL types of dementia = memory loss. KNOW YOUR AUDIENCE.
I once had a resident who wouldn’t shower. So, one of the staff members offered to take her on a long trip (1.5 hours one way) to her favorite casino if she took a shower. Guess what? She took a shower. But then, for days after she continued to ask about it and refused to shower until he kept that promise. Her daughter had to come take her to the casino..
TIP 3: Know the person with dementia
Know who you’re fibbing to. I suggest starting with a small fib that you can honor.
Keep in mind, some professionals will tell you not to lie at all. There are a lot of ethical standards around that. Ethically, most professionals agree only to use lies as a last resort (before medication) and if it is in the benefit of the client. We prefer to use other techniques first.
Sometimes, lies can become too intricate and confusing for not only the person with dementia, but also the people telling the lies.
MISTAKE 4: Assuming a person with dementia cannot handle the truth.
We assume that someone with dementia can’t know they have dementia. So we lie, redirect, validate, until the person becomes so frustrated. I once had a resident that moved into our dementia unit from assisted living. Her family insisted in creating an alternative story (lying). Eventually, after she insisted on an answer as to why she was there (and the lies weren’t cutting it), I told her the truth. “Your memory is getting worse and there are more people here to help you when you get confused.” She accepted that answer, asked where her room was. She was happy to see her books there. She never asked again.
TIP 4: Tell the truth!
It took us 2 weeks before we told her the truth. Two weeks of her confusion, worry, anxiety, sadness, fear, etc. We didn’t know how she would react, but we should have given her the opportunity. If the truth hurts the person, you can employ one of the other techniques.
I often recommend a caregiver be honest with their burden as well. Saying to the person with dementia “I feel sad. I miss the way things used to be” is a simple way to express your feelings to your partner. Most caregivers assume that after a person is diagnosed, they’ll never receive comfort for their feelings from them again. This isn’t true.
MISTAKE 5: Speaking around the person with dementia.
This is my BIGGEST pet peeve. Today, I conducted a training where I shared this story:
I was in a community with a client, who wasn’t feeling well. I let the nurse know and shortly after she came into the room. My client was lying in the bed, and I was sitting on the bed with her. The nurse started talking about the clients eating habits, her bowel movements, her nausea, etc. without ever asking the client how she feels or even acknowledging her.
Think about this: you’re at the hospital and the doctor comes in. Your significant other is standing next to you holding your hand. The doctor starts saying to your significant other “Well, it looks like she had food poisoning from something. Did she eat sushi recently?” Why can’t they ask you? You’re wide awake. Fully able to talk. Wouldn’t you be insulted?
On the contrary, sometimes people will ask to speak to someone in the hallway. They’re speaking in hushed tones in front of the person. This is still equally frustrating.
TIP 5: Include the person with dementia in all conversations, especially those about them.
I admit, my response to this technique can come across as rude to the other party involved, the one ignoring the person with dementia. But then again, I don’t care because they’re being rude to the person with dementia. Here is what I suggest:
Lead by example. “Mrs. Smith, why don’t you tell me how you’re feeling right now?” You can even become more specific. “Does your stomach hurt? Is it your chest?” etc.
Another way I do this is by saying, “Could you please speak up? She can’t hear you.” OR if the person is speaking loudly enough, you can say “She’ll understand you better if you look her in the eyes when you talk to her.” Finally, you can say “Let’s ask Mrs. Smith.”
What are some of the common mistakes you have made or seen others made? Do you have a tip? Comment below and let’s see what other mistakes we can start correcting!
Bonus Mistake: Mistaking side effects of medication for effectiveness.
Sometimes, we assume that because a person is not performing a behavior (such as aggression) shortly after introducing a medication to manage the behavior, this means the medication is working. Sometimes, these medication side effects include drowsiness. If the person does not have the energy to perform the behavior, they won’t. After a few days the behavior may return.
Bonus Tip: Before assuming a medication is effective, wait for the doctor’s opinion.
Medications should be used as a very last resort and always follow doctor’s orders AND guidance. We recommend using a GERIATRIC PSYCHIATRIST for psychiatric medication. If you notice a change, report it to your doctor and they can guide you on what to expect next.