Common dementia practices that hurt more than they help
When I was growing up, my dad was the king of quick fixes. We always had duct tape handy and he knew how to work a drill. The fix didn’t look pretty and it may not have lasted long, but it got the job done for the time being. Quick fixes are common in dementia care. Whether a person with dementia is living at home, in an assisted living community, at the hospital or a rehab facility, or anywhere else, those caring for someone with dementia need to act quickly sometimes.
When we use quick fixes as long-term solutions, we are potentially violating an individual’s rights and independence and providing sub-par care. The most common quick fixes I see are:
- Modified Clothing
- Locking doors
While some quick fix techniques may be beneficial at times, as all techniques are case-by-case and individual specific (person centered), they should be considered carefully for long-term benefit.
When lying to people with dementia, professionals will often call it:
- Therapuetic Fibbing
- Compassionate Deception
Lying is not the same as “joining someone’s reality.” When joining someone’s reality, we are meeting him or her where they are in their belief of current circumstances. Lying is telling someone we know to be untrue. A common example we see of this is when a person with dementia asks where a deceased relative is. Here is an example of lying:
Client: Where is my mother?
Caregiver: She is going to be here after dinner.
I have seen this backfire quite often. First, the person with dementia may not have memory loss and therefore, they may be expecting their mother after dinner. If she doesn’t come the client can feel abandoned or upset that they were lied to. An alternative would be to ask questions (this is based off a real life example):
Client: Where is my mother?
Caregiver: That is a good question. I don’t know your mother, where would she usually be at 2:00pm on a Wednesday?
This allows the person with dementia to share information about their mother so you can join their reality. You will be meeting them where they are.
In this example, the client responded, “I think she’s dead. I can’t remember where she is buried.”
Can you imagine if we had told her that her mother was coming after dinner? She may feel confused that she believes she is dead or frustrated knowing that we lied to her, which would also break down the trust.
If a client says, “My mother will be here after dinner,” this is a great way to ask questions about her mother to learn more. By asking questions rather than simply responding with solutions or answers, we can learn more about the clients we are working with.
They types of behaviors usually prevented with clothing are public masturbation or urination. Many companies have created modified clothing that can be used to prevent behaviors such as one-piece clothing that zips up the back. Caregivers have put belts on backwards to prevent behaviors as well. . Sometimes these techniques can work as the person is unable to remove their clothing on their own. This is a great example of when it may be a quick fix, but not a permanent fix. These kinds of techniques can impair a person’s ability to toilet independently, remove clothing if they are too hot or uncomfortable or simply communicate the need to use the restroom or that they are too hot or uncomfortable. Furthermore, one piece clothing that zips up the back does not allow a person to choose their clothing and even when designed to look like real clothing, it does not necessarily look that way or match the style the person prefers.
If a person has the ability to toilet independently, we should not be using such clothing to prevent behavior. However, if a person needs prompting to use the bathroom it may be appropriate. However, a better option would be a jumper that would go under the clothing. I have seen a biker shorts/tank top combination that can be worn under regular clothing. A person can still remove and add clothing if they get warm or cold.
Locking doors that a person is not able to go into is a common way of preventing a behavior. I also see that caregivers will lock doors a person with dementia cannot go out of, especially when living in the home. Locks on doors can be a trigger. Many facilities have requirements on locking a door in and out of a dementia unit and it is necessary for safety, however, when we begin placing locks on doors, it can cause a person with dementia frustration. How would you feel if several rooms in your home were locked without you knowing? It would be very frustrating.
Rather than placing locks on doors to rooms or closets throughout a home or community, examine whether or not there is a way to alter the environment to make it safer for a person with dementia.
The final type of quick fix I would like to discuss is medication. I am not a doctor and therefore will not comment on the efficacy or prescribing of medication. I have the opportunity to work with many psychiatrists and physicians as they prescribe and monitor medications used to manage behavior. However, the challenge I see is that caregivers may see a decrease in behavior when in reality; it is a side effect of the medication. The important thing to consider with medication is to give it time and ensure you have other long-term non-pharmacological solutions to use the behavior. It shouldn’t be used as the only technique and the client should be closely monitored and all changes documented and reported to the prescribing doctor. Each doctor will have their own follow-up and reporting requests that should be closely adhered to.
The point of mentioning medications is that this is not something that should be used alone. Practice other techniques to ensure the person is receiving the best care possible. Medication can be helpful in reducing underlying causes of behaviors related to mood or psychological issues, but should not be the only solution. Other forms of non-pharmacological interventions may include: redirection, validation, music therapy, art therapy, exercise, reminiscing, or many others.
While these techniques may be effective at times and sometimes a quick fix is necessary, they should not be the permanent solution. Consider other methods of managing behaviors and understanding behaviors as communication to improve the quality of life for the person with dementia. When in doubt ask yourself “Does this improve their quality of life and the quality of care provided for the long term?”