Much research has been done on the course and cause of Alzheimer’s disease, yet it is only once you care for someone with the disease that you become aware of the devastating grasp of this monster. Dementia is an umbrella term for a variety of subtypes of neurocognitive disorders, of which Alzheimer’s disease is most prevalent. Alzheimer’s disease and other types of dementia are of increasing relevance as populations are ageing globally and the age-related nature of Alzheimer’s disease means that the incidence of the condition is increasing. Alzheimer’s disease presents with a variety of challenges, not just for the person with the disease, but for those providing care.
Kitwood (1997), a social psychologist, reiterates the importance of using a holistic approach to the management of dementia as there is great interplay between the neurological damage and the psychosocial environment. The psychosocial environment and our care approach have a direct influence on the wellbeing of the person with dementia.
Understanding the person with Alzheimer’s disease is crucial, whether treating an unrelated problem or treating symptoms of the disease directly. Trans-50 focuses on the following aspects that are vital to providing special care to persons with the disease: the environment, knowledge of the person, purposeful engagement and mindfulness.
At Trans-50 it is of utmost importance to us to firstly understand who the person behind the disease is. This includes an initial person-centred care assessment to establish past and present likes, dislikes, routines, favourite meals, hobbies, experiences, skills and interests. Understanding the biography and history of the person allows us a greater understanding of the individual.
Kitwood refers to this concept as “personhood” which is defined as “a standing or a status that is bestowed upon one human being, by others” and implies recognition, respect and trust. This forms the cornerstone of our approach toward being able to provide support services and care for a person with dementia.
Secondly, people with dementia need an environment that allows easy access, familiar objects and adequate wayfinding which in turn encourages independence and autonomy. When creating dementia enabling environment, aspects such as lighting, colour, signage, accessibility, familiarity and safety should be paramount, including an allowance for sensory enhancement and participation. The environment should entice the older adult to continue participating in activities of daily living, for example, washing up of dishes, cleaning and cooking or baking. These skills and abilities remain long after the onset of the disease and should be encouraged. Forming part of our enabling environment is multisensory rooms (MSR) or environments which allow residents to relax or interact with and control the elements within the room. It creates a sense of control and allows the person with dementia or the person with a disability, to change and influence their environment in a positive way. Although research on the use of MSR in elder care is limited, we have experienced that this environment can improve a person’s mood, have a calming effect on those experiencing aggression, anxiety or disruptive behaviour and improve communication and enhance interpersonal interactions.
To support the concept of purposeful participation, it is important to know the person behind dementia – and that is what person-centred care is all about. Engagement in activities that are purposeful, allows people to feel good about themselves, brings meaning and purpose and helps them to experience a sense of belonging. People with dementia can engage in activities in different ways and at various levels. Activities are adapted to suit the functional level of the person involved. Activities range from gardening, baking, pet interactions, exercise, crafts, doll therapy, music therapy, volunteering and many, many more.
The most important aspect of providing dementia care is to embrace and practise being mindful. Mindfulness is the act of focussing on the present and being conscious and aware of what is happening in that given moment while also accepting your own feelings and thoughts. Mindfulness allows us to focus on the individual and often the lucidness that may be experienced in a single moment and acknowledge the persons’ current experiences and emotions, allowing them to feel validated. Validation allows us to connect with the person with dementia and places emphasis on the emotional aspects of conversations and less on the factual content or correctness thereof. By validating the person, you show respect for the person and his/her feelings. It is of great importance to validate a person with dementia, allowing them to feel heard, acknowledged and valued, rather than dismissed, marginalised or slotted into a general routine of one size fits all. Validation is closely linked to mindfulness and rather than attempting to deter or ignore irrational behaviour, it allows us to be present and accept without asking why.
Providing care to residents with dementia requires us to join them in their reality, rather than diverting them back to ours. By entering the world of the person with dementia we can assist in reducing the immense feeling of anxiety, allowing the person to experience a sense of security, empathy and trust.
In conclusion, remember to provide dementia training and support to your care employees. This will include the rotation of staff to prevent burnout within the care environment. Staff partake in fun activities and should also be mindful of their tolerance threshold and communicate openly with management when they suspect they might be suffering from caregiver burnout. An inviting, warm and comfortable staff room, away from the unit, allows staff to re-energise during break times. We also encourage employees and family to spend some time relaxing in the sensory room to soft music or a darkened room to dull the senses and create a more relaxed environment.
National Care Director for Trans-50