DEMENTIA CAREGIVERS NEED SLEIGHT OF HAND

Advanced dementia sufferers will have serious memory problems. They will however still have old memories, often very comprehensive ones.Many of these memories will be good ones and if you are a caregiver for your partner, or other loved you will probably have access to photo albums or even film of the family. Your patient should be encouraged to look at these and remember. The reason is that new memories are very difficult for a dementia patient do deal with and in fact being asked about recent events can be very stressful and cause difficult behaviour, whereas past memories can be comforting. In his book 'Contented Dementia', Oliver James writes; 'In the absence of more recent information, people with dementia are liable to interpret what is happening around them as being a situation from the past.' The SPECAL technique, which treats memory as if it were a photo album enables patients to consult old pages in the album that have happy memories for the patient and relate them to the present.. This enables patients to live contentedly in the present, but through the past.
Oliver James goes on to say there are three golden rules for dealing with those suffering from dementia.
1.  Don't ask questions
2 . Learn from your patient as they are the experts on their disability.
3. Always agree with everything that they say and never interrupt them.
The SPECAL technique is now widely recognized as being very successful. It works by creating a social environment in which the patient is never required to recall something from the recent past.
If those looking after the patient realize that they interpret what is happening around them as being part of their happy past, they will go along with whatever the 'fantasy' situation is in the patient's mind. Thus if the patient was keen on playing bridge everyone will imagine that they are all playing bridge and indeed actually play it if appropriate.
Thus, it is important to go along with all fantasy roles related to the past and wherever possible and practical, allow the patient to do almost anything that he wants, provided of course that it isn't dangerous.
Not asking questions is particularly important because all questions require an answer that can be difficult and stressful for the patient. Caregivers need to learn how to side step questions. For example, instead of saying; "Would you like a cup of tea?";  say; "I think that we'll have a cup of tea." Don't say;"Would you like to go for a walk." This will require thought and stress the patient. Instead say; "I think that we could go for a walk." This should be said, with a slight hint of a question, but one that doesn't need a reply.
Learning from the patient involves not only the facts about their medical condition, but also as much as possible about their past.This will become particularly important if the dementia moves into Alzheimer's disease.
Agreeing with the patient means side stepping statements and perhaps diverting the patient to another subject.
It is of course completely contrary to human nature not to point out that a patient's view of things is wrong, but caregivers must learn to avoid correction by 'side stepping' and wherever safe and practical allow the patient to do as he pleases and act out a role and participate, just as if you were in a stage play.
One nursing home built a mock railway station in the grounds where patients wanting to go home could wait for the train and eventually be told that the train had been delayed or cancelled and the patient could be taken back into the care home for a cup of tea.
There is no doubt that being a caregiver is possibly the hardest job on the planet and one that calls for patience and imagination.

It is a beautiful Autumn day here in Paarl and we are still able to eat breakfast outside with our small view of the Drakenstein Mountains. We are all well and my dementia is still stable. My new book; 'My Memories and I.' is coming along very well.
David Barnato.
Paarl. South Africa.
banratod@blogspot.com