Top tips for optimising care for people with dementia

Communication

• Be conscious of your facial expression, eye contact, posture, and use a calm tone (but not patronising) in order to show you are fully attentive and listening.

• Slow down, and avoid asking multiple questions or commands that involve memory. 
• Set the scene; orientate person to the activity or intervention, breaking it down one step at a time.
• Optimise their strengths using biographical history / ‘This is Me’, and support weaker areas of functioning.
• Be mindful not to highlight areas of deficit as this may result in increased agitation or aggression.
• Listen to the emotion, this may tell you more than the words themselves.
• Do not argue or confront, this can only make things worse.
• Validate what they are saying or doing and provide reassurance and acknowledgement.
• Reduce background noise and excessive stimuli. Try using actions, pictures or objects if you are having difficulty communicating.

Environment

• Use the following to support orientation: Clocks, calendars, post-it notes, diaries and alarms, clear, appropriate and visible signage with pictures and words.

• Use lighting to support day/night routine.  
• Reduce noise particularly at night.
• Blackout blinds will enable sleep and prevent early morning waking.
• Avoid moving the person through different environments unnecessarily.
• Personal items with significance, used in conjunction with their diary/biographical history will enable person centred connectivity between their past history and current environment, therefore reducing stress.

Stimulation

Discuss topics which the person enjoys. Use activities to help distract, divert and stimulate them in something they find meaningful, e.g. cooking, gardening or knitting with supervision if required. People like to feel valued with a sense of purpose and role. Activities should be failure free so be expected to go with the flow. Think about engaging different senses during any activity. Reminiscence and talking about their life experiences is a great way of demonstrating their values as a person. Use of old photographs may be a good place to start. Activities should not be for too long and be aware that some may prefer group activities and others may prefer one to one activity, either chair based or on the go!

Managing behavioural changes

There are multiple factors that may affect behavioural changes. First check for any physical health conditions such as pain, or delirium. Consider sensory needs such as making sure they have their glasses, hearing aids or dentures, ensuring access to food, drink and toileting are supported.  Psychological conditions including changes in thought patterns and organisation, perceptions, and interpretations an understanding of what is happening. Lack of social interactions with others, absence of family members, lack of stimulation, or change of environment affects behaviour. Medication should only be considered when all other interventions have not been successful.

Carers

Carers should be signposted to join their GP’s carers register, recognising specific needs to maintain their own health and continue in their caring role. It is important for carers to stay connected with their friends, family and community. (See overleaf for local support services available). People with dementia or cognitive impairment and their carer should be offered the Butterfly scheme and ‘This is me’ passport to support them across our services. Full carers’ assessments are accessed through Surrey County Council.