#54: Helpful Sentence Structure in Dementia
Show notes: Special edition
CASE STUDIES
Episode #2 – Series #2
Helpful sentence structure in dementia
In this series of podcasts we are exploring case studies – and in this episode we will look at dementia and sentence structure to improve engagement.
We will cover:
- How to activate our five senses
- Identifying fear and providing reassurance to those impacted by dementia
- Differentiating between simple versus complex sentences.
The case study we will focus on here involves a lady who we will call Ruth, and she wanted to go home. I will share her story and discuss strategies on how we can deal with an elder who repeatedly says they wants to go home.
Dementia, a very common neurological condition in late life, is not a normal part of aging and is used as an umbrella term for lots of different conditions and illnesses, including Alzheimer's disease. There are lots of different types and symptoms of dementia, it can be early onset, or late in life, and may or may not be formally diagnosed. Broadly, it is a term for loss of memory and other thinking abilities, which are severe enough to interfere with an individual’s daily life. We see lots of people in aged care and home care settings with dementia, and it can be hard to diagnose, especially when in their usual routines.
Ruth is living in an aged care setting, and continually says she wants to go home. For example, we might be offering to take her to an activity or outing, or be providing her usual daily care and she is repeatedly saying ‘I want to go home’. Do we tell her there is no home to go to? That she is here because she has dementia and needs care? Or try and change the subject by distracting her by looking out the window?
Sentence structure and practical strategies to address this repetitive behaviour is something I’ve been asked about many times over the years. Often we know it is dementia causing these behaviours, but we don’t want to spend our days having the same conversation over and over again. So what can we do instead?
My number one strategy is to check in with your client. Ask how are they going. How are they feeling? And exploring what is behind that sentence.
‘The sentence “I want to go home” is not uncommon, but exploring what stands behind that sentence is. Dig deeper – what is it that the person may be wanting to say but is not able to, due to neurological changes they may be experiencing?’
So for Ruth, she might be saying ‘I want to go home’ but could be meaning, ‘I’m feeling fearful’ or ‘I’m scared’. How would we then respond to someone who is feeling sacred or anxious?
Providing reassurance is a common response, perhaps letting them know they are safe, checking if they need to eat or go to the toilet. They may be bored and struggle to engage in activities. At these times the thought of being back at home is reassuring, and is the easiest way for them to articulate how they feel. A lot of people with dementia are in good physical health and have little insight into their challenges, as they see themselves as being well, so may find it hard to understand why they can’t be at home.
For Ruth, it turned out that she was really fearful of her environment, she found it really challenging to be around other people, particularly in the dining room, where she felt it was too noisy and overwhelming. The fear was around large group settings, and being at home was a safe environment for her. So we started looking at how we could get her to sit on the quieter side of the dining room, and she was able to form a friendship with another lady. Once she had this connection, she stopped requesting to go home as much, and started spending time with the other lady and attending to the gardens, where they had their routines of what they attended to. Gradually, Ruth began to engage in the care facility, and eventually, when she was on outings with her daughter, she would look forward to returning as she now recognised this as her home and her safe place.
An activity I often do with elders who may be having difficulties with sentence structure involves sharing the start of sentences and allowing them to fill in the gaps. You can access the sentence structure resource on my website https://www.wisecare.com.au/resources and can also source emotion cards which are similar from a variety of places including Officeworks. Start with cards and activities where there is only one missing word or idea, avoiding complex sentences with more than one idea. Be mindful of this, as we can often slip into complex sentences without realising it.
I used the flashcards with Ruth, and they helped her articulate how she was feeling and what she needed. We were able to help her make connections, and to articulate her desire to tend to the garden – and it had never looked as good as when Ruth was looking after it.
In this episode you will learn:
- How to improve communication with elders impacted by dementia
- The importance of uncovering what is behind their desire to go home
- Why it can be difficult for elders with dementia to articulate how they feel.
Resource: please reach out to [email protected] to access the flash cards resource
