Working with clients who have dementia can be very challenging, particularly in a rehab setting where you are trying to restore function and maximize independence. Clients may make little to no progress and be constantly on the verge of discharge, or they or their family may be pushing for discharge home and all you keep thinking about is how many unsafe actions you have observed in the past three sessions alone. If you find yourself constantly frustrated and wondering how to set your clients up for success when everything seems against them, consider these four suggestions.
Use familiar routines.
Clients who have dementia will often struggle with new activities and new tasks, so keep the activity or task as familiar as possible in order to ensure the highest level of performance. A client may not be able to tell you how they normally do things, so don’t hesitate to ask caregivers or family members about the client’s habits and routines. Find out things like when they typically bathe, how they dress, what their average day is like, etc. Then try to set up your sessions as close to this as possible. For example, if your client typically showers in the morning before breakfast, chances are they will perform better if you follow this routine when you work on showering tasks rather than trying to get them to do something different such as sponge bathe after breakfast. This may mean you will need to adjust your schedule to best meet the routines of your client, or work with staff to adjust their schedule to better fit their familiar routines. But if the goal is to get your client as independent as possible, then it will likely be worth it.
Use familiar environments.
Imagine waking up in the middle of the night in your own bedroom and having to get to the bathroom. Chances are, you can safely and successfully navigate the path to your bathroom with very little light. Now imagine waking up in the middle of the night in a hotel. The task of getting from your bed to the bathroom just got more difficult and most likely requires more light to be completed safely. Once you are out of your familiar environment where you unconsciously know exactly how many steps it takes to get from one end of your bed to the other, habitual tasks suddenly become much more difficult. The same thing is true for our clients. Like any of us, clients with dementia will perform better in familiar environments. And when dementia, like the darkness of a room at night, is further complicating a seemingly simple task, familiarity can mean the difference between success and failure. If your client is struggling repeatedly to perform a task safely and independently, consider a visit to their home to try the task in their familiar environment. They just might surprise you with how well they do.
Use errorless learning.
Most of us learn from our mistakes and from the problem solving we need to do to resolve those mistakes. But that’s not been found to be true with clients who have dementia. Instead, clients with dementia have been found to learn or relearn skills more effectively if they practice those skill without errors. That means your job as the therapist is to control the environment and task so that the task can be completed correctly and with as few errors as possible, whether this means verbally cueing the client or using hand-over-hand assistance or any other manner of strategies to ensure accurate completion. As they practice these skills with your guidance and without mistakes, your clients can increase both safety and independence in their daily routines and occupations.
Have patience, patience, patience.
Last, but definitely not least, working with clients who have dementia requires a lot of patience. And having patience can mean the difference between giving up too soon and sticking with it long enough to make progress. So always, always, remember to have patience. Tasks will often take longer, so plan accordingly, and progress will likely be slower so set realistic short term goals that are achievable for your client.
Working with clients who have dementia can be challenging, but it can also be very rewarding. You may not be able to control many of the the client factors, but by controlling the environment and occupation you can set your clients up for their highest level of success, maximizing both safety and independence to improve overall quality of life regardless of the discharge location.
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References:
de Werd, M., Boelen, D., Rikkert, M., & Kessels, R. (2013). Errorless learning of everyday tasks in people with dementia. Clinical Interventions in Aging, 2013(8). 1177-1190. doi:https://doi.org/10.2147/CIA.S46809