Philip Y. Kao PhD thesis - Research@StAndrews:FullText

Care without any formal training, I attended a few workshops at Tacoma Pastures on
how to work with residents with dementia.
These workshop classes touched on areas such as dealing with challenging behaviours,
improving caregiver interactions and enhancing communication skills with residents, as
well as with learning about dementia and its effects on the brain. Because memory loss
is not the only symptom associated with dementia, caregivers were instructed how to
work with residents who suffered from depression, hallucinations, drowsiness,
inactivity, and a host of other psychiatric symptoms. Residents with dementia also have
trouble speaking and finding the right words, and can require assistance with basic
mobility. In one of the training courses I took, Jennifer, a middle-aged woman instructor,
began the class with a picture of the healthy brain and then launched into a description
of how Alzheimer’s affects the brain by way of atrophy, neuritic plaques, and
neurofibrillary tangles. We also learned about the mini-mental state examination
(MMSE), a 30-point short questionnaire used by the resident doctor of Tacoma Pastures
to quantify cognitive function and screen for cognitive loss. Jennifer moved beyond the
medicalized brain to discuss how caregivers should interact with the residents. She told
us that we should always make eye contact and speak slowly. Jennifer said, “It is
important to explain things over again, and to engage in positive reinforcement. Try
avoiding getting them stressed. This means avoid situations that will cause the resident
agitation and added confusion. One simple way to do this is to remember: don’t turn
your back to the resident when picking out their clothes.” The instructor continued
with other examples. We were told that when confronting certain residents with food
choices, it was better to ask yes or no questions. Instead of asking them whether or not
they wanted chicken or beef, for example, Jennifer said that we should always phrase
the question as: would you like chicken/beef, yes or no? With respect to creative lying,
we were told that if someone had progressed dementia we should avoid reminding
them about their deceased spouses. She said, “Don’t lie exactly, but rather than confirm
whether or not their spouse is still living, validate their feelings. This will help you with
your caregiving. We can’t change what they think, but we can change how they feel.”
When residents resist care or are uncooperative, Jennifer said to re-approach them at a
later time. She said specifically, “Give them ten minutes or so, and if they are taking
meds, wait until after they have taken their pills to re-approach.” She concluded one
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