Caregiver Training: Communicating with a Client with Dementia (Middle Stage) | CareAcademy

Still working on that book?

What?

Oh,

you startled me.

Yes,

it's wonderful.

He reminds me of my father.

He was a salesman.

I didn't know that.

That's interesting.

And you want to get ready for bed?

OK.

OK,

so brush your teeth, and try using the toilet, and then

we'll get your slippers off and get you in the bed,

OK?

No,

no,

no,

no,

no, teeth first,

then slippers.

OK.

Oh,

OK.

OK.

Don't forget to floss.

Middle-stage dementia is a more severe memory

loss where some distant memory is retained,

but new material is quickly forgotten.

This stage is typically the longest and can last for several years.

In middle-stage dementia,

damage to the brain can make it difficult

to express thoughts and perform routine tasks.

You may notice the person jumbling words,

having trouble dressing,

or refusing to bathe.

There may be personality changes like getting

frustrated or angry, or acting unexpectedly.

Being a caregiver for someone in the middle

stages of dementia demands flexibility and patience.

As their ability changes and functioning independently becomes more difficult,

you'll have to take on greater responsibility.

Daily routines will need to be adapted, and structure will become more important.

Here are a few additional tips.

Prepare yourself for the challenges of middle-stage dementia

by familiarizing yourself with its symptoms.

When your client asks the same questions repeatedly,

respond with patience and a calm voice.

Your client may really be looking for reassurance,

not answers.

So, don't necessarily respond to the question itself

so much as the emotion behind the question.

If your client can still read,

help them by providing written reminders, so they can handle some tasks on their own.

Tell your supervisor and the decision-making family member

if you're seeing changes in behavior or ability.

A doctor's visit might be needed to rule out illness or side effects for medication.

Hi,

just checking in.

Do you need to use the restroom?

No.

Are you sure?

It's been a while.

I'm not a child.

Of course, I'm sure.

I understand,

but I have to check.

It's time to wash up for dinner now anyway,

so let's take care of that,

OK?

Oh,

OK.

Maybe we'll,

um,

change your pants too,

just to freshen up a little.

I didn't.

Oh,

it's OK. Darn it.

You must feel like you're babysitting a child.

No,

it's not a problem,

really.

We'll take care of it.

It's no problem.

Let's go. OK, let's sit.

OK.

There you go.

How's the book?

What?

The book.

Is it good?

Oh yes,

he's running from the man with no nose.

Voldemort?

Is he the one with no nose? Mmm-hmm.

Silly.

I don't know why they couldn't give him a nose.

Can you imagine?

No ears either.

I don't understand how he got those glasses to stay on. (LAUGHING SOUND)

The kids he went to school with must have been terrible about that.

No nose,

no ears,

scar on his forehead...

Children can be so cruel. Mmm-hmm.

My mother,

she was a school teacher,

you know? Oh.

She wouldn't tolerate any of that nonsense in her classroom.

And we couldn't get away with it either at home,

I'll tell you.

Any sass or any back talk,

and we get into trouble.

When father got home, he...

He was a door-to-door salesman,

you know? Oh.

He sold those...

What are they?

Those,

those things...

Oh,

you know,

those things,

they're square,

you know what I mean?

They're square.

Oh.

That's OK.

I bet your father was a really good salesman.

He was wonderful.

I loved him so.

Oh,

I bet you miss your father and mother from time to time.

They sound lovely.

Have you seen my glasses?

Maintain eye contact when communicating,

and try to approach the older adult from eye level or lower.

Standing above your client can make them feel threatened.

Hi,

Joan.

It's time for bed now.

Reduce distractions.

Use a calm voice and speak clearly,

slowly,

and in a friendly tone.

What? Now? (GESTURES OF BRUSHING TEETH AND GOING TO SLEEP)

That's ridiculous.

I just had breakfast,

it's barely 10 a.m.

Well, I liked your hearing doctor.

She seemed nice.

When did you meet my doctor? This afternoon, at your appointment,

remember?

Oh,

that's right.

She's really nice.

I thought so.

So, are you excited about your new hearing aid?

It's great.

I hear everything now.

Good.

So, let's go brush your teeth.

OK.

Don't argue with your client.

If they're saying something that you know is incorrect,

try to move the conversation around the

issue rather than directly contradicting them.

OK,

sit on the bed,

please.

Good.

Now, take your slippers off.

OK.

Now we're gonna lie down.

Give simple directions one step at a time.

All right.

Would you like to read a while?

Yes,

I would.

OK.

There you go.

All right,

and I'll be back in 20 minutes,

OK?

All right.

OK.

Ask yes or no questions whenever possible.

All

right,

let's try to use the bathroom once more before bed.

All right,

stand,

please. Good.

Where are we going?

We're going to the bathroom.

Oh,

all right,

OK.

Your client will need more assistance with ADLs

and IADLs like choosing proper clothing for the season

and remembering to use the toilet.

Your client will also need assistance with regular bathing.

Communication difficulties can cause your client to withdraw,

leading to feelings of depression.

Hey,

we were just talking about your garden.

What do you think?

Should we have someone plant some roses?

I like roses.

I know you do.

I think you'd enjoy having them.

Actively engage your client in one-on-one

conversations to avoid feelings of exclusion and isolation.

Try to be flexible,

patient,

and supportive as your client tries to communicate.

The way you say something is often more important than what you say.

What do you need?

Have you seen my glasses? (GESTURES TOWARDS NECK)

Oh,

why can't I remember that?

That's OK.

That's why I'm here.

So, what do you think about white roses?

If your client repeatedly asks a question,

remember that they can't recall the answer you just provided.

Instead of answering the same question multiple times,

try reassuring them that everything is fine and you're there to help.

Then,

try to distract them by discussing a new pleasant topic.

Would you like some help eating?

Let me help you.

Be observant.

You will need to adjust your communication tactics as

your client's needs increase and change throughout the stage.