I’ve been an occupational therapist for 15 years. During most of that time, I have worked with older adults who are recovering from strokes, joint replacements, surgeries, and general illnesses. A fair number of patients I see also have cognitive impairments. Sometimes “dementia” is clearly listed in the patient’s chart under their medical history and sometimes…there is nothing in writing to indicate that the patient has a cognitive issue yet the other therapists and I can definitely see signs of impairment in their safety awareness, verbal processing, and memory recall.
There are several different terms, but dementia is typically the word used to describe a progressive decline in cognitive functioning. It is not a normal phase of aging, but more and more people are being diagnosed with dementia. And while the diagnosis can only come from a doctor, I often find myself educating patients’ family members on how to help their loved ones who are experiencing dementia or cognitive impairments.
- Be agreeable. If my patient is sure it’s April despite the snow outside and the Christmas decorations in the halls, then by gosh, it’s April. If someone mistakes me for their daughter, then I smile and go along with it until they realize I’m the therapist while we’re doing exercises. In my opinion, there is no reason to argue with someone who has dementia. Arguing or trying to correct a patient often makes them embarrassed or defensive or tearful. My favorite phrases to use when someone’s cognition doesn’t match with reality are “Well, if you say so” and “How about that” and “I didn’t know. Thanks for telling me”.
- Be patient. Be incredibly patient. And then be patient some more. When I was pregnant with my daughter, I ran a therapy group at an adult day-center. Everyday, a lady named Linda would get so excited to see me. “Ohhh! You’re pregnant! When are you due?” Each day she asked and each day I told her and each day her excitement was just the same. One day after she had gotten all excited about me having a baby, I turned to help another group member for awhile. When I got back to Linda, she started clapping. “Ohhh! You’re pregnant! When are you due?” In a matter of ten minutes, Linda had forgotten. Each day after that, her dementia progressed rapidly, but it did not diminish her daily excitement about me being pregnant. Towards the end of that spring, she was asking me every three to five minutes when I was due. Patience. Endless patience.
- Be present. One of the truths I have discovered with patients who have dementia is that they KNOW when I’m fully present with them and when I’m distracted. And usually, they will call me out on it, especially if I’m spending too long reading something on my computer or I’m taking time getting an update from a nurse about the patient’s status. My patient always seems to know when I’m not fully engaged. Not all people with cognitive impairment want someone to sit close and hold their hand, but eye contact and using a genuine voice is key to connecting with this population even if they’re not willing or able to talk. So electronics are set aside, conversations with staff are done later, and distractions are kept to a minimum while being completely present and invested in our time together.
Whether you work in healthcare or simply know someone with dementia, just do your best, whatever your best might be. Families comes in all shapes and sizes, and families grow in all directions to create new shapes and sizes. Be agreeable. Be patient. Be present. Be the best of those you can for anyone with cognitive impairment. They will love you for your efforts.
