The Challenge of Dementia
In the skilled nursing setting, many of the patients on my schedule have a dementia diagnosis. Whether displaying mild signs such as repeating a story or severe moaning and perseverating over mundane details, I try to keep the treatment focused on their functional goals. When it comes to touching dementia patients, whether during a transfer or giving tactile cues, I enter their personal space with caution.
After years of lifting, scooting and facilitating patients and their movements, I don't hesitate to touch my patients when teaching or in greeting. The patient's with memory impairments, however, can be impulsive and particular. Recently, I had one patient (with mild dementia) snap, "Don't touch me!" after I tried to lightly stoke her back to soothe low-back pain she was experiencing. Later on that day, as I was leaning forward to offer a moderate assist for a sit-to-stand in the parallel bars, the patient asked if he could kiss me. This is the same patient who tried to take a swing at a CNA and me when we tried to get him out of bed that morning.
Whether a confused patient becomes combative or "too friendly," my therapeutic tactic is to re-direct. At times redirection can only happen in a quiet, calm environment. And even then, redirection and focusing on the task can be futile. Although frustrating at times, I remind myself that this patient's therapy is just as important as the next patient's knee-replacement rehab as we are working on maintaining strength, function and safety during transfers.
It's also important to keep in perspective that these people have lived full lives, including marriage, raising children, having careers and surviving wars. I happen to be one of the last people they'll meet in their lives who is there to help ease their pain. Although aspects of their brain are now dying, they deserve the same respect as any other patient. It just can be a more delicate therapy session.
Do you have patients (with dementia or not) who are "more challenging" than others and if so, do you have any strategies that can assist other therapists (like myself) in helping these patients progress?