Soon after my husband Jonathan started working in a dementia home, he told me about something that had happened during his day.
It was a Sunday lunchtime and everyone was getting ready to sit down to eat their Sunday roast, when he heard three of the residents having a worried discussion. Amongst the three of them they had come to realise they had no money and were upset that they were not going to be able to purchase the lunch.
Jonathan had not come across this before and paused to think how to deal with the situation, when a caregiver came along and said “Great news, it’s Sunday. You don’t need to pay today”. The residents concerned were delighted and sat down and enjoyed their meal. What a nice way of dealing with their confusion.
This situation and ones similar come up quite often in the dementia home.
When I was six years old I went into hospital for an operation. After the operation I had a dreaded “Nil by mouth” notice above my bed. I don’t know how long this was there for but it felt like weeks to a six year old.
I can remember at some stage asking a nurse if I could have some food. She told me I would be allowed to eat the next day. I awoke on what I assumed was the next day and after what felt like a lifetime, I saw the nurse and asked her when breakfast was coming. The nurse got very cross with me. She said she had already told me I could eat tomorrow. I remember feeling very upset and confused by this.
Looking back, many years later, I assume I had fallen asleep and had woken up on the same day thinking it was already tomorrow (maybe it was only 10 minutes?). I don’t actually remember feeling very hungry, just confused and a bit lost.
As a child lying in a hospital bed meals are really the only way of breaking up the day. I didn’t have a clock and I can remember it felt like such a long time. Possibly the idea of a meal was a way for me to feel grounded and looked after. The nurse was probably a very nice person, and she was busy, but it would have made a big difference to me if she had answered me in a different way.
Having labels to differentiate times and days is something we humans have done for centuries and it’s hard to imagine what life would be like without them. Even those of us who don’t keep strict routines are aware of morning and evening. Even if we eat at 4pm and call it lunch, or work shifts, and maybe go to bed in the “morning”.
Not remembering what meal we are up to, or if it is day or night, can make us feel out of control. Even coming out of a movie theatre on a bright sunny day gives us a weird feeling, or coming off a plane on the other side of the world - but we adjust pretty quickly.
Sometimes a person living with dementia can eat a meal and immediately forget about it. So while someone is still finishing the lunch dishes they are already being asked if the next meal is ready. I can see this could be frustrating.
What is it this person is needing? They can’t really be hungry. Possibly they are feeling lost and adrift. They don’t remember eating lunch, but they know it is an important part of their day. They are looking for the familiar signposts that tell them where they are in the day.
Somebody telling them that they have just eaten may not be giving them what they need.
A person may express that they are feeling adrift in other ways too. Someone living with dementia repeatedly asking questions such as what day it is, or what time, may be looking for signs to help them. We may think, what does it matter to them what day it is? But these are the landmarks we have all grown up with and without them wouldn’t we too feel a bit lost?
When a person is feeling insecure a simple answer to their question or simple distraction may not work for very long. They need a change that grounds them and makes them feel safe again.
When words of reassurance are not enough here are a few ideas you can try. These are also things you can do for yourself, or someone else, when feeling stressed, adrift or having suffered a shock.
Sitting down and having a cup of tea often can be a good way of settling someone.
It’s a very English drama thing to do, to offer a cup of tea. I have laughed in the past when I’ve seen TV shows when something unimaginably bad happens and someone says “Get that down you lov’, a nice cuppa”. Magic tea - the ladies on Corro were always good at this.
But it is the ordinary that grounds us, normal things we have been doing since childhood.
A drink of some sort is always a good option as it is something very familiar and has the benefit of helping to keep the person hydrated. Tea, coffee, hot chocolate, lemonade, or a nice cool water may do the trick.
Another option is a lollipop or ice block. Sucking on something can be very soothing. Other favourite sweets may work too, but being aware of possible choking hazards is important.
Suggesting a walk before the next meal, or whatever a person has been fixated on, can work when appropriate. This has the benefit of offering several sensory stimulators and movement which can lift a person's mood.
A blanket around someone's shoulders or across their lap can often be comforting when they are feeling uneasy.
Other calming activities can be listening to some well loved music, or looking and talking about favourite photos.
Smell can also be something that can help ground someone feeling unsettled. Maybe a well known scent from childhood, such as cinnamon or peppermint. A hand massage with some nice smelling oil or moisturiser is an idea and has the added benefit of a soothing touch.
It is not always easy to know what is troubling someone, especially if that person doesn’t even know themselves. It may take more than one try of different methods to find the thing that actually works. And it can be a difficult thing to manage if you have more than one person in your care.
Offering comforting words that go with this caring action, so a person
knows they have been listened to, can also make a big difference. Sometimes finding the right words of reassurance may be all that is needed.
And of course never forget the power of a hug. It may be just what a person living with dementia needs to make them feel a sense of peace and part of the world again.