Knowledge Exchange

Use empathy intelligence when caring for persons with dementia.

December 2019 blog post written by Angela Dickieson R.N., B.Sc.N.

“Put yourself in their shoes and undo yours.” Jeremy E Sherman Ph.D., MPP

When educating students or health care staff on challenging behaviours in persons with dementia, I like to take the approach of “How would I feel if...”

Let us begin. Get in tune with your emotions, thoughts and feelings, including your physical responses (your heart rate, your breathing, body language, and facial expression); write them down for each one.

With each statement listed, close your eyes and imagine this happening to you today, right now, in your present moment..

1. Your child tells you, you no longer can drive your car and takes the car keys away ….

2. It is a cold snowy winter December day, in 2019, but everyone tells you it is a hot sunny July day, 30 degrees Celsius and the year is 2050….

3. A stranger escorts you to the bathroom, pulls down your pants, asks  you to sit on the toilet, when done, wipes you, washes your private areas, AND applies “diapers/briefs”, before pulling up your pants….!!

4. It is the end of the work day, you need to get home and prepare supper for the family. When you try to open the door to leave, you find it is locked, yet, other people easily can exit. When you try, it will not open…. You have been hanging around the exit door for over an hour in hopes to “get out” because your family is waiting at home for you. You ask people to help you get out but they say “no, you cannot leave…”

5. You have a really bad headache/ migraine and you ask the people around you if they could quiet down with the noise. They are speaking a different language and do not understand what you are saying. The noise is getting louder and louder.  You just need to go into a quiet area and maybe some Tylenol to ease the pain, but no one seems to understand what you are saying that the pain is severe.

Your reality is what is happening to you and around you, in this moment. Reflect on how each scenario made you feel physically and emotionally; be honest with yourself (embarrassed, scared, confused, disgusted, anxious, angry, your heart is beating fast, your respirations are fast, maybe you are feeling sweaty…). You are dealing with the fright, fight or flight response which are responsive or protective behaviors. They could look like this: aggressively pushing past people to get out,  raising your fist, yelling/ screaming, swearing, pushing, pinching, pacing, crying, hitting, punching etc.)

What is needed from those around you, to calm you down?

  • Should they be arguing that you don’t know what you are talking about?
  • NO! This would escalate your responsive/protective behaviors, not calm you down.
  • Reorient you to the year 2050 and tell you, your home is in a retirement or nursing home?
  • …which you KNOW is FALSE!! Again this will frustrate you even further. That person is confused!!!

My guess is, there is nothing I can say to you to convince you that my reality is the real thing, correct?

What is the best approach?

Validation and redirecting, and don’t argue with them! You will lose the battle.

We will use the same scenarios above, but you are now the care giver.

1. “I see you want to go for a drive in the car…. I love to drive with you as well. Would you join me for a ride as I need some practice with my driving?”

2. “Tell me, what exciting things are happening at this time of the year? Do you feel cold? Would you like a warm blanket ?”

3. “Let’s use the bathroom before we go to the activity. I can help you freshen up so that you feel great!”

4. Meet them at the exit. Greet them with a smile and speak in a gently voice “Is it time to go home and make supper for the family? What are you planning on making? (Gently take their hand and move them away from the door and walk down the hallway while still talking to them.) I am planning on making a spaghetti supper tonight and I will serve chocolate to the children. You do like coffee after your supper?? I feel like having a coffee. Would you like to join me??  You have validated the person and gently redirected her away from the door. Now she has forgotten why she was trying to exit seek and will have a coffee with you. Her anxiety is no longer an issue.

5. We know that pain is too often undertreated in the person’s with dementia. They may not be able to articulate what they are feeling and instead, it presents as responsive or protective behaviours. An example would be, if you touch a sore shoulder while trying to dress the person in the morning, you might get yelled at or punched. Knowing their past medical and surgical history might give a clue as to where they may have pain. Perhaps having the doctor / nurse practitioner (NP) order pain medication 1 hour prior to i.e. morning cares, will reduce the behaviours while dressing the person. Perhaps something new is causing the pain/discomfort. It should always be assessed by a physician/NP.

Remember, their reality is not our reality. Meet them where they are and validate them. Gently redirect them and engage in something meaningful to that person. If that person was you would you not want to be treated the same?

Lastly, put a smile on their face. It is very catchy and everyone feels good!

About the author:  Angela Dickieson R.N., B.Sc.N. is the Clinical Educator for Seniors’ Mental Health Services and ECT at Providence Care Hospital in Kingston, Ontario.