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Skip to 0 minutes and 7 seconds We know where we are at this moment, because we know where we’ve just been and we’ve got a sense of what we’re going to do next. When you have difficulties retrieving information, or what you’re retrieving is outdated, then you can’t always be sure where you are, what you’re about to do. So you’re in that sense where you may well be time shifted. So I think at the moment, it’s February, 2016. You may well think it’s February, 1951. So your behaviour will be led by that belief. And then we may get into some confrontation, which frequently, it happens in care when we’re caring for folk.

Skip to 0 minutes and 54 seconds What we may find is if there’s a woman looking out the window around about half three of an afternoon and sees young children in uniform going past the care home, that may well trigger her to think about her own past. And because she becomes time shifted, she may think, I’ve got to go and pick up my own children. And you can just imagine yourself if you thought that your children were waiting at the gate and your job was to go and pick them up, how distressed that person could be. So problems with orientation often can cause some of the problems, the behavioural problems. And that would be very stressful for both the carer and the person with dementia.

Skip to 1 minute and 42 seconds Well you can imagine, the care home doors are likely to be locked and the staff will not let the person out. But you have a 100% belief that you need to go and pick your children up. Now what are you going to do? Well one of the things that we do is we use a few techniques. One of the overarching techniques is a thing called RAM. It’s sort of an acronym. So the first thing we do is the R of the RAM, is we reduce the emotion. The A is assess the need. And the M is meet the need.

Skip to 2 minutes and 17 seconds So if we just think of the R for a second– so any situation where we get people who are emotional, such as the woman we just described, we’ve got to reduce the amount of emotion. Because even if you think about yourself, when you’re very angry or very anxious, it’s very hard to think. People with dementia have a double whammy, because they’ve got the dementia plus the heightened emotion. So the first thing is try to reduce the emotion. And again, that’s through the body language skills. That’s even pacing language. But also we need to identify what the person wants. And because of some of the communication problems for people, that might be difficult.

Skip to 3 minutes and 0 seconds If we’ve got a lot of time, we may well get information from the family, we may get information from the GP, we’ll get information from the carers. We look for the patterns by keeping charts. And we do a formulation. And that’ll be the assessment bit. And then once we identified the need, we would try to meet it. In this particularly case about the woman who had young children potentially waiting at the gate, obviously we can’t do that. So then we get into a different scenario about how we might simulate the need.

Skip to 3 minutes and 34 seconds So in that sort of situation, what we’re trying to work out here is, is there any way we can help give the person the feeling that they don’t need to go and pick up the kids.

Skip to 3 minutes and 48 seconds So we need to work that out. If there’s not– and often in these situations, we can’t simulate it– we may need to try to distract. So can we get the person moving from their current focus, their current thing that whole memory and their whole body is thinking about onto something else? If it’s not a particularly emotional topic, we can do that. But in this case, again, we’d be struggling, because again, the drive is so huge. So we may in this particular case, and we frequently do, have to resort to things like therapeutic lies.

Skip to 4 minutes and 26 seconds We then have to ensure that that particular lie meets her needs and is also consistent with her past, because unless it’s consistent with her past, she’s not going to believe it. So what we would need to do is formulate what would be an appropriate lie. So we’d look at, did anybody else ever pick up the child?

Skip to 4 minutes and 55 seconds Who would be a safe person to pick up the child? Because we don’t want to put her in a situation where she feels even more alarmed. So an example might be if her sister regularly picked up the children on a Friday night, that’s what we might say to her. Do you know it’s Friday today, and it’s your sister’s turn to pick the kids up? And that would be an example of a person-centered lie being completely consistent with her biography.

Non-confrontational approaches

Avoiding confrontation is a golden rule of communicating with people with dementia. If a person has a different reality to our own, it may be futile to try to redirect them to our reality.

‘How would you feel if somebody continually told you that you were wrong?’

In this video Ian describes some approaches we could use avoid confrontation. He talks about ‘RAM’ - three steps to think about before we act. These are:

  • Reducing the Emotion

  • Assessing the Need

  • Meeting the Need

In the next steps, we will take a look at how we might reduce the emotion and meet a person’s need.

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Dementia Care: Staying Connected and Living Well

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