Freda
As I entered the room at the nursing home, Freda looked up at me with the foggy eyes of dementia, trying to place me and looking for my name tag. I repeated my name, speaking in a steady, calm, friendly voice, trying to make a connection with this dear elderly lady who was not feeling well and so confused. We talked a few minutes as I did a visual assessment and sat down in the folding chair by the bed. As her Faith Community Nurse, I checked on Freda with some regularity, watching for changes, trying to encourage her, the staff, and the family. Sometimes I suggest small interventions that might help make Freda’s life more enjoyable.
How do we continue to connect with our patients that have dementia? What are some ways we can show kindness and build a bridge of communication when the usual pathways fail?
How to Bring Sunshine to Dementia Patients
Below are some practical ideas. You will likely have many more, but maybe this list will get you started thinking about the little ways to bring some sunshine to your patients. Some of these will be completely impossible but there may be one or two that spark your enthusiasm. I hope you will share others in the comments.
When dementia clouds the mind and confusion sets in, we must work harder to appeal to the various senses: vision, hearing, touch, taste, smell. We also work to find ways to connect to the spirit. The tangles of Alzheimers and the brain shrinkage of vascular dementia both erase connections and leave those that suffer adrift in a sea of loose associations, waiting for bridges to form, so they can dock and enjoy moments of clarity and memory.
Some of the docks available to us as nurses include anything that appeals to the five senses.
Smell
Have you ever smelled something that just took you back to a moment in time? This happened to me recently: As I walked down the long hall of the retirement community, on my way to visit a member of our congregation, I inhaled deeply and was suddenly fully present at my own grandmother’s assisted living, thirty years in the past. What was it? Maybe it was the elusive combination of Jergen’s hand lotion and laundry detergent. Although I couldn’t pin it down, I enjoyed the feeling of being back with my grandmother and my heart held a sweet ache of longing for a few minutes as I remembered and missed my grandmother again. What takes you back? More importantly, what might take your patient back and help them make a meaningful connection? Is it Rosewater spray or Lavender sachet? A particular type of soap? Hot tea with cubes of sugar or brewing coffee? Be on the lookout for smells that are practical to bring to patients. In my daily walk, I often pass a lavender bush. I always let my hand touch the plant as I pass by and then walk on with my hand covering my face, enjoying a scent that takes me back to age 7 when I had a birthday party and several children brought Lavender perfume as a gift. A sprig of rosemary, mint or some other aromatic or essential oil, can bring enjoyment and connection to your patient.
Sight
What is it that can help those with dementia bring back enjoyable memories from the past?
Technology makes motion-activated picture screens practical and helps us bypass the clunky photo albums.
Nature offers up a regular array of free stuff: leaves changing color, acorns, wildflowers, bird feeders, pumpkins, fruit, etc. Recently, with the cooperation of grandchildren, I was able to raise several Monarch caterpillars into butterflies. The process does take some assistance, but is fascinating every step of the way!
Spiritual reminders of their faith. Depending on their faith tradition, a variety of symbols might be used to occupy some of the wall space around them, serving as gentle reminders of what continues to be a comfort to them.
Sound
How about playing a song from when your patient was 14? Going back in time is now easy with the help of Youtube and other apps that serve up an infinite variety of music from bygone eras. Did the person with dementia play an instrument? Were they into old-time country or big band? Sometimes we have more information about our patients than at other times, but even with just their age, we can make some good guesses about what might bring them some connection to the past.
Taste
This is a fun one! If your patient is still able to eat and enjoy food there are many possibilities. But even if they are no longer able to chew or fully participate in eating, there are some ways to make connections through food. It just takes a taste to evoke the memories!
1. A cold Coke in a little bottle with a paper striped straw bobbing up and down
2. Corn bread with honey
3. Candy sticks or traditional style candy—Cracker Barrel keeps a good assortment!
4. Hot bread with butter.
5. Candy apple
6. Pound cake
7. Apple butter
8. Chow-chow
9. A lovely wine.
10. What else? What does this list make you think of?
Touch
This one requires care, thought and responsiveness in the moment. People with dementia can easily fluctuate, within the same encounter, to being pleased with a touch to becoming agitated. Just as they may know the visitor initially and a few minutes later look puzzled and ask who they are, so touch can alternate between being pleasant to irritating within a short span of time. It is up to the nurse and caregiver to be discerning about how to best approach a patient with memory loss.
Spiritual connection
While sensory connection may be easier in some ways, spiritual connection is also a necessary focus of attention. Familiarity can be helpful. If the person is from the Christian tradition, old songs, liturgical prayers (The Lord’s Prayer, for example), can all bring back memories and sometimes participation. Prayers, meditation, scriptures from their faith tradition, can all work together to help bring peace to a troubled mind.
As nurses, we have many opportunities to administer care to persons with dementia or some type of cognitive deterioration. As professionals, we continue to look for inspiration and new ideas about how we can do this better. I hope you will share below thoughts that may inspire others.
