Dealing with demented patients

I was on my rural placement and had a patient with dementia. I haven’t had much experience with demented patients and I found communicating with the patient and hence trying to assess their mobility a bit of a challenge.

I approached the patient as any other, by introducing my self and giving a brief explanation of why I was seeing the patient. The patient was very pleasant and for each question I asked they would answer yes, for example ‘Would you like to come for a walk? Even though the patient had agreed to come for a walk, they did not initiate it, i.e. they did not stand up. I then asked them ‘Can you stand up?’, and offcourse the patient said yes, but did not stand up. I then remembered some dementia tips that we had learnt at uni; short commands, trying to avoid questions or choices as this can tend to confuse patients with dementia. So told the patient ‘stand up’, and held their hand and put my hand on their back to give them some tactile cuing as to what I wanted them to do. The patient stood up, and I said ‘lets go for a walk’, and after a few repetitions the patient started to walk.

After this first encounter I began to think of ways that would have been more effective with a demented patient. For me, I worry that the patient may be more lucid then I may pre conceive, and I feel like I should always start talking to the patient as if they are cognitively unimpaired. This is ok to start off with, as you can gage how impaired the patient is and hence change your communication style accordingly. I got thrown with this patient, as when they answered my questions, they were followed by an appropriate comment (eg. Q: ‘Would you like to come for a walk?’ , A:‘Oh yes, that would be lovely’.) I had dealt with a demented patient before and they would answer similarly and then get up and walk with me. However, it was obvious straight away that this patient would not initiate movement with these questions. I should have changed my communication approach with this patient to be more task oriented (eg. Lets go walk down to the tea room to have some tea.) Instead of telling the patient to do one mobility task at a time, I would have been able to assess them all just by giving her a reason to get out of bed and walk. I will apply this technique next time I encounter a demented patient.