People in different stages of dementia show different symptoms in their communication, socialising, emotions and behaviour. JCCPA advocates a people-centred care approach, which involves understanding why a person with dementia acts the way he/she does; and builds empathy with them to take care of their needs effectively.
Understanding the People-oriented Approach
- Personality and interests
Caregivers can arrange suitable activities according to the family member’s personality and interests. Introverts might be reluctant to join social activities due to communication barriers. Arrange calming activities such as horticulture, calligraphy and knitting.
- Lifestyle habits
People with dementia may be used to fixed schedules for eating, bathing and working. Organise such activities according to their schedule as much as possible and maintain regular hours and habits.
- Value orientation
Though people with dementia have impaired cognition, their core values are unchanged. Caregivers can appeal to their core values to pacify them. For example, if a family-loving dementia member is cranky because of communication problems, pacify him/her by saying that his/her loved ones are really worried about him/her.
- Past experiences
The life experience, work and achievements of people with dementia affect their thoughts and behaviour. For example, those who have been through a war might hoard. When family members help them clean up, they can talk about putting items in storage or sending them back home to help ease their minds.
- Cultural background
People from different places have different cultures. For example, Chaozhou folks are often thrifty and hardworking, while Shunde people tend to be low key and easy going. Caregivers need to understand that the behaviour and thinking of people with dementia are shaped by their cultural background. They need to be tolerant and accepting.
- Family and social life
The family background and friendships also affect the mood and behaviour of people with dementia. For example, people growing up in a patriarchal family may favour sons, so it will be helpful to have the sons take turns to visit, and discuss the care and living arrangements with the cared person who has dementia to ease their mind and make them more willing to listen to the family’s recommendations.
- Physical changes
The mobility of people with dementia will decline as they enter different stages. For example, most people with dementia can still move on their own in the early and middle stages but will be wheelchair-bound in the later stages. Caregivers need to ascertain if the people with dementia has become dependent on the wheelchair or really can’t walk, and then decide how to deal with it. They should not assume that he/she is not trying hard enough to walk or conversely keep him/her in a wheelchair because it is convenient for care.
- Reaction to medication
Adjustment of dosages, medication types and brands for people with dementia may all trigger reactions, leading to changes in spirit, mood and behavior. Caregivers should be aware that issues for the people with dementia could be drug related.
- Pain and discomfort
A decline in verbal expression might make people with dementia show their discomfort in other ways such as a reluctance to move, an unwillingness to eat or loss of temper. Caregivers should observe the physical condition of the person with dementia to help understand any change in his/her situation.
- Hallucination and delusion
People with dementia may hallucinate, such as seeing a deceased relative, hearing a child’s voice or feeling bugs crawling on their body. They may also be delusional, such as thinking that their family wants to poison them, or someone is entering the house to steal things at night. Caregivers should not argue or accuse them of having problems. Instead, they should observe their physical condition and emotional reactions to understand and comfort them. For example: ask them if the imagined relatives or children they see come often or if they cause harm. Gauge their response and then contact the doctor immediately.
- Emotional control
People with dementia show substantial emotional changes due to communication barriers and diminished control over their emotions. They may cry easily when thinking of the past or throw a tantrum for being awakened. Caregivers should not take the harsh words to heart or wonder if they are providing enough care.
- Cognitive decline
The cognitive ability of people with dementia will gradually decline as the degeneration progresses. This will cause communication and self-care difficulties. They are not intentionally making life difficult for their caregivers. In certain cases, those with dementia can still cook at early stages but may forget how by the middle stages. Rather than accusing them of not trying, caregivers should help those with dementia solve their problems.
- Social activities
Social activities can help people with dementia keep their minds active and slow down cognitive decline, as well as promote their mental health. Caregivers can arrange suitable activities for them based on their personality, interests and abilities.
- Family support
People with dementia might not be cognitively conscious or expressive, but they can still feel the care of their family members. They need assistance with care and long-term life planning. Family members should agree on the care arrangements early on, so the cognitively impaired need not worry due to family discord over care plans.
- Psychological needs
Despite being cognitively impaired, people with dementia still have psychological needs such as self-esteem, self-worth and care. Caregivers should let them do whatever they are capable of, such as cleaning and volunteering, and reminisce together about their life achievements and contributions and make them feel respected and valued.