By Lissy Edwards, DCC practitioner

We know that dementia can cause damage to the frontal lobe which results in changes to lots of important skills. The frontal lobe plays a key role in what is known as ‘executive function’ which is a term that describes skills such as weighing up information and making decisions, organising and planning our time, thinking flexibly and dealing with the unexpected, problem solving, managing risk and acting safely, controlling our impulses and giving us our ‘get up and go’. Our video on ‘What can change’ lists how some of these changes might affect behaviour.  It can vary from person to person, but below we have listed a few common challenges that you might come across with suggestions on ways to manage this.

If someone has difficulty:

 

Getting going

Give verbal and visual prompts to help start a task. For example, if a meal is left in front of a person with dementia they may not be able to get started, and may need a verbal or physical or visual cue. Just because they don’t eat, doesn’t mean they’re not hungry. It may just mean they are unable to get started.

Stopping an activity

If someone has difficulty with stopping doing something they may need a verbal or tactile cue.  The difficulty with ceasing an activity is known by health care professionals as perseveration. It can occur in speech as well. If, for example, someone is searching through cupboards for an item, they may forget what they are looking for and become focused on the emptying of cupboards and be unable to stop or they may continue to keep brushing their teeth for far longer than usual. If this happens the person with dementia may need a verbal cue to stop ie. ‘it looks as though you have finished brushing your teeth, why don’t you put the toothbrush down’ If this doesn’t work you may need to give a gentle touch on the arm or hand.

Planning/carrying out a task

Break it down: it really helps to divide tasks down into single steps. Most simple tasks have multiple steps – an example would be brushing teeth. It is important that you prompt the person one step at a time e.g. let’s go to the bathroom, turn on the tap, pick up your toothbrush etc.

Making decisions

Break the task down. Use paper and pen or whiteboard to write down the decision that needs to be made. Help the person think of pros and write these on one side and cons, write on the other side.  Giving structure to tasks like this can make it more accessible and ensure the person with dementia is still involved in decision making.

Following instructions

Give short and simple pieces of information e.g. if you are explaining where you are going, focus on the key points and don’t include lots of detail. Try to keep eye contact with the person as they will be aware of your facial expression. People with dementia are often highly reliant on your visual cues and facial expression to make sense of what you are saying.

Completing a task

Ask the person with dementia for their help with a task rather than doing it all for – or to – them. E.g. ask them to hold the fork with you rather than feed them. A useful way to think about this, is that we should not feed a person with dementia, but support them to eat and drink – it’s a subtle but important shift of focus. If you are cooking, can they chop vegetables, lay the table, fold the towels, fill the glasses of water etc? Think about doing ‘with’ not ‘to’.

And if what you are doing isn’t working:
  • Stop what you are doing
  • Step back and provide space
  • Think through what might be happening and what else you can do to help  
  • Then re-approach and try something slightly different
  • If it still isn’t working try to leave it and come back to it at another time.