Evaluating What Works in Dementia Care - Autumn Leaves

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Evaluating What Works in Dementia Care

caregiver and elderly womanThis is the fourth in our 5-part dementia CARES series. Learn how to properly respond to dementia-related behaviors here in the previous post. Click here to start at the beginning of the series. 

CARES is a well-known and practiced method in dementia care and stands for Connect with the Person, Assess Behavior, Respond Appropriately, Evaluate What Works, and Share with Others. It focuses on person-centered care, the changes that happen to cognitive skills as dementia progresses, how those changes impact behavior, and how to understand behavior as a form of communication. It also includes an entire module on the CARES® Approach, a person-centered, easy-to-remember approach that can be applied to the care of any person in any situation and at any level of dementia progression.  

During the Assessing Dementia Behavior and Language post in this CARES series, we discussed the importance of care partners wearing detective hats to interpret clues and determine what their loved one needs or is trying to communicate through their behavior. Well, it’s time to put that hat back on now that you’ve responded appropriately to their cues.  

This “evaluating what works” part of this process is where we really have to pay attention to how the person with dementia reacts to our response. Are they calm or agitated? Smiling or grimacing? Complacent or combative? Remember that they may not be able to tell you in words and may still be communicating with us through more subtle signs that could be easily missed. It is crucial to recognize and evaluate if these signs are all indications of whether our response was successful, or if we must go back and revisit previous steps, like Assessing and Responding to find the appropriate route forward.  

A person with dementia may not be able to tell you in words that you have met their needs in that moment, but their actions will be an excellent indicator. For example, you noticed they keep taking loose papers from every surface around the house and stuffing them into drawers, so you preemptively cleared all the surfaces before they woke up for the day to try and eliminate this behavior. Did they notice the absence of papers? If so, how did they react? Were they confused? Sad? Angry? If not, congratulations – you may have found the ideal solution to this issue!  

If they are continuing to show signs of agitation, it is time to consult your detective’s notes to see what else may be causing this reaction. Perhaps they have a lot of pent-up energy and without this activity; they are unsure where to channel it. Maybe they felt these papers were important to them and are distressed that they are now “missing” which may prompt accusations of theft. Or it could just be that they like to tidy in the mornings and you simply need to find something else for them to pick up and put away so that they can feel helpful around the home.  

In dementia care, it’s likely you won’t get it right the first time… or the second, or sometimes even the third! But, don’t despair if your first…several attempts “fail.” Because we must rely on our loved one’s unique ways of communicating with us, it may take a few tries to understand what they’re trying to tell you. It can be easy to get frustrated and throw up your hands in defeat, but the solution is within reach if you simply approach the situation from a different perspective. Be patient. Inspiration will come. 

As care partners, we must leave no stone unturned as we navigate our way through this journey. It’s not uncommon for caregivers to need to start the CARES steps over again to fully reevaluate the situation. Start by reconnecting with your loved one; what might you have missed before that you can see now? Is there something in their life portrait that you may have overlooked? Think of the habits that may be ingrained in their behavior from past hobbies and careers; could they be helpful in determining how you approach the situation? In the above example, perhaps this person was in an administrative role earlier in life and enjoys organizing papers. Setting up a small desk for them with their own papers and office supplies may be the perfect way to ease their agitation and keep them from moving important papers that belong to you. 

You may also have to reassess their behavior. Is there another possibility for why you are seeing it? Try to go back and consider other contributing factors such as whether or not they had a good night’s sleep or what they may have eaten (or NOT eaten) which could easily impact how they are feeling and behaving on that particular day. Remember also that medications can have a big impact on demeanor and behavior.  

Once you’ve gone back through those steps, it’s time to respond appropriately to the situation and try a new approach. What are they trying to tell you through their behavior that you may have overlooked? Remember that a person with dementia may no longer be able to communicate through words, but relies more heavily on actions. We must be aware of this “unspoken” language and pick up clues along the way.  

If you do get discouraged and start to feel frustrated, helpless, or even alone—it’s okay and completely natural. The important thing is what YOU do to help yourself handle and deal with your emotions. Every day, and sometimes every hour, can be different when it comes to dementia. What works today may not work tomorrow under a new set of circumstances. If you feel you could benefit from added help, Autumn Leaves holds regular support groups which are open to anyone caring for a loved one with dementia. These groups focus on the caregivers, offering educational topics and an outlet each month to give you the tools you need to be successful as a care partner and advocate.  

If your new approach doesn’t work simply try going back through the first four CARES steps and the solution will eventually be revealed. 

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