Person Centred Elderly and Dementia Care Principles

Some activities are designed to assist the person maintain or restore certain functions, such as eating more independently. But all activities need to capture the person’s interest; or else the activity will be of little or no value. When applying all the other principles, the activities should result in a pleasant, rewarding, and positive interaction.

The first few minutes of your visit with a dementia sufferer are often the most important. It is caring to introduce yourself on every occasion; you may consider this unusual at first but is important unless the person easily and obviously recognises you (e.g., saying your name and your relationship to them followed by saying that you have come to visit them today and would they mind helping you with some things.)

One of the key principles is checking , can the person read , use the most appropriate font , check if they retain information , for example my name is ******, then ask what is my name , check if they answer ot do you have to repeat , this helps establish communication methods with the resident.

Once you have established a connection, you can then build on this foundation (e.g., “would you like to arrange some flowers or pair some socks?”) Importantly you should feel comfortable in this interaction and the person’s response well be the best indicator of what you should do. If the person is not interested, try something else.

As exampled above, it is helpful to present the person with a choice. Plus, when offering this choice, it is helpful to present visual prompts for each (e.g., a flower and a sock). This enables the person to respond more easily. Conversely general questions such as ‘What would you like to do today?’ can be very difficult for a dementia sufferer to answer.

Should the person find it hard to choose the first time, you can take the lead. Choose something you think will be engaging or of interest. Start demonstrating how this activity works, invite them to participate. Again, you will then have to observe their response to decide if you should continue with this activity. If you think that their attention is wandering, you may want to change.

The first part of this principle, ‘Talk less’, very much depends on the person’s capability to speak. How much you speak should match how much they speak. If the person is (or has become) a chatterbox, feel free to chat just as much. If half of what they are saying sounds somewhat confused, it still may be good to continue talking with them. Just speak in a calm and warm voice, this may not result in any meaningful conversation but can still have a reassuring and calming effect on the person. You are acknowledging and honouring their wish to socialise and communicate with you.

However, there are numerous reasons why the person may have become less comfortable with speech. They may lose the ability to speak or may even revert back to a first language. They may still be able to speak English but become frustrated because they are aware that their speech is confused or because they lose their train of thought. In such instances, it is best to avert this frustration and reduce speech in your interaction as much as possible. This may require some practice and, again, the person’s response is the main indicator to determine if you can still use some basic sentences or if it is best to greatly reduce your spoken words throughout your visits.

As with most things, the person’s preference may change over time.

Regardless of how much speaking you do, you should always demonstrate every step of an activity and repeat your demonstration until the person is able to imitate unless they have lost interest in which case it may be time to change activities.

By accommodating any physical impairment, the person may struggle with, will always help your interaction. Many elderly suffer some visual and hearing loss, so well-adjusted glasses and hearing aids can improve the person’s experience. Sometimes one ear may function better than the other, or it is found to be easier for the person to reach and lift one arm than the other. With regards to vision, it may help to test a couple of print sizes to establish if and what the person is able to read. You may want to move around your reading material as well, to find where they are best able to see.

It is usually easiest to do the activities at a table but be mindful that some chairs can be uncomfortable (especially for people who have had hip problems). Again, trialling a number of set-ups may result in an optimal environment to start the activities. For example, a TV tray may fit over the lap of someone sitting up in bed, and activities can be performed on the tray.

It is mostly more effective when communicating with most dementia sufferers to slow down, both in speech and movement. Don’t however speak louder because the change in tone may agitate the person. With the hearing impaired, it is best to sit close by and speak in a calm tone. Even if they can’t hear exactly what you are saying, the sound and tone of your voice may be reassuring to them. Plus, by demonstrating each step of each activity, you can communicate what you are asking them to do anyway.

You may also need to adjust the speed at which you are moving. Your normal pace may be too fast and may add to the person’s confusion. It is best to observe their response to establish the best pace to be working at. As a general rule, it is best to work at a pace that matches the pace of their movements.

When inviting the person to participate, you should use visual cues that represent the activities you are suggesting. Whenever you give them another choice, you can continue to use these visual prompts.

The main cue to use is pointing to direct the person to what you are asking them to do. After demonstrating the activity (repeatedly if necessary), the person may respond to your invitation to do the activity themselves. However, if the activity consists of a number of steps, the person may not remember all the steps. A first response could be to point from the object they are holding to the place where it should go. You can repeat this a number of times; hold their hand to put the object together, or gently take the object from them and demonstrate again – but always keep in mind that their self-independence is of importance in every activity too.

This principle applies if the person is not actively participating in your activity, as may happen when you first introduce an activity and the person may need to adjust to this certain form of interaction first. For example, if you are screwing nuts and bolts together, you can hand the person one of each; or hand them the bolt and put the nut within reach on the table. The idea of this principle is that you first of all respect that they may not be ready to participate with what you have in mind. You may still present your materials to see if they capture interest

You may want to try an activity that is of interest to you too – so be guided by the person’s response to observe if they share your interest. Even if they are just observing what you are doing, this may sometimes still be a positive interaction.

Every activity consists of steps, e.g., doing a jigsaw includes:

1. looking at the picture (together)
2. handing the picture to the person to hold
3. looking at the puzzle
4. looking at the pieces
5. placing the pieces into the puzzle.

You may be able to teach the person every step, one after the other, or they may only be able to do one step at a time. You can help by pointing and demonstrating each step until they are able to do the whole sequence.

Handing them a pile of jigsaw pieces to sort may be too much to ask. However, if you present one piece after the other, the person can focus on each shape. The same applies to uncluttering the environment: clean the table you will be working at, present materials for one activity at a time, step by step.

It is not necessary to complete a task; the main purpose of the interaction is to engage someone’s interest. If the person does complete a task, you can ask them if they enjoyed doing it and would they like to do it again? In this way, they are in charge of what you are doing with them.

This final principle is closely related to the first principle. The aim of your interaction is to pass some enjoyable time – that’s all. The person does not have to do everything ‘right’ (or anything for that matter); they do not need to complete an activity. If blue socks keep getting placed on the pile meant for red socks, does it really matter – as long as they are absorbed in the activity? Try not to correct the person if they are enjoying themselves. If they get frustrated by their mistakes, it is time to make changes.