Dealing with Dementia

The other day there was a bit of a buzz at the nurses station. I’m currently on my rural placement around 800km from Perth and for the first time anyone could remember a patient was transferred from Royal Perth back to this town- by ambulance! There was even a doctor who came along for the 8 hour drive from Perth. Normally patients are transferred via a Royal Flying Doctor Service (RFDS) so this was quite unusual.
The patient was an elderly lady with severe dementia who had a long history of falls and fractures and this time had suffered a fractured neck of femur. She had been in Perth for about 2 weeks and had not been out of bed during that time because she screamed and complained if anyone tried to move her. The first time I saw her was with another physio and we managed to get her to stand, walk about 1.5 metres with a frame and sit out of bed in a chair. She screamed a couple of times but the nursing staff who had known her previously thought we were amazing for managing that much with her. Without thinking about it I realised ta we had used several strategies to encourage the patient to comply with what we wanted her to do.
I guess the first thing we did was to take the time to introduce ourselves clearly and explain a little bit about what we do as physios. I tried to imagine what it would be like to be in her place not remembering from one day to the next what people do and that we were trying to help her.
The next thing I did was to try and set a goal with the patients so she would want to achieve the same thing as us. She had a Bible beside her bed so I asked her if she would like to sit in the chair next to the window so she could enjoy the view and be able to read her Bible. She seemed to like the idea so we encouraged her that each step was part of achieving that goal.
The next technique that we used was distraction. Whenever she complained of pain we would distract her by asking her what she could see out of the window or what she liked to do. Afterwards the other physio explained that people with dementia are similar to children in that they respond poorly when they focus on the pain or problems that they are suffering. This is why distraction was such a useful technique.
The final thing we did was to allow the patient to do as much as she could by herself before we helped by assisting her to step or roll. She found any passive movement very painful and she was very stiff so encouraging her to do the movement was much more effective.I learnt a lot from the experience over several days with this patient and will feel a lot more confident when treating other patients with dementia in the future.