Treating patients with dementia

A 93yo female presented to my ward with a left fractured head of humerus and a left fractured tibial plateau, both injuries were being treated conservatively and the patient was unable to ambulate. It was also mentioned in the patient’s current medical conditions that she had dementia. The patient had undergone a general anaesthetic to realign the head of humerus and as a result had a left lower lobe collapse. My main aim of the treatment session was to educate and teach the patient SMIs.

On the first meeting with the patient, they were in good spirits and very cooperative within the session, I began to question the diagnosis of dementia. However, the next day the patients presented with clear signs of dementia and would not cooperate within my session. I had begun the session the same as the previous day by explaining what I would be doing. I then proceeded to ask the patient to do some SMIs, however the patient refused and held their breath. I tried again to explain why they needed to do the breathing exercises and yet they continued to hold their breath every time I asked them to take a deep breath. By this stage, I was getting very frustrated and annoyed that the patient refused to do such a simple exercise. After 10 minutes of trying to get the patient to cooperate, I gave up and said I would be back tomorrow. The next day when I went to treat the patient earlier in the morning and they were very cooperative and did everything that I asked.

The dilemma raised from this experience is; people with dementia if they refuse physio treatment do you keep trying to convince them on the benefits and hope that they will change their mind or do you just leave the session for that day.

I HAVE LEARNT THAT WHEN TREATING PATIENTS WITH DEMENTIA THE TIME OF THE DAY WHEN YOU SEE THE PATIENT CAN BE IMPORTANT FOR THEM TO BE COMPLIANT. PLUS WITH THIS PARTICULAR PATIENT WITH DEMENTIA THERE IS ONLY SO MUCH EDUCATING YOU DO AND IF THE PATIENT STILL REFUSES TO ALLOW PHYSIO THEN THERE IS NOT MUCH ELSE WE CAN DO. GIVEN THE ABOVE SENARIO AGAIN, I WOULD ACT THE SAME AS ABOVE HOWEVER WOULDN’T GET ANNOYED AS I WOULD KNOW THE NEXT DAY THE PATIENT MAY BE LUCID AND COOPERATIVE. DOES ANYONE HAVE ANY OTHER SUGGESTIONS OF STATEGIES TO TREAT PATIENT WITH DEMENTIA?