Severe Dementia

I was treating an elderly lady with a # hip who had severe dementia. I had never had a patient with severe dementia before. This patient was difficult to wake up, and communication was very limited. I was to assess the patient’s hip and mobility status. It was difficult to get a precise assessment of her hip in regards to strength and ROM.I tried different techniques, saying short words, repeating words and allowing plenty of time, to try get her to do the actions I required for assessment.

It was frustrating as it wasn’t going as easy as I thought. Assessing muscle strength seemed to be the most challenging. In the end I found a way that suited this lady. This involved doing repeated passive movements and gradually taking my assistance away with each repetition and saying a couple of prompts. In the end this patient showed general strength to be sufficient to stand and walk. Surprisingly, this lady was quite good at standing and walking and required very little prompting. She responded well to physical guidance rather than verbal.

From this situation I was introduced to some of the challenges faced when treating patients with severe dementia. Although challenging, once I had worked out the best strategy for this patient, it became easier in treating the patient at the end of the session and simple on subsequent sessions. Some of the strategies we learnt at university when dealing with dementia patients included breaking down tasks, gentle physical facilitation, clear slow voice, visual cues, eye contact/facial gestures and limit distractions. When seeing the patient, I also thought it was important to try having the same therapist treat the dementia patient as this would mean the patient and therapist would be familiar with each other.

In future, I would approach a dementia patient using less verbal communication and more physical facilitation, keeping in mind dementia patients may respond differently. It is important to allocate time for these patients especially in the initial session so the therapist can work out the best means of assessing and managing the patient. I also learnt that a patient with dementia can fluctuate throughout a day, so a therapist needs to be able to be relatively flexible in when they can see them. I hope to continue developing the skills to treating patients with dementia, best done by further exposure to such patients.