One of the most important lessons in dementia care is that when something isn’t working, the answer doesn’t always lie with the person. Sometimes we need to look at the environment.
A dark doormat, for example, may appear to a person living with dementia as a hole, a step or something unsafe to cross.
Imagine standing at your own front door believing there is a hole in front of you. Someone tells you, “It’s fine, just walk over it.” You don’t move. They repeat themselves, perhaps a little louder. You become anxious, they become frustrated, and suddenly we have what might be described as a “behaviour”.
But what if, rather than focusing on the person’s response, we looked at what they were experiencing?
As an occupational therapist, I’ve spent much of my career thinking about the relationship between the person, the activity they are trying to perform and the environment around them. When one part of that equation changes, we can often adapt another.
Dementia makes this particularly important. Changes in cognition, perception, communication and memory can make once-familiar environments and everyday activities more difficult to navigate.
Something as ordinary as a bathroom can become confusing. An object may no longer stand out clearly from its surroundings. A reflection or shadow may be misinterpreted. A familiar activity may suddenly contain too many steps to follow easily.
To the family member watching, it can be baffling.
Why won’t Mum use the bathroom? Why has Dad stopped eating? Why does she become upset when we leave the house? Why does he keep doing that?
Behaviour Can Be Communication
This is where skilled dementia care can make an enormous difference.
Rather than starting with the behaviour, an allied health professional can look more broadly at what might be happening around it. The person’s health, cognition, communication, physical abilities, sensory changes, routines, environment and life story can all provide clues.
Sometimes what we call a “behaviour” is a form of communication.
Pain may look like agitation. Difficulty understanding an instruction may look like refusal. A swallowing problem may contribute to avoiding meals. Poor balance may create fear around showering. Hearing or vision changes can alter how someone experiences a room or conversation.
The answer isn’t always obvious, and it isn’t always dementia.
Supporting Families and Carers
When someone develops dementia, the effects rarely belong to that person alone.
An estimated 446,500 Australians are living with dementia, with more than 1.7 million people involved in caring for someone with the condition.
Partners, adult children, friends and carers can find themselves trying to solve problems they have never encountered before, often while managing their own worry, exhaustion and grief.
They may be doing everything they can, but without understanding why something is happening, everyday interactions can become frustrating for everyone.
Good allied health intervention can help make sense of what is changing and identify practical ways forward. Just as importantly, it can give families and carers greater understanding, confidence and strategies to draw on when the clinician isn’t there.
The goal isn’t to create dependence on therapy. It is to help the person and those around them navigate everyday life more successfully.
Other Health Needs Still Matter
A person living with dementia can still experience pain, falls, weakness, depression or anxiety, communication and swallowing difficulties, weight loss, reduced mobility and challenges managing everyday activities.
Yet there is a risk that once dementia becomes part of someone’s story, everything is viewed through that diagnosis.
I think allied health has an important role in challenging that.
Dementia may change how we provide care. It shouldn’t automatically change whether we should provide it.
Physiotherapy and exercise physiology can support mobility, strength and physical function. Speech pathology can address communication and swallowing. Dietetics can explore nutrition, weight and mealtime difficulties. Mental health clinicians can help understand distress, mood and changes in engagement. Occupational therapy can examine the interaction between cognition, everyday activity and the environment.
When those disciplines work together, we can see something much bigger than a diagnosis.
We see the person trying to continue living their life.
Changing What’s Around the Person
Healthcare understandably spends a lot of time focusing on the person — improving strength, restoring function and addressing changes in health.Dementia sometimes asks us to look in another direction.
What can we change around this person so they can continue doing more of what matters to them?
That might mean changing the environment, the activity, how we communicate, or the support around the person.
Sometimes it means helping a family understand that what looks like resistance may be fear, confusion, pain or a world that no longer looks quite the way it used to.
To me, that’s one of the most valuable contributions allied health can make to dementia care.
Not simply treating dementia, but helping the person and the people who love and support them find better ways to live with it.
Sometimes that journey can begin with something as simple as noticing the doormat.
To learn more about dementia and our approach, contact Recovery Station on 1300 588 851 or click here to make a referral.
Until next time,
