The Rules of Engagement

Caring for a loved one with dementia is more art than science. What works one day does not the next. There are some basic rules of engagement, but most of the time it seems we must be flexible and creative in dealing with a person who is in a frequent state of change.

The basic rules of engagement involve approach, voice, and touch. We must be mindful of the basic sensory deficits in a person living with dementia. They may have reduced peripheral vision and a loss of depth perception. Their auditory perception has changed as well, and they may have lost their ability to identify the direction from which a sound is coming.
They will also have lost the ability to process information as quickly as a healthy person does. What we grasp in an instant may take them several seconds to process. When we speak at a normal rate, they may completely lose some of the words in the sentence we have spoken.

When we approach a person with dementia, the basic rules are: Approach at eye level. Pause at least three feet away to get their attention. Smile, speak slowly, lower your tone of voice, and use simple sentences.
Do not move closer until you have eye contact and an indication that they are ready to receive you, which may be an outstretched hand or a smile. Only then can you approach closer and make physical contact by gently but firmly grasping their dominant hand, which is the hand they might hit with if an improper approach has startled them.
Never approach quickly or from the side or behind, which will be out of their range of vision. Always use a soothing voice. Smile, compliment them, and address them by name. Remember that even if they understand every word you say, they will process the information at a slower rate. Pause between sentences and never hurry them.

Once you have mastered the skills of approach, voice, and touch, you need to be mindful that their reality may not be the same as yours. Often, a person with dementia may move within their mind to an earlier time in their life. This is why they may call you by a different name. The first time a loved one with dementia does not recognize you, it really hurts. You must not take it personally. You must try to remember that they are not giving you a hard time; they are having a hard time.The cardinal rule of dementia care is to validate what your loved one believes and says. Never contradict and never argue.

Beyond the basic rules of approach, voice, and touch, you are often in unknown territory. What worked one day may not the next. But if you find ways to validate what they do and say, care-giving will become much easier.
Keep in mind that individuals living with dementia do not live in a world of logic. They live in a world of feelings. They react to how others make them feel. As a caregiver, a big part of your job is to make them feel validated and useful.

Debbie Selsavage is a Certified Independent Trainer in the Positive Approach to Care, a Certified Dementia Practitioner, and President of the Board of Directors of the Alzheimer’s Family Organization. Her company, Coping with Dementia LLC, is dedicated to making life better for individuals and their caregivers who are living with dementia. Contact Debbie at [email protected].