Seasonal Memories

It’s a beautiful day…

IMG_0080
Beautiful Day September 2017

This morning’s discussions on the radio about the end of Summer and whether you take the astronomical or meteorological date as the official start of Autumn reminded me of a conversation with my dear Mum about this very subject.  Mum’s dementia affected her speech to such an extent that I had to be very creative to engage in an exchange of ideas. It was the need to use all the senses as communication channels that inspired me to begin the ReminiScent journey….

On this occasion Mum and I were taking a short walk around the village were she lived. It was a pleasantly sunny day for the time of year, just like today.  As we walked I admired the golden trees and noted the increasing number of leaves on the ground.  Heading back inside, I commented to Mum that Summer was coming to a close and it would soon be Winter.  She looked at me blankly – so I stopped in front of a young tree, pointed upwards to the yellowing leaves upon it and repeated my sentence more slowly.  Still she looked at me blankly so I stooped, picking up a crisp golden brown leaf from the floor. Taking  Mum’s hand I placed the leaf there and pressed it against her skin, repeating the sentence once more.  This time Mum looked at me, looked down at the leaf and smiled.  “Christmas” she said.  Just one word but it was enough and I was so thrilled to have thwarted dementia to connect with her in a shared Autumnal experience that delighted Mum because she had understood me.

Communicating with people who live with dementia can be a challenge.  For many families it feels frustrating and pointless.  Nothing makes me more sad that hearing a person comment that they rarely visit a relative “because he\she never knows I’ve been anyway”.  We need people to understand that dementia may well mean that the detail of a visit may well be forgotten almost immediately – but the feelings that the visit evoke will significantly impact that individual’s well being – so visits are always worthwhile.

Conversation and activity is the best way to stay connected with a person who is living with dementia. Below are a few tips to inspire you to keep relationships alive when dementia interferes.  Your relationship is a vital part of your relation’s quality of life.  Be inspired to keep it alive, even if they don’t remember your name, or know why you are there. You can still be a person with whom they feel safe or have a bit of fun.

10 Tips to help you communicate:

  1. Make eye contact & smile.
  2. Introduce yourself so that the person with dementia doesn’t have to work hard to place you.
  3. Remember that background noise can make it harder for a person with dementia to concentrate on what you are saying.
  4. Speak slowly and in shorter sentences. Always be prepared to repeat yourself patiently.
  5. Listen! Even if the story is one you’ve heard before, and before, and before…. Giving your attention is respectful and improves self esteem.
  6. Use multiple different ways to stimulate cognition; the sound of your voice, an image or artefact to look at, the feel, taste or smell of something. We can reinforce the concept we are trying to convey by using more than one sensory channel.
  7. If you struggle to know what to say, go for a walk, to talk about what you see, or bring conversational props with you. Topic cards are helpful and can be used as a game. A magazine or photograph gives a platform to launch a natter even if it is a bit one-sided.
  8. In a group, encourage the person with dementia to join in.  If they talk, stop what you or someone else is saying to listen as otherwise they might forget what they want to say.
  9. Don’t say ” Do you remember?” It puts people living with dementia under pressure!  Rephrase what you want to say to make a statement rather than a question.
  10. Never assume that someone doesn’t understand the conversation going on around them, even if they appear unable to join in.  You’d be very surprised just how much a person will absorb from family chatter. In our family, we stopped talking to Mum about the day-today activities of our grown up children as we thought it too difficult for her to understand. One Sunday she was sitting in the kitchen when my son visited. As he greeted her as he passed by, she said ” Do you like it?”  ” Do I like what Grandma?” he said, sitting down next to her.  My jaw dropped as she said ” Your job?” No one had told her that my son had now left university – but most clearly she had understood the conversations we had between ourselves!

 

The power of smell…

Baking, gardening, a soak in the bath….scent is as much part of these experiences as the end result of the task or the sumptuous feeling of the treat.  Recently, a sulphurous waft from a struck match instantly transported me back to  childhood with memories of my father’s, now socially unacceptable, smoking habit.  And then there are all the iconic products whose scents bring back so many memories; Vosene with which mother scrubbed our hair weekly, Nivea for when skin need some loving care, Germoline for the many cuts and grazes…I expect you can recall the scents even as you read their names!

Smells are a powerful connector to the past because of the way the sense connects with the brain.

Brain pic - Thoughts_feelings_behaviour

Like taste, smell is a chemical sense. Scents are detected by sensory cells at the top of your nose called chemoreceptors. These are stimulated by airborne molecules and send electrical impulses to the brain which are interpreted as specific odours – turning a sensation into perception.  The response is so fast that there are two distinct stages;

The first is an immediate awareness of the odour and whether it is pleasant or not, or if it represents danger ( such as the smell of burning toast or of something putrid, for example.) This is intuitive – you will have no awareness of thinking about it.

The second response stage is more considered:  we analyse what we smell and try to identify it. This is a very individual process. Smell, more than any other sense, is linked to the parts of the brain used for emotion and memory. So one person’s favourite smell is to be avoided by another, depending on the associations we each make with that particular smell. For example, the smell of cut grass is a perennial indicator of happy summer days, unless you suffer from hay fever…

Tuning into the senses can help well being for us all.  There is increasing awareness of the benefits of sensory stimulation. This therapeutic approach uses everyday objects to arouse one or more of the five senses (sight, smell, hearing, taste and touch) with the goal of evoking positive feelings. It can be very beneficial to people with mental health issues. Developed in the 1960’s, the therapy was originally was designed to help children with learning disabilities. It was a way to explore and learn in a stimulating and safe environment that provided enjoyable, age-appropriate activities. Since then, the therapy has become widely used to treat other conditions, including autism; chronic pain; brain injuries; Alzheimer’s; and other forms of dementia.

Ultimately we use all five senses to interpret the world around us. Consciously tuning into them contributes to a thoughtful approach to life and tuning into the scents that surround us every day brings another dimension to life.  For people with dementia using all the senses increases the probability of comprehension.  The link between the sense of smell and memory and feelings directly relates to the same parts of the brain that are most often affected by the disease.

Smells remind us of people, places and things like no other sense. They are a novel way to trigger a conversation, verbal or not, depending on a person’s capabilities. A recent study found that just 10 minutes a day of meaningful engagement improves emotional well being in the elderly…how simple should it be for families and carers to provide that? And yet, many elderly people ( with or without dementia) find themselves under employed and under stimulated when living in residential care. Conversation cards and sensory installations can help people engage with each other, create soothing areas of calm or just gently coax stories out of new residents.

Smell is an emotional sense which means that, even if a person can not relate the facts of an occasion, if they recall how that thing or place made them feel –  then the smell of something they used to love may well bring a moment of happiness.

And if I can achieve that for a people living with dementia – it makes my day!

Being Mortal – by Atul Gawande

Being MortalI was recommended to read this book by a visitor to our stand at the recent Health + Care Show in London. It is a compelling read, if somewhat unsettling at times.  It brought back many memories for me..and, let’s face it, end of life is not a comfortable subject to discuss.  However, as the title of book states and the author describes – there is only one thing certain in life and that is that we are all, one day, going to die – it’s just a question of how.  This well written book discusses the effect that modern medicine has had on the way people die, the impact this has on their quality of life and how our society provides the care they require.  He explores the American approach to eldercare and charts his own journey of discovery away from being the surgical “fixer” that he was trained to be in medical school, to being able to open very difficult conversations with elderly people and individuals with terminal illness  to identify what really mattered to them and what sort of care would help them achieve what matters most.

Definitely a must read for anyone who hopes to live life their own way, right to the end and for everyone involved in caring for people.

The Five Most important things…lessons from Shirley

Tips from a dementia carer

Dignity and respect are much used words in dementia care.  Understanding what they mean is very important – and made more difficult by the fact that, as this disease progresses, the definitions change slightly…

IMG_0389

Shirley was my mother. She was diagnosed with vascular dementia over 10 years before her death.  Initially she managed very well with us all supporting her, providing a guiding hand when she got muddled, then helping her stay connected with us all, extended family and friends.  Finally her cognition was affected to such an extent that she could no longer read her favourite magazine, watch TV, or join in the banter that she had always enjoyed.  Throughout it all, however, the essence of Shirley was always there, though sometimes you had to look hard to see it.

Shirley’s Five most important things:

  1. Hobbies & relationships: People with dementia still want to enjoy the things that they’ve always enjoyed. You can make them feel happy by helping to find a way to exercise, read, go outside, or visit friends. Encourage people to visit. Even if your loved one forgets visitors have been, the visit itself will leave feelings that will keep them content.
  2. I am not a child: Dementia does not lead to an automatic love of Bingo, colouring books or toys.  Do not infantilise people because of the disease.  Therapies work for individuals; watch and listen to see if they are relevant to the person you are caring for.  Chances are, if they weren’t interested in board games or jigsaws before dementia, they won’t be now!
  3. Purpose & praise: Find things to do that have a purpose and give lots of praise.  Gardening, dusting, hoovering, sorting the washing, hanging out the washing. Shirley used to love to do the ironing; it frighten me to death but she felt that she was helping me and that made her feel useful.  As her dementia progressed I used to quickly remove all the delicate or complicated items from the basket – but we kept the activity going for as long as we could.
  4. Looking as I should: Remember that your loved one is still the person you’ve always known. You can make them happy by ensuring that they are dressed and cared for in a way that you would expect them to do themselves.  Coordinate clothes, chose outfits that are comfortable, have their hair dressed and look after finger nails and feet. Everyone feels better about themselves when properly groomed.
  5. Talking and listening!  Using prompts such as conversation cards, photos, newspapers, or outings, talk to people with dementia normally , even if the response is just a smile.  When language had completely disappeared Shirley still understood the conversations around her.  Once, for example, when in hospital after a fall, a doctor asked me if I thought Shirley would object to him examining her, I replied that I had no idea how she might react, but that as he was a guy she  probably wouldn’t object as she liked men…To our mutual amusement, Shirley opened her eyes and laughed, enjoying the joke at her expense, even under those circumstances.

Loving Lavender

Diffusing the smell of relaxation

Lavender. What’s not to love about this plant?  The scent, the colours and the soft feel of it are all just wonderful. It is renown for the therapeutic effects of the fragrant oil it produces.

Caring for my mother, who lived with dementia, I used lavender extensively both in her room and in hand creams for massages. It relaxed both of us!

When Mum moved into residential care I used lavender essential oil in a diffuser in her room. It created a pleasant and relaxing atmosphere that the staff loved as well as Mum and other residents. The latter was a slight problem – as Mum did not take kindly to other residents entering her room uninvited!

Essential oils have been used for therapeutic purposes throughout the history of mankind. Before we could distill or manufacture, we burned or boiled oil bearing leaves and flowers to make them release their scent.  Herbal remedies are part of folk lore – many are now being discovered to have some scientific basis for the effects that have been perceived for centuries.

Aroma therapy is one way that we can contribute to the well being of elderly people, especially those with dementia.  Fragrant oils provide a stimulus for the brain as well as pleasantly scenting a care setting. Mum enjoyed hand “pamper” sessions and I frequently found myself performing massages on a whole group of ladies.  The social gathering that spontaneously happened around Mum and I during our activity led to much laughter and sharing of dollops of scented hand cream.  It was indulgent. It made everyone feel special. It was a dose of normality as well as a treat! I very much hope that, as dementia care becomes more widely talked about, emotional well being will one day be seen as just as important as the practical aspects of physical care.

The sense of smell is directly connected to the parts of the brain that are responsible for memories and feelings.  It is a natural connection then, that when the scent of essential oils are breathed in they stimulate these parts of the brain and influence your emotional health.

Scientific evidence suggests that aromatherapy with lavender may slow the activity of the nervous system, improve sleep quality, promote relaxation, and lift mood in people suffering from sleep disorders. Hence the traditional use of Lavender Scented pillows.  Studies also suggest that massage with essential oils, particularly lavender, may result in improved sleep quality, more stable mood, better concentration, and reduced anxiety. In one study, people who received massage with lavender felt less anxious and more positive than those who received massage alone. There have been several small studies that suggest that lavender aromatherapy may help reduce agitation in people with dementia – though too small to be statistically significant, I very much hope that we can encourage greater use of scent, particularly lavender to soothe and bring pleasure to people living with dementia.

Some scientists have said that lavender  stimulates brain activity in the amygdala in a similar way to some sedative medications!

Imagine!

See lavender diffuser here

sffssfsf

New study says meaningful activity improves quality of life!

Well – there you go!

A large scale trial led by the University of Exeter, Kings College London and Oxford Health NHS Foundation Trust concluded that Person-centred activities combined with just one hour of social interaction can improve quality of life and reduce agitation for people with dementia living in care homes, whilst saving money.

Ever since I became involved in caring for my mother back in 2011, I have fought against the general perception that a dementia diagnosis meant that normal life should go on hold, you suddenly develop a love of Bingo and live in some bygone era..

Many of the generally accepted activities in care settings are, in my opinion, rather patronising. They stereotype elderly people, particularly those with dementia, in a way that no other sector of society is subjected to.  As a regular visitor to my mother’s care home for the last 2 years of her life, I found that props provided a kick-start for conversations that attracted the attention of other residents.  My visits to my own mother were soon being regularly enjoyed by a whole group of people.  They loved to talk about their homes, gardens, children, the dresses they wore, jobs they did, foods they cooked and a whole host of details about their likes and dislikes. We were, intact, recreating the coffee mornings with their friends that they had always enjoyed!  I was able to enter into their world and, even if the same story was continually repeated, I knew that by showing an interest in hearing it, I was adding huge pleasure to that person’s day by giving just a small amount of mine. Talking is the very best therapy and listening is a skill that is undervalued in elder care.  Feeling listened to can have such a profound effect on a person’s self respect, making them feel happier and more content, thus avoiding conflict and the “agitation” referred to in the study results.

We  now understand why a person with dementia might recall something from their youth more reliably than whether they have eaten breakfast.  The connection between long and short term memory and the belief that people with dementia live in the past is not something that I can relate to.  Most of the people that I have met are forgetful, have various coordination or, like my mother, speech difficulties and enjoy reminiscing.  They did not, however, live in the past and I, as I see it, our job as a carer, is to try to keep people engaged in the world in which they live for a long as possible.  We can stimulate conversations by using images, sounds, scents. We can soothe by gently stroking an arm or hand.  We can bring the outdoors in to those who find changing environments stressful.  We can make sure their surroundings smell nice and ensure that they are carefully dressed ( repeatedly, if necessary) and groomed to the standard they would have wished before dementia.

It’s all about dignity and respect and seeing people and individuals – just the same as everyone else.