Therapeutic interventions
Interventions aimed at creating a consistent sense of identity
You can help create a consistent sense of identity within the person living with a dementia by keeping the following in mind. I have provided these ideas again, as in our last blog, as list for you – you may wish to print them out – place them on the staff room walls – these interventions should be thought of as bricks as you continue to lay solid foundations for your person centred approach (More foundations for your care structure) and there should be evidence of attempts to implement these approaches within the individual plan of care
- Allow grieving for losses. (these losses may be physical, psychological or social)
- Teach problem solving. (despite the common assumptions most people living with a dementia can and do still learn)
- Encourage new relationships.
- Encourage the development of emotional support by re-expanding the person’s social network.
- Reverse internalisation and feeling of unemployment and displacement leading to fears of uselessness.
- Maximise esteem-creating activities. (Montessori principles – no fail)
- Reverse dependency.
- Increase ease of memorising and apply signage and signposting.
- Encourage new learning and relearning.
- Minimise disability.
- Initiate individual counselling/person work with staff skilled in handling losses and grief.
- Use a problem-solving approach, maximising personal agency and environmental control.
- Look at ways of providing care which encourages people to interact.
- Look at establishing group work, drawing on common experiences to encourage group cohesion and networking outside the group.
- Attempt to establish contact with old friends, for example through the church or the British Legion, etc.
- Encourage expansion and enjoyment of the retired position. (life history and life story as clues to ‘what would a perfect retirement have meant’ to this person)
- Help with the use of long- term memory and abilities to be useful and creative here and now.
- Encourage the person to make and give gifts, perform own tasks, enjoy and use social activities groups.
- Structure daily living so as to include personally memorable and meaningful events, outings, visits, groups, etc.
- Establish failure- free teaching for staff
- Provide structured outings to previously familiar localities.
- Substitute activities to maintain interest.
- Use aids to compensate for failing or lost abilities and adapt the environments to make them controllable for the person, memorable to the person and understandable for all.
- Creativity on your part will help to enable these ideas and more to be put into practice.
- The only limit on the way we can help people with dementia to maintain their identity lies within us.
- Anything that you think would reinforce the personhood of those we help should be tried. If we accept that people with dementia are in a constant struggle to maintain their self- identity, our duty is to assist in this process.
When coupled with measures to help the person maintain their emotional security, todays blog ideas will begin to demonstrate an establishment actually practicing a person centred approach to care delivery.
Always keep at the front of your mind each time you begin your work ‘if we forget who we are, our place in the world and the ways we can contribute to others – then what are we?’ Our role is to assist the person living with dementia, their family and friends and our colleagues to think constantly and consistently “who this person was, what they were, how they contributed and most importantly – who are they now, how can they continue to interact, to contribute – to matter?”.
We previously stated that one of the big questions when we are entering old age and uncertainty is “what will become of me?” well – what will you do today to answer that question for those you care for?
Till next time
Paul Smith – Dementia Care Expert
