Fifty percent of people with dementia also suffer from depression (Alzheimer’s Society). This figure is likely to be much higher during the Coronavirus pandemic where isolation, disrupted routines and increased worry takes its toll. Anxiety and depression compounds memory problems and thinking abilities and makes carrying out daily activities more difficult. It can lead to withdrawal, loss of skills and behavioural problems. It also causes increased worry and stress for families and caregivers.
Cognitive Behavioural Therapy (CBT) is a successful treatment for anxiety and depression, but can these techniques be used to help those with dementia? CBT helps you to manage problems by changing the way you think and behave. Surely the decline in thinking and memory ability in someone with dementia makes this impossible?
As their memories decline, people with dementia can lose touch with who they are. Their memories are what reminds them of their values and beliefs and gives a sense of identity. If we can stimulate their thinking process using reminiscence techniques to remind them who they are we can promote a sense of belonging which in turn brings about a positive change in behaviour, increased interaction and a lifting in mood. Make reminiscence part of everyday routines using life story work, and take every opportunity to incorporate it into each activity and general conversation.
If someone can’t remember that they have had visitors, they may be left feeling that nobody cares about them. We can try using memory aids, notebooks, diaries and whiteboards to remind them that they are cared for; and encourage visitors to leave messages, cards, photos or little gifts. This in turn can promote a greater sense of feeling valued and more settled behaviour.
Decline in language abilities and being unable to communicate effectively and interact with loved ones is another challenge that leads to frustration on both sides. Being unable to understand, or misconstruing what someone has said can unfortunately lead to negative reactions, arguments and breakdown in communication. For the person with dementia, this just reinforces negative thoughts about themselves and the world. They feel helpless and that nobody likes them. They need positive reinforcement to feel good. Join the person with dementia in their world and try to avoid “putting them right” or challenging their beliefs. Pay attention to non-verbal communication to try to gauge the emotion they are expressing.
Encourage residents with dementia to participate in meaningful activities that are within their skill set and allow a sense of success. Pleasant activities can easily change someone’s mindset, improve mood and decrease anxiety. Music, in particular, can reduce agitation and transform someone with dementia from withdrawn to joyful. It can also improve the mood of caregivers, which in turn leads to more positive interaction and reinforcement that life is worth living.
Adapting CBT techniques is something we can try to help those with early to mid-stage dementia to cope better with symptoms of anxiety and depression, to regain more control over their lives and improve overall wellbeing. It is something that we are probably already doing without realising it, but if not, there is nothing to lose in giving it a try.