TRAINING & EDUCATION Sensitive Situations
The growing prevalence of dementia means all care workers should be fully trained in how to deal with its symptoms. Dementia experts from adult social care charity, Making Space, offer their advice for caring for those who experience hallucinations.
One of the most complex aspects of caring for people with dementia is dealing with delusions and hallucinations. Exploring the potential causes of these false beliefs and explaining to care staff what the person is experiencing will help carers understand the world from the service user’s perspective.
Dealing with Delusions A person with dementia may experience delusions they believe to be true; for example, they may believe they still work when in fact they retired years earlier. Providing evidence or repeatedly telling them this isn’t true won’t alter their belief and can become frustrating for all involved.
Training programmes should urge care staff to avoid entering into arguments. Carers should attempt to respond to the feelings and not the facts. In the case of a person having the delusion they are at work, carers should be advised to go with it. Explore with the person what they did at work and provide support for them to fulfill their need for occupation.
Delusions can also be experienced in the form of paranoid beliefs or accusations directed at others. The person with dementia may be unable to remember where they put an item, due to not having formed a memory of the event. They might then reach the conclusion that another person has taken it.
All staff should be trained to explore ways to alleviate distress: help with their search and find out why they are looking for the item. Try to provide an alternative way to address this need for attachment and comfort. But don’t automatically discount the suspicion being based on fact. Could
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someone have actually picked up their bag or pen by mistake?
Remind all care workers that people with dementia always have meaning behind their actions. It is the carer’s responsibility to discover what is really happening for that person and what they need in the way of assistance.
Handling Hallucinations Some hallucinations can be relatively harmless: seeing shapes, hearing tapping noises, or persistently tasting onions. They are false perceptions but they may not result in negative feelings. Other hallucinations can be much more distressing. People may see animals in the room, hear angry voices, or feel bugs crawling on their skin.
If the person with dementia complains of olfactory hallucinations – smelling things that aren’t there – care staff should consult a doctor as they can be an indication of a serious underlying disorder.
Check for signs of physical injuries such as bruises or a bump to the head if a person is experiencing hallucinations; a fall can be the reason. When you are sure there are no external causes, use person- centred distractions such as listening to music or doing puzzles. Above all, reassure. Calming words go a long way to alleviate distressing hallucinations.
Understanding Triggers Changes in situations that most people may not notice can have a huge effect on people with dementia. If delusions and hallucinations are becoming more prevalent, it may be due to a change in the environment. Different combinations of medications can also be a trigger, so if a new medicine has been prescribed or a dose increased, speak to a doctor.
Care should be taken to make the environment comfortable as unfamiliar people or environments may be disruptive. Is the TV too loud? Are visitors coming more often? Look for patterns. Are they happening around the same time every day? Circadian rhythms can disrupt the person’s ability to relax in the late afternoon, causing increased perception difficulty.
Delusions and hallucinations can be worrying both to experience and to witness, but they don’t have to be distressing. Staff should be trained to avoid undermining a person’s emotions and always attempt to support them to move from a threat state to a soothing one.
Open body language, a smiling face and active listening can go a long way. While we currently can’t cure these conditions, consistency of care will enable people who have them to live as happily and comfortably as possible.
www.makingspace.co.uk www.tomorrowscare.co.uk
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