Dementia and challenging behaviour

We need to look at new ways to support communication for dementia as it is the key to unlocking the person from the prison of challenging behaviour

Ronny was a fighter pilot in the war. During that time, he was well known for his bravery in the face of seemingly insurmountable odds. When he came back from the war, he went on to own his own garage and repair cars in his home town. He married Martha and they settled down and had two children, Jamie and Sarah. When he retired he and Martha wanted to spend some time traveling around Britain seeing old friends from the war and indulging his passion for steam locomotives. He loved nothing more than to go to the model railway club and help to strip down old engines and rebuild them so they were running smoothly. Life was sweet.

Then one day when he was 72, unexpectedly he found Martha on the floor of their kitchen when he came home. She had had a heart attack and had died suddenly. For Ronny, on this day his whole world was gradually turned upside down. His gentle, quiet, loving Martha was gone forever.

Memory problems

In hindsight although it seemed that Martha was the one that was dependent on Ronny, in truth it was the other way around. Martha was the thread holding Ronny together, and without her his life, independence and memory began to unravel. He had been having memory problems for a few years, and now without Martha to remind him what to do and in a storm of blinding grief, Ronny found himself barely able to cope.

Then he had a fall and fractured his hip. In hospital, he was confused and delirious, frequently lashing out at people who came near. He refused to do any rehabilitation for his hip and so walking became extremely difficult. In the end, he was placed in a nursing home where he continued to be defensive to most attempts to help him. He didn’t know what day it was, and found it extremely difficult to express himself.

Very slowly, with help and some medication, his depression started to improve. However, the dementia continued to make his communication and thinking difficult leading to significant frustration when other people didn’t understand what he wanted. The staff in the nursing home would often say “Ronny’s being challenging again” when he lashed out at them.

One day, one of the carers asked the visiting Speech and Language therapist if she would be able to see Ronny and help, she agreed. After an assessment and working with his children to find pictures and photos from his life, the Speech and Language therapist was able to help. She was responsible for programming a tablet for Ronny to use, which could help him remember important people and events as well as orient him to the here and now.

Technology to help

There was an app to help him remember and reminisce over his past achievements and passions as well as his family. In here there were lots of scanned photos of the planes he used to fly, his comrades and his medals. There were also lots of photos of when he and Martha were younger and holidays with their children. Each of the photos had a little description with it to help Ronny remember the details as well as explain it to others. Ronny spent hours looking through these photos and descriptions, reliving his past. The LifeTimesTALK app or My house of memories app (from www.liverpoolmuseums.org.uk) are two lovely options for this.

Then there was an app to help him communicate with other people his choices for his mealtimes, favourite TV programmes and other day to day activities. The MyChoicePad app or Choices to go app are two great options for this.

Finally, there was an app with a diary and day to day planning so he wouldn’t forget things that were important to him. It had the time in a big clock as well so he could keep himself oriented. He was so thrilled to get an invitation to attend the model railway club annual dinner and kept on looking that up to make sure he wouldn’t miss out on going! The Can plan is a great app for this.

The staff at the nursing home noted an immediate change in Ronny. He was more talkative engaged and the challenging behaviour was mostly behind him. “It’s like he was a prisoner in his mind and now he is free” one said. Other residents also could be found talking to him about things they were all interested in – model railway engines, aircraft, their experiences during the war. The tablet has given him new outlets to communicate which has helped him enormously to get back some of the quality of life that he had lost with his dementia and depression.

By Kim Clarke, Speech and Language Therapist MRCSLT, MSPA, MASLTIP.

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