Since her husband passed away five years ago, 92 year-old Mrs. Jones has lived alone in her apartment. She’s recently noticed that her walk is a little unsteady. Her daughter is concerned that Mrs. Jones is becoming more forgetful.
It’s true: Mrs. Jones now experiences little “memory losses” that progress to forgetting how to cook. As a result, she enjoys “tea and toast” for breakfast and lunch on an almost daily basis.
Mrs. Jones eventually checks in with her family doctor, who runs some tests. She is diagnosed with Alzheimer’s disease. At-home care is arranged, along with Meals on Wheels.
After a few weeks, Mrs. Jones becomes more weak and unsteady. She slips in her kitchen, falls and fractures her hip.
After surgery, her physiotherapist notices that Mrs. Jones is quite confused. The combination of surgery, pain medication, and an unfamiliar environment has resulted in unusual behaviours. While she is usually friendly and easygoing, Mrs. Jones is distracted, resistant to moving, and tells the physiotherapist to “get out of my room, I’m not going anywhere.”
What’s going on?
These types of behavioural changes in dementia are also known as “responsive behaviours.” They may include:
- Calling out
- Pushing away
- Resisting care
These actions may make sense to the person experiencing dementia, but caregivers (family, friends, you) can find them difficult to understand in their desire to help.
Along with short-term memory loss, difficulties completing common daily living tasks and losing the ability to think clearly are common traits of Alzheimer’s disease. Helping patients with Alzheimer’s disease to recover from illness or injury, in hospital or at home, requires skill and knowledge in understanding these cognitive and behaviour changes.
One of these special skills is learning to use “Gentle Persuasion Approaches” (GPA).
Physiotherapists who have undertaken GPA training have successfully used these approaches in rehabilitating patients with Alzheimer’s disease. The approaches are calm, respectful and demonstrate an understanding that each behaviour has particular meaning for the person. They acknowledge how the person may be feeling, maintain the person’s dignity and help to distract and redirect them toward what they need to do at the moment.
How do Gentle Persuasive Approaches help?
Gentle persuasive approaches help the person feel that their concerns are heard, and develop trust that their needs will be met. Family and caregivers learn to consider what needs may be being expressed by the person through the behaviour, such as pain, hunger, thirst or anxiety.
Some common gentle persuasive approaches that family, friends or caregivers can use to help patients are:
Search for the meaning of the behaviour. Try to understand if the person is hungry, thirsty, feeling lost, or in pain by observation and assessment.
Validate the feeling – “I know you feel out of sorts because your leg is sore and you are away from your home.”
Join into the person’s need – “Let’s see if moving to a different position, like standing up, might help you feel better.” If pain or thirst, provide medication or a drink to meet the need.
Redirect the behaviour – “Let’s walk over there, where people are listening to music.”
Distract the person from the behaviour – “Do you have a song you like? How about we sing it together?”
Pause and approach again later – Sometimes, distraction may not work immediately, so try stopping, and approach again after a short time. Because of the short term memory loss, the person may not remember that they initially did not wish to move, or if pain was the cause, pain medication may have had time to take effect.
Look for sudden behaviour changes or behaviours that vary greatly through the day and persist; this could be a sign of delirium. Delirium is a medical emergency and can indicate a change in health, such as infection, or other serious condition, and the person should be referred for urgent medical check-up.
To learn more, the Alzheimer Society in your area provides regular education sessions on Gentle Persuasive Approaches for families and health service providers.
Helen Johnson is a physiotherapist with over 30 years’ experience spanning a variety of health system sectors, from acute care, rehabilitation, community and specialized geriatric outreach. She completed her Master’s degree in Health and Rehabilitation Science, Health and Aging at Western University in 2011.
In 2012 she was recognized as the first Clinical Specialist Seniors’ Health, in the newly launched Canadian Physiotherapy Association (CPA) Clinical Specialty Program. Helen is currently the Education Coordinator for the Seniors’ Health Division of the CPA, and served as Division Chair from 2012 to 2014. Helen joined the Chatham-Kent Health Alliance in the role of Erie St. Clair Local Health Integration Network Rehabilitation Lead in January of 2013, and serves on a number of working groups of the provincial Rehabilitative Care Alliance.