Dementia Case Study 1

Mrs A is 78 years old and has dementia of the vascular type; she came to Aranlaw from hospital where she had been admitted when attempts to support her to remain in her own home were unsuccessful due to her failing memory, disorientation and lack of understanding of risks. These problems caused her to neglect herself and frequently leave her own home and get lost, often in the middle of the night. One of the things that made her particularly vulnerable was her tendency to talk to complete strangers, telling them that she lived alone and where her home was. When Mrs A arrived at Aranlaw she was very frightened and angry and did not understand why she was not able to remain in the flat that she had lived in for over 20 years, she was suspicious of everyone believing that we were all in some way to blame for what was happening to her. We started to gather as much information as we could about Mrs A’s life history and significant events. We were given useful information by neighbours, a friend of many years and Mrs A’s GP who had known her for over 20 years.

The Aranlaw team immediately adopted the helping techniques recommended for managing behaviours that are the result of the person feeling uncomfortable and fearful at this stage of the illness. These include ensuring that staff do not expose the person’s weaknesses, working with all feelings expressed including anger which can be frequent and sudden in onset, keeping our distance until invited to get closer, acknowledging and validating feelings rather than ignoring them or taking things personally. Most importantly we acknowledged Mrs A’s lifetime of experience as a senior nurse, asking her opinion on simple issues where we knew she would be able to feel that her input was valued and helpful. We gave her a key to her own room and encouraged her to choose what colour she would like it painted and where she would like to hang her pictures.

Within 4 weeks Mrs A behaviour started to change in a way that suggested our care strategy was having a positive impact on her and helping to make her feel more secure and comfortable; she started to confide in two staff she now trusted, she admitted that she was frightened of not being in control and of having memory difficulties. Mrs A became increasingly humorous, wanted to help staff and other residents as much as she could and was engaging and affectionate towards those staff she trusted. Mrs A no longer seemed uncomfortable when in the company of residents in Stages 2 and 3 of their illness instead she tried to help them as she was now feeling confident that she was respected for her professional skills and knowledge.

Mrs A has been with us for nearly a year now, she continues to live her life to the full despite her dementia; she likes to ‘work’ a full shift with the day staff only taking herself off to bed when the night staff have arrived and she feels that things are running smoothly, she goes out regularly for walks with carers and enjoys nothing more than accompanying Managers when they go to collect prescriptions etc from GP surgeries.