Dementia Case Study 3

Mrs C came to Aranlaw House when the care home she had been living in closed down. Mrs C had complex heath problems and these had been the focus of her care in her previous home; her dementia seemed to have been seen as part of her overall ‘frailty’ and no dementia specific care had been given to her. Mrs C was doubly incontinent and although she could weight bear she was unable to walk more than a step or two when being transferred with two staff. In the Home she had previously lived in Mrs C had been cared for in bed for most of the time as staff had felt she just wanted to sleep and was more comfortable in bed. Mrs C had lost a considerable amount of weight and was prescribed dietary supplements to drink to increase her calorie intake.

Mrs C spoke only a few words and would often sit for long periods humming to herself or singing the same line of a song over and over again as she pleated the hem of her skirt or repeatedly ran her hand over the table as if wiping it clean. As staff approached Mrs C to offer her help or bring her food or drinks she would often appear startled; not appearing to see them until they were right in front of her. Sometimes Mrs C could eat independently but more often than not she needed carers to assist her to eat and drink, she seemed to take no pleasure from eating and almost always declined to drink the supplements she had been prescribed.

We quickly realised that many of the needs that Mrs C had had been incorrectly attributed to her physical health problems. She was in fact exhibiting behaviours and visuo-perceptual and communication difficulties that indicated she had dementia at Stage 3. At this stage of the illness it is important to provide stimuli that is within the person’s visual field, which may be greatly reduced as the result of poor peripheral vision, loss of acuity and ability to see colour, as well as the person no longer being able to turn or raise their head easily to see in front of them or to look at what may be next to them. Social stimulation and activity at this stage is critical to prevent the person slipping prematurely into Stage 4.

Our staff now approached Mrs C more slowly; always from the front and gently spoke her name as they approached. When close to her staff crouched down to her level and used touch to confirm they were there and focusing on her. Gradually Mrs C stopped jumping as we approached and her eye contact with staff increased. We gave Mrs C a brightly coloured duster and she would often pick this up and wipe at the table as she had previously with her hand but she would attempt to fold the duster up and put it tidily on the table. Staff thanked Mrs C for helping to clear up and she would smile in response.

We started to try and offer Mrs C finger foods and it was now that we discovered her love of pizza, cocktail sausages and strawberries! Mrs C seemed to be much happier to eat when given the opportunity to feed herself with foods she could pick up and eat as she felt hungry. We found that a favourite drink for Mrs C was a strawberry smoothie and we added Complan and cream to increase the calories that Mrs C really needed. In her first month at Aranlaw Mrs C put on 2 kilos in weight and her enjoyment of food seemed to be returning.

Mrs C started to sing along to music we played when she recognised the tune and we noticed that she was now much more awake than when she had first arrived. Our Activity Co-ordinator spent time with Mrs C’s daughter obtaining a full life history and recording significant events so that we could all be aware of what was important to Mrs C and what she might enjoy reminiscing about or any activity we could include her in. We discovered that Mrs C had been a very proficient knitter; until about three years ago she had still managed to knit blankets for charity. We realised that Mrs C could no longer complete this task but we gave her some different textured and brightly coloured balls of wool and were amazed by how much enjoyment she got from just moving the balls around on the table or in stroking the wool against her face. Mrs C appeared to be very content at Aranlaw; over the next nine or ten months her physical health problems decreased and she gained weight and enjoyed her food. Mrs C’s daughter told us that she was able to enjoy the time she spent visiting her mother for the first time in several years.

Mrs C’s dementia did progress and for the last six months of her life she was in Stage 4 of her illness. At this stage the person is often very withdrawn with their eyes closed as if sleeping and they make little movement or attempts at vocalization. This was how Mrs C was for much of the time although we still had times when her personality was still very evident; when she might laugh out loud at something she saw or heard and have us all laughing with her, even though we might not know what had amused her so much!

Mrs C was now very withdrawn from everyday life at Aranlaw but we did not want her to miss out on the things we knew she had loved so when her daughter bought her a recliner chair we would wheel her into her usual position in the lounge for periods of the day and she could still be seen holding her balls of wool against her cheek or sometimes she would hum along to her favourite tunes. If we held her hand when the music played she would enjoy it if we tapped out the tune together. Mrs C really loved having her hands massaged; her whole body would visibly relax and she would smile and open her eyes when spoken to during her treat

Mrs C passed away at Aranlaw with her daughter and other family members present; our in-depth knowledge of Mrs C and all that mattered to her enabled us to provide her with the care she needed until the end of her life. Mrs C’s daughter continues to pop in and see staff and residents at Aranlaw; she tells us that she enjoys the opportunity to reminisce about her mother with people who knew her for the wonderful person she was.