There are 1.5 million people in the UK who are either living with dementia or caring for those with dementia. 25 million people in the UK have a close friend or family member with dementia. They are looking for organisations that show support and understanding for people with dementia. Don’t underestimate how important your knowledge and understanding might be.
What is dementia?
The word dementia describes a set of symptoms that include memory loss; difficulties with thinking, problem-solving or language; and changes in mood or behaviour. There are many types of dementia; different types affect different parts of the brain, and so inevitably symptoms vary from person to person. The most common forms of dementia are Alzheimer’s disease and vascular dementia.
Dementia is caused by damage to the brain (whether by disease or injury); it is not an inevitable part of ageing, as many people believe. The symptoms will gradually worsen as it progresses and there is no cure. Dementia mainly affects people over the age of 65 but younger people may also develop dementia.
How do I know if someone has dementia?
There are no obvious physical signs that show someone has dementia. Someone accompanying a person with dementia may indicate to you that the person they are with has dementia. (Some people refer to ‘memory problems’ rather than using the word ‘dementia’.) If they do, try to continue to involve the person with dementia directly in the conversation.
The common symptoms of dementia are:
- Memory loss – some people remember things from a long time ago much more easily
- Communication problems – including problems finding the right word for things. People might also struggle to follow a conversation
- Difficulties with thinking things through and planning
- Confusion about time or place
- Sight and vision problems
- Unusual emotional behaviour or responses – becoming sad, angry, frightened or upset
- Restlessness or disorientation – in unfamiliar or noisy environments people with dementia may become confused or ill at ease
How you can help
You already know the importance of good customer service. The following tips may help you assist someone who is experiencing some of the difficulties associated with dementia.
Offer understanding and reassurance
- Be patient; allow the person to take their time as rushing them will increase confusion
- Be friendly and smile
- Respond to the emotions they are experiencing
- Ask direct questions, rather than “What would you like me to do?”
- Make eye contact; gain the listener’s attention before you begin talking by calling them by name
- Never stand too close or stand over someone to communicate; position yourself at eye level when talking to them
- The person should be able to see your face clearly; sit facing them and do not cover your mouth
- Speak clearly and calmly; don’t shout
- Use short, simple sentences; don’t give too much information at once, and ask only one question at a time
- Speak at a slightly slower pace; and give them time to process what you have said and respond
- Don’t talk to them as you would to a young child; those with dementia are grown adults and so should be treated as such
- Listen to what the person is saying, and give them plenty of encouragement
- If you have not understood fully, tell the person what you have understood and check with them to see if you are right
- If possible, use visual clues
- Use humour whenever possible though not at the person’s expense
- Sometimes holding hands will encourage the person to respond when all else has failed
Be aware of the environment
If your surroundings are noisy, busy or there are sounds that might be distracting, this can make people with dementia uneasy. Try to reduce background noise or offer to move to a quiet place to speak further.
Dementia affects everyone differently so you might be able to suggest adjustments or put relevant practices in place. A small action may make a significant difference.
Offer practical support
- Somebody with dementia may feel anxious about their ability to carry out tasks or activities. Try not to put them under pressure: break down tasks into smaller tasks, supporting them along the way
- Be patient: tell them there is no hurry
- If someone forgets what you have just said, repeat your sentence patiently as if you had not said it before
- If the listener has difficulty understanding what you are saying, find a different way of saying it
- Provide a quiet place where it is easier to offer one-to-one assistance
Dealing with a difficult situation
- Stay calm
- Reassure the person with dementia or anyone with them that they are not under any pressure
- If the situation remains difficult, ask a colleague for assistance
Assessing the ‘mental capacity’ of someone with dementia
Mental capacity is the ability to make a decision, whether that is a decision which affects daily life, or to undergo a surgical procedure, or to sign a legal document such as a Will or Power of Attorney.
All adults are assumed to have capacity unless there is evidence to the contrary. Capacity is “time and decision specific”: that is, a person’s ability to come to a decision is assessed in relation to the specific choice that has to be made at the time when it needs to be made. A person is deemed to be mentally incapable if they cannot communicate their decision.
The two-tier test for mental capacity is:
- Does the person have an impairment of, or a disturbance in the functioning of, the mind or brain? If no, the person is mentally capable. If yes, consider the second tier.
- Does the impairment or disturbance mean that the person is unable to make the specific decision at the time that it needs to be made? If no, the person is mentally capable. If yes, the person is mentally incapable.
A person may have capacity to make some decisions but not others. All practical steps should be taken to taken to help the person make their own decision, such as:
- Explaining or presenting the information in another way
- Choosing a location where the person feels more at ease
- Choosing a time of day when the person's understanding is better
- Obtaining the help of a family member who may be able to assist with communication
- Postponing the decision if the incapacity is temporary
Separate from, but linked to, mental capacity is ‘undue influence’. This is where a person has the mental capacity to make (or not make) a decision, but is forced or coerced into making that decision by someone else. As such, whilst obtaining the help of a family member who may be able to assist with communication can be very useful, this must be balanced with the need to ensure that it is the person who needs to make the decision who is doing so of their own free will. This may well involve seeing that person alone for at least part of the meeting.