Can over-caring 'cause bigger decline' of people with dementia?

Care staff and families need to be mindful they don’t fall into the trap of over-caring for people with dementia, warns dementia care expert, Anne Kelly.

The dementia nurse believes people with care needs ‘can become over-reliant on their carers’, with well-meaning family members and staff doing everything for the person with dementia rather than enabling them to do it for themselves. This 'over-caring' can then lead to physical and cognitive decline.

Ms Kelly, who has been a leading figure in promoting a Montessorian approach to care in her native Australia, believes people with care needs should be as independent as possible to protect their dignity, offering a real purpose for living.

She says: “Dementia can make people feel worthless and miserable and the routines of the care home can so easily rob them of their independence and dignity.

“The Montessori approach can dramatically improve their well-being and enable them to do things for themselves again rather than having things done for or to them. It empowers not only patients but carers and families too.”

Letting people with dementia 'self-initiate' their own activities

Ms Kelly points out that care sector leaders can be reluctant about the concept of Montessorian care for older people, as essentially it was a learning system designed for very young children. For the past few decades, the care industry has been trying to get away from the idea that older people shouldn’t be infantilized.

However, the main ideas behind the Montessorian system for early-years-aged children are to encourage independence, be led by a child’s interests, praise a child for things they are good at, and most importantly, let them do things for themselves within a risk-assessed environment.

Ms Kelly believes these aspects of Montessori thinking can tranform the quality of life for those with dementia by helping them care for themselves and their community.

Activities play a vital part in achieving this.

Many activities, for example, can be 'self-initiated' according to Ms Kelly. She says: “If people have activities in their environment, they will self-initiate those activities which means you don’t need to have staff doing them. If you have activity groups run by people with dementia there’s no staff member required.”

‘The moment someone requires assistance with food they start going downhill’

Another fundamental aspect of Montessori philosophy is to observe in order to understand the individual to offer holistic care designed for that individual. Ms Kelly says she spends a lot of time just sitting and watching the person; trying to find out what they can and can’t do. She says she asks herself: “Can they find the toilet, do they know where their room is, can they dress themselves?”

These observations need to be carried out at regular intervals to look out for areas of decline. It can then be assessed whether the individual is able to retrieve some of their previous physical and cognitive functions through meaningful activities, exercise and repetition.

Self-feeding is a particularly important area. Ms Kelly advocates that independence should be retained as long as possible with feeding, to try and avoid further decline in health and wellbeing of residents.

Ms Kelly explains: “We need to keep people feeding themselves for as long as possible because the moment someone requires assistance with food they start going downhill.”

The nurse believes care home routine can be very task-orientated. Due to time constraints, residents get automatically fed by staff.

She says: “I went to one care home and there was a woman with advanced dementia who was able to pick up a spoon and put it to her mouth, but a month later she wasn’t able to.

“She had to stoop down to the spoon, so I asked staff what was going on and they said, ‘she’s having her breakfast’, to which I replied, ‘yes she is, but look at how she’s eating - she’s losing the ability to use her spoon’.”

To help the resident tune her fine motor skills, Ms Kelly designed a repetitive set of tasks which involved the resident moving balls into buckets.

The effects were immediate with the resident reportedly eating her lunch with the spoon raised to her mouth as previously.

Residents never say ‘I don’t care if you feed me’

Residents with dementia don’t want to be spoon-fed and will take part in motor skills exercises if they know what they are for, and in all likelihood, they will enjoy them too, according to Ms Kelly.

The dementia nurse says: “People say to me ‘well how do old people feel having to do that for themselves“, and I explain I haven’t had one person with dementia say to me, ‘I don’t care if you feed me’.”

She adds: “People with dementia will hang onto their independence for anything because they are losing so much, so you say ‘Jack, if you keep doing this activity it is going to help you keep feeding yourself, you don’t need to have us keep feeding you, do you?’

Unlike with traditional care home activities, many of the activities designed to enable residents to do things for themselves, are repetitive - although some variety can be introduced if residents get too bored with one particular set of tasks.

Ms Kelly believes that residents with dementia will pursue these repetitive tasks with the same relish as a preschooler in a Montessori setting.

She says: “Children in a classroom will try and do things over and over and when they are bored they will tell you. With traditional activity programmes in residential settings there is this tendency to go, ‘well we did that last month, so we won’t do it this month, whereas in a Montessori environment we repeat activities over and over again because repeating activities is how people get good at them.”

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