Know the person who is living with Dementia

Life Stories

Life Stories

Carey Bloomer RGN, Nurse Manager – Marches Care Ltd, uses two case studies to highlight that environmental and social engagement can be more effective in relation to enhancing quality of life than pharmaceutical interventions. Events of the past are extremely important and can very often have a significant bearing on how to care for someone.

The Challenge

A person with dementia who is agitated is highly likely to have a poor quality of life; this can be very stressful for the person with dementia, for the people living with the person, the staff caring for the person and for their family and friends. At Marches Care Ltd we felt it was important to try to improve the quality of life for the person with dementia; reducing the need for anti-psychotic drugs and sedation was a key objective for us.

What was the difference we made

Our approach ensured that:

  • We knew the persons history which helped us to understand any possible reasons for the challenging behaviour or agitation.
  • Our employees were more confident to work with people and think creatively to find person centred solutions.
  • The person with dementia had a fulfilling role in life with their needs met, making their life worthwhile.
  • We were able to demonstrate a reduction in the use of sedation and anti-psychotic drugs.
  • The family and friends could see an improvement in their loved one’s quality of life.

How we did it

Mary had been diagnosed with severe Alzheimer’s and was admitted from the psychiatric unit to our EMI unit; she had been an inpatient in the local hospital for 8 months.

Prior to admission to The Marshes EMI unit, Mary was prescribed medication including anti-psychotic medication and sedation both day and night. An assessment undertaken prior to admission outlined that she was disruptive at night and needed sedation as she would call out and shout for help, cry and become very distressed.

Staff observed that Mary accepted all care well and her diet and fluid intake was very good. During the day with constant reassurance and positive behaviour techniques Mary became quieter and started to interact with the staff and other clients. The anti-psychotic medication was stopped along with the day time sedation. After 3 weeks, Mary had settled into her new home and the days were very easy for Mary but the nights still were challenging she would cry out and shout if the door was closed or the lights dimmed.

We asked Mary’s family to complete a life story book about Mary; we use life story books to enable us to understand the person and in situations where the resident cannot recall much of their past we ask relatives and friends to help fill it in.

When Mary’s son returned the book it was discovered that she had been in an orphanage in Scotland as a child. This raised a few interesting points and in probing further with the family we discovered that as a punishment the children would be locked in a dark cupboard under the stair case for hours if not overnight. We wondered if this could be linked to Mary’s disturbed nights. We decided to leave Mary’s lights on full during the night and kept her room doors opened, even the toilet door and the wardrobe doors were kept open. We found that Mary then slept peacefully all night, this lead to her night sedation being stopped. On the occasions Mary woke during the nights she was given gentle reassurance to help her back to sleep.

The impact of using Life Stories can be both negative and positive for families. Mary’s family felt terribly guilty; they felt that they should have realised the problem earlier. The staff had an important role in reassuring the family that it was not their fault; however the family were thrilled to have back a contented and happy mother.

How we did it

Doris was admitted from the psychiatric unit at the hospital. Her assessment prepared prior to her admission indicated that she wandered around the ward, looking busy and worried, and that she rarely sat down and did not do so even to eat. She wandering purposefully all day and was exhausted by early evening.

Doris had no family but she had a very good friend who agreed to help us complete her life story book. We found that Doris had been an accounts clerk until she was 72, she had worked all her life and had only gave up work when she had a stroke.

Doris would often be found in the nurses’ station tidying up and ‘tutting’ at the mess; initially we encourage her to help. She would pile papers up and generally feel as though she had a role in the home. Unfortunately we found that Doris was also good at removing papers from the office so it became increasingly difficult to allow her to help.

Without a role Doris would wander up and down the corridors, as a team we discussed how to give Doris a role within the home that would be meaningful to Doris but did not disrupt the smooth administration of the home. We decided Doris could “do the accounts”. We gave Doris a large button calculator and gave her a space where she could sit each morning to "do the accounts". At 1 pm Doris would stop to have lunch for an hour, and then she would start back on the accounts at 2pm, she finished each day at 5 pm. We found this familiar routine gave her a feeling of self worth and the place within our community that she craved. On a Saturday having done the accounts all week she Doris felt she could justify her lie-in until 9am. Doris stopped wandering and her distress disappeared.