'Why do they do that?': Alzheimer's expert Teepa Snow educates caregivers about interacting with dementia patients

  • Posted: Tuesday, May 27, 2008 12:01 a.m.
    UPDATED: Saturday, November 22, 2008 12:11 a.m.

By Katie Scarvey
The Salisbury PostWhen Teepa Snow was 7, she had to make sure that supper was on the table for her grandfather promptly at 5 p.m. ˇ meat loaf, macaroni, and green beans ˇ or he'd get upset.
She knows now that her grandfather had dementia, although back then, she says, "we thought all old people got like that."
Friday, Snow spoke to a group of health care professionals at Abundant Living Adult Day Services. Snow has been in the dementia care field for 28 years.
"Tie 'em and dry 'em," she said, summing up the state of Alzheimer's care in her early years as a professional. "That's what we did all day long."
The "tie 'em" refers to the restraints that were typically used with dementia patients, who were often heavily drugged. The "dry 'em" refers to changing adult diapers.
Fortunately, care of those with dementia, Snow says, has changed dramatically since then.
Sponsored by Abundant Living and the Lutheran Home at Trinity Oaks, Snow's interactive training session was open to area nursing and assisted living facilities staff at no charge.
Snow, a well-known dementia care and training specialist, began by discussing the difference between the minor indignities of agingˇ normal forgetfulness, slowing of cognitive function ˇ and the more serious symptoms of dementia.
An animated presenter, Snow engaged her audience frequently and dramatically by taking on the role of a person with dementia.
Snow grabbed her audience's attention early on, eliciting plenty of smiles as she shuffled around the room, smacking her lips.
Snow's ultimate goal, however, was not to entertain but to educate caregivers, to teach them positive ways to interact both emotionally and physically with patients, to give them practical ways to minimize stress and help patients maintain dignity.
"She is without doubt the most dynamic and awesome presenter I have ever seen," says Barbara Garwood, executive director of Abundant Living Adult Day Services.
As Snow took on the persona of someone with Alzheimer's, she mimicked the behaviors familiar to those who deal with the disease: confusion, paranoia, hostility, belligerence. Around the room, there were nods of recognition.
Snow didn't shy away from bringing the most difficult aspects of the disease to the forefront ˇ like impulse control behavior caused by damage to the brain. That might include ugly racial slurs coming from the mouth of a person who never exhibited such behavior before.
Her advice for caregivers is based not only on practical experience but on an understanding of the organic changes that occur in the brain of someone with dementia. In her presentations, Snow shows her audience how the Alzheimer's brain differs dramatically from the normal brain ˇ and how the damage wreaked by dementia cannot be fixed.
"They're doing the best they can," she says.
"We gotta stop yellin' and fussin' with people for what they can't help."
The daughter of an Alzheimer's patient should not pressure her mother to recognize her, saying, "Which one am I, Mama? Which one?"
"She's not holding out," Snow says. "This is brain failure."
If an Alzheimer's patient says that someone stole her purse ˇ when the most likely scenario is that she misplaced it herself ˇ arguing and reasoning and trying to yank her back to reality is not the approach to take.
When an Alzheimer's patient asks a question, often, a caregiver's truth-based answer is simply not helpful, given the nature of the disease.
"You are used to answering questions," Snow told her audience.
"Stop answering questions and start meeting my (the patient's) needs."
Snow's approach: If a patient asks, "Have you seen my grandmother?" the most helpful response is not, "Your grandmother isn't here," or even "Let's go look for her," but simply to echo what she's told you.
Say: "You're looking for your grandmother," and follow up with: "Tell me about your grandmother."
Caregivers need to listen more, Snow said, so they can help patients fill in their memory gaps as the disease progresses.
Allowing patients to talk is important, she says. Patients may be confused, but they still need to feel connected to the people around them.
Don't try to correct ˇ go with the flow, Snow said. Being "right" isn't necessarily helpful. Empathy, for Snow, is more important than trying to impose a reality that is long gone.
"We've got to get better and smarter at how we respond to these episodes," says Snow, who believes that when caregivers manage their actions and words, they can change for the better the outcome of interactions.
Snow also helped her audience understand how to physically approach patients with dementia ˇ valuable information for nursing home staff who may have many such interactions in a day.
Caregivers need to respect a patient's personal space, just as they would do with anyone else, Snow said. Patients are easily startled and frightened by caregivers who are not aware of their needs.
"Greet before you treat," Snow said.
There are 70 different types of dementia, Snow said. Alzheimer's is by far the most common, accounting for 60 percent of all dementias. Alzheimer's has an average age of onset of 75 and a progression of 8-12 years.
Early onset dementia ˇSnow prefers the term "young onset" ˇ can strike in a person's 30s or 40s. Snow spoke of a 37-year-old woman ˇ a former gymnast with three children ˇ who is in the middle stage of dementia. Young onset dementia is more aggressive, and those diagnosed can expect only 3-5 years, Snow said.
Dementia, she believes, is a thief that steals many things: memories, impulse control, the ability to use language and understand what others say, the ability to care for yourself and move around safely.
Although sometimes family members are in denial about the symptoms, it's important that dementia be diagnosed early, since some causes of dementia can be treated. However, only 20 percent of dementia is diagnosed in the early stages, Snow said.
Contact Katie Scarvey at kscarvey@salisburypost.com.



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