Observing people with dementia in their environments

Sometimes when a person with dementia has problems communicating, observing them in their environment can tell you more than a direct conversation. 

Pros and cons:

Useful for: gaining insights to answer questions about people's experience such as

  • What are people doing or trying to do?
  • How exactly are people doing this?
  • How do people describe what's happening?
  • How do people understand what's happening?
  • What assumptions are being made, and who is making the assumptions?
  • What do I see happening?
  • What have I learnt from my notes about what I observed?
  • Why did I note down the things I did?

The last question is a reflective one. Qualitative research is subjective and we all have biases, so it's important to do your best to be self-aware in trying to be as objective as possible.

An observational tool could be used to evidence that people with dementia are supported to engage in activity that is meaningful to them. It can demonstrate

  • that they are being supported to maintain existing skills and try new activities where appropriate
  • have opportunities to socialise with staff and other service users whilst doing so.
  • that independence is being supported and people with dementia are being treated with respect and valued as they would be outside of the service.

An observational tool can be used to identify areas in which outcomes are being achieved and potential areas for development. It can help staff to reflect on the way their service is working and support a continuous improvement cycle. 

Downsides and risks: take great care in your ethical considerations so as to ensure you do not breach privacy, confidentiality and consent, etc.

How to conduct observations 

Your approach will depend on how formal the observation part of your process is. In the example below of combining observation with direct feedback in a hospice, the approach was simple and informal.

For a more forma approach, you might like this in-depth guide by Nick Fox, Institute of General Practice, Northern General Hospital, Sheffield. 

Real-life examples featured in this resource

Observation used to evaluate experiences of people with advanced dementia

Observed walk through in PLACE assessment at Keech Hospice, Luton

Useful Links

Stories of Dementia research report: an evidence-based investigation into the care that people living with dementia receive following an acute hospital admission (2019)