2. Supporting someone with memory loss
If the person's forgetfulness could put them at risk in any way, you may be able to take precautions that can help them live safely. These might include leaving a written reminder by the door so that they don't forget their keys when they go out. Or it could mean fitting a device that cuts off the gas supply if they put a pan on the stove and then forget about it. However, on the whole, it's important to help a person continue to do things for themselves and to remain independent. Those around the person with memory loss should try to be flexible and patient as far as possible. They should also encourage the person with memory loss to remember what they can without making them feel pressured - using frequent reminders for example.
Although memory loss affects each person differently, there are some characteristics that are relatively common in people with dementia. There are four common areas in which people with memory loss experience difficulty:
- remembering events
- taking in new information
- recognising people and places
- separating fact from fiction.
Most people with dementia remember the distant past more clearly than recent events. This is because memories tend to decline in reverse order to when they were experienced. People will often have difficulty remembering what happened a few minutes or hours ago, but can recall, in detail, life when they were much younger. However, as the condition progresses, even these long-term memories will eventually decline.
People with dementia are often understandably anxious about forgetting their past. This is particularly concerning in the early stages of the condition. Those around them should try to provide opportunities to share memories by looking at photographs, letters and souvenirs together. This can help jog the person's memory, and may help them feel more calm and in control. Talking about the past can be enjoyable for the person with dementia. It may also help the person retain their sense of who they are.
Sometimes, a person with dementia may seem to be living in the past and insist, for example, that they have to wait for their mother to take them to school. If this happens, those around them should try to relate to what the person is remembering or feeling, as this is their reality, rather than contradicting what is being said.
Not all memories are happy ones. If the person seems very upset by certain memories they will need the chance to express their feelings, and to feel that they are understood. If they seem sad, it can help to encourage them to talk about it and offer comfort, rather than changing the subject.
Taking in new information
People with memory problems will find it very hard to absorb and remember new information and events. In some people with dementia, the part of the brain that allows new information to be processed may be damaged and they may have no recollection of hearing a piece of information before. Because their brain has not retained the information they have been given, they may believe that this is the first time they have heard it.
The following tips will help:
- Keep information simple, and repeat it frequently.
- Break new activities down into small steps.
- Try to enhance what is to be remembered by using words, pictures, gestures, calendars and notice boards.
- When asking for information give cues and context rather than using vague questions. For example, ask, 'Did you have breakfast this morning?' instead of, 'Have you eaten?'
- Routines and keeping things the same are very helpful. Try to begin any new routines as soon as possible, to give the person time to get used to the new way of doing things.
- Try to avoid telling the person that they have had this information before.
Recognising people and places
Someone with dementia may eventually lose the ability to recognise people, places or things. This is because the brain can no longer remember things or put information together. The person may even fail to recognise their own reflection in a mirror and think it is someone else. Or they might worry that a relative or close friend is an intruder in their home. It is common to think that a younger relative is their spouse or parent. Some cases of problems with recognition are linked to family resemblance.
This can be distressing for the person, but it can also be upsetting for those around them. If this happens, try to find tactful ways to give the person reminders or explanations. This will reassure them, and will help them to continue to make some sense of their environment and the people around them. Family and friends can find it distressing if the person with dementia no longer recognises them. In such situations it's important that they talk these feelings through with someone they trust.
Separating fact from fiction
As dementia progresses, the person may sometimes confuse fact with things they have imagined. If this happens, try to focus on the feelings they are trying to express, and relate to them, rather than correcting the detail. For example, if they think their bag has been stolen when actually they have just put it somewhere and forgotten, this may make them feel that the world is a threatening place which can lead them to feel insecure. The feeling is true (a sense of feeling threatened) even if the details (the bag being stolen) are not.
It may sometimes appear that a person with dementia is making up stories. However, what they believe to be true may be related to some residual, patchy memories and their way of making sense of these.
No one likes being corrected all the time - it may simply be irritating, but it can also severely undermine a person's confidence. If you continually correct the small details of what a person with dementia is saying, they may become reluctant to join in conversation or activities. For this reason, it is important to focus on the emotions behind the statement rather than the facts or details.
There may be some instances where it is important to clarify or correct what the person with dementia is saying - for example, if they incorrectly accuse someone of something. In this case, it must be done sensitively, in a way that does not criticise, undermine or embarrass the person. However, it is also worth remembering that they may not recall the correction and this might need to be repeated.