An Overview of Dementia and How To Interact With Those Affected

This week we are continuing our series on causes of altered mental status.  A very common police response involves interaction with elderly persons whether it involves shoplifting, abuse or neglect, wandering, or wellness checks.  In this Medical Monday we will talk about dementia.  We will explore what dementia is, the progression of dementia, and how to best interact with people affected by dementia.  

Many people think that dementia is a disease experienced by elderly people before it progresses into Alzheimer’s disease.  That thought process is incorrect.  Dementia is NOT a disease, but rather a generalized term that is commonly used to describe deficits in how the person communicates, thinks, and how they remember things.  It is important to note that dementia is not a normal process of aging.  Dementia occurs because of damage to brain cells.  Not all elderly people will experience dementia.  

Dementia is generally split up into four different phases.  They are:

• Mild Cognitive Impairment – Most of us experience this anyway.  This is characterized as general forgetfulness.  Just because you experience this does not mean that it will develop into full blown dementia in all cases.  
• Mild Dementia – With this phase people will occasionally experience memory loss, getting lost, and confusion.  
• Moderate Dementia – In this stage people will need assistance with simple items such as getting dressed.  These people can also be easily agitated and be overly suspicious.  (I guess this could also be most cops!!)
• Severe Dementia – The people in this phase will need full time care.  They are typically unable to control bladder function, cannot speak, and have difficulty with even holding their head up.  

It is common in a person with early onset dementia to have difficulty in finding the right words.  It is also common for them to become easily confused, disoriented, and oftentimes they will be repetitive.  The best advice that I can offer all law enforcement officers is to be patient.  This can be difficult at times for us for a myriad of reasons.  Just think of the phrase “slow is smooth, smooth is fast.”  This phrase definitely applies here.  Here are some additional tips for interacting with people with dementia:

• If feasible, approach from the front and attempt to avoid startling the person.
• Explain who you are and that you are there to help.
• Maintain a calm and friendly demeanor and voice. Remember to smile. 
• Speak slowly and allow around 15-30 seconds for a response.  
• If the person becomes agitated, try changing the subject.  This distraction technique is very beneficial in establishing a rapport as well as keeping the person calm.  
• Do not automatically assume that because they are elderly, they are hard of hearing.  
• Ask simple questions.  Yes or no questions are optimal.
• Avoid correcting the person or “reality checks.”  This will most likely lead to the person becoming more confused or aggravated.

I hope that you were able to gather some useful information from this Medical Monday.  As always, if there is something that you would like to add, or if you have any questions, please let me know in the comments below.  I look forward to hearing from you!