Making a move to a new environment is fraught with emotion and uncertainty for anyone, but for Alzheimer’s and dementia patients, unfamiliar surroundings can cause anxiety, agitation and agression.
AnnaMarie Barba, the director of Summer House, a memory care unit within Walnut Village continuing care retirement community in Anaheim, Calif., has worked with Alzheimer’s and dementia patients for many years and in various senior living settings. She is always looking for new techniques to calm patients’ minds and redirect their attention during times of stress.
Attempting to complete daily activities can be difficult enough for dementia patients. When it comes to adapting to an entirely new environment, the challenge can result in extreme frustration. “For those suffering from cognitive impairment, learning new things can be over-stimulating, creating stress and agitation,” Barba explains. “I started thinking, why not use something that’s familiar to them to help redirect? Perhaps something that has personal meaning or that they’ve enjoyed in the past as a way to help them adjust?”
What Is Redirection?
Redirection is the process of shifting attention away from whatever is causing anxiety or distress and toward something more soothing. In training dementia caregivers, the Alzheimer’s Association outlines the process of changing the situation, task, the environment or the topic of conversation to manage and minimize behavioral symptoms. The act of redirecting has proven to be an effective technique that does seem to have a soothing, therapeutic effect on dementia patients.
Barba initially relied on this concept to develop and implent a redirection strategy to help seniors make the adjustment to her facility, however the practice has proven to be effective in reducing dementia-related behaviors over the long term. Any time a resident at Summer House is irritated or anxious, Barba uses redirection and relearning techniques to focus their attention on familiar activities or tasks that the person used to enjoy in the past.
Recreating Familiar Surroundings Assists in Redirection
To formally implement redirection techniques, Summer House created immersive “life skill stations” in the community. These areas are set up with props to look like a baby nursery, an office space, a workshop and other classic settings that residents may have frequented throughout their lives. Each simulated environment serves as a visual reminder of past roles, careers and life events. For example, the baby station has a crib with dolls, a stroller, a rocking chair and other items commonly found in a nursery. By gently being guided to this life skills station when agitated, a resident may suddenly remember her role as a mother. She may sit in the rocker and begin a conversation about raising her children. Redirecting the mind by focusing on familiar surroundings brings back memories of happier times and often stops fretful behaviors.
“With Alzheimer’s and dementia patients, we are constantly re-acclimating them to their environment. Our goal is to make life more familiar through sight, smell and touch,” Barba says. One Summer House resident spent a lifetime gardening and planting roses. To help her remain engaged and maintain a sense of purpose, she has been given her own garden plot to tend to. When she is feeling confused or upset, staff members know to direct her to her plants and work through gardening techniques together.
Another resident enjoyed playing the piano in his youth. Today, he plays the community piano and even puts on mini-concerts for the other residents. “Relearning an activity is more valuable for Alzheimer’s patients than learning a new one,” Barba posits. “It still provides a challenge, but it is one that’s within their comfort zone.”
But does the technique really work? According to Barba, the proof is in the subtle signs she sees in her residents. “It’s often the non-verbal clues that show the dementia-related behaviors are subsiding. Their shoulders start to relax, their fingers stop fidgeting and their eyes become more focused.”
Redirecting techniques have even reduced medication usage for some residents at Summer House. Instead of giving a patient medication for anxiety, they’ll be directed to their flower bed, piano or “office space.” They’ll become refocused and redirected and will calm down naturally.
Redirection and Relearning Must Be Personalized
Redirection techniques must be tailored to each individual. So, Barba meets with each new resident upon their arrival to learn as much as she can about that person: his or her favorite music, foods and hobbies as well as important personal and family events. She then develops a unique care strategy focused on activities that have played a significant role in their life.
Much of the initial input comes from family members. “I’ll ask specific questions about their loved one’s life, like what their hobbies are or what their favorite thing to do on a Sunday is,” explains Barba. This is one of the many benefits of families actively participating in the memory care selection and move-in processes and continuing to visit regularly after the transition is complete. Visitors can help staff fill in valuable knowledge gaps about their residents, which has the ability to greatly enhance the care they provide.
Understanding the Causes of Dementia Outbursts
The Copper Ridge Institute, a residential care community for those with Alzheimer’s and related dementias in Sykesville, Md., is also sensitive to their residents’ abilities and limitations. “Outbursts and agitation could be a sign that a current activity is too difficult or too overwhelming for a patient,” says Cindy Steele, RN, BSN, MPH, the nurse scholar and behavioral management specialist for Copper Ridge and assistant professor of psychiatry at Johns Hopkins University School of Medicine. “Switching to a less complicated and more familiar task may lessen their agitation because it provides a sense of accomplishment, morale and self-worth.”
Steele emphasizes that it is important to get to the bottom of why the person is having an angry outburst and address whatever is causing it. For example, a patient may be unsuccessfully trying to communicate pain or discomfort stemming from a physical problem, such as a headache or urinary tract infection (UTI). Or it may be something as simple as their surroundings being too cold, too hot or too noisy. Treating the underlying issue(s) is the best way to alleviate dementia-related behaviors.