When researching and learning about how to care for patients with dementia, you will often come across the concept of “R’s.” Some will speak about seven R’s, some five. Here at Protea Memory Clinic we like to refer to the four R’s; namely Reassure, Reconsider, Redirect and Relax. These four R’s act as a guide for those caring for a patient. They show how best to maintain a stable environment for the patient as well as a helpful mindset for the care-taker. Below we will break down and summarise each of them.
Reassure
Those that suffer with dementia will spend a lot of time confused, particularly when routines or surroundings change. In their confusion they may become difficult in a number of ways. They may shift from their usually amiable selves to lashing out and being belligerent. They may suddenly start to panic and become incredibly anxious. When this happens the first step should always be to reassure them that they are safe. Their actions are a defence mechanism founded in suddenly feeling insecure and in danger, so reassuring them that you are there through simple actions like talking calmly to them, holding their hand, providing them a sense of familiarity, can go a long way to calming them down when they appear to be getting worked up.
Reconsider
It is crucial to remember that each and every person is an individual and that this extends to those with dementia as well. People don’t suddenly become carbon copies of each other just because they have a diagnosis. This means that caring and treating a patient can’t be a simple broad strokes approach; care needs to be made to know what works for the individual. While one patient may respond incredibly well to spending more time in the garden, another may find this overwhelming to their senses. If something doesn’t seem to be working for a patient, reconsider your approach. But as an extra note for the care-giver; if you find yourself getting frustrated that the person you are caring for seems to be getting worked up more and more often, perhaps reconsider things from their perspective. What may be perfectly acceptable to you, such as a sports game playing on the TV on full volume, may be like nails on a chalkboard to them. With a simple change in perspective, there can be a lot more harmony in the house.
Redirect
Redirection is the natural progression of the Reconsider step. While the former step is focussed on getting to know the patient as an individual, this step is all about acting on what you have learned. It’s about finding the triggers that can cause a patient to become confused or agitated and redirecting that energy before it has a chance to manifest. For example, knowing a patient can become quite aggressive when they become hungry, even if they don’t realise they are, can be mitigated by scheduling their mealtimes close enough to each other or by providing snacks when you can see them becoming antsy. If you know your patient gets overwhelmed easily when there are too many people around, provide a safe space in the house they can go to when you can see it becoming too much. This will take time and effort but once you are able to recognise the triggers and when they are starting to take effect, you can be proactive with your approach.
Relax
All the previous steps culminate in this final step, providing an environment where the patient is able to relax. Everyone becomes agitated throughout the day and longs to be able to relax at home where they feel safe. The reason you feel safe is because it’s your home with your things and stamped with your identity. For most patients, once the disease has progressed sufficiently, they are unable to live in their own home anymore and must either move to a facility or to a family member. If the surroundings are completely unfamiliar, no matter how much of an effort you take to make them feel welcome, they will become anxious. They will feel like a stranger. But doing something as simple as decorating their new room to mirror their old one can make it feel like a haven where they can escape to relax. It won’t be quite the same and they will still have to leave their room, but having somewhere to go back to will help immensely. In addition to this, providing the means to play their favourite music can do wonders. The therapeutic effect music has can never be overstated.
We hope this brief summary gives you some small guidance on where you are and what to do on your own journey. In the end, every patient needs the same thing we all need: safety, stability and to be known as an individual. Knowing this should help the rest of the journey fall into place.
