Here are some tips I picked up today at “Accepting the Challenge,” a two-day seminar sponsored by the LOA Area Agency on Agency, the Adult Care Center of Roanoke Valley and the Roanoke area Alzheimer’s Association.
The speaker was Teepa Snow, a Raleigh, N.C.-based occupational therapist who lectures nationally — and quite dynamically — on the topic of dementia care.
Snow’s reputation as a dementia expert brought out a room full of area caregivers and folks who work with Roanoke’s elderly population. “Dementia still has a stigma and caregivers too often think they are all alone,” Snow said. “It’s like cancer used to be years ago.”
Here are some highlights of her Wednesday talk, with thanks to Roanoke social worker Leah Mayne who took notes for me when I had to leave for a while.

1. Don’t force yourself or your agenda on a person with dementia. “If something’s not working, stop.” The person with dementia can’t; don’t argue with that. The caregiver should figure out another approach instead. “It’s like learning to dance — but you’ve got to let them lead.”
2. Having the right dementia diagnosis is important — there are several different kinds and different treatments for each one. Also: the earlier, the better. Only 23 percent of all dementia cases are diagnosed in the early stages. “There is still a misunderstanding in the medical community that it doesn’t matter, or that’s just a natural part of getting old. “Too often doctors will give a patient a sample of Aricept and dismiss the symptoms as being normal signs of aging.”
3. Approach people with dementia with care, giving first a visual cue (a hand wave), then a verbal cue (“Hi, Jane, how ya doing?”) and finally a touch cue (Snow demonstrated this by crouching down to the person and slightly to the side in a “supportive stance,” holding the person’s hand with her palm on his palm, her hand on the bottom facing up). Use this introduction before attempting to do a task, such as giving liquids or buttoning a shirt.
4. The United States has the highest rate of dementia in the world, with 5 million cases and a 10 percent increase in cases in the past 10 years. Particularly troubling: The spike in numbers of younger people with the disease, including those in their 30s and 40s.
5. The more intelligent the person, the likelier he/she is to mask the signs of dementia. Experts believe the brain is damaged by dementia 5 to 10 years before the first behavioral symptoms are exhibited.
6. Remember, it’s a brain disease — not unlike a kidney disease or congestive heart failure. “People with dementia are doing the best they can at that moment. It’s not their fault; it’s brain failure. Would you tell someone with congestive heart failure to breathe better?”
7. Dementia is often misdiagnosed when the actual culprit is depression or delirium. “If you’re not a strong advocate, you’ll get bad care.” Demented people in the emergency room with signs of delirium are often given sedatives instead of tests for the five most common causes of delirium: urinary tract infections, dehydration, electrolyte imbalances (often caused by taking too many medications), bowel impactions and stroke. “Too often the physical cause gets ignored. People die every year because they don’t get the care they deserve.”
8. Use the faculties a person has left. Snow showed a video of a woman who had difficulty navigating a hallway – until the aide working with her thought to sing the patient’s favorite church hymn. They ended up walking down the hallway singing and holding hands the entire time. “You have opportunities to create moments of joy, or you can create moments of disaster and hardships.”
9. Don’t approach a person with dementia from behind. Make sure they see you before you talk or touch them. Avoid touching forearms because elderly folks’ forearms tear/bruise easily. Remember that their peripheral vision has diminished too, so it’s best to put your face directly into their line of vision when speaking to them.
10. Figure out how to laugh. People with dementia don’t need people around them who can’t laugh at the situation — and themselves.

— Beth Macy