The Knack of Quality Alzheimer’s Care

Article by David Troxel, MPH
Edited by Heidi Hill

In the early 1900’s, Dr. Alois Alzheimer met Auguste Deter. Auguste was experiencing memory loss and confusion, was unsure of time and place, and expressed fear, anger and despair over her situation. During one interview, she tells Dr. Alzheimer, “I have lost myself.”
Dr. Alzheimer recognized that Auguste was an important patient – he suspected that something was going on neurologically, and he followed her until her death. She ended her days in what was then known as a “lunacy asylum.” While staff was not deliberately cruel or uncaring to Auguste, it is doubtful that she had any real quality of life.

Moving forward 100 years, we still do not have a truly effective treatment for dementia, but we do know how to give quality care. In David Troxel’s work and writings, he believes it stems from what is called caregiving “knack.” Knack is the “art of doing difficult things with ease,” or “clever tricks and strategies.” It’s about showing love, patience, flexibility, humor and traveling the journey with the person with dementia.

David Troxel, MPH, along with Virginia Bell, co-developed the Best Friends model of dementia care (www.BestFriendsApproach.com). The model suggests that what a person with dementia needs most of all is a friend, a “Best Friend”. He or she lives in a world that can be frustrating and frightening. The person with dementia doesn’t always understand what is happening to them and around them. It’s like being in a foreign country where you don’t know the customs or speak the language.

How do we give good care with the “knack”? Here are some ideas recommended by David Troxel.

PRACTICE LIFE-AFFIRMING COMMUNICATION. Persons with dementia respond to simple things like compliments, “Dorothy you look so pretty in your pink blouse,” or “Dad, no one plays golf like you!” Compliments take almost no time and cost no money, but lift a person’s self esteem and spirits. Ask simple opinions like, “George, do you think my tie matches my shirt?” It can lead to a spirited discussion and shows that you still value them.

DON’T ARGUE. If the person says that President Eisenhower is doing a great job, you should say, “I like Ike too!”

EMBRACE THE LIFE STORY. Professionals in long-term care settings should know 100 things about each person. Knowing someone’s favorite color, favorite sport team, hidden talents—and even how he or she enjoys their morning coffee—allows you to touch memory and establish a relationship. When the person believes he or she “knows” you – it helps them feel more safe, secure and valued.

ENJOY CREATIVE ACTIVITIES. One reason we have challenging behaviors stems from pure and simple boredom. Keeping someone engaged fights depression and helps them “use it or lose it.” Activities that touch the spirit—like being out of doors, being with children, or enjoying creative arts—are recommended. Persons with dementia still enjoy the experience of learning so David teaches a short class on Washington State apples, quilting, US History, or even the Mona Lisa. When you teach a class on the Mona Lisa, for example, it can evoke old memories of a trip to Paris or even be an opportunity for humor, “Should we give Mona Lisa a make-over?”

EXERCISE. Research has shown that exercise may help prevent dementia, but also may slow the atrophy of the brain. Keep persons with dementia as active as possible!

SOCIALIZATION. The brain loves company. Keep a person involved in his or her community as much as possible to provide stimulation and socialization. Adult day centers are embraced by David for this reason. In many ways, they are the treatment for dementia.

LEARN ALL YOU CAN. A well educated caregiver is the most effective. Our field of knowledge is constantly changing. Go to workshops, visit reputable web sites, and become involved with the Alzheimer’s Association and The Neurological Resource Center for more support and knowledge.

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