This is a presentation I made at the Social Work Hospice and Palliative Care Network General Assembly in Philadelphia in February 2015.

1. Making Meaningful Connections With Dementia Patients at
the End of Life
Pam Adams, LMSW

2. Rationale
•To become familiar with interventions that will enable one to
make connections with dementia patients that are meaningful
for both the client and the practitioner
•To feel more confident in one’s skills while developing plans of
care for patients who have dementia
•To feel empowered to cultivate a more therapeutic relationship
with patients who have dementia

3. What is Dementia?
• Dementia is the loss of cognitive functioning
• loss of the ability to think, remember, or reason
• loss of behavioral abilities
• interference with daily life and activities
• Signs and symptoms of dementia result when
• once-healthy neurons (nerve cells) in the brain stop working
• neurons lose connections with other brain cells
• Neurons die
• While everyone loses some neurons as they age, people with dementia experience far greater loss.
• It is believed that around five million people in the United States have age-related
dementias
» (Institute for Dementia Research & Prevention, n.d. Retrieved from
http://idrp.pbrc.edu/faq.htm).

4. Most Common Types of Dementia
• Alzheimer’s disease - Affects memory first and later progresses to affect other cognitive
abilities, such as speech, ability to reason, and movement.
• Vascular dementia - Often the result of a stroke in which small areas of the brain are
irreversibly damaged. Sudden onset. Symptoms depend upon area of brain affected, but
often memory and other cognitive functions, such as decision-making, are impaired.
• Dementia with Lewy bodies - Leads to a decrease in cognitive ability, hallucinations,
movement problems, and delusions.
• Frontotemporal dementias - Affects personality and speech but not memory.
» (Dementia Care Central. (n.d.). Types of dementia. Retrieved from
http://www.dementiacarecentral.com/aboutdementia/facts/types)

5. Common Myths About Dementia
• Dementia is a normal part of aging.
• People who have dementia do not understand what is going on around them.
• I should correct and reorient the dementia sufferer when what they say is wrong.
• A person who has dementia is incapable of making decisions.
• People with dementia are oblivious to their symptoms.
• Dementia results in aggression.

6. Sensory Stimulation in People With Dementia
• Our senses—sight, smell, taste, touch, and hearing--connect our minds
with our environment.
• Patients who have dementia retain their ability to perceive their
environment via their senses.
• They can still derive pleasure and joy from pleasant sensations.
• They can still experience displeasure and emotional distress as a result of
unpleasant sensations.

7. Benefits of Sensory Stimulation
• Increased social interaction
• Increased alertness
• Increased concentration
• Improved self-esteem
• Feeling of connectedness to one’s environment
• Improved overall mood
• Increased relaxation
• Stimulation of memories

8. Best Practices: Suggested Activities for
Sensory Stimulation
• SIGHT: Photographs, art work, videos, picture books
• SMELL: Cinnamon, maple syrup, vanilla, lemon, baby powder, pine
trees, peppermint, coffee, fresh cut grass, cookies, perfume
• TASTE: Ice cream, pudding, favorite foods
• TOUCH: Familiar objects, various textures, hand massage, back rub
• HEARING: Music, read aloud, humming, singing

9. Best Practices: Tips for Activities of Sensory Stimulation
• Entertain.
• Focus on short bursts of activity due to decreased concentration.
• Be patient.
• Provide simple, repetitious, and easy steps.
• Stimulate, but avoid too many challenges or choices.
» (Alzheimer Society Canada. (August 31 2012). Living with dementia: Late stage.
Retrieved from http://www.alzheimer.ca/en/Living-with-dementia/Day-to-day-
living/Staying-active/Late-stage).

10. Case Discussion: Edith
• Senile dementia, age 88
• SNF resident
• Widowed and had a supportive daughter who was appropriately involved in her mother’s
care.
• Alert but aphasic.
• Bed bound and completely dependent for all of her ADLs.
• Raised numerous children including her own, plus nieces, nephews, and local children;
de facto foster parent.
• Lessons learned:
• Tapped into memories of raising children
• More engaging with social worker during visits
• Able to use alternative methods of communication to say goodbye

11. Case Discussion: Oleta
• Alzheimer’s disease, age 89.
• SNF resident.
• Alert but aphasic.
• Bedbound and dependent for all of her ADLs
• Two daughters were supportive and visited daily, but they were feeling disconnected from their
mother.
• Responded bright colors and music.
• Lessons learned:
• More engaging with social worker during visits
• Daughters were taught to use these skills and reported feeling more connected with their
mother
• Able to express her grief when her best friend died

12. Case Discussion: Alma
• Alzheimer’s disease, age 92
• Living at home with daughter and granddaughter
• Language dysfunction (repetition of a single syllable)
• Played the piano, was ambulatory
• High caregiver burden
• Lessons learned:
• Lost ability to communicate verbally but retained music and singing ability
• Used sensory stimulation to soothe and engage patient
• Taught caregivers to use these skills

13. Conclusion
• Dementia sufferers is a challenging population.
• There is a high frequency of caregiver burden and staff frustration.
• Engaging each of the five senses overcomes many dementia-related barriers.
• Social workers have a key role to play.
• We must go into their world rather than try to pull them into ours.
• Get a comprehensive history about the patient’s interests, likes, job history,
hobbies, etc.
• Be creative and think outside of the box.
• Be patient! This is not an exact science. You won’t experience breakthroughs
during every visit.