The Daily Telegraph published the first in a two-part interview with Oliver James today – a clinical psychologist who, with his mother-in-law, Penny Garner, have developed a system of working with people who have dementia which they call:
SPECAL (Specialised Early Care for Alzheimer’s).
As the article describes, this is a model which works on triggers that are appropriate for the individual – Garner uses some examples in relation to her mother, Dorothy, who had dementia
“If while getting ready for bed, I noticed she had lost track of whether she was buttoning up the cardigan ready to go out or taking it off to go to bed, I would fiddle with my buttons alongside her and say ‘Oh good! No more travelling for us today! Glad we’ve got a bed for the night!’ I found that this simple cue was all she needed. Without it, she was inclined to get half-way through undressing and then start getting dressed again.”
The key themes of the model seem to be that:
SPECAL also teaches carers to avoid asking questions, because that means the person with dementia has to search their recent memories – and that can distress them. Carers are taught to supply reassuring information if the person with dementia asks questions. What the carer says is less important than the feelings their remark generates. The third rule is never to contradict, because that will also cause upset.
As a model, it would seem to concur with the recent evidence presented by the BBC following research carried out in Aberdeen, Abertay and St Andrews’ Universities that people with dementia may remember more than it seems and that questioning can be distressing although more facts can be recalled by patients depending on the ways that questions were asked.
With Professor Trevor Harley at Dundee University, being quoted by the BBC as having said
“we found that if you probe the patient in the right way with appropriate questions that support them to search their stored knowledge, they can often generate more detailed information.
“That is, the knowledge isn’t always lost at all. Of course eventually the information might be completely lost, but this might happen much later than people have previously thought.”
As mentioned many times before, a lot of the work I do is with people who have diagnoses of dementia. This research, these writings, all seem to point to the need to be clear and not make assumptions about what a person can or cannot understand. It is important too, that we, as professionals, term phrases, questions and discussions in ways that can best be understood.
I’m curious enough about the SPECAL training in particular to investigate further. One of the practice issues we discuss at work from time to time is the need for honesty and how important it is, or not, to validate what is being said by a patient even if it is not based in the present reality.
I honestly think the path of causing the least upset is instinctively the path that would create the most positive interactions – but its good to see it laid out in research!