The Pocket Guide to Mouth and Dental Hygiene in Dementia Care. Dr Daniel Nightingale

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The Pocket Guide to Mouth and Dental Hygiene in Dementia Care - Dr Daniel Nightingale

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personhood.

      2. Sport/leisure interest: Most people have interests outside work and this is one of the things we all cherish as part of work–life balance. Again, people often achieve things during their pursuits – being able to talk about the day Fred won the golf tournament or when Sandra won the final of the pool competition brings up fantastic memories and puts people in a really good place as far as their mental health is concerned.

      3. Family (if there is no family, choose another topic such as fashion – something based on what you have learned from the individual’s life story and ‘Getting to know you’ event): If you ask most people, family is, and always was, their major priority throughout life. There is so much that can be discussed here, and very often, as healthcare professionals, we can relate to many of the same experiences and stories. All parents face similar experiences when bringing up children and can often speak with pride about their accomplishments. Holiday destinations and times such as Easter and Christmas are always fun to talk about.

      You must be motivated to instigate the conversation and ask questions that are clear, concise and basic. We do not expect the individual to process complex information, and very often they will focus on topics and events that are based on history. Remember: the only time period that matters to someone living through cognitive change is the present. Whatever happened five minutes ago is irrelevant. Whatever is about to happen in five minutes’ time has no impact right now. This very second, the second you are engaging with the patient, is the only action that matters. It is easy to fall into the trap of talking about upcoming events or further treatment if in the dental chair.

      TIP NUMBER 4: ACTIVITIES

      The reception area of a dental office can be a negative place to be. People waiting to see the dentist are often very nervous, highly anxious and afraid. These are natural feelings and emotions that most people feel when visiting a dentist or doctor of any type. Usually, there are a few magazines scattered around and perhaps a few toys for children to entertain themselves with.

      Let us think about some of the day-to-day challenges faced by those experiencing their journey through dementia:

      • Increased anxiety in unfamiliar surroundings

      • Restlessness due to decreased ability to concentrate

      • Agitation due to inability to comprehend certain experiences

      • Frustration due to forgetfulness.

      Challenges are likely to be unique to each individual; however, these four highlighted above are common experiences.

      There are a number of ways in which we can ensure available activities in the reception area or waiting rooms that are interactive, engaging and stimulating while at the same time being age appropriate and not too challenging, or completely fail free.

      First, there is adult colouring, which is a growing activity enjoyed by many throughout the world. There are some books that are relatively basic and quick to complete.

      A second activity is recognition cards such as word games. For example, show a card to the person that has ‘That is water under the …’ written on it and they have to find the word that completes the sentence (in this case, the word is bridge). Again, this activity is quick and can be concluded at any time.

      Something that many people with neurocognitive and neurological disorders respond to is music. Playing music that the person relates to will contribute to bringing down anxiety levels and improve the person’s mindset.

      By talking with the person, their family and friends, and including the questions mentioned in Tip 2, the dental team will be able to identify the most appropriate activities for patients.

      TIP NUMBER 5: THINK ABOUT FLOOR AND COLOURS

      Two primary colours (yellow and blue) and three secondary colours (orange, green and purple) are the best colours for dental offices and treatment rooms.

      Consider that many of those living with dementia will have difficulties with their sight. This will be due to either their condition, the natural aging process or a combination of both. This further enhances feelings of confusion, disorientation and isolation. Consequently, levels of both fear and anxiety will increase.

      The use of colours, especially in a contrasting way, makes a huge difference. You can highlight important areas while losing unimportant, unwanted and unneeded areas. Colour can also be used to highlight risks as well as elevate mood.

      It is best to avoid the colour red as much as possible – including red clothing such as uniforms and scrubs. It is a colour that can induce rage and is often associated with danger. If we consider a red traffic sign, it means STOP.

      For some people living with dementia, in particular those with Lewy Body dementia (the third leading cause of neurocognitive disorder), there is difficulty with spatial awareness. This is due to damage of the brain’s posterior parietal lobe, which means awareness of oneself in space is lost. Someone with this issue struggles to understand the relationship of organized objects in a particular space when there is a positional change. People manage better on an even floor that does not change due to gradient, colour or texture. In other words, try to ensure the floor remains constant and unchanged. This can help reduce falls risk as well as improve the environment, so it is more predictable.

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