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Putting the pieces together

Dementia-care workshop held

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Taking good care of the estimated 20,000 Manitobans with dementia isn't easy. Ask any of their loved ones or caregivers.

On Monday, 50 of them gathered at a dementia-care workshop in Winnipeg to learn how to treat the person rather than the disorder.

It's called "PIECES" training, which focuses on the person's physical, intellectual, and emotional makeup as well as their capabilities, environment and social history. It's meant to help people understand the care needs of people with dementia by seeing their behaviours as attempts to communicate those needs, said instructor Joyce Klassen.

"The person-centred approach really helps us to see them," said Klassen. The PIECES training is part of a two-day Alzheimer Society of Manitoba Dementia Care 2014 conference at Canad Inns Polo Park that ends today.

For one 79-year-old attendee, whose wife has dementia, it's an education that's going to help them both. "It's excellent," said the man, who didn't want his name published because his wife doesn't know he's attending the PIECES training.

He's learning about the different types of dementia, the impact of damage to different parts of the brain, how it affects behaviour and how to respond to it.

Damage to the parietal lobe that alters perception hit close to home for him.

One day, his wife was in her dressing gown and people on their high-definition TV were talking, he said. "She wouldn't go in the living room because 'they' were in there," he told the class.

"Our reality is not their reality," PIECES instructor Patti Chegwin said. They're responding to the world around them they're desperately trying to make sense of. They may see a health-care aide trying to put a stick in their mouth when really it is a toothbrush, she said. If they push it away, it's in self-defence but could be misinterpreted as aggressive behaviour, Chegwin said. "Often it is our approach" that causes agitation, she said.

Damage to the frontal lobe can cause anosognosia, where the person has no awareness anything is wrong with them. "They have no filter," said Chegwin, who recalled coming back from a vacation in Mexico and seeing her mother-in-law, who has frontal lobe damage and dementia that have affected her social graces.

"The first thing she said to me was 'I see you haven't lost any weight.'" Chegwin took no offence. "For her, that's a big deal," she said.

Understanding someone's background, or just knowing the major "mountaintop" events in their life, can go a long way to understanding their behaviour.

"They are doing the best they can -- it's not on purpose."

To illustrate the point, they showed a short film called Darkness in the Afternoon. In it, a happy young woman in a red dress walks down the sidewalk, drawing a lot of smiles and attention. She stops by a duck pond, and an old man takes her arm and tells her she's too close to the water's edge.

"Keep away from me you mad old bastard!" she says, terrified, running off into the bush. He follows her and pleads lovingly with her to get in the car. She screams and lashes out at the stranger.

He hits her and puts her in the car, saying he's taking her home. She can't unlock the seatbelt and grabs the steering wheel, nearly causing an accident.

He threatens her.

When he gets her to the house, she throws a stool through the bedroom window and jumps out. She's taken to the hospital.

When she's told her husband is there to pick her up, she bites him and runs away. Hiding in a bathroom looking in a mirror, she doesn't recognize her reflection -- a bruised and cut old woman in a torn nightgown.

The husband of the Alzheimer's sufferer at the training session said the film showed what it's like to live with the disease.

"I want to find the video on the Internet and show it to our family."

Republished from the Winnipeg Free Press print edition March 11, 2014 B3

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