Fisher Center for Alzheimer's Research - Says "Interact With The Afflicted Person Within His or Her Own Frame of Reference"

The Fisher Center for Alzheimer's Research Foundation, directed by Nobel Laureate Dr. Paul Greengard at The Rockefeller University, says "interact with the afflicted person within his or her own frame of reference for the world, even if it has little to do with reality." Different stages of Alzheimer's or Dementia require different approaches to interaction and communication.

When I was working at a skilled nursing facility that specialized in Alzheimers and Dementia there were three main sections in the building for the residents. Each wing was for residents at a different stage. The style of communicating was according to the stage of their illness.

(1) Early Stage. One wing had residents in the early stages of Alzheimer's or Dementia, who might be forgetful or confused sometimes, but still recognized people and places much of the time. Part of the time they might seem as if there was nothing wrong with the way the brain was functioning, and then part of the time some confusion or forgetfulness would occur.

People in the earliest stages might still be gently cued or prompted to bring them back to our usual reality when they became confused. If this did not seem to work, or it caused agitation, then we would just go with their reality.

(2) Mid-Stage. A second wing had people in the mid-stage of Alzheimer's or Dementia. In a way, this was the most challenging wing for the staff. One moment someone might be completely lucid, and perhaps later in the day, when fatigue or sundowners began, the person might be in another world.

For example, there was one resident who would be fine in the morning, but in the late afternoon she would ask for some dressy clothing, her fancy hat and a dress purse. She would want to get ready to put on her fanciest outfit to get on a plane later for "the trip."

We might say something like "OK, but let's just eat dinner first, before you go, then we'll get ready." Moment by moment the reality changes and after dinner everything would be different again.

The residents in the mid-stage wing were sometimes agitated or combative, and we learned to relate to them in their own reality, not to argue or contradict.

(3) Advanced Stage. The third wing had residents who were in advanced Alzheimer's or Dementia. They usually had severe difficulty with the ability to speak, to perform simple tasks of the activities of daily living, and to walk.

However, some could walk very well, but had severe sundowners and agitation. When they were in a sundowners episode they might walk and walk. Up and down, and all around the halls of the facility they would go, which was locked to protect them from wandering outside and getting lost.

We learned to determine what the person's reality was, and to speak and interact with each unique person by referring to his or her reality.