New Approach to Dementia Care

Dementia care often becomes a source of daily friction for families trying to maintain normal routines. On a recent episode of the series Aging Untold, Teepa Snow discussed how caregivers can reduce that friction. Snow is an occupational therapist and the founder of the Positive Approach to Care organization.

Snow argues that the language families use to describe the condition matters. She prefers the term "brain change" over words that suggest a steady decline. She noted that while people with dementia may lose specific abilities, they often develop new ones. For instance, she observed that individuals who rarely swore might begin to do so. Others who would never ask strangers for help may suddenly approach them to say they need to get home.

"People think all the time of brain failure and brain loss, and I talk about brain change because the reality is neuroplasticity exists whether you have dementia or you don’t," Snow said. "So let’s use what we have and let’s use what they have."

When asked how to handle a parent who refuses to shower, take medication, or get dressed, Snow advised against forcing the issue. Gerontologist Sam Cradduck posed the scenario to illustrate a common family struggle. Snow suggested asking the person for help with a smaller, specific task instead of demanding a full routine. She described pointing to a smudge on her own cheek and asking the person to use a washcloth to remove it while looking in a mirror.

She also suggested asking the person to wash their hands before cooking dinner. If a person will not participate in those smaller steps, a full shower is unlikely to happen. "I’ve got to back up a little bit and try to figure out what’s getting in our way of the interaction," Snow said.

Snow also addressed the use of written reminders, such as sticky notes labeling cups or plates. She explained that following a written sequence requires the hippocampus, which she described as the learning and memory center, to access previous steps and identify the next one. The front of the brain attempts to sequence the actions. Snow stated that families should recognize the person likely needs more direct support to complete these tasks rather than relying on paper cues.

Snow concluded by telling families that both the person with dementia and the caregiver are doing their best. "You’re both doing the best you can, and if you want something to change, one of you is going to have to change," she said. Because the person with dementia is already experiencing brain change, caregivers must build new awareness and skills. She added that not every family member is suited for hands-on care, noting that it is hard work and some may be better suited to organizing the overall plan.

Snow emphasized that caregivers should accept their role in the dynamic. The goal is to adapt the environment and the interaction to fit the current state of the brain.