When concentration becomes difficult

I suspect that from time to time most of us lose our focus on a task, object, TV programme, person or other aspect of our life that momentarily requires us to put aside all other thoughts and images to ensure our full attention. This lack of concentration is sometimes associated with a lack of interest in something or someone who we are meant to be focusing on, or a need to ‘get something done’ that we perhaps really don’t want to do at that time.

In the context of living with dementia, however, a lack of concentration can be more than an occasional annoyance and become very pervasive into daily life, both for the person themselves and those around them. A problem concentrating is something that many people with dementia report as an early symptom and it can come in many guises, from difficulty in concentrating when reading and writing, to problems focusing in conversations, when driving, watching TV, or completing routine tasks of daily living that previously held the person’s attention.

I can only imagine how frustrating these issues must be for a person with dementia, and whilst they may act as an early warning sign to seek help, a diagnosis can at best explain the problem rather than making it go away. As a person’s dementia advances, problems around concentration can become much more acute and affect an individual's ability to focus on eating a meal, drinking a drink, getting dressed, washing themselves or participating in hobbies and activities.

For those around the person with dementia, be they family, friends or professionals, this lack of concentration from the person with dementia may also pose problems. It can lead to frustration that the person isn’t focusing on something that they need to focus on (like eating), and massive concerns about their wellbeing. These worries often set off a pattern of trying to persuade the person with dementia to concentrate on whatever it is they aren't concentrating on, and if that doesn't work the family member, friend or professional exercising their power and bossing around the person with dementia.

First and foremost, I am not a fan of trying to make people with dementia do things that they either don’t want to do, or in the context of a lack of concentration, are struggling to do. What I am a fan of is trying to find alternative ways to support the person so that life can remain as familiar and comfortable for them as possible.

So for example, not everyone can concentrate for long enough to sit at a table and eat or drink. That’s fine. They might prefer to sit in a comfortable chair with a meal on their lap, or eat finger food on the go while they walk (my dad went through a phase of doing this). We can often become very fixated on people doing things in an ordered way, or in the ‘usual’ way, or in the way they’ve always done them, and if the person with dementia responds well to those options then great, but if they don’t it is important to be flexible and modify the way we support them rather than expecting them to conform to what we want or believe is necessary.

These modifications often happen more readily when we think about the essential aspects of life – like eating and drinking – but often happen less automatically with the elements of daily living that might be seen as ‘optional’. Here I am thinking about supporting a person’s hobbies or interests, or even just helping them to do things that keep them physically active or mentally alert.

Lack of concentration shouldn’t mean a person with dementia has to abandon things they previously enjoyed, or indeed give up discovering new things. What is needed is an understanding that the person may not approach a hobby, interest or task in the same way that they used to – IE: sitting and reading a book, watching a favourite film from start to finish, participating in a board game, doing needlework, cooking, housework, gardening, painting/drawing etc – but that they may still be able to do these things in a different way (change location/time of day etc), in shorter bursts of activity, and/or with more intensive assistance (helping the person, not doing it for them).

When concentration wains some prompts may be helpful, like talking to the person about what comes next, or inspiring them by reminiscing about aspects of their early life that might relate to what they are trying to do. For example, if the person is doing something creative like painting or drawing, but struggling to start or continue with it, thinking about something they loved in early life might just spark a thought that they can commit to paper.

If the person struggles with conversation, some picture and word cards might help. Make sure any glasses or hearing aids that are usually in place are being used, and that distractions are minimal or non-existent (a blaring TV in the background is rarely a good idea). Think too about balance - respect independence but don't leave a person with dementia struggling or disappointed because they can't complete something. For example, if concentration is difficult when reading a book, see if the person would like you to continue reading it to them when they have gone as far as they feel able to that day.

Above all, offer gentle encouragement, and try to back up the person’s fleeting thought processes by helping to think for them in a completely person-centred way, sensitively anticipating, guiding and reassuring. This should always be supportive, rather than in any way controlling, and it will inevitably involve a lot of patience, time, calmness and perseverance.

Until next time...

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A 'can do' attitude

Watching Paralympians you cannot help but be inspired by their ‘can do’ attitude. For these athletes, there is no barrier too great or no dream they cannot fulfil, which for a society that so often sees the negative before the positive is both refreshing and thought-provoking.

How often in dementia care do professionals stop to think about what a person can do, rather than what they cannot? So much focus is placed on need and incapacity, drumming into care providers, clinicians, families and indeed those living with dementia, what this disease takes away from a person, often extinguishing in the process any hope of living well with dementia.

Whilst the progression of dementia brings significant, irreversible changes that can be painful and upsetting for those living with it, their families and carers, it is often the case that someone with dementia can still do things that they enjoy but perhaps in a different way. More open-minded, innovative thinking can increase the quality of life for someone living with dementia immeasurably, but it needs families, care-providers and other professionals to see beyond the disease to the person within.

Eating is a common area where independence is often lost completely and unnecessarily. During my father’s 9 years in 3 different care homes, he went from being someone able to feed himself a huge selection of foods independently, to someone who needed to have all of his food pureed and spooned into him and all of his drinks thickened and spooned into him. During this transition, finger foods helped him to feed himself, and even during the advanced stages of his dementia, there were days when his mind was focused and his hands were active and strong enough to take the spoon, with assistance, and put it into his mouth, or hold the bowl or plate whilst he was fed. Supporting him to do this helped him to realise some of his potential in that moment, made the meal a more engaging experience for him, and demonstrated his desire to eat and live, a key factor to highlight to clinicians who felt that he had no quality of life and no desire to remain alive because he had dementia.

Communication is another area where incorrect assumptions are made about a person’s ability. Because society places such a huge emphasis on clear and concise dialogue, when someone with dementia can no longer hold a conversation, it is often felt that they do not have thoughts or feelings because they cannot express themselves in the conventional way. When my father could no longer speak more than half a dozen words, music and songs became his form of expression (as I wrote about here). Lyrics tumbled out, in the correct order and at the right time, showing how his mind was working and that his memories were still alive. Crucially, music also gave a window into his emotions, proving that you do not need to ask someone how they are feeling to find out this information. I have also seen how old films, TV programmes and reminiscence sessions with cards, pictures, objects, quotes and phrases can also trigger conversation from people who otherwise would not communicate.

Lack of concentration in someone with dementia can often be at the root of why so many care professionals give up on people living with dementia. If they cannot concentrate to eat, drink or talk, and many only want to pace the building constantly, it can be felt that they are simply beyond help. Not so: providing something to focus on, like a favourite possession from their past, can help to focus the person and improve their concentration.

Many people also believe that the hobbies someone used to enjoy before dementia become out of reach as their dementia progresses. However, with creative thinking and the help of innovative products where they are needed, you can transform the daily life of someone with dementia into an experience where therapy and pleasure go hand in hand. One of my father’s great passions was gardening, but sadly this was not encouraged at the nursing home where he spent most of his years in care. Even when the garden was finally landscaped into an area that was wheelchair friendly, residents generally only went outside if a family member took them (as I wrote about here), and activity was frowned upon. What a difference a few modified gardening tools, and attitudes, could have made.

Care providers need to become more aware, committed and forward thinking in how they approach the needs of people with dementia. Everyone is capable of something, and with the right support, encouragement and assistance, things can be achieved that exceed everyone’s expectations, including those of the person with dementia who may be feeling that they have lost purpose and ability, and are now deprived of activity in their life as a result. Many products that are produced to assist with tasks are heavily promoted within the disability market, of which dementia is not naturally positioned, but someone with dementia can often have physical problems that require additional assistance and, regardless of that, many products can have multiple uses when a creative brain and a holistic approach are deployed.

Often obstacles to someone with dementia being able to show what they can do are simply solved to enable positive interaction. For example, is the person sat comfortably and properly supported in a chair or wheelchair that is right for their build/posture etc? Are they dressed appropriately and at a comfortable temperature? Are they hungry or thirsty? Do they need the toilet or are they sat in a soiled pad? Is the environment free of other distractions? Is the person otherwise in good health and not suffering with an infection that can impair their ability to participate? Are they being communicated with in a manner that is appropriate for them? Answer these questions positively, and you can be assured that the person with dementia, however limited their abilities may appear, can join in something that they enjoy.

In many respects, the worlds of disability and especially disability or impairment in the young, are streets ahead of dementia care when it comes to demonstrating a 'can do' attitude. Yet thinking back to the lives our older generation had in their teens, twenties and thirties, many of them would have been up against great hardships and setbacks but powered through regardless with hard-work and dedication. Indeed, many veterans will say that wars were only won because those fighting abroad and those at home had a ‘can do’, will-to-win attitude, even against the odds. Keeping this spirit alive helps to keep our older generation, and especially those living with dementia, alive, engaged and leading enriched and meaningful lives. If our Paralympians can do it, it is not beyond the bounds of possibility in dementia care.

Until next time...



You can follow me on Twitter: @bethyb1886

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NOTE: If you run a company involved in the production of innovative products for people with dementia, I would be interested in hearing from you. Please contact me through Twitter or Facebook.