Understanding Dementia
• Causes and Risk Factors
o Advancing Age – Age may be the biggest risk factor, but dementia can also affect people in their 40s, 50s and 60s.
o Family History
o Genetics
o Risk Factors and Brain Health – alcoholism, drug addiction, diabetes
• Common Symptoms of Dementia
o Memory Loss That Disrupts Daily Life
o Challenges In Planning or Solving Problems
o Difficulty completing familiar tasks
o Confusion with time or place
o Trouble understanding visual images and spatial relationships
o New problems with words in speaking or writing
o Misplacing things and losing the ability to retrace steps
o Decreased or poor judgement
o Withdrawal from work or social activities
o Changes in mood or personality
Positive Physical Approach to Care®
Connect with the Person Living with Dementia using the following steps:
1. Personal Physical Approach
2. Positive Personal Connection
3. Positive Action Starters
4. Hand under Hand
When making the connection look to incorporate the following:
• Visual, Verbal and Touch (VVT) cues that match abilities
• Recognize unmet needs and distress
• Create supportive environments
Step 1: Personal Physical Approach
• Pause at six feet – make eye contact
• Greet and smile – seek social contact
• Show hand for handshake (near your face)
• Offer to shake hand – move forward after an OK
• Match speed to response time
• Move from front to side into supportive stance
• Greet with handshake and your name
• After handshake, slide into Hand-under-Hand
• Get to a matched height, respecting intimate space
• Approach from the front – moving slowly
• Keep shoulders and face back – respect their intimate space
• Use the supportive stance (stand on their dominant side-not in front)
• Get to their eye level (central vision) staying at arm’s length
• Wait for their response before continuing
• Make positive statements
“Let’s try…”
“Do this…” (show what you want the person to do with your body)
“Could you please help me…”
Always Remember
• Visual, Verbal and Touch (VVT) cues that match abilities
• Recognize unmet needs and distress
• Create supportive environments
Approaching When the Person is Distressed
• If the person is upset, look concerned, not happy
• Let the person move toward you, keeping your body turned to the side to be supportive, not confrontational
• If the person is seated and you don’t get permission to enter personal space, turn sideways and kneel at 6 feet out. Offer greeting and handshake again and look for an OK to come into their personal space. It will usually come at this time with this more submissive posture.
• After greeting, try one of two options:
• “Sounds like you are (give an emotion or feeling that seems to be true)?”
• Repeat the person’s words to you:
• If they said, “Where’s my mom?” you would say, “You’re looking for your mom (pause)…Tell me about your mom…”
• If the person said, “I want to go home!” you would say, “You want to go home (pause)…Tell me about your home…”
Just Remember
• Keep your voice calm, low, and rhythmic
• Keep it short and simple
• Give simple choices – “this or that” or “this or something else”
• Use objects – show them – just don’t say it!
• Break task / movement down – one step at a time
• Ask the person to try or to help you
• Use empathetic statements
“Sounds like you are…(give emotion)”
“Looks like you might…(give condition)”
“I’m sorry that happened, that’s not ok”
“This is hard, I hate it for you”
Step 2: Positive Personal Connection
• Greet – Introduce yourself and use their preferred name
“Hi [their preferred name], it’s [your name].”
• Compliment – Indicate something about them of value
“You are looking really colorful today!”
• Notice – Point out something in their environment
“You must love [item] seeing how well you care for it.”
• Seek – Explore unmet likes, wants, or needs
“it’s a bit chilly in here, a hot drink would be nice. Do you prefer coffee or tea?”
Acknowledge reaction or response
• If positive and permission given – move forward with task
• If no permission given, back away, change something, and re-approach
Always Remember
• Visual, Verbal and Touch (VVT) cues that match abilities
• Recognize unmet needs and distress
• Create supportive environments
Step 3: Positive Action Starters
• Help – Be sure to compliment his or her skill in this area, then ask for help with something
“You are so good at , would you please help me?”
• Try – Hold or point to the item you would like to use, possibly sharing in the dislike of the item or task
“Could we try this?”
• Short and Simple – Give only the first piece of information, maybe offer a timeframe of 1-5 minutes
“It’s about time to (first task)”
• Step by Step – Only give a small part of the task at first
“Lean forward” (to stand up)
Keep it Going
Thumbs up
Positive affirmation, genuine support
At the End
“Thank you for working with me.”
Step 4: Hand Under Hand
Use Hand under Hand to:
• Greet and connect
• Offer comfort and support
• Guide and direct movements
• Assist with fine motor parts of a task
• Use utensils, tools or materials
• Do With the person, Not to the person
Always Remember
• Visual, Verbal and Touch (VVT) cues that match abilities
• Recognize unmet needs and distress
• Create supportive environments
Cathy Hamlin
CTS, CPC, TSC, PHR
B.S. Health Administration – Duke University
Assisting Hands Richmond
Executive Administrator
