The situation

People with dementia may see illusions due to cognitive impairment and sensory loss. In the follow case, Bing Shu (a person with dementia) has been living with his family in the same place for many years. He started to see illusions after his children renovated their home. He is often scared by his own reflection or reflections of others in the mirror. How would you handle this situation?

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You can utilise your knowledge of behavioural therapy as introduced in Treatments of Dementia > Behavioural Therapy to find out the antecedent, behaviour, and consequences involved.

Antecedent:

Bing Shu sees illusions in the mirror.

Behaviour:

Bing Shu gets frightened and says the reflections in the mirror are thieves.

Consequences:

Bing Shu is scared and tenses up.

After this, you can identify the needs of the person with dementia using the person-centred care model as introduced in Caregiving Skills > Identify Care Problem.

Personality/Background:

Bing Shu got sick easily when he was young. He was short and weak, so he was bullied by others frequently. Therefore, he tends to hold back from arguments and threats as an adaptation.

Thieves broke into Bing Shu's house twice when he was young. It took Bing Shu a long period of time to recover from those incidents. Even now he is scared.

Physical health condition:

The physical condition of Bing Shu has been very stable. It is not a major reason for his illusions.

Neurological impairment:

Bing Shu's dementia has progressed to the moderate-to-late stage. As a result of his cognitive impairment and sensory loss, Bing Shu is unable to identify that what he sees in mirrors are just reflections.

Social psychology:

Bing Shu started to lose interest in his hobbies as a result of his dementia. He stopped joining the activities at the nearby elderly centre a few years ago. The lack of social experience makes it more difficult for Bing Shu to trust and interact with other residents.

You can handle the situation as shown in this video.

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Step-by-step explanations

Relax yourself
Validation: Rephrase their emotion or need
Remain flexible
Relax yourself
Validation: Express their emotion till they calm down; find solutions
Remain flexible
Validation: Orient to the reality

Illusions can be caused by various reasons. The way the son handles the situation is as follows:

  1. Follow the feelings and thoughts of the person with dementia.
  2. Calm him down with the validation approach.
  3. Utilise the knowledge of behavioural therapy and find out the activating events by observing the consequences. The consequences include the emotional feelings, physical feelings, and actions of the person with dementia.
  4. Find out the beliefs of the person with dementia using the support of the person-centred care model and identify underlying needs.

Problems are often caused by the difference in perception. It is much easier for you to solve a problem when you can understand the way the person with dementia thinks.

You may think of the following solutions in which you can place yourself in the position of the person with dementia.

  • Environmental modification: Remove the stimulus
  • Enhance communication: Reality orientation
  • Behaviour management: Identify the pattern of the behaviour
  • Medical intervention: Pharmacological support

Remember to stay calm and remain flexible when dealing with the behavioural and psychological symptoms of dementia. You will be more relaxed then.

You can design preventive measures by combining your knowledge and skills in communication, behaviour management, environmental modification, and activity design to fulfil the needs of the person. For example:

Personality/Background:

  1. Environmental modification

    e.g. Decorate the environment with previously displayed items.

    Aim: To increase the sense of belonging in Bing Shu.

  2. Activity arrangement

    e.g. Arrange reminiscence activities for Bing Shu to participate in and focus on.

    Aim: To enhance Bing Shu's self-esteem.

  3. Activity arrangement

    e.g. Give Bing Shu more affirmation on his physical strength during physiotherapy sessions.

    Aim: To enhance the self-esteem of Bing Shu.

Neurological impairment:

  1. Environmental modification

    e.g. Remove mirrors and items that can reflect light, make the interior brighter, etc.

    Aim: To prevent Bing Shu from seeing illusions.

  2. Behaviour management

    e.g. Record the details of Bing Shu's illusions, such as time, frequency, and content.

    Aim: To identify the pattern and cause of Bing Shu's illusions.

  3. Enhance communication

    e.g. Do reality orientation for Bing Shu so that he can remember his own reflection, what is a mirror, location of mirrors, etc.

    Aim: To prevent Bing Shu from getting confused.

Social psychology:

  1. Activity arrangement

    e.g. Encourage Bing Shu to join social engagements by accompanying him to the nearby elderly centre.

    Aim: To encourage Bing Shu to have social engagements.

  2. Activity arrangement

    e.g. Simple housework, categorising, calligraphy, etc.

    Aim: To keep Bing Shu busy.

  3. Enhance communication

    e.g. Show Bing Shu around the home frequently.

    Aim: To increase Bing Shu's sense of belonging in the new environment.

Physical health condition:

  1. Arrange a sight test for Bing Shu.

    Aim: To prevent Bing Shu from seeing illusions due to visual problems.

  2. Arrange a hearing test for Bing Shu.

    Aim: To prevent Bing Shu from feeling anxious due to hearing problems.

  3. Consult a specialist for Bing Shu's condition.

    Aim: To introduce suitable medical interventions on time.

The suggestions listed above may not be applicable to all cases. However, you can discover other possible solutions by combining behavioural therapy and the person-centred care model. You can also make your life easier by identifying preventive measures for other problems with the help of the person-centred care model.

Summary
You can restore calmness in your mind easily through frequent practice of relaxation exercises. Please refer to the "Self-help Tipsme" for more details.