Dementia Care

Dementia changes how a person experiences the world — memory, language, judgement, the reading of faces and rooms — while the person themselves, their feelings, dignity and long-practised habits, remain. The care task is to hold onto the person while the condition keeps moving: to keep meeting them where they now are, rather than mourning where they were or insisting they return.

Much of the suffering around dementia is not caused by the disease but by environments and interactions that stop making sense. A corridor of identical doors, a mirror at night, a loud dining room, being suddenly touched from behind by someone talking too fast — these produce fear, and fear produces what files call "behaviours". Decode instead: recent research and long practice agree that distress usually has a findable cause, with pain top of the list, then infection, hunger, boredom, needing the toilet, or grief.

The most useful skill is joining the person's reality. When a 92-year-old asks for her mother, the fact you could state is not the truth she needs; the feeling underneath — wanting safety, wanting someone who loves her — is. "Tell me about your mum" comforts; "your mother died in 1987" wounds, again and again, each time as the first time.

• NICE NG97: dementia — assessment, management and support: person-centred care, involving the person and family, structured approaches to distress before medication, and carer support.
• MCA 2005: decision-specific capacity; best interests shaped by the person's wishes, values and life; restrictions minimised — see also the DoLS topic and the June 2026 deprivation of liberty ruling.
• Regulations 9–13: person-centred care, dignity, consent, safety and freedom from improper treatment all bear directly on dementia practice; antipsychotic misuse engages Regulation 12.
• Equality Act 2010: dementia is a disability — reasonable adjustments (time, signage, communication) are a duty.
• National policy attention is high: dementia featured in the Casey Commission's 2026 early recommendations, including scaled-up research trials.

CQC looks for staff who know people, not just diagnoses: life stories used, communication adjusted, distress logged with triggers explored (ABC charts or similar), and evidence that pain is actively considered when behaviour changes. Environments are assessed for dementia-friendliness — signage, contrast, lighting, quiet spaces, safe walking (never "wandering") routes. High or unreviewed antipsychotic use, blanket restrictions, and "behavioural" language masking unmet needs all draw criticism. Meaningful activity is expected daily — sitting in a lounge circle with the television on is not it.

• Approach from the front, at eye level, smile before words, name yourself, one short idea at a time, and wait — counting silently to ten after a question respects processing time.
• Use the life story daily: former teachers may settle when "helping check the register"; a farmer may need to be outside at dawn. Meaningful occupation beats generic bingo.
• When distress rises: rule out pain first (consider a structured tool like Abbey Pain Scale), then toilet, thirst, hunger, noise, temperature, and who or what was present when it started. Chart it — patterns are the diagnosis.
• Redirect with feeling, not facts: validate the emotion, then travel somewhere better together ("You miss her. She always had the kettle on, didn't she — shall we put ours on?").
• Shape the environment: contrasting toilet seats and crockery, clear signage with pictures, personal memory boxes at doors, lighting up in the day and calm at night, mirrors covered where they frighten.
• Keep decisions with the person: offer two real choices, use objects and showing, and assess capacity per decision rather than assuming its absence.
• Support families as partners and grievers — they are losing someone slowly while helping you care for them.

Example 1. Every afternoon around four, a former school caretaker becomes agitated, trying doors and pushing past staff — labelled "exit-seeking". His daughter mentions he locked up the school every day at four for thirty years. Staff give him the job back: a ring of keys, a round of "checking the windows" with a worker, a sign-off sheet. The agitation becomes purpose. Nothing was wrong with him; something was missing.

Example 2. A normally settled woman starts hitting out during personal care. Before anyone says "she's becoming aggressive", the senior insists on the checklist: the pain tool scores high on movement; the GP finds a hip problem; analgesia is given before care, and slower, narrated washing with her preferred carer resumes. The hitting stops within days. The behaviour was a pain report — the only language available.