clinical focus
Well, try to keep them from getting
so frustrated, because what precipitated
the event was actually the combination
of their brain change and what got to
them at that point: what happened in
the environment, what happened in the
interaction, what time of day was that,
how fatigued were they?
We need to ask what, when and where,
so we can figure out what happened and
try to ensure it doesn’t happen as often.
It sounds like this means being a little
more considered in our approach to
those with dementia.
Yes. People who are living with dementia
are using what they have. So, if I tell you
that I’m looking for my mum even though
I’m 82 and you know that my mum is
long gone, what you want to think about
doing is saying, “So, you’re looking for your
mum. Tell me about her. Now, were you
needing her for something, or did you just
want to talk to her?”
What that signals most frequently is
someone is sort of lost in time and place.
Their brain is not oriented, which means
the little part of their brain called the
hippocampus is not doing its job in the
right way, but it is doing a job, and it’s
saying, “Well, Mum’s there and she’ll help.”
Find out why she might be looking for
her mother rather than saying, “Well, your
mum’s dead.” That’s not going to get us to
where we want to go. What we might do is
cause more distress.
This is part of the series of seminars
you’re teaching here. What are some
of the simple tips you’re telling people
and providers to try?
One of the things to think about is, would
you be comfortable if someone simply
walked up to you and was trying to get
your shirt off? Do you think you’d be okay
with that?
No, I don’t think I would.
I don’t think you would either. If I want to
do something that’s fairly intimate, which
care often is, what I may want to do is,
“Hey, Andrew, it’s Teepa. Listen, you’ve got
something on your shirt right there. Here’s
a fresh one. Tell you what, let’s see if you
can switch out of that.”
That’s a little less intrusive and rude.
It sets us up so that we’re forming a
relationship before we start trying to get
the task done.
Also, it gives me a chance to get a feel
for how you’re dealing with me and how
you’ll feel about me dealing with you.
It’s a tricky thing, because often carers
are provided with ‘How do you get a task
done?’, and yet, in dementia, it’s really
about ‘How do we form a relationship so
we can get this thing done?’
It’s a lot of empathy and validation. If
she says, “I just changed my shirt,” then
you could say, “Oh, you just changed your
shirt? Gosh, but I thought you’d had that
one on for a bit. I’m sorry.”
Well, you’ve got something right there,
which doesn’t invalidate her statement,
because there’s no point in pushing at
somebody whose brain is broken. But it
does allow me to give you some new data.
And if I give you new data, maybe we can
get to someplace different. It’s a different
way of guiding a relationship, rather than
trying to push and get what I want.
I’m interested in your background. You
graduated from Duke University with
a degree in zoology. How did you end
up as a dementia expert?
Isn’t that funny? Well, I actually had five
majors before I finally had to figure out
what I was doing. My mother said: “Either
you graduate this semester or you’re
paying for the next one.” I ended up in
zoology, but it had a lot of branches
before then.
What got me where I’m at now is
I went in and got a graduate degree
from the University of North Carolina in
occupational therapy and worked at the
School of Medicine on a program on
ageing. We started working with people
with brain failure, including head injuries,
trauma and stroke, and then ageing in
general and dementia. That kicked it off.
harder than just another quick fix. What we
are experiencing often is the use of anti-
anxiety meds instead of the antipsychotics.
If we look at the behavioural challenges
that people living with dementia
experience – and many elders in other
care situations – one of our challenges
is accepting that their interpretation of
what’s right for them and our desire to
deliver care may not be on the same
page. We’re not investing what we would
want for ourselves in that ability of those
care providers.
Before you came over, were you aware
of the royal commission we’ve been
having, and are people in the US aware?
Those of us who are involved in dementia
are certainly aware of what’s happening.
It’s weekly that we’re hearing something
going on – sometimes good and
sometimes “Wow, that’s significant”.
One of the things that the group over
in Canada, the US and the UK have heard
about a fair amount is the quality of food.
This is an interesting thing because that’s
come up quite a bit in some of the reports
coming out [of Australia], and that’s less
of a thing that we’re finding [in the US].
That’s really interesting to me. It’s certainly
not that it’s ideal [in the US] and it’s got big
One of our challenges
is accepting that their
interpretation of what’s right
for them and our desire to
deliver care may not be on
the same page.
In Australia, a big conversation we’re
having is how we view those with
dementia and the elderly more widely.
Are you guys having those same
problems around the way we talk about
and view ageing and the elderly away
from dementia? issues, but not the amount of press that’s
been coming out [of Australia] on that.
The other things – abuse, neglect – yeah,
that’s pretty universal, unfortunately.
Yes, but we have done something a little
different. The thing about chemical
and physical restraints that you are now
starting to address, that was a push several
years back. We said, “This has got to stop.
This is not okay. This is just convenient.
This is not care.”
We’ve been working harder on that for
a bit longer. It’s not that we’ve been wildly
successful at what people are calling
non-pharmaceutical intervention, because
we still have to learn the skill. That’s always We have a website with lots of free
YouTube videos and free information.
It’s www.teepasnow.com. Most people
in Australia have learned about me
through YouTube videos. They’re used at
universities and colleges, and among care
and family members, because it’s an area
of practical skill. I’m very practical. If I need
to figure out how to help you get clean,
then my job is to try to figure out how to
do that so you find it acceptable. And if
not, that’s not care. ■
Where can people find out more about
your philosophy and work?
agedcareinsite.com.au 29