Peter McNamara is about to feel what it’s like to have dementia — with all the ravages of aging piled upon him at once.
He dons garden gloves with several fingers banded together, then a nose clip that dwarfs a giant clothespin. The lenses of his sunglasses are a confetti of small dots, which make everything he sees a puzzle of size, depth, and shadow. Popcorn kernels in his shoes make standing and walking painful and wobbly. His headphones stream a blizzard of indecipherable sounds.
“How does that feel?”asks his facilitator, Alyssa Mackey, who brings “A Walk in Their Shoes,” dementia program to businesses.
McNamara looks bewildered. He stares anxiously at his co-workers.
“Now I want you to pull a string out of this big bag then tie it.”
He pulls out a washcloth instead.
When she finally hands him a string, McNamara can’t tie it. The elements of his costume come off.
“I didn’t understand a single sentence. I did feel stressed and that noise is overwhelming. I had no clue what you were telling me at all and my feet hurt. Just the dexterity to tie my shoes, I couldn’t get that done,” said McNamara, president of the New Hampshire Automobile Association, where employees gathered recently for the dementia simulation and training session.
“You were in that for two minutes,” said Mackey. “Can you imagine spending 15 years like that?” said Mackey, who brings the program to businesses, libraries, senior centers, municipalities and emergency responders.
Mackey, a dementia trainer and director of business development at The Residence at Salem Woods, an assisted living and memory care facility, helps caregivers, librarians, municipal and business employees and emergency responders experience the sensory and cognitive plundering that comes with dementia and learn to be slower, more patient, gentle and plain-spoken with compromised elders — skills that seldom come intuitively.
“You need to take care of your loved ones, but you need to do it in a way that’s healthy for everyone,” said Mackey.
Current research shows that 33 percent of family caregivers exhibit symptoms of depression, and 61 percent report very high ongoing stress. Learning communication and redirection techniques can help diffuse tension and calm both patient and caregiver.
There are over 24,000 known cases of Alzheimer’s disease in New Hampshire and another 50 percent yet undiagnosed — a fraction of the state’s predicted cases, according to the Alzheimer’s Association. As baby boomers age and the number of sufferers increases nationwide, dementia trainers offer strategies to make life more manageable, predictable and pleasant. The goal is to grow sympathy, understanding and verbal and nonverbal communication skills between family, business and community members and affected spouses, relatives, strangers and patrons who are anxious and easily confused.
Music and redirected thoughts and conversation can quell agitation in patients and patrons who may be frazzled by sudden noises, bright or flashing lights, even disturbing color contrasts in floor tiles, and unnerved by questions and answers they don’t understand.
Facial expression, stance, proximity and tone of voice become messages for those with limited speech, hearing and language comprehension. “More than what you say, they will remember how you made them feel,” said Melissa Grenier, regional manager for the Alzheimer’s Association in New Hampshire, which provides training for caregivers, businesses, police and fire departments — including in Portsmouth, the state’s first dementia-friendly city, to help people interact in ways that aren’t anxiety-provoking.
“It’s important to be mindful of the way you’re communicating,” said Mackey. Keep outside noises to a minimum — that includes loud sounds, yelling, call bells, and alarms, she said. Hearing aids pick up every background noise, and should be left at home or turned down in restaurants, stores, crowds and holiday gatherings.
“Background noise will keep feeding into the brain and create confusion,” said Mackey, who offered these tips for interacting:
Speak slowly and concisely. Break complex sentences or directions with multiple steps into short, simple statements.
Always approach someone who may have dementia from the front. Put your hands out and smile. If the person becomes upset, put your hands up – a universal symbol that defuses a perceived threat.
If someone appears to be hallucinating or reliving memories, “Just go with it,” said Marta Silakka, a nurse at the NH Auto Dealers Association Workers’ Compensation Trust. “Don’t say, Oh, Mom, that happened a long time ago. Try to let someone be wherever their happy place is.”
“Don’t create a situation you’re going to have to mediate,” said Mackey. “Let them be in that spot in time, rather than being aware that they’re 85, their husband has died, and they’re in a nursing home.”
When someone is sitting in a chair or on a bed, ask them to dangle their feet and move their legs and feet before standing up.
“The brain is about two percent of our body mass, but it uses 25 percent of oxygen. When someone panics, 50 percent goes to the brain. They’ll have a harder time walking,” and with any activity of daily living, she said.