Monday 22 February 2016

When concentration becomes difficult

I suspect that from time to time most of us lose our focus on a task, object, TV programme, person or other aspect of our life that momentarily requires us to put aside all other thoughts and images to ensure our full attention. This lack of concentration is sometimes associated with a lack of interest in something or someone who we are meant to be focusing on, or a need to ‘get something done’ that we perhaps really don’t want to do at that time.

In the context of living with dementia, however, a lack of concentration can be more than an occasional annoyance and become very pervasive into daily life, both for the person themselves and those around them. A problem concentrating is something that many people with dementia report as an early symptom and it can come in many guises, from difficulty in concentrating when reading and writing, to problems focusing in conversations, when driving, watching TV, or completing routine tasks of daily living that previously held the person’s attention.

I can only imagine how frustrating these issues must be for a person with dementia, and whilst they may act as an early warning sign to seek help, a diagnosis can at best explain the problem rather than making it go away. As a person’s dementia advances, problems around concentration can become much more acute and affect an individual's ability to focus on eating a meal, drinking a drink, getting dressed, washing themselves or participating in hobbies and activities.

For those around the person with dementia, be they family, friends or professionals, this lack of concentration from the person with dementia may also pose problems. It can lead to frustration that the person isn’t focusing on something that they need to focus on (like eating), and massive concerns about their wellbeing. These worries often set off a pattern of trying to persuade the person with dementia to concentrate on whatever it is they aren't concentrating on, and if that doesn't work the family member, friend or professional exercising their power and bossing around the person with dementia.

First and foremost, I am not a fan of trying to make people with dementia do things that they either don’t want to do, or in the context of a lack of concentration, are struggling to do. What I am a fan of is trying to find alternative ways to support the person so that life can remain as familiar and comfortable for them as possible.

So for example, not everyone can concentrate for long enough to sit at a table and eat or drink. That’s fine. They might prefer to sit in a comfortable chair with a meal on their lap, or eat finger food on the go while they walk (my dad went through a phase of doing this). We can often become very fixated on people doing things in an ordered way, or in the ‘usual’ way, or in the way they’ve always done them, and if the person with dementia responds well to those options then great, but if they don’t it is important to be flexible and modify the way we support them rather than expecting them to conform to what we want or believe is necessary.

These modifications often happen more readily when we think about the essential aspects of life – like eating and drinking – but often happen less automatically with the elements of daily living that might be seen as ‘optional’. Here I am thinking about supporting a person’s hobbies or interests, or even just helping them to do things that keep them physically active or mentally alert.

Lack of concentration shouldn’t mean a person with dementia has to abandon things they previously enjoyed, or indeed give up discovering new things. What is needed is an understanding that the person may not approach a hobby, interest or task in the same way that they used to – IE: sitting and reading a book, watching a favourite film from start to finish, participating in a board game, doing needlework, cooking, housework, gardening, painting/drawing etc – but that they may still be able to do these things in a different way (change location/time of day etc), in shorter bursts of activity, and/or with more intensive assistance (helping the person, not doing it for them).

When concentration wains some prompts may be helpful, like talking to the person about what comes next, or inspiring them by reminiscing about aspects of their early life that might relate to what they are trying to do. For example, if the person is doing something creative like painting or drawing, but struggling to start or continue with it, thinking about something they loved in early life might just spark a thought that they can commit to paper.

If the person struggles with conversation, some picture and word cards might help. Make sure any glasses or hearing aids that are usually in place are being used, and that distractions are minimal or non-existent (a blaring TV in the background is rarely a good idea). Think too about balance - respect independence but don't leave a person with dementia struggling or disappointed because they can't complete something. For example, if concentration is difficult when reading a book, see if the person would like you to continue reading it to them when they have gone as far as they feel able to that day.

Above all, offer gentle encouragement, and try to back up the person’s fleeting thought processes by helping to think for them in a completely person-centred way, sensitively anticipating, guiding and reassuring. This should always be supportive, rather than in any way controlling, and it will inevitably involve a lot of patience, time, calmness and perseverance.

Until next time...
Beth x

You can follow me on Twitter: @bethyb1886

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