In more advanced dementia, a person may appear to have lost many of the abilities needed to engage with others. However, this doesn’t necessarily mean that the person you are visiting is not present. You may see their eyes follow you as you move towards them or when you squeeze their hand you might feel them squeezing back. When talking to them you might see by their facial expression that they understand a lot of what you are saying, even though they might not respond verbally.
Even when someone appears withdrawn it’s important to remember they could be aware of everything that’s being said and happening around them. Therefore, never say anything or act in a way in front of a person with dementia that could make them feel upset or undermined. Even if a person isn’t responding be gentle and sensitive. Be aware that sometimes they may just want some peace and quiet like we all do from time to time. Just be aware that some people are naturally quieter than others preferring to watch and listen rather than joining in.
While we need to respect people’s preferences it’s important to make sure that no one ends up being left out or forgotten. When someone is quiet, it doesn’t necessarily mean that they are withdrawn. We need to be observant of their mood and ensure there are opportunities for them to be more engaged if they would like to be.
Equally you need to be careful not to assume that just because someone is being quiet and undemanding that they’re OK. It can be easy to overlook the fact that the person has, in fact, become withdrawn because they are not happy. This is most likely to happen when a number of people living with dementia are together, like in a care home setting. A person who is withdrawn may have some needs not being met. An attempt to investigate the reason for their withdrawal and meeting the needs could result in them becoming more engaged because they feel that they’re being cared for or a particular need (like needing to go to the toilet) is being met.
When you visit a person who seems withdrawn it’s important not to assume that this is a permanent or inevitable part of their dementia. One of the most important things we can do when ministering and caring for people with dementia is to find ways of making contact with them. Often, we need to be prepared just to sit quietly letting them know we are there. We don’t want to put any pressure on them to interact if they are not ready, willing or even capable to. Using gentle touch, if appropriate for the individual, can be a good way of making a connection that just says ‘I’m here’.
It is easier to visit someone in the more advanced stages of dementia if you know them well. If you don’t know them particularly well spend some time talking to those who knew them before you visit. Knowing the person is particularly helpful when you are trying to connect with them as you can talk about things that are relevant to them or play their favourite piece of music.
Even if a person only engages with others from time to time, these moments can be very significant and help the person feel that they are not alone. Ministry to those living with dementia is one of the most humbling yet important forms of ministry. It is so important that you don’t abandon them or their primary carers (often a husband or wife) at this time when they need you the most. Even if it feels like they don’t appreciate your presence or even remember who you are.