On the journey from mild cognitive impairment and on through various stages of dementia, discussions with professionals, at which patients are very often present, tend to focus on deficits. I have been very aware of this recently after help from an occupational therapist whose aim was to see what S can still do and how her skills can be developed and extended. She concentrated on putting socks on and teeth-cleaning though some of her observations and advice could be generalised to other activities.
This was helpful, not only because she was pleasantly surprised at S’s ability to respond to requests despite the distraction of her auditory hallucinations, but because S was receiving encouragement and a positive response. It made me realise that we haven’t met many professionals who have been as positive. It is more usual for them to ask questions which highlight deficits and then to suggest to carer and patient that this is only to be expected. There’s an underlying fatalism that doesn’t escape S’s notice.
I have always believed that people, whatever their age and condition, respond to other people’s expectations so I can understand why some people with dementia would rather not see ‘doctors’.
The message I take from all this is that it does no harm, and may do a lot of good, to concentrate on what people with dementia can do rather than what they can’t.