A few weeks ago I was asked to deliver a workshop, at a dementia leads conference, about starting to write for publication. I was fortunate to have the opportunity to sit in on the fascinating workshop before mine. A local lead nurse described and demonstrated the toolkit she had designed. The speaker had identified a significant number of reported falls by people living with dementia had occurred when they were ‘wandering’ and that carers and care providers struggled to both understand and manage this behaviour. The toolkit aimed to help carers to understand and manage when someone ‘walked with a purpose’.
A poster that the speaker had produced highlighted a number of different reasons that may drive a person living with dementia to walk with a purpose. Two particular reasons really resonated with me. These were when people were continuing a habit or seeking something they felt was missing. After the conference I talked about this with one of my colleagues, a very experienced Later Life nurse. She told me that, in her clinical practice, it had been very common for female service users to become very agitated around school finishing time. These service users were remembering a time when they had to be at the school gates on time to collect young children.
All of this made me think about those of us who own animals; farm animals as well as companion animals. Animals provide such rigid routines for their owners that form very clear demarcations to the day.
Those who walk their dogs every day at certain times, often with several, if not many generations of dogs, can have very specific routines. For those of us that have animals that live outside of the home, such as horses and farm animals, the seasons and available daylight are significantly important. For me, in the winter there is always a rush to try and get to my animals in the last of the fading light. My winter days become organised around morning and evening visits and feeds. At this time of year I become probably quite infuriating to friends when I tell them I have to leave at a certain time to be back to do my animals.
I wonder how these ingrained routines and behaviours surface for those living with dementia and how much these old daily patterns drive walking with a purpose behaviours. Added to this, those with behaviours that were carried out at particular times of day may be significantly affected by changes in light levels. This can be especially pronounced at dusk. I wonder how this interacts with the already recognised issue of changes of behaviour as the sun goes down when there can be increased agitation and distress.
What do we do about it?
I am amazed at the skill and knowledge that my Later Life colleagues have in their work and they will probably be much more skilled to answer these than me (and I hope they might comment). For me, it comes back to those core skills of mental health nursing – of knowing those who we are working with, understanding who they are and the importance of their histories. In an article written for the Care Coordination Association (CPAA) https://bronwizview.wordpress.com/2013/08/21/the-place-of-animals-in-mental-health-recovery/ I considered the place of animals in recovery but I had never really considered the role of animals for those living with dementia.
Whist visiting PAT animals are a wonderful, important service; at the conference I began to imagine how it would be to have memory problems. Someone brings me a dog to fuss. Then they take it way. At this point I suspect I would become distressed and very possibly angry.
Maybe we need to think about the possibility of residential animals wherever possible, but taking in to consideration both human and animal welfare. So, should I need care or nursing accommodation in the future please could I have a home with several cats, a dog and if possible two donkeys in a paddock outside my window? It’s really not much to ask for is it? It would make me much easier to care for. And happier.