Calming presence

There are times when we are all need to hear a familiar voice or see a friendly face. For people with dementia such a need can be intense and ever-present.

Research has shown that playing videos of family members or tape-recording the voices of relatives to be played on personal stereos have reduced problem behaviour in people with Alzheimer’s. The creation of such a simulated presence has reduced verbal outbursts and improved mood.

“I first found out about simulated presence in an article at Bradford University while I was studying on the diploma in dementia course,” says carer support worker, Barbara Clarke.(1) “The researchers found that using tapes of carers’ voices giving messages of reassurance calmed down problem behaviour in people with Alzheimer’s in 91 per cent of cases.”

However, Clarke felt the idea could be taken one step further. “We thought it would be better to use new technology and use DVDs. We could put together selected pleasant memories, video clips, scan photographs, written works or posters, play favourite music – indeed include anything that was relevant to a person’s life.”

Separation anxiety between the carer and person with dementia is at the root of much problem behaviour. “So to reduce the anxiety, we start off with a message from the carer explaining why they couldn’t be with them at that particular point but that they would be back shortly.”

The first DVD was for the husband of a carer who regularly attended the carer support group, but who would get distressed whenever she left to attend. Apparently, his parting gesture was always to ask her to “run all the way home”. So the carer included this on the DVD, saying: “I’ll be home shortly and I promise I’ll run all the way.”

The DVDs, which are put together first by a part-time technician, can be presented in a straightforward timeline or can be more interactive. For example, Clarke’s own DVD for her mother opens with a menu of pictures of Clarke, her son and her grandson. “Click my picture and it plays a video of me at work with the message, ‘I’m at work at the minute, I’m really busy, but I hope to see you soon. I was just thinking of you and that holiday we had…’

“It then moves onto pictures of the holiday that had been scanned in with music that my mum likes. It then ends with another video of me at the office saying, ‘well I’m going to have to crack on now as I’m really busy but I’ll be over to see you at five o’clock as normal.'”

Clarke is looking to develop this further by producing a treasure box to accompany the DVD. She says: “The box would have – say if a child is important to the person – baby talc, teething rattle, Farley’s Rusks. This would give the holistic experience of smells, tastes, touches and so on. If it’s a wedding we could include things like an old horseshoe, dried roses, programme from wedding, cake, sherry glass.”

Clarke points out, however, that it’s not just a reminiscence idea: “One man with dementia we work with isn’t particularly interested in old photos – but is really keen on fishing, Skegness, Ken Dodd and Bolton Wanderers football team. So his DVD features these things – and his treasure box could have a fishing basket, and a Ken Dodd tickling stick. It can be adapted.”

Although Clarke says that everything has been well-received, there was a danger of the DVDs being too impressive. “We found that carers were so impressed that they wanted to keep watching,” she says. “But there’s no point having a DVD saying, ‘I can’t be with you right now’ when the carer is sitting next to you. So we realised we needed to burn two discs – one for the simulated presence and one for both to sit and watch together.”

(1) P Woods and J Ashley, “Simulated presence therapy: using selected memories to manage problem behaviors in Alzheimer’s disease”, Geriatric Nursing, 16, 1995

Lessons learned