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“It is a worthwhile pursuit to make your practice dementia‑friendly!”

Many dental practitioners are not well-trained in caring for patients with dementia, nor in assisting their care-givers in helping them maintain their oral health. (Image: RossHelen/Shutterstock)

Adria Thompson is a speech–language pathologist on a mission to help clinicians and caregivers of people with dementia improve the care they provide. Through social media, Thompson has reached millions of people who previously received no formal instruction on how to provide quality care in dementia cases. Dental Tribune International spoke with Thompson about her company, Be Light Care Consulting, and the advice she gives to dental practitioners who want to provide excellent care and create a clinic environment conducive to treating patients with dementia and to educate caregivers on oral health maintenance in patients with dementia.

Adria Thompson. (Image: Adria Thompson)

Ms Thompson, you are one of the most visible instructors teaching best practices to caregivers of individuals with dementia. Could you share a bit about your background and the creation of Be Light Care Consulting?
I have been a speech–language pathologist since 2014, working in long-term care facilities like nursing homes, assisted-living facilities and memory care communities. I provide one-on-one speech therapy services to older individuals for communication, swallowing and cognitive deficits. Over the last few years, I slowly started to realise how much I love working with individuals with dementia, and I spent a lot of time focusing on learning as much as I could about how to provide the best dementia therapy.

I was approached by a company I worked for to create a training programme to train other therapists to be as comfortable and effective as I was at the facility I worked at. It was a great opportunity to stretch myself and practise training others. My husband’s job moved us from Kentucky to Washington, and I decided to go out on a limb and start my own consulting business in September 2021. Within six months, I had gained tens of thousands of followers on social media, and it has opened so many doors to the conversation around dementia care!

Do you only work with dementia patients?
I’m approaching one year of working in my consultation business and focusing on providing education, support and training to individuals caring for people with dementia, so currently I am only working with individuals with dementia and their caregivers. Before that, as a speech–language pathologist in long-term care, I was providing services to geriatric patients for many conditions affecting communication, swallowing and cognition.

What tips or guidance can you offer to dental clinicians who are working with patients at different stages of the disease?
It is important to know as a medical provider that there are many types of dementia and that patients can be experiencing various stages of cognitive decline within each. Therefore, it is vital to treat individuals with dementia much like all other patients—like individuals. My best advice is for dental professionals to learn how to assess continuously how things are going and know how to shift.

Think about each thing you do on a spectrum from the easiest to understand to the most complex. Let’s take asking questions as an example. You may want to ask a patient with dementia whether he or she is experiencing any oral pain. A complex way to ask that would be “Tell me about your pain level”. This would assume that the person knows you are speaking about his or her mouth (being at the dentist) and that he or she is able to create a narrative about the pain. This type of open-ended question is complex. If a patient is unable to respond to this, a simpler way of asking this question is by forming it into a yes/no question and adding more context, such as “Does anything in your mouth hurt?”, and then asking for a gesture rather than a verbal response by saying, “Can you show me where?”.

My best advice is for dental professionals to learn how to assess continuously how things are going and know how to shift.

If the patient is still unable to respond to this, then expect only non-verbal reaction to this question. This may be how someone with the most severe stages of dementia may be able to communicate. For example, you can place the patient’s hand on your forearm as you touch each tooth and mouth area to feel for any flinching or tensing of the body. All these forms of obtaining information are effective, but have different levels of expectation of the patient’s abilities.

Adria Thompson, founder of Be Light Care Consulting, specialises in helping care-givers and clinicians provide great care to dementia patients. (Image: Adria Thompson)

When working with patients, how can practitioners go beyond the symptoms in treatment? For example, helping patients feel comfortable, setting realistic care goals, and understanding what patients can handle in terms of chair time and treatment duration.
In order to help individuals with dementia feel comfortable in the dental chair, it is important to know what symptoms of their neurological condition they are experiencing. This will be different for everyone, but in general it can be expected that individuals with dementia will experience challenges in communication, orientation and memory.

When we think of communication deficits, it may be assumed that the person is no longer able to say the words he or she wants to say as easily. However, dementia can affect all forms of communication, including expression, comprehension, writing and reading.

The best ways to communicate effectively with individuals with dementia are to sit on their dominant side, within their natural line of sight, obtain eye contact before speaking, use a slow rate of speech, speak clearly and without figures of speech, and pause between sentences and ideas so that they can have extra time to process. It is perfectly acceptable to ask a caregiver for a few tips on how to best communicate before the first interaction. Throughout the session, it is important to tell the patient what you will be doing next and use gestures to explain what to expect.

Individuals with dementia experience disorientation, meaning that they may not know where they are or what is to be expected. For individuals without cognitive deficits, simply being in a dental office is enough context to communicate what is going to happen. This is not the case for individuals with dementia, and you need to clearly communicate who you are and what you are going to do.

Throughout the session, it is important to tell the patient what you will be doing next and use gestures to explain what to expect.

Related to orientation is the concept of proprioception. Proprioception is knowing where your body is in space. Many people with dementia struggle with knowing where their bodies are in space, and so any sudden changes in posture and positioning will result in fear. It is for this reason that dental professionals need to move slowly when reclining them and take breaks throughout a visit if they are feeling overwhelmed.

Short-term memory loss is far more common for individuals with dementia than is long-term memory loss. This means that they will struggle to recall what they had for breakfast, what they are waiting for while in the waiting room and what you told them 30 seconds ago. It is for this reason that dental professionals may have to repeat themselves more often and explain what is happening next with every single step.

As far as recommendations for the duration of treatment, I recommend prioritising treatment. Always start with the most important treatment indicated in case the patient stops treatment at a certain point in the visit. Until then, allow for breaks as needed and continually assess his or her agitation levels.

It is essential to provide the same level of, or maybe even more, education to caregivers than you would to a patient.

How can clinicians better educate and support caregivers in the management of oral healthcare for their patients? What would you advise beyond brushing, for example in the case of edentulous patients with removable partial or complete dentures?
Caregivers get no training and are constantly having to figure things out as they go along. Never assume that they know things! For example, a woman recently reached out after I made a video about dentures saying that she was never told that her husband’s dentures needed to be stored in water. She always just sat them on a table and now they no longer fit him. He probably knew that piece of information at one time, but she was not a denture wearer and did not know how to properly care for them. It is essential to provide the same level of, or maybe even more, education to caregivers than you would to a patient.

Any tips for clinicians who want to more clearly market their practice as being friendly to these patients?
Marketing yourself as a healthcare professional who is “dementia-friendly” would be welcome to so many caregivers! It is important, however, that your entire staff is trained adequately. Everyone from the receptionist to the dentist needs to know how to support individuals with dementia and their caregivers. Longer visit times may need to be scheduled, and the environment will need to be safe. It is a worthwhile pursuit to make your practice dementia-friendly!

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