Practice Management Alert

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Seeing patients who have dementia affects your practice beyond coding diagnoses, and physicians and other frontline staff who interact with patients should be knowledgeable about empathetic ways to interact with people whose demeanors or behaviors may seem confusing or inappropriate.

With more than 5 million people in the U.S. living with dementia, according to the Alzheimer’s Association, there’s a good chance that, no matter your specialty, some of your patients are represented. And with the COVID-19 pandemic requiring new means of interacting, people living with dementia may be more stressed than ever.

Focus on Education Generally

Plus, according to a survey conducted by the Alzheimer’s Association, 92 percent of primary care physicians (PCPs) believe that patients and caregivers expect them to know the “latest thinking and best practices around dementia care,” an expectation that could leave you or an unprepared team member high and dry. Many physicians surveyed received little or no focus on dementia during their formal medical education, and it’s easy to believe that other people who work in physician’s offices have even less exposure or education — even though they too interact with patients.

If you do any kind of continuing education with your staff, featuring a topic like best practices for communicating with people living with dementia may help you avoid uncomfortable moments or frustrated patients or staff. If you don’t have any kind of formalized program, it’s still important to help staff understand some important ways to interact with patients.

“The shortage of dementia care specialists needs to be addressed, but considerable focus must be given to ensuring dementia care education, training, and ongoing learning opportunities are available for primary care physicians,” said Joanne Pike, DrPH, chief program officer of the Alzheimer’s Association in Washington, D.C. “In addition, we need to consider how primary care physicians are supported within the health system to provide robust, quality care. Demands for dementia care are increasing and primary care physicians are about to be under siege.”

“Effective communication is critical when caring for a person with dementia. Changes in a person’s ability to communicate can vary based on their environment and where he or she is in the stage of the disease,” the Alzheimer’s Association tells TCI.

One of the most important takeaways for people interacting with people living with dementia is that the disease affects each person differently, so there’s no one-size-fits-all approach. However, some general tips are to speak and interact directly with the person — not just with their caregiver or companion — and to try and conduct conversations in quiet spaces with minimal distraction. Regardless of whether the patient is in the early, middle, or late stage of the disease, it’s important to speak clearly and slowly, the Alzheimer’s Association says. Utilize eye contact, as well as other forms of nonverbal communication, like pointing or gesturing.

Know How to Adapt to COVID-19

Knowing some aspects of living with dementia can vastly improve the patient and staff experience while mitigating the risks of COVD-19.

“Emergency situations, such as the current COVID-19 pandemic, present special challenges for people living with dementia and their care team,” the Alzheimer’s Association says. “It is important that all members of a person’s care team, including front-office staff, recognize and adapt for these added challenges to ensure people living with dementia receive the best possible care.”

For example, underscore the importance of hand hygiene by placing written reminders in the bathroom, near the sink, and throughout the office wherever you’ve placed public hand sanitizer.

Personal protective equipment (PPE) generally and masks, specifically, can be an issue for people living with dementia or Alzheimer’s Disease (AD).

“People with AD can have sensorial deficits and perceptive troubles, leading to difficulties in seeing, facial and emotional recognition, hearing, and understanding their interlocutors, and even much more, when face masks are added to physical distancing, because they are confronted with a physical barrier and a fragmented perception of the face, which may no longer even induce a feeling of familiarity and no emotional recognition,” say Roger Gil, emeriti professor of neurology at University Hospital at Poitiers and director of the ethical reflection area of Nouvelle-Aquitaine in France, and Eva M. Arroyo-Anlló, who works at the department of psychobiology at the University of Salamanca, Neuroscience Institute of Castilla-León, Spain.