Scenario for discussion

Anna, an 82-year-old widow with early onset dementia, had lived at the facility for four years. She loved talking about golf and gardening. During the day, Anna weeded and hosed the shared garden while telling fantastic stories about her golfing days to anyone who would listen. As her dementia worsened so did her memory, gait and balance. One day, while she was hosing, Anna tripped and fell. The large cut on her scalp needed stitches and she had a black eye.

Staff thought she might break her hip next, so they gave her hip protectors and the manager told them to supervise Anna whenever she gardened. Anna refused to wear the hip protectors and was unhappy with staff telling her when she could go outside. Because her short-term memory was poor she forgot to tell staff when she wanted to go into the garden. Anna kept gardening until she had another fall, breaking her hip and tearing the skin on her arms and legs.

Fearing she would injure herself again, staff put Anna into a chair with a table insert to stop her walking as often as she had in the past. She was very agitated, her dementia worsened and it was harder to understand what she said. A staff member spoke to Anna’s doctor about these changes and he prescribed a tranquiliser. Over time, Anna stopped talking altogether and for hours sat motionless in her chair. Her days of gardening and storytelling had come to an end.

Exercise

Management and staff should discuss this scenario from the viewpoint of:

  • a manager
  • a staff member
  • Anna
  • her family.

Think about the following questions:

  • Could the risk of falling have been minimised earlier without having much affect on Anna’s activities in the garden? What strategies could have been used?
  • What other person-centred alternatives would have been worth trying?
  • What were staff expectations following the first fall? What were Anna’s expectations after the first fall? How realistic were these expectations? While still using a person-centred approach, was it possible to meet both staff and Anna’s expectations? If so, how? If not, why not? What alternative actions could have produced a better outcome at that stage?
  • Despite Anna’s decline as a result of dementia, at what times in this scenario would a person-centred approach have differed from the one described? Why?
  • In what ways might family, friends, volunteers or others have been involved to bring about a better outcome?