What are the three golden rules of dementia care?

Introducing the three golden rules of dementia care

The three golden rules of dementia care form part of a unique approach to dementia care called the SPECAL method and they are: don’t ask questions, listen to the expert, and don’t contradict. These golden rules can seem counter-intuitive at first, but when used properly they can make life much easier when communicating with a person living with dementia.

At Carefound Home Care, all our care professionals are introduced to the principles of the SPECAL method and how the three golden rules can help us improve the well-being of people with dementia.

Here we provide a brief explanation of the three golden rules of dementia care and how you can use them to communicate with a loved one or someone with dementia.

The three golden rules of dementia care are:

1. Don’t ask direct questions

When asked a direct question the person with dementia may not be able to access the factual information they need to answer it, which will only increase their awareness of their own disability and cause them unnecessary distress. It is therefore important to avoid direct questions. Although this does not immediately come naturally, it’s amazing how much information you can get without asking direct questions.

2. Listen to and learn from the expert – the person with dementia

For people living with dementia, feelings can be more important than facts. Information you give them should therefore generate good feelings, rather than causing them more anxiety than they are already experiencing. You can do this by listening to the questions the person with dementia frequently asks and learning what the best answer might be for them. Once you have found the best answer to a question, it should be recorded and used consistently by everybody communicating with the person. This can significantly reduce the number of anxious questions the person with dementia asks.

3. Don’t contradict

The first two golden rules of dementia care relate to questions, whether asked or being asked. With the third golden rule we’re considering statements. ‘Don’t contradict’ means don’t argue with what the person with dementia is saying. As dementia progresses, the person is increasingly likely to refer back to their pre-dementia past in order to understand what is happening in the present. This means as carers we need to adapt to the sense they are making of their situation, rather than applying common sense which may be contradictory. Take note of the language the person uses and follow their lead, so that you don’t disturb the sense they are making of their situation, and you encourage them to tell you more. If you contradict them or tell them they’re ‘wrong’, you will give them the feeling that they have been wrong footed, and they won’t be clear how.

The three golden rules are taken from the SPECAL method which began as an acronym for ‘Specialised Early Care for Alzheimer’s’ and was created by a UK charitable organisation called the Contented Dementia Trust.

The SPECAL method is a unique dementia management method which seeks to work positively with the condition, rather than trying to ignore or defeat it. It has been shown to:

• Slow the rate of deterioration
• Reduce the need for medication
• Enable people to remain in their own homes for longer
• Avoid distress when transitioning to another care setting

The SPECAL method is based on a particular way of understanding dementia from the perspective of the person with the condition. It uses the analogy of a ‘photograph album’ to help understand how normal memory works, how ageing impacts it, and the single dramatic change that happens with the onset of dementia.

The photograph album represents our memory system with each of our memories stored as a photograph in our album. New memories arrive all the time in our album as we experience things, and they have two features which are the facts and the associated feelings. We constantly refer back to recent photographs in our album to help us make sense of what we are doing and how we feel about it.

As we age, there is no change in the way we store photographs in our album, but we do become slower at finding the photographs we need. When somebody develops dementia however, memories are stored as a new type of photograph in which the facts of what has happened are not stored, although the feelings are. This means that the person with dementia has feelings-only ‘blanks’ in their photograph album and will quite reasonably refer to these when trying to make sense of their surroundings. Because they posses ever fewer facts about what has happened in their life, they will have difficulty making sense of their immediate surroundings and will refer back to older photographs in their album to try and match what is happening to them now. As the number of fact-free, feelings-only blanks increases, feelings become much more important than facts for the person with dementia.

Once this analogy of the photograph album is understood, it becomes easier to see why common sense will not always work when communicating with a person with dementia and why using the three golden rules of dementia care can help reduce their anxiety and improve their well-being.

At Carefound Home Care we believe that the three golden rules of dementia care can help carers be more effective when helping a person living with dementia.

It is for this reason that we introduce all our care professionals to the SPECAL method, the concept of the photograph album, and how the three golden rules can be applied to maximise the well-being of people living with dementia.

If you have any dementia-related questions or would like to learn more about the SPECAL method and the three golden rules, don’t hesitate to contact our local experts.