Self-Awareness: When Things Become Not So Crystal Clear

Self-Awareness: When Things Become Not So Crystal Clear post page

By Online Dementia JournalMarch 14th, 2021

Self-Awareness: When Things Become Not So Crystal Clear

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by Julie Gala, MA, CCC-SLP,

Assistant Director of Clinical Services, and PAC Independent Certified Trainer


Life isn’t always seen through rose-colored glasses, especially for our Persons Living with Dementia (PLwD) who are transitioning GEMS States from Diamond to Emerald. Clarity becomes more muddled and they start losing their sense of self. As PAC trained care partners, we may be the first to notice when the disease process progresses and the PLwD is transitioning to the next state. Maybe we start hearing phrases such as, Where am I, Why are you playing that music, Of course, I can drive home; give me my keys, That’s not my husband, or I already changed my clothes. The PLwD is starting to lose awareness about themselves including hobbies, interests, relationships, orientation, safety awareness, and participation in daily tasks.

As trained care partners, we know that Emeralds present with the following common issues related to the progression of dementia and we have the skills to connect each to the decline in self-awareness:

Thinking care was provided routinely when it was not

Unaware of mistakes that were made in sequences

Resists or refuses help from care partners

Gets lost and can’t find where to perform their care

Limited awareness of real needs versus what they think they may need

Feeling like they need to be somewhere else, always on the go

Looking for people and/or places from the past

Losing important things, and thinking others stole or took them

Doing private things in public places, consider activities of daily living

Having emotional meltdowns

Treating strangers like friends and visa-versa

Now that we know what is not normal, let’s remove our rose-colored glasses and put on our binoculars to dive into strategies to set our Emeralds up for success during this loss of self-awareness. Emeralds enjoy participating in the following tasks:

Doing tasks that are familiar and visible

Historic tasks and people and places

Engaging with or helping others

Finding important people or things, wanting to find the supervisor

Having a job or purpose

Getting finished and doing something else, even if not completed correctly

What can we as care partners do with this information? More like, what can we not do with this information. Our priority in setting up a caring and positive environment for our PLwD is to know who they are. We should obtain a history of their likes, interests, and dislikes so that our intervention strategies will be successful. This can be performed via patient, family, and/or care partner interview, observation, and therapeutic use of self.

When a PLwD begins to lose self-awareness, we can support Activities of Daily Living/Instrumental Activities of Daily Living (ADL/IADL) completion with the introduction of visual aids. Initiate daily routine tracking, schedules, and be sure to set up ADLs in the same locations each day to build routine. These strategies may assist when the PLwD thinks care was already provided and allows them to have more control with less resistance over their care.

Task initiation, progression, termination, and transition to a new task may start to become more difficult for the PLwD who is losing self-awareness. During the task, the person may not recognize errors and become frustrated when errors are pointed out by care partners. We can support the PLwD by providing visuals aids and visual and verbal demonstration of what we are expecting them to accomplish. For example, if we want a PLwD to tie their shoelaces, but they are having difficulty initiating the task, let’s get into supportive stance, offer a Positive Physical Approach (PPA), and get to their level to introduce a positive approach. Then we will move on to the visual demonstration for the PLwD of what we want them to complete by modeling the task on ourselves. We are giving a visual cue while setting up the expectation of what should be completed.

If we start to notice that a PLwD is losing awareness of their relationships with others, let’s reach out and learn more about their care partners. We can assist with memory/photo books and offer one on one conversations with the PLwD about each person including who they are, how they know them, and what emotions they may feel when talking about that person.

In summary, our PLwD will transition through the dementia process and lose self-awareness, but we as trained care partners, have the tools to optimize their personal and positive approach to care.

Julie Gala, MA CCC-SLP, has been a PAC Certified Independent Trainer since 2019. She has been a Speech-Language Pathologist working in the long-term care setting for 13 years with a specialized focus in dementia education. Julie worked with her co-trainer to transition PAC workshops to virtual trainings during the Public Health Emergency ensuring Physical Therapists, Occupational Therapists and Speech-Language Pathologists throughout their company had the tools needed to provide a positive culture in dementia care.


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