Patients with dementia have a risk of falling that is two to three times higher than that of cognitively intact elders. Participation in occupational therapy and/or physical therapy can be crucial to prevent falls or to rehabilitate after a fall or hospitalization.. However, some patients with dementia refuse to participate and might even get angry when approached. 
As an occupational therapist with an expertise in dementia care, I would like to offer some tips to other therapists when working with the patient with dementia who refuses or gets angry. Of course you can never force the person to do something they do not want to do . But we should not give up too easily to find a way to help the person gain strength, balance, and abilities for everyday tasks through rehabilitation.
Sometimes all it takes is opening your mind to a new approach to the patient and to the path you take to help reach the patient's therapy goals. Here are 10 tips to try to help gain trust and cooperation from your patient.
- Introduce yourself, every time - To the person with dementia, each encounter with you might seem like the first one. For this reason, introduce yourself each time, even if it is your 8th visit. Be sure to speak slowly and give the person time to respond. Demonstrate what you would like the person to do.
- Take your time - If the first time you meet the person, they tell you to go away and get angry do not immediately leave and give up. The person may be intimidated by you and not know what you want - so of course their guard will be up. Try to talk to he or she a few minutes before leaving. Ask about pictures in their room, compliment their clothes, or ask if he would like a cup of coffee or tea. Or ask family about the person's history. You may not get billable therapy minutes in this few minute time frame, but you will start to gain a bit of trust with the patient and may learn a bit about him so you have a connection to start with next time.
- Use validation when needed - For instance, if the person tells you they are tired or upset, validate what they are saying: "It sounds like you have had a difficult day. You must have a lot on your mind." You might be saying this even if the person has been in bed all day. It doesn't matter what you, the therapist, thinks. It matters what the person thinks. Take some time to validate what the person is feeling first and then move on: "I bet a walk over to that large window would feel good. Let's see what flowers are out there" and so on.
- Consider avoiding the word "therapy" - This word might turn off the person, as he might not not know what that means. "Let's take a walk"... "put on a sweater"... "make a snack together" can be better received and can be activities that can meet therapy goals if set-up correctly. This brings us to one of the most important tips for giving therapy to individuals with dementia...
- Incorporate skill-building into functional tasks - Doing rote exercises, including using weights or bands, may be rejected by the person with dementia who is reluctant to participate. But this does not mean the person must automatically be discharged due to lack of participation. Try adapting your approach, so that you are working on component skills within the context of function. Occupational therapists can easily work with a patient during self-cares, working on balance and endurance during dressing or when walking around the room. Physical therapists might use walking, watering plants, playing catch with another patient, making a bed or riding a stationary bike, all of which are functional, life activities. Catching the person when they are already getting out for meal time or an activity can be a good time to meet the person and slide into treatment.
- Incorporate common hobby items into treatment -This might entice the person with dementia to participate. The MindStart dementia products can be used when working on coordination, cognitive processes, and visual-perceptual skills when used from a seated position. They can also work on endurance and balance when used from a standing position.
- Find the person's good times of the day - Morning is often better for individuals with dementia.
- Try again when a patient refuses -Talk to them a bit before leaving as mentioned above and tell them you will come back. The mood may be different later. Or have another therapist try. Sometimes a different person has more success. If there is a nursing aide who has developed a relationship with the patient, ask him or her to help the patient go along to therapy.
- Incorporate family when refusals are an issue - Often a family member will be able to lighten the mood or provide the person with security, so that the patient is more willing to work with the therapist.
- Speak to the physician -Sometimes the physician can encourage the patient or even write a note or 'prescription' for a daily therapy session. You can then use this to show the person that the physician would like him or her to work with you (which is, indeed, the case for physician ordered therapy services).
With some patience, empathy, and creativity, therapists can usually gain cooperation from the reluctant patient with dementia, leading to successful therapy sessions and, ultimately, improved function and quality of life.
