Clinical question
How can I counsel and support caregivers of persons living with dementia?
Bottom line
Sadavoy and Wesson highlight the risk of burnout faced by caregivers of persons with dementia and the need to assess, engage, and support caregivers.1 They state that “all treatment interventions fail in dementia unless the unit of dementia assessment and management is recognized to be the live-in family caregiver–patient dyad.”1
How, then, can we better counsel caregivers in our offices to help them care for their loved ones?
In a recent Canadian Family Physician blog,2 the merits of the SMILE Framework were presented. This framework was developed by a caregiver who had analyzed how she managed to provide care to her mother for several intense but fruitful years. The goal of the framework is to help enhance the relationship the caregiver has with a loved one who is living with dementia.
Evidence
Approach
The framework (Box 1) can provide caregivers with some ideas and strategies to augment others that might be suggested by physicians to deal with specific behaviour or challenges, or provided by support groups such as the Alzheimer Society of Canada (who should be consulted for most dementia management plans).
Box 1. SMILE Framework.
Stages of life: Just as our parents accept us at every stage of our life as we grow up (baby, toddler, teen, etc), accept the person with dementia at every stage of their illness. It is better to enjoy and love them as they are now than to get stuck on how they used to be
Moments: Whenever possible, caregivers should look for and try to create precious moments. The caregiver who created the framework tries to create or enjoy “a nice moment” 3 times a day and view any additional moments as a bonus. This can give her a sense of success during trying times
Interconnect: Although friends might fall away and family might not always understand, it is important to never isolate oneself. Caregivers should try to turn to neighbours, support groups, information sessions, community services, and others whenever needed. The caregiver is not just the caregiver but is also a care coordinator, connecting and inviting others to participate in the patient’s care
Laugh out loud: A smile and a laugh can help with responsive behaviour and can be contagious. Finding things that make the person with dementia laugh can help with difficult situations and is good for everyone!
Experiment: What works one day might not work the next; the caregiver will need to experiment. Experiments should not feel like failure—if something does not work it can still stimulate creativity and collaboration, especially as the person’s illness progresses
Implementation
The SMILE Framework is a great place to start. Try it with your own patients and friends or family members living with dementia. Although it has not been studied, it makes good sense and cannot do harm!
Caregivers can also be directed to the “60 Tips” strategies to help them care for themselves while caring for someone living with dementia.5 Caregivers should also be directed to resources from the Alzheimer Society of Canada (www.alzheimer.ca), which is a relevant program to consider for all patients with dementia.
Geriatric Gems are produced in association with the Canadian Geriatrics Society Journal of CME, a peer-reviewed journal published by the Canadian Geriatrics Society (www.geriatricsjournal.ca). The articles summarize evidence from review articles published in the Canadian Geriatrics Society Journal of CME and offer practical approaches for family physicians caring for elderly patients.
Footnotes
Competing interests
None declared
This article is eligible for Mainpro+ certified Self-Learning credits. To earn credits, go to www.cfp.ca and click on the Mainpro+ link.
La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro d’avril 2018 à la page e167.
References
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