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Best Friends Approach: The Terraces staff develops ‘knack’ for dementia care


Photo By: Colleen Ryan/Special to the Town Crier
Photo Colleen Ryan/Special To The Town Crier

Dementia-care expert David Troxel advises staff at The Terraces at Los Altos’ memory-support center, The Grove.

When The Terraces at Los Altos opens its new memory-support facility, The Grove, in July, staff will embrace residents with dementia with a philosophy that emphasizes socialization and sensory-stimulating activities.

Pioneered by author and dementia-care expert David Troxel, the “Best Friends Approach” underscores the importance of creating an empathetic, activity-rich environment. The Terraces’ parent company, the nonprofit American Baptist Homes of the West, hired Troxel as a long-term consultant to train and advise staff at The Grove.

Troxel spoke at a forum sponsored by The Terraces, “New Trends in Dementia and Alzheimer’s Care: The Best Friends Approach,” May 4 at Los Altos United Methodist Church. The presentation included a panel featuring local elder-care advocates Bonnie Bollwinkel, Dr. Ronda Macchello and Karen Duncan (see article, page 34).

Troxel’s book, “A Dignified Life: The Best Friends Approach to Alzheimer’s Care” (Health Professions Press, 2003), co-authored with Virginia Bell, offers both family and institutional caregivers strategies for improving communication, encouraging positive behavior and solving problems.

“There’s a lot we can do to lift people up and give quality of life, to engage the person (with dementia) ... and help them do their best,” he said.

What every person with dementia needs, Troxel said, is a “best friend, someone who has empathy and understanding and is supportive.”

Socialization is key

“Dementia,” an umbrella term for various brain disorders that impair cognitive function, is not an exact diagnosis, according to Troxel, who added that dementias have different flavors and personalities that require different medical approaches. Alzheimer’s disease, the No. 1 form of dementia, commonly manifests in memory loss, disorientation and changes in behavior.

“If I had a broken arm, you could see the cast,” he said. “But we can’t see a broken brain. So a lot of times our expectations are really out of whack.”

As caregivers for older adults diagnosed with dementia, Troxel noted, it’s important to realize that the patient doesn’t make decisions the way he or she used to and proves progressively less able to rationalize and reason.

“(Caregivers) can’t just stay the same or else we don’t get anywhere,” he said. “We have to change some of our approaches.”

While dementia medications are tolerated with mild side effects by most people, and Troxel supports their judicious use, he noted that they are akin to “jumping out of an airplane with a parachute – they slow you down, but you eventually hit the ground.”

“Socialization is the treatment for Alzheimer’s,” he said, adding that The Grove’s philosophy is that “hugs are better than drugs.”

Developing the ‘knack’

Troxel’s Best Friends Approach encourages caregivers and family members to ask themselves a question: “How can I come out at the end of this feeling good instead of feeling completely exhausted and bitter?”

To create a positive environment for dementia sufferers in memory-care programs or at home, Troxel recommended that caregivers work on the relationship, be supportive, figure out ways to understand patients’ needs and be there for them.

“What works for us, works for them – giving hugs, compliments and simple choices … things that we would want,” he said.

When training caregivers, Troxel highlights the importance of a “great old-fashioned word” – “knack.”

“It means the art of doing difficult things with ease or clever tricks and strategies – having the knack,” he said.

The “knack” requires interacting with humor, flexibility, patience and respect. Such an approach from caregivers and family members, he added, allows them to avoid becoming the “bad guy” and encourages them to let go of the little stuff and forgo arguing.

“In dementia care, we have to adjust,” he said. “We need to assess the situation and make a change.”

Troxel attributed many of the behavior problems Alzheimer’s patients exhibit to boredom, simply not having enough to do.

“I want to create a program that maybe someday I’ll be in,” he said. “I don’t think I want to play bingo every day. Why not take an online tour of the Louvre and look at the Mona Lisa?”

According to Troxel, elements of a quality dementia-care experience include purposeful chores, creative activities, animals, conversation, incorporating the life story, exercise, music, being outside, learning and growth, and laughter.

When Troxel trains staff, he role-plays with them, demonstrating how to give compliments to elevate people and make them feel good.

“Our goal at The Terraces is to know 100 things about every patient,” he said, whether it’s that they love the San Francisco Giants, sleep in their socks or once hit a hole-in-one. “When the staff knows a lot about them … it makes them feel safe, secure and valued – it makes them feel known. And everything goes better.” 

For more information on The Grove at The Terraces at Los Altos, visit www.theterracesatlosaltos.com/care_memory.php.

For more information on Troxel’s Best Friends Approach, visit bestfriendsapproach.com.

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