Is “Picture Talk” a Valuable Intervention In the Care of Persons with Dementia?

In recent years, I have used pictures I’ve taken on my smartphone or received from others, as part of how I relate to my patients.  Pictures are a powerful way to share common human experiences that even my advanced dementia patients can find interesting. Most of these pictures are of my dog or grandchildren or places in the area that have a story associated with them.  I commonly will then ask my patients about their experiences with similar circumstances.  

Recently I had the chance to share my pictures with one of my patients. She is a woman from India who only speaks Punjabi and is quite demented with many fears from her past that seem to be very real in the moment.  With the help of an interpreter, I was able to show her a beautiful picture of a local lake at twilight. I told her I used to swim in that lake and asked her if she had done this in India. She smiled and said “never” with my young interpreter surmising that women in her area of India were not permitted to swim for modesty reasons.  I then showed her a picture of my 7 year old granddaughter sewing a skirt. She couldn’t recall sewing in her past, but I was amazed to see how engaged she was in learning about my granddaughter’s experience.  

In another experience, I met with a patient who commonly refuses basic care from our CNAs.  During my visit, I started by showing him some of my personal pictures of the above lake and one of my 4 year old grandson wearing a crown to celebrate winning a game of “Chicken Foot” dominos. Again, I was surprised to see how receptive he was to engage in conversation with me about our personal experiences.  By connecting with me personally, I witnessed an improvement in his disposition, interest and receptiveness to me. He then answered simple questions about his health, permitted my exam, and even thanked me for my visit.    

These experiences raise the question of whether our staff should be attempting to engage challenging patients with smart phone pictures and stories prior to providing care that may require some action on the part of the patient.   My dementia patients seem more receptive to my care when I engage them by this technique.  

During the August California Partnership to Improve Dementia Care call, one of the participants talked about the value of creating visible personal biographies with pictures as a tool for providing more personalized dementia care.  They found the patients to be much more receptive to basic care centered around conversations about their past. Another person commented on the value of sharing pictures of patients when they were much younger to the caregivers to help them see each patient as a person with a past story worth knowing and learning more about.  

On the Partnership call, California nursing homes boast the fourth lowest use of antipsychotics among all the states at 11.1%, with Hawaii the persistent best at 7.7%.  Since the Partnership nationally began targeting poorly-performing facilities (“late adopters”) in 2017, those facilities nationally and in California have experienced progressive reductions in use of antipsychotics.  In the coming year, the partnership hopes to provide more online dementia care resources to help facilities improve the competencies of current staff and to those new to dementia care.  

As I reflect on the faxes I have received this year alerting me about incidents where a patient has exhibited aggressive behavior towards a caregiver, I wonder how many of these incidents were triggered by a task-oriented, hurried approach that failed to first engage the patient with a friendly slower approach.  Once that is done, support for the next activity may be easier and less likely to provoke aggressive rejection of care.  

I don’t have research data to support the above observations and thoughts, but do think facilities may find an improved dementia care experience from fostering “Picture Talk.” 

If any of you have more formal experience or are aware of outcomes research on this subject, please contact us at CALTCM so we can make that information available to our members.

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