Course content – PFLEGE-16
10. Module 9 · Personal hygiene & nutrition in dementia
10.3. Case, consolidation & transfer
Two cases and what to take away
Resistance understood
Mrs L. fiercely resists personal hygiene in the morning – she is described as ‘aggressive’. A carer understands the resistance as communication and looks for the cause: Mrs L. was a ‘night owl’ all her life and never approachable in the morning (life history); in addition, unannounced touch startles her. The team moves Mrs L.’s personal hygiene to later in the morning, announces every step, works calmly and with a familiar person. The resistance disappears. The case shows how understanding resistance (life history, fear) and empathetic adaptation make care succeed – entirely without coercion.
Mrs Hartmann and the mealtime
Mrs Hartmann (fictitious), 87, has advanced dementia. For some weeks she has eaten very little and clamps her mouth shut when a spoon approaches. A carer says “she does not want to eat”. Another proposes to hold her head still. Lena (fictitious), a care assistant, notices that Mrs Hartmann turns her head away when the spoon comes from the left, and that she is calmer when someone sits beside her at the same height. Her daughter reports that she always loved sweet porridge and drank tea with honey. The team brings her to a quiet corner for meals and sits beside her. The carer gives time and puts the spoon in her hand and guides it gently. They try porridge and tea first. They also report the clamped mouth and weight loss to the nurse in charge, who arranges a check of her teeth and swallowing. A loose denture is found. After it is fixed, Mrs Hartmann eats more, with help, and the team continues to offer favourites in small portions.
Analysis. (1) The refusal was communication, not a lack of wish (Figure 9.1). (2) The way of approaching, from the side and at eye level, affected fear and control. (3) Life history gave the key to favourite food (Module 5). (4) The team looked at the body as well as the attitude: dental pain was one cause (Figure 9.2 and the five groups of causes). (5) Holding the head still would have been coercion with a risk of harm and choking, and does not fit into care (section 240 StGB). (6) Reporting the weight loss and possible swallowing problems let the right professionals decide, instead of the carers deciding alone.
What does “relationship beats technique” mean?
Name three common reasons for resistance to care.
What do you do when a person resists personal care?
Why contrast at the table?
Which signs at meals must you report?
Which section of the German criminal code covers coercion?
Key messages
- Relationship, calm and familiarity matter more than technique in basic care.
- Resistance is a message: look for fear, shame, pain, being overwhelmed, cold or loss of control.
- Announce each step, use small steps and respect privacy and habits.
- Make meals recognisable with contrast, one dish at a time, finger food and favourites.
- Report coughing, choking, weight loss and possible pain; do not decide these alone.
- In Germany, force in care conflicts with sections 240 StGB and 1831 BGB; person-centred planning follows section 2 SGB XI.
- When did you last hurry a person with dementia through care, and what did they show you?
- What do you know about the washing and eating habits of the people you care for, and where could you find out more?
- How do you feel when a person resists, and what helps you to stay calm?
- ☐ I find out the person’s habits and preferred time for washing and eating.
- ☐ I announce each step and wait for a sign before I begin.
- ☐ I stop, calm the person and try later when they resist.
- ☐ I check contrast, noise and setting at meals.
- ☐ I report swallowing problems, weight loss and signs of pain and I record what worked.
Exercise: Think of a person with dementia who resists care. What could the cause be (fear, shame, pain, being overwhelmed, wrong time)? How could you adapt care in a dementia-sensitive way (relationship, announcing steps, life history, no coercion)?