Family history collages for residents with dementia

This was the buzz of the break room. Watching her talk to her stuffed bear and rant at some invisible tormenter, it was easy to forget that this woman had once led a very interesting and impactful life. With this information about her past, however, everything changed. The staff never again saw this resident as a sweet elderly woman with dementia. She was a woman who had stepped into the fire and lived to tell the story. She was a woman with a past. She was interesting and impressive. She was a hero. We asked both the resident and her daughter unending questions about her stories. The daughter followed up with a huge collage of pictures of the resident’s entire life. We became part of her family and her family became part of us.

It is purely out of necessity that when caring for a resident with dementia, caregivers often become focused on the resident’s needs in the here and now. How do we keep this resident safe? How do we get this resident healthy? How do we improve this resident’s strength and mobility? It is very easy to forget, in the midst of a resident’s rants about how much she hates her brother (who has been dead for 15 years) or her constant requests for cigarettes (which she is not allowed to have), that the resident once led an amazing and dignified life. But after our war hero’s family provided a multitude of pictures to help her remember her loved ones, we were unable to walk into her room without seeing her rich history. There were pictures of her long-deceased husband, whom she often asked for, and of her many grandchildren, whom she didn’t recognize. She talked at length about her coworkers and childhood friends in England. Until her daughter filled in the blanks of this woman’s life, the missing piece for us had been the understanding of who she really is.

The December 2010 issue of Gerontological Nursing1 published a study on how providing family history collages for residents suffering from dementia may not only help the resident compensate for memory loss but also help caregivers know who that resident really is. It is important to provide constant reorientation for residents with dementia. The staff regularly reorient on the person, date, time, year, and location. So it seems logical that having more knowledge about who residents actually are, as opposed to who they seem to be, would improve the ability to reorient. It was the hypothesis of this study that the more information provided to staff regarding residents, the better their ability to remind residents who they are, where they come from, and why they are here. A staff with insight into not only the resident’s medical history but also personal history should be better equipped to individualize care for that resident.

Oddly enough, however, in the study, although the staff agreed that they had improved their knowledge of the resident’s likes and dislikes, they did not perceive that the level of person-centered care had changed. This was an interesting outcome as it seems intuitive that improved personal knowledge of anyone anywhere in our lives would impact how we react and respond to that person. Perhaps the caregivers in this study were a group already focused on person-centered care. The author of the study made a point of stating that their findings show that a change in nursing staff knowledge may not always lead to behavioral changes and that a change in nursing staff behavior may not lead to changes in outcomes. These are important points, and it is difficult to know precisely why the rather small study showed no improvement in care provision from the standpoint of the care providers. Anyone who has seen the use of a family history collage may refute these findings. I have seen how an increased knowledge of a resident’s history can affect the staff in a positive way, and I asked other nurses what their experiences have been with the use of pictures in reorienting residents with dementia.

This was the subject of a discussion with Diane Carter, the executive director of the American Association of Nurse Assessment Coordination (AANAC). Diane has worked in long-term care (LTC) for most of her career, starting off as a candy-striper in her youth. She related that when she was a director of nursing they used personalized history boards to help reorient residents. She feels strongly that more information about a resident’s personal and family history can help the staff see a resident with dementia in a different light and can help caregivers, who often just see the resident in his or her current state, connect more fully with the person. It is a useful and relatively simple intervention, Diane went on, saying that experience has suggested the intervention is effective.

This issue was addressed in a survey to the AANAC membership. The survey was posted on the AANAC Web site for a short time and included the following questions:

1. Is it helpful when family members provide a more extensive personal history of a resident that is supported by pictures?

   Out of 238 respondents:

   • Yes-170 respondents (71%)

   • No-18 respondents (8%)

   • Sometimes-51 respondents (21%)

2. Does improving nursing staff knowledge of a personal history improve person-centered care in residents with dementia?

   Out of 242 respondents:

   • Yes-217 respondents (90%)

   • No-3 respondents (1%)

   • Sometimes-22 respondents (9%).

3. Do you think a picture board showing events in a resident’s life generally assists staff in strengthening relationships with that resident?

   Out of 244 respondents:

   • Yes-181 respondents (74%)

   • No-12 respondents (5%)

   • Sometimes-51 respondents (21%)

This survey was completed largely by nurse assessment coordinators working in LTC. It was a small survey of only 244 respondents and was designed to get a bit of feedback from nurses regarding how they interpret their own responses to interventions aimed at giving them more insight into the residents they care for. Clearly, most of the respondents of this informal AANAC survey believe that more knowledge of a resident helps improve care. Additionally, a majority agreed that pictures were either helpful or sometimes helpful in providing better person-centered care. This is different from the responses in the Gerontological Nursing study. The administrators interviewed following that study, however, overwhelmingly agreed that adding family history collages for residents with dementia was helpful. Some even had plans to begin using family history collages in the rooms of all residents with dementia. Again, it is not clear why the caregivers had such a different viewpoint of the impact of these collages.

Considering the difficulty in caring for residents with dementia, instinct suggests that the more information available on each resident, the better. Asking a family to put together a family history collage could serve to allow that family the opportunity to reminisce about their loved one and also to feel grateful for the joys that person was able to bring them in their lives. It is a noninvasive and simple intervention that offers the opportunity to both learn about that resident’s life and support the individual that he or she is today. Why not give it try? There is nothing to lose. LTL

Ingrid Johnson Serio, RN, BSN, MPP, is the Director of Content Management for AANAC. She can be reached at

iserio@aanac.org.

Reference

1. Buron B. Life history collages: Effects on nursing home staff caring for residents with dementia. Journal of Gerontological Nursing 2010; 12:28-48.

Long-Term Living 2011 April;60(4):18-21