Dementia: Outside In
Module 3 - Lesson 2 of 5
Introduction
What exactly is meant by looking at dementia from the outside in? We use this phrase to describe what people without a diagnosis of dementia focus on when they think about dementia.
Warm Up
What do you see when you look at a person living with dementia?
Take a minute or two to jot down or make a mental note of all the things you observe.
- What do you see?
- What do you hear?
- How do you think about what you observe?
Dig In
Dementia from the Outside In:
Our perspectives shape our views and responses. When a health professional looks at dementia from the outside in, for example, she may focus on the various causes of dementia. Care is then described in terms of symptoms and treatments. Public health and social policy-makers might focus on what resources will be needed. Care partners might see behaviors they associate with sadness, love, frustration, and stress.
Benefits
Positive aspects of an Outside In perspective include the following:
- Being aware of a person's vulnerability moves us to protect them from abuse, neglect and, exploitation.
- Being aware of difficulty communicating needs moves us to try to understand a person better.
- Being aware that a person with dementia may neglect their physical health reminds us to pay attention to it for them.
- Being aware of how many people are going to need care for dementia in our aging society inspires us to begin planning.
- Being aware that brain diseases cause dementia inspires us to do medical research.
Risks
Risks of an Outside In perspective include the following:
- Prematurely lowering expectations and causing excess disability
- Assuming loss of decision-making capacity and interfering with autonomy
- Over-prescribing psychotropic medications
- Not wanting to let individuals take any risks and causing loss of self-efficacy
Putting It into Practice
Review the following list of observations about persons living with dementia. Add to the list what you noticed from the warm-up exercise at the start of this lesson.
- Repeats same questions
- Gets lost easily
- Likes to walk
- Has trouble following directions
- Gets disoriented about time, people, and places
- Becomes frustrated while doing tasks if hurried
- Doesn’t recognize you, themselves or their family
- Neglects personal safety, hygiene, and nutrition
Using an outside-in perspective, think about a person with dementia who gets lost easily. How might you intervene? (Think about your answer first, then click here!)
Wrap Up: Lesson 2
An outside-in perspective of dementia focuses on what the person has and what he or she can't do as a result of the dementia. Unwanted behaviors are explained as symptoms. An outside-in view can be useful, but it is not enough if you want to provide for high-quality dementia care.
In the next lesson, you'll see how adding a new perspective—dementia from the inside out—improves care and increases well-being.