Dementia and the impact of social withdrawal

Dr Roberts writes a monthly guest post for Inside Ageing, where he explores topics relating to dementia care and diagnosis. If you have a particular question or topic that you would like to see covered please let us know –

One of the main challenges for those living with dementia is social withdrawal. This is not good for anyone, let alone someone whose psychological vulnerability is magnified by the experience of dementia. Disengagement of this kind leads to a loss of confidence, which becomes a vicious cycle, and there comes a point when it can be near impossible to convince the person to socialise or to attend activities they once enjoyed.

This of course can then have flow-on effects on others – family members, for instance, who miss out on their own opportunities to get out and see people as they do not feel they can leave their loved one at home alone.

Social withdrawal can be due to several factors, including the initial loss of confidence that accompanies the awareness of cognitive problems. It is not surprising that those with poor memory worry they won’t be able to follow conversations easily and that this may lead to embarrassment. Then there are concerns about getting lost or being unable to cope when out and about.

When someone you care for is cognitively intact, the best advice to improve your brain health is to experience as much novelty as you can – visit new places, mix with people you don’t know, try out unfamiliar activities and the like. If they are not stressful, all these things exercise the brain in a good way.

The same advice applies if they are in the early stages of dementia, but there comes a point when the unfamiliarity can be bewildering. Moving into an aged care facility after years at home is a classic scenario in which this is observed. Routines are lost, and faces are not recognised, leading to distress.

This move into aged care is unavoidable for many of course, but there are things that can be done to help. I always recommend personalising their new home as much as possible – put photos around the room and cherished paintings on the wall. Bring their favourite chair and other pieces of furniture from home.

Anything that orientates a person and helps them navigate their environment helps ease concern.  I was heartened recently to hear of an initiative where a supermarket well known to most Australians plans to work with an organisation specialising in dementia care to embed one of their stores in a dementia-specific village.  This will reportedly be modified to facilitate the process of shopping for those with dementia, but even without this, I suspect the familiarity of the branding and logos may cognitively ‘anchor’ the person into that environment and make the experience of shopping far more relaxing.

Familiarity in this case breeds content, and the more the cognitively vulnerable feel calm in their surroundings, the more actively they will engage with it. This may have several positive effects: Increased physical activity as they are more inclined to venture out and travel to places; improved mental health, as supportive contact with others is critical to our sense of wellbeing; and quite possibly cognitive benefits from the problem solving and stimulation that comes out when visiting communal areas where pleasurable tasks are undertaken.

We know from research that cognitively stimulating activities can favourably affect brain health and provide a buffer against the physical damage that results in dementia. The flip side of this is that when individuals stop doing things it is a slippery slope.  I’ve personally witnessed the accelerated decline that occurs when those under my care stop engaging with the world and others. Providing scaffolding that allows people to interact more substantially with the world around them is one way to prevent this, and familiarity is one powerful way to achieve this.

Dr Roberts is a medical specialist and expert in cognitive assessment and is the founder of the Your Brain in Mind cognitive optimisation clinic, where he works alongside a team of experienced and passionate healthcare professionals to assess clients’ brain health. He is also the author of Mind Your Brain: The Essential Australian Guide to Dementia (UQP, 2020) and the creator of BrainScan, a phone app that allows users to know and address their risk factors for poor brain health and dementia.


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