Detective Work in Dementia – ‘Where There’s Smoke, There’s Fire’


Dementia is all about watching body language, noticing small changes and thinking like the person with dementia. They often cannot express their pain or thoughts, so it is up to carers, nurses and family members to notice these subtle changes and take action. It is very much like being a detective and looking for clues.

Alzheimers Disease in the early stages usually impacts the short term memory but may not affect the long term memory until it progresses. Some people with dementia believe they are still living in older times and may re-live events or incidents from their past.

I would like to share a recent story at the nursing home that sparked my interest and I am sure many of you may have had similar situations occur that may make you think differently about them.

There is a resident called Barney who communicates well and every story he has shared with me to date has been 100% true. A week or so ago the staff told me ‘Barney flipped out’ . His behaviour was strange (non violent) but not his normal self and very peculiar. He was difficult to manage and was hard to distract when he became fixated on things. One of the staff told me that Barney was talking about a fire at the time.

This week I decided to visit Barney to see how he was and he instantly told me about an incident with a fire. He told me he his father built a fire-proof house in the country and he watched his father walk into the fire and he was killed. I have no idea if the story was true, but I would bet there was a heavy element of truth in what he was saying to me.

Afterwards I thought about what he had told me and I was wondering what was really going through his mind at the time. Why did he behave so strangely and what sparked the behaviour? I then went into his room and I noticed that his room smelt of smoke. There is no smoking allowed in the rooms, however I couldn’t get past the fact I could smell smoke. I have read that with people with dementia often have heightened senses including ‘smell’. If Barney was smelling smoke, this may trigger an unpleasant thought process causing the behaviours.

I then asked myself the following questions:

-Is the smoke smell in his room triggering a bad memory and reminding him of a previous traumatic incident?
-Is he re-living the past in his head and did he believe he was stuck in his burning house and was in a panic, and hence behaved the way he did?
-Does he have an old relic in his room from that fire that is making his room smell?

People are often too quick to ‘blame the dementia’ and increase or add more medications to control the behaviours. When in fact, maybe if the room was aired out, and the staff aware of his past history, they may be able to tackle the behaviour in a different manner?

Anyway, this is a small insight as to how it can be beneficial to step into the shoes of a person with dementia to truly understand their behaviours.

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