• Best foot forward 18 January 2019 | View comments

  • ‚Äč18th January 2019 | By David Jolley

    Our Dementia Conversation this week included a young woman who provides a specialist service for people who have difficulty finding shoes which are the right shape, comfortable and maintain or improve their gait. One of the keys to her entering this field was the difficulty which a family member had, following a number of strokes and the emergence of dementia.

    Feet are so important to us and we know that some people neglect their feet for want of being able to reach them, lack of money to afford chiropody, or not noticing as things get worse and worse. Chiropodists love to show you bottled and preserved examples of overgrown nails from great toes – onychogryphosis www.healthline.com/health/onychogryphosis

    Strangely I have not found a study which looks systematically at the prevalence of such problems amongst people with dementia but it would be worthwhile. There have been such studies of dental problems https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1754-4505.2003.tb00283.x and I remember a project from the Salford Psychiatric Register which did this too. Difficulties arise in similar fashion at the two ends of the body – lack of awareness and loss of routines initially, complicated then by resistance to help which is too easily seen as an attack.

    We diverted to comparing stories and views on best practice when someone with dementia requires to be seen by a specialist – for help with feet, teeth, hair, clothing or whatever. Some people insist on seeing the individual with dementia just by themselves. This may be seen as confirming their personhood and individual dignity. There can, however, be problems if the individual with dementia is unable to describe their difficulties, and may simply deny that there is a problem. A supplementary ‘history’ from a carer is invaluable – as is the presence of a carer to take note of what is said so that the necessary action is understood and can be done, with feedback of the outcome to the professional. Everyone agreed that carers should not hog the discussion and we must avoid being lured into being the only one talking to the expert. As in most things, adjustment according to the circumstances will be best – rigid guidelines are not helpful.

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