Can a Dementia Patient Be Truly Noncompliant?

Turning and repositioning patients regularly is one of the foundations of pressure injury prevention. Patients who resist caretakers’ efforts to reposition them increase their own risk of pressure injuries – and are often labeled a “noncompliant patient” or “non-adherent.”

In order to really be a "noncompliant patient," however, the patient must understand:

  • what you (the caretaker) are trying to do
  • why you're trying to do it
  • what negative results are likely to happen if you don't do it

If one of the above elements is missing, true, they're not doing what you want them to do, but they can't really be termed "noncompliant."

Can a dementia patient really be noncompliant?

The short answer, according to Prof. Joyce Black of the University of Nebraska: probably not.

Dementia patients are most likely to refuse repositioning and other standards of care. While this is incredibly frustrating for a caretaker who genuinely wants to give the best care to his patients, calling it noncompliance is inaccurate.

Most dementia patients have trouble with at least one of the above stages of understanding – if not all three.

He doesn't understand why you're trying to turn him. All he knows is that you're making him uncomfortable for no apparent reason.

She doesn't understand the imminent danger of a pressure injury. She can't rationally weigh pros and cons and decide whether or not she wants to be repositioned.

For mentally sound noncompliant patients, like young, paralyzed accident victims, discussing why you're repositioning them and the dangers if you don't can be helpful.

When it comes to dementia patients, discussions like that just leave everyone more frustrated and potentially hostile.


Actions You Can Take to Promote Compliance

You are not going to get your dementia patients to understand you. The only way to help your dementia patients become more compliant is to understand them.

Ask the questions:Why does your patient refuse to be repositioned? There is a reason. It’s your mission to figure out what the reason is. The source of the patient’s frustration and refusal is often a minor problem that can be solved easily – as long as you uncover it.

Does repositioning…

- cause the patient pain?

- cause shortness of breath in certain positions?

- obstruct view of the television, the window, or another attractive sight?

- wake the patient and make it hard for him to get back to sleep?

Any of the above issues can be solved, or at least minimized. Adjusting pain medication, testing out positions for comfort and a rolling television cart to an alternate location will go a long way toward increasing compliance for these dementia patients.


Collaboration as a Strategy

When conducting this investigation, include the patient’s family. They will often know instinctively why their family member is acting the way she is - and they might have ideas on how to get around the resistance.

When caring for a dementia patient at risk for pressure injuries, get to the root of the "noncompliance." Talk to the patient and his family. Figure out the cause of the issue, and brainstorm solutions.

You’ll often find the solution to noncompliance right before your eyes – as long as you’re looking at the situation through the eyes of your patient.