Summary
In this Care Lab episode, Emilia talks about her new book focused on helping caregivers manage daily care challenges for people living with dementia. Drawing from 15 years of experience as an occupational therapist, Emilia explains why dementia-related behaviors happen, how cognitive changes impact everyday activities like bathing and dressing, and why simplifying tasks and environments is essential. She introduces her DEFFT care model—Distraction, Empathy, Familiarity, Flexibility, and Tuned-in—to give caregivers practical, memorable tools. The book is designed as a hands-on reference guide for family and non-medical caregivers navigating the evolving journey of dementia care.
Key Questions Answered
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Why did Emilia write this book?
She repeatedly encountered the same daily care questions from family and non-medical caregivers struggling with dementia-related challenges. The book consolidates practical strategies to address those common issues in one accessible resource. -
Why is an occupational therapist uniquely qualified to write about dementia care?
Occupational therapists specialize in daily living activities, fall prevention, task simplification, and adapting environments. With extensive experience working with older adults and people with dementia, Emilia brings both clinical knowledge and practical strategies. -
Why do people with dementia remember old events but not recent ones?
Dementia can impair the brain’s ability to encode new memories. Long-term memories may remain intact, but recent events may not be processed or stored properly, leading to frustration for caregivers who expect short-term recall. -
How do cognitive changes affect daily activities like bathing or dressing?
Slower processing speed and sensory overload can create a “traffic jam” in the brain. When tasks or environments are too complex, the person may freeze, resist, or become agitated—not out of stubbornness, but due to overwhelm. -
What is the DEFFT care model?
DEFFT stands for:-
D – Distraction (use or reduce it intentionally)
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E – Empathy (respond with understanding)
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F – Familiarity (keep routines and environments consistent)
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F – Flexibility (caregiver adaptability)
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T – Tuned-in (pay close attention to underlying needs)
It provides a simple, memorable framework caregivers can return to throughout their journey.
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Transcript
Brandy Archie
Welcome to Care Lab everybody. Today I have an extra special guest who is an author. Do you see the extra guest? It's Emilia. She wrote a book. You did write a book. And so we wanted to have an extra special episode to talk about Emilia's book and why it's important and what's going to be in there and why you should get a copy. So let's get started. All right, let's do it. I think she does not need an introduction because you know her. But what I do want to know is,
Why did you decide to write a book?
Emilia Bourland
So I actually decided to write this book and mostly wrote it a few years ago. OK. The book is about daily care tasks for caring for people with dementia. And the reason that I wrote it is because I was working so much with non-medical professional caregivers and family caregivers at that time who were all asking me these same basic questions over and over again and really struggling with these daily care challenges for caring for people with dementia — things like, how do I get someone to bathe? This person doesn't want to do X, Y, or Z. They're falling, they're wandering. What do I do? And so basically, that was the genesis of the book. Rather than, not that I'm not happy to answer those questions — I definitely am, and I enjoy that part of caregiver education — but if this many people are having all of these same exact questions, and of course, they're the same questions that I've been coming across in my practice for the last 15 years now… Yeah. Then let's go ahead and just write a book about this.
Brandy Archie
OK, so that makes total sense. Let's back all the way up. Yeah. So why are you qualified to write a book about dementia and self-care? Talk to us about like what your role as a professional is in that and why it's important to hear from an occupational therapist about it.
Emilia Bourland
Yeah, so that's a great question. Why am I qualified? Because there are a lot of books out there written by a lot of folks and a lot of them are great books, obviously. So I'm uniquely qualified as an occupational therapist. So first of all, I'm a licensed and certified occupational therapist. I've been in practice for just about 15 years now. All of my practice has been with adults and older adults and the vast majority of it with older adults across the entire care spectrum, including so many people with dementia and their families. Occupational therapists are sort of uniquely qualified to talk about these specific issues in dementia care because we are the authority on things like basic activities of daily living. We are authorities on fall prevention. We are authorities on helping people get done what they need to do on a daily basis, regardless of what's going on. And so I have a ton of experience working with people with dementia and their families, answering these questions, working with caregivers — both professional and family caregivers. And yeah, so there you go.
Brandy Archie
So OK, I think one of the underlying things that we know is happening in our society is the rates of dementia are rising significantly. I don't think there's anybody listening today who doesn't know somebody or isn't actively caring for somebody who has dementia or has done that in the past. And so the need is really great. But if there is anybody listening who's worried about that and maybe nobody in their family has been diagnosed, talk to people a little bit about what happens kind of when somebody gets diagnosed and why — explain why there's this gap in so many people not knowing how to help handle these daily living activities with somebody who has dementia, like bathing and dressing. Why are those challenges? What is the missing gap and why did you need to fill it with this book?
Emilia Bourland
That's a really big question. It is. I'll do my best to answer it in a way that makes sense. So dementia — you're right, there are a growing number of people being diagnosed with dementia. Of course, our older population is sort of skyrocketing in comparison with the rest of our demographic population just because of baby boomers. And so it's natural that this diagnosis is going to go up. I think that it's also really misunderstood, though. You know, in my practice, so many times I see that any kind of cognitive issue is immediately labeled as dementia. And that's, of course, not necessarily the case. There can be lots of reasons for underlying cognitive issues.
Dementia really describes a group of general symptoms. It is not in and of itself the disease. Dementia can be caused by a lot of different things, but there are some common factors that go together with it. A lot of times, it’s just really, really poorly understood. Although I do think it's getting a lot better now. I see much better education out there in the world about dementia, and that’s so important. But yeah, it’s still really misunderstood, and there’s not necessarily a great level of understanding among laypeople who haven’t worked with someone with dementia. Most of the world, it’s not your job to know anything about it. Even healthcare providers may not have a lot of education or experience with it.
My role as an OT, working with older adults, has naturally given me this expertise. We get specialized education on it in graduate school, too. But even then, the way people understand dementia often differs from the underlying processes that are really going on.
A really good example: caregivers often get frustrated when a person with dementia can’t remember what happened five minutes ago but tells a story from 50 years ago in perfect detail. That’s normal. People with dementia often remember older events better than newer ones because they can’t lay down new memory anymore. So things that happened five minutes ago didn’t really “happen” for them. Understanding this makes you more patient and helps you approach caregiving more effectively.
Brandy Archie
Like an example that you could probably get out of your own life is if you ever drove home from work and don't remember driving home from work, even though you arrived safely, You do it so often that it's a different reason than Alzheimer's, but the experience is similar in that you do it so often that you don't think about it. So you didn't take in any of that information. didn't encode any of that information at that time because you're thinking about whatever other thing and it was very automatic for you. And so while it would make sense for me to ask you like, well, didn't you say there was an accident on the whatever highway on the way home? And you're like, no. And like, how is that even possible? You do passed it, but you weren't paying attention to it. Your brain didn't absorb that information and lay in and code it. And that is happening in Alzheimer's all the time with your short-term memories, even though you feel like, like literally I just told you this a few seconds ago.
Emilia Bourland
I think another really great example, just the whole like memory issue, because of course, memory is not always the primary symptom for all types of dementia. Dementia can be caused by a multitude of different diseases and disorders. And so while we often associate memory as being like the thing, and of course, memory is a huge part. It's a huge part of it, It's not always the first thing that comes up for every form of dementia.
Brandy Archie
Okay, so what I really love for you to talk about is like, what is happening that makes it so that our everyday tasks are being affected? Because what you just said was that you don't maybe lay down new memories, but a lot of our everyday tasks have been doing for 50, 60, 80 years. So what are some of the challenges that people might see and what are some of the strategies that you talk about in the book?
Emilia Bourland
Yes, that's a really good question. And I do want to be clear at first that just because and one of the things that we do primarily is occupational therapists working with people with dementia is we kind of help to unlock those old skills again. And what I talk about in the book are some of these strategies that we actually use to do that.
So first of all, why do people start having a harder time doing their daily tasks? It's not always because the underlying motor function or the underlying physical function is gone. A lot of times it can be because that, so when someone has dementia, it's a disease of the brain, right? So, so many different areas of the way the brain works and the way the brain processes information can be affected. So a great example of this is the way people process sensory information. It's a lot easier when folks have dementia to become overwhelmed with the amount of information that's coming into them.
And another common cognitive issue associated with dementia is a slower speed of processing information. think of it like a traffic jam on a freeway. you've got a traffic jam during rush hour, there are too many cars all trying to go to the same place at once on that freeway, right? So everything slows down. It's basically gridlock and then nothing gets done.
On the other hand, if there's only a handful of cars on the road, they go straight down the freeway, they get exactly where they need to go. You can kind of think of cognitive processing for people with dementia in the same way. If we overload people with dementia with too much information or ask them to think about too many parts of a task all at once, can make it so there's basically like a logjam of their ability to process that information and then everything kind of freezes up, they won't know what to do, they can become angry or agitated.
It's really important to keep in mind that people with dementia are people first. They are not a diagnosis first. And so the people that we're talking about who have dementia are going to have natural human emotions and reactions to feeling, to knowing it's a certain point that they're supposed to be able to do something, but for some reason they can't. Think about how you might feel about that. Yeah.
Brandy Archie
That would super frustrating. So frustrating. You might also feel angry. You might feel ashamed. You might feel defensive. And at the same time, not be able to verbalize all of those emotions or even pick them apart in your brain to be like, I feel ashamed. I feel frustrated and then do something about it because it's all still jumbled up in there.
Emilia Bourland
Yeah. So one of the tasks that I talk about throughout the book and sort of the way the book is organized is it's organized in chapters based on the activity or challenge that you're trying to accomplish or the challenge that you're seeing. And in each chapter, it gives specific kind of tools and tricks and tips that you can try. So you have lots of different strategies in your toolbox, the same way an occupational therapist essentially would approach it, but in a slightly more simplified version. So one of the main things that we talk about throughout the book is the idea of simplifying tasks, simplifying the environment.
offering just a little bit at once instead of a whole lot. And really it's kind of amazing what it looks like when you just do these very simple changes that aren't about the person with dementia. Unfortunately, we don't have the capacity at this point to change the person with dementia, right? We don't really have great treatments for that yet, especially past really early stages.
So we have to be focused not on changing the person with dementia, but changing the experience that they are having while we're trying to get that person to bathe, while we're trying to get them to toilet, while we're trying to get them to please sit still for just a second so I can cook dinner. Right. Right. Right. So it's really about how can we focus on that experience.
Brandy Archie
You gave us a lot of information and nuggets there. One of the things that I noticed when I work with families who are caring for someone with dementia, they think that came in sprinkle some magic fairy dust. But what really did is simplify the situation. Yeah. And while they have been trying to simplify, I don't think everybody graphs how simple it needs to be and how even the number of words, the speed at which you provide those words can cause that log jam that you talked about, can cause that traffic jam. So you think you're being really simple and basic because you didn't give them a whole paragraph, but even a whole sentence might be too much. And so like being able to pair as few words as possible with maybe a visual cue and then also doing it in a very familiar way, like trying not to change it up from how they used to do it, is like super simplifying it down. So now we're one car on a five land highway so we can definitely get through.
I think that's like one of the key things that people don't fully grasp. We tell them to simplify, but it really does need to be like as minimal as humanly possible. Yeah.
Emilia Bourland
And in the book, it really walks you through the steps of how you can truly simplify both an environment, but as well as a task, depending on what you're looking at. I like that you bring up the idea of familiarity too. So the concepts in the book are organized around this sort of care model for folks with dementia that I came up with called DEFFT. And DEFFT stands for distraction. So we can use distraction to our advantage and we can also make sure that we don't have too much distraction in the environment, right? E is for empathy because listen, no one's getting out alive unless we have empathy for the person that we're caring for and for ourselves. And so that is one of the most powerful tools that anyone... at anyone's disposal. There are two F's in depth. The first one is for familiarity. Keeping things familiar is so important for people with dementia because at a certain point, new learning isn't possible anymore because remember, if you can't lay down new memories, you really can't learn new concepts. So keeping things as familiar as possible is really, important. The second F is for flexibility.
Emilia Bourland
And that is not flexibility of the person with dementia. It's for our flexibility as caregivers, right? And then the T is really simple. just means tuned in. So often we think when someone has dementia, if they start acting up or, you know, if XYZ seems to be going on, we just automatically blame the dementia when often there's a different underlying cause and caregivers know their people.
better than anyone could ever know their people. So simply staying tuned in and understanding that a change has a reason is a really, powerful thing to do, both from a general day-to-day challenges standpoint, but also from a potential other health care issue standpoint.
Brandy Archie
I love that you put it in such a simple format that's easy to remember. Remember, pun intended. And really breaks down the underline things that can be useful and helpful because like it's a whole book of information people should read it but also they might not just remember this all these details on page 25 right but if we can keep those pieces in our brain about making things familiar and making sure we're tuned in and using empathy and what's the D distraction just using distraction or trying to eliminate eliminate distraction yeah like those are simple concepts that you can hold on to and like come back to right? And so I think it's really important to have some simple mnemonics that you can keep with you because the thing, caregiving is stressful and you need to have some tools in your pocket to be helpful. So that part is great. I think that one of the things that helps me to understand it better is to put it into some format where you've experienced it already. And while you should most definitely not treat somebody with dementia like they are a baby or kid, because they are grown up, there are some things that are similar in a way that you should think about how their brain might be processing. Like if you think of, because what I thought about when you said tuned in, it's like, if you have a little baby who doesn't have any words, you're paying attention to all of the signs and things around them. That's right. When's the last time I fed them? I haven't changed their diaper. Maybe that's why they're crying. I see they're positioned poorly and maybe they're hurting. I need to pick them up. Like you think about like all the things that could be causing their cry because you can't.
They can't tell you specifically, but from adults, we expect adults to be like, use your words, tell them what's going on. Why are you upset? If you're upset with me, you're going to come talk to me about it, right? Well, when we're dealing with dementia, that just might not be possible at all. Not only that they're not capable of using words in a way that's clear to tell you what's going on, they might not even be able to break that down in their brain to feel that. If you ever felt overstimulated yourself, sometimes you don't feel like
I am overstimulated. I am going to now go sit down and take a nap because that's what I need to do. You scream about the thing that you're having trouble with and then you take a breath and say, okay, hold on. It's not these kids' fault for yelling at me because they are a little, I am actually overwhelmed. Let me go sit down. You know what I mean? And like that takes processing. And if you don't have that processing ability, then you can't do that. But that's where the empathy comes in at. Because once you think about it in those, at least that's how I feel, when I think about it in those terms, I'm like, I would never be angry at a baby for crying. Because they can't do for themselves, my job to do for themselves, right? And I need to be paying attention, tuned in, in order to get to their needs. And so if I take that same theory and empathy and approach, knowing that this is a brain thing and not an obstinance thing and not a, they're just being honorary thing, then it's so much easier to actually figure out what the real problem is.
Emilia Bourland
Yeah, that's, I think that's a great way to make that concept really accessible to people because we've all at some point probably had some experience, even if it was just babysitting, caring for a little baby who couldn't talk for themselves. And then absolutely we're so, we're laser tuned in to what could possibly be wrong. And it does again, and I appreciate you saying that like, we always want to treat adults as adults. We never want to baby talk people. We don't want to infantilize people. Like these are adults who deserve the respect of adults. But we have to be equally tuned in in that way to say is this person wet? are they soiled? are they uncomfortable? because they've been sitting maybe they're getting up because if that chair is not comfortable? because they've been sitting too long, maybe they're getting up because they're bored, know, these are these are people first with human needs.
Brandy Archie
Yeah I wonder if like one of the challenges with being a caregiver for somebody with dementia is that while you might get all your ducks in a row today, two or three or five months from now, those ducks might not work the same. 100%. Right? And so what kinds of help do you have for people when they're thinking through like, okay, this works for me now. And now all of a sudden none of the strategies I was using before are as useful.
Emilia Bourland
Well, I think so a couple of things about that. One, that is one of the reasons why there's multiple strategies per chapter laid out is understanding that every strategy won't work for every person and will not work forever necessarily, right? Because it's a bit of a moving target. But I also tried to treat these strategies as things that could themselves be what we call graded. was trying to think, we're laughing because graded is an occupational therapy term, but could themselves be adapted or changed or simplified from the caregiver's perspective based on what you're seeing in the person that you're caring for too. So, you know, the goal of this book was to take these what can seem to be like really complex things that we're sort of sorting through at a therapist level and really pair them down into the most simple, kind of easy to follow concepts and then pair that along with some good education on why you might be seeing these things in the first place and how these things go together. That way caregivers can hopefully be as empowered as possible to keep going back to the book.
keep referencing chapters over time. It's not the kind of thing that you would probably like read once and be done with it. You're gonna flip to your section. I think of it more, but you certainly could. But I sort of think of it more as a reference manual, like use the parts that you need when you need them. It's written in such a way that you could skip to any chapter and get a good full picture on that particular issue without necessarily having to go back and forth in the book. I do recommend reading the first couple of chapters because it goes over some general types, some common types of dementia or some common causes of dementia, which I think are really important to know about because certain diagnoses that cause dementia can present different ways. just knowing what you're looking at and why is really, really helpful. And then it also goes over some of the common symptoms, how they affect behavior and then just goes over the death care model. But other than that, people can just go back and forth and reference as they need to.
Brandy Archie
I love that because one of the things that our healthcare system really kind of fails at is being able to provide support over time. And we have so many progressive diseases in our country that we have to deal with, but you only often get a clinician and an expert to help you when there's an acute issue. Like a fall has happened, a new diagnosis of dementia has happened, right? I have a flare of my MS.
So now I'm getting help. Whereas you need some kind of constant ability to have access to really good information. So you know that you're not just randomly Googling stuff that you're not sure if you can trust or not and that you're getting it. And so to write as a reference, encyclopedia is a thing that you can keep coming back to is such a valuable asset so that you have support throughout this whole journey. Cause it is totally a journey and things are going to continue to change. Yeah.
Emilia Bourland
One of the other things I tried to think about was understanding that people will need professional help with a clinician in person at various times during the journey. no book can replace that entirely, right? So there are built-in sections in there to say like, hey, if you're seeing this, it's probably a good time to talk with an occupational therapist, to bring this up with your doctor, to ask for a PT. Because a lot of times people just don't also know
when resources are likely to be available or what those resources are. And there is no single solution for the all-encompassing act and journey that is caring for someone with dementia. There's just not. You need a village. You need a team. And so the book, think, is a great part of that team that can hopefully also help to empower people to say, to be able to speak up and say when there's a need where a clinician needs to be involved.
Brandy Archie
So who do you think the book is best for? Like who is the right person to pick this book up right now? Like what's happening for them and who are they?
Emilia Bourland
I think there's a lot of different types of people who can benefit from the book. But really the book is written for like lay people, caregivers. So folks who, so it could be professional but non skilled caregiver, someone who doesn't necessarily have any formal training and, but is caring for people in their day to day job. but also certainly for family caregivers as well. I think that there is, you know, there's so much wonderful education out there for, for clinicians. And if we just go and get it, we can get it. I think it's a lot harder to find to get into that really like very practical stuff for folks who are in the weeds, boots on the ground, day to day, having to deal with this stuff. And so those are really the folks who this book is written for.
Brandy Archie
That makes total sense and is probably the biggest gap in the education or the ability to access the information that you need in order to not just struggle by yourself. I think one of the key things is like, I'm so glad that you plugged in like, hey, you're seeing this, maybe you should as for PT, because people are just doing the best that they can do. And all you can think of is like, well, this is change and this is hard. So now I'm going to do this. And that's fine. We do have to adapt. But also there are professionals that are slated to do certain things. And do you have to know when to plug in with them? Because if you're not connected with anybody who's telling you that, then you're not at a neurologist appointment or you're not in the hospital. There's nobody to like say, here you go.
Emilia Bourland
Yeah, that's right. I think a big part of being empowered as a caregiver and in our healthcare system is we think sometimes about being empowered and be like, well, I'm empowered. I can do this all on my own. It's all on me. No, no, no, no, no. Being empowered means that you are able to be a great advocate, that you have resources that you can access. And ultimately, you know, that you feel like you are confident to go and get those things and do those things when you need to. So is it about having information, is it about having knowledge and having a skill set of your own? Absolutely. But it's definitely not about having one thing that allows you to do it on your own. It's about understanding and having the confidence to build your team and knowing when to go and build that team.
Brandy Archie
Building the team. I think we talk about that a lot. I feel like I'm having those conversations as a professional with other people and with other professionals. I don't know if I hear a lot of family caregivers saying that. And I really hope that you hear that coming from us that like, you need a team. It's not that you want a team. You need a team. You need a team and you need to know who to go to. I think it's very similar to like when you first become a homeowner, right? When you become a homeowner and you've been renting and now you own a house.
There's like all this stuff that you didn't know you needed to know or do. I need a plumber. I need an electrician. need, maybe I need somebody to shovel my snow. Maybe I need somebody to cut my grass. Like these are none of these, this is your team. Like you need to have some way to deal with that. And your life runs a lot better when you know who to turn to when you have a problem. You don't have, you don't need a plumber every day. You don't need electrician every day. But if something happens, you probably need help right now and you need to know who to go to. So having that team outlined is really important.
Yeah. So that's that's a key thing. So tell everybody where they can find book.
Emilia Bourland
So the book is available on Amazon. If you have Kindle Unlimited, it's free to you right now. even if you don't, you can purchase it digitally or you can order a paperback. I do think it's great if you have a way to like, you know, tag things, highlight things, take notes. You can do that digitally or you can do that in paperback. think it really just depends on what works best for you. Sure.
But it is something that I would plan to keep around as a guide, as a reference for a lot of your journey. And then when you're done with it, pass it on to someone else who needs it. Sounds good.
Brandy Archie
Well, I'm so glad that you put the time in to write it and create a resource for people, it's a thing that I don't know. I care about it all the time. I'm coming in as the clinician, as an occupational therapist at some acute stage, but far after they were struggling, you know? so it feels bad. It breaks your heart, right? Yes.
Emilia Bourland
You don't want people to get to that point where they're struggling. I would so rather folks not have to go through so much pain unnecessarily. Yes.
Brandy Archie
When there are solutions that you can implement today in the way that you provide your caregiving, just as long as you know it. So thanks for putting that out there for everybody.
Emilia Bourland
You're welcome. And I hope people enjoy the book. Hey. If you have it, if you've read it, let me know what you think. Share a comment, you know, all the things.
Brandy Archie
And when you do read it, you need to leave a review. yeah. So people can find it.
Emilia Bourland
Please do that. All right. We'll see you next time. On Carelab. Bye!
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