blog

With my colleagues, Stephanie Petty, Amanda Griffiths, Dons Coleston, we have been looking at how people with dementia express themselves when distressed and how health professionals respond when this happens. One study, which is part of Stephanie’s PhD, has involved interviewing members of a hospital ward team and asking them questions about what they do in these circumstances. Two specific questions ask the staff what might be tried to help the person with dementia and, of these responses, what they find to be effective.

We have submitted a paper on our findings and it looks as if it will be published, which is great news for us. This blog is not to detail everything we found but suffice it to say that not everything that was suggested seems to be effective – for example, reassurance and calling the patient’s family weren’t endorsed as being effective in practice. However, one strategy that was identified as being useful was offering the person a cup of tea. The anonymous peer reviewer of our paper commented that the offer of a cup of tea should be regarded as a cultural construct, and that we should add some text to make that point in our paper. This piece is about tea drinking in a UK cultural context; drinking tea in China or the Japanese tea ceremony are beyond the present scope.

A cup of tea is obviously more than simply a hot drink. The cultural construct refers to all the other things that go with it. For example, the cup of tea is deeply at the heart of our lives. In the hospital setting, it would almost certainly be made with a teabag, the hot water coming from a small wall-mounted water heater rather than a kettle. It would almost certainly be made with milk. Sugar will be offered but not presumed. One or two (plain) biscuits may be provided. The tea is likely to be in a cup with a saucer. Offering and making the tea and sitting with the person while they drink it is a small act of kindness. It allows something from the ordinary, familiar world to enter the strange, possibly threatening context of the hospital ward. Time stops for a while for this reverent act.

The tea provides a focus, a temporary break, which makes other things bearable. Almost as though you couldn't face more difficult realities, such as talking directly about illness or upset, or facing the whole of the rest of the day, without this containing and structuring ritual. It somehow makes the day bearable. Everybody knows what to expect, we are just having a cup of tea, it takes this amount of time, which limits the feelings of being anxious, stranded, can't be yourself-ness that comes with being in hospital (for the staff too, who get overwhelmed by the chaos). 

Offering ‘a cup of tea’ is different from some of the alternatives that could be posed. For example, whether you would like ‘a cup of coffee’ is different. Coffee is alerting, ‘let’s go for a coffee’ suggests either being at work or being socially active, e.g. morning coffee during a hectic session of shopping. The ‘cup of coffee’ may also have an associated agenda, which the ‘cup of tea’ doesn’t. It may be that the response to being offered a cuppa tea is ‘I’ll have a coffee’ so the end result is coffee; however, what matters is that the offer was made in terms of tea. ‘Would you like a drink?’ is a different offer altogether, and open to the suggestion that alcohol may be involved. Also, it is probably too open-ended a question for a distressed, frightened hospital patient who has dementia.

Whenever I visit my 90-year old mother, I always offer her a cup of tea. She accepts it, we drink tea around her, she usually leaves it untouched. Last week, she drank almost a full mug. I think she was dehydrated as it was very warm outside and in her room. The mugs are familiar from when she had her own house. The cup of tea is central to our short visits. It enables us to take a break together and share this cultural comfort.

Tom Dening, and colleagues

16th August 2018