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A Quick Overview:

Being Reasonable, Rational and Logical Will Only Bring to the Surface Responses Such as Anger, Fear, Arguing, Combativeness and Aggression. When someone is acting in ways that don’t make sense, we tend to want to carefully explain the situation from our “normal perspective”, calling on his or her sense of appropriateness to achieve more “normal behavior” and compliance. However, dementia-challenged adults are no longer able to access the “boss function” in their brain any longer, so they cannot respond as they did before dementia to discussions, arguments, or customary communication approaches, no matter how much our reasoning seems like straightforward common sense to us. This simple motto applies well to communication with a person with any form of dementia; “Only tell them what they can handle, and as the dementia progresses, they can handle less and less.”

People With Dementia are Unable to Exist as Before in Our “Reality”. When someone has short term memory loss, they can often forget important more recent occurrences and details- e.g., that their sister is deceased. If we attempt to remind them of long ago painful losses, we only end up triggering the former agonizing and hurtful feelings of loss and grief that they had forgotten. When someone asks to go home, reassuring them that they are at home (your “reality”) often will lead to an argument, as you are only “disagreeing” with their very real vision of surroundings they are experiencing right now in their “reality”. Redirecting and asking someone to tell you about a person they are asking about, (When was the last time you saw ____?, How is _______doing?), or about a home they are envisioning from their past, (Where is your home?, Who is waiting at home?, What color is your home?), is a better way to calm the restlessness, distress, or anxiety the dementia-challenged may be presenting with these questions or statements.

Creative Interventions (Re-Framing Your Offering of Information) Reduces Stress. Our natural tendency is to want to give information based in our “reality” and “truth” with those suffering from dementia, when indeed they now process information you give them differently based in their dementia “reality” and “truth”. When someone has dementia, giving too much information that is truth based in your reality can lead to distress for us, and the one we are caring for. Does it really matter that the one you are caring for thinks she is going shopping with her sister today, even if her sister passed away several years ago? Is it okay to tell your loved one that the two of you are going out to lunch and then “coincidentally” stop by the doctor’s office on the way home to pick something up as a way to get her to the doctor? Or tell your loved one that their favorite uncle is coming for a surprise visit very soon, and they need to bathe and get “prettied up” for this special company? Keep in mind, they often can only remember the moment, and making each moment happy and serene will give them, and you, more meaningful moments overall.

Making “Deals” No Longer Works. If you ask the dementia-challenged to NEVER do something again, or to remember to do something, it will soon be forgotten. For people in early stage dementia, leaving notes as reminders can sometimes help, but as the disease progresses, this will no longer work, as it becomes “too much information” , to be processed by a now faulty processing function. Taking action, rearranging the environment, rather than wasting energy talking, scolding, discussing and making deals, will usually prove to be a more successful, and less stressful approach. For example, getting a teakettle with an automatic “off” switch, or removing the knobs of the gas stove and storing them in a safe place out of sight and reach until supervised cooking can occur is better than verbally warning someone of the dangers of leaving the stove on, or stating that no cooking is to be done unless they can be appropriately supervised.

Doctors Often Need to Be Educated By You. Telling the doctor what you see at home is important. The doctor can’t tell during an examination that your loved one has been up all night pacing, or is forgetting to turn off the stove, or is no longer performing personal care activities, and often the dementia-challenged adult will “rally” and present a “normal” façade for the few minutes they are being seen by their doctor. Sometimes doctors, too, need to deal with creative interventions; e.g., telling the patient that an antidepressant is for memory rather than depression. Setting up good communication with the doctor without your loved one present to help to keep them informed will also help both of you get a true picture of the ongoing effects of the dementia.

You Can’t Do It All On Your Own. Asking for Help Does Not Make You a Failure, Failing to Ask For Help Will More Likely Make You Fail. When people offer to help, the answer should always be “YES.” Have a list of things family, friends, neighbors or professionals can do to help you, whether it is bringing a meal, picking up a prescription, helping trim the roses or staying with your loved one while you run an errand. This will reinforce offers of help. It is harder to ask for help than to accept it when it is offered, so don’t wait until you “really need it” to get support. And the sooner you introduce help to the one you are caring for, the easier it will be for them to accept help from others as the dementia progresses and they depend on you for more and more care.

You Cannot Always Provide Care in the “Right Way”. Just as there is no such thing as the “right way” to always parent, there is no such thing as the “right way” approach to caregiving. You will experience the full range of human emotions, from frustrated and impatient to joy and peace, like a roller coaster ride, from moment to moment on any given day. Learning to watch for and appreciate any positive meaningful moments, you will share with your loved one or client a more cooperative and less stressful relationship overall as you traverse this challenging dementia care journey.

It Is Easy to Both Over estimate and Under estimate What Your Loved One Can Do. It is often easier to do something for our loved ones than to let them do it for themselves. However, if we do it for them, they will lose the ability to be independent in that skill, and not have the opportunity to experience even small feelings of accomplishment. On the other hand, if we insist individuals do something for themselves but not have the ability to be 100% successful completing a task, they feel discouraged and we end up creating agitation and frustration, and probably stifle any increase in their ability to perform a task. Not only is it a constant struggle to find the balance, but the balance may shift from day to day.

Making Decisions Becomes More Difficult. Asking “What would you like for dinner?” may have been a perfectly normal question at another time. But now we are asking our loved one to make a decision when they no longer have the ability to access the normal brain function to realize what they want, might not feel normal hunger pangs, and even if they answer, might not remember that they wanted the food they were able to request earlier. Saying “We are going to eat now” encourages the person to eat, helping to avoid the dilemma of having to make a decision without the normal brain functionality of making single choices from a frightening barrage of too many, or no options.

It Is Perfectly Normal to Question the Dementia When Someone Has Moments of “Normal” Cognitive Ability. One of the hardest things to do is to remember that we are sometimes responding to the effects of the cause of the dementia, and sometimes responding to the person who once was before the dementia began robbing them of normal functions. Everyone with dementia has times when they make perfect sense can respond appropriately, and function very near normal as before. We often feel like that person has been faking it or that we have been exaggerating the problem when these moments occur. Remind yourself that the dementia steals from the brain, making access to functions look sort of like “swiss cheese”, with random holes, and random cheese. When someone with dementia goes to access a brain function, they may access cheese, or may only access a hole. We are not imagining things—they are just experiencing a “cheese moment”, or a “hole moment”. Remember to treasure those fleeting “cheese moments” whenever you catch a glimpse of them, sharing in those “meaningful moments that allow for enhanced relationships.

Need more information about caring for someone with dementia?

Contact Information:
Laura Wayman, The Dementia Whisperers
www.laurawayman.com | laura@lovingapproach.com 
916-663-0770 | 866-947-7773