Caring for a loved one with Dementia may be one of the hardest things we ever do. The change in personality and behavior is not a choice, but a response to the chemical and structural decline of the brain. Caregivers can quickly be overwhelmed when their loved one no longer communicates in the same ways they used to. Managing the challenges can be more productive when we practice hard conversations and know how to respond to difficult behaviors.
First, let’s discuss some of the triggers that can elicit challenging behaviors.
- Overstimulation (when my brain can’t process all the visual and auditory input coming in. I’m uncomfortable but don’t know why).
- Frustration from skills they are losing (language, senory loss, coordination, independence).
- Memory loss (I don’t remember moving my purse, so somebody must have stolen it).
- Medical changes (urinary track infections, fever/illness, or sundowning)
The prefrontal cortex of the brain is the last part of the brain to develop in maturity, and the first to decline with many types of dementia. The cognitive skills controlled by the prefrontal cortex are important for understanding reasonable expectations from your loved one. The skills often affected include: Impulse control (holding your tongue or actions), Logic and reason, Sequencing (initiating, transitioning, and terminating activities), Making choices, Self-awareness (when to ask for help), and Considering other people’s perspectives.
HOW CAN WE HELP REDUCE TRIGGERS and DEMONSTRATE EMOTIONAL SUPPORT?
THE DO’s:
Identify what skills remain and focus on using those skills during daily routines. For example, if they have the motor skills, have them fold the washcloths, stack the dishes, pull the weeds, tinker with the tools, in a controlled environment where they can feel successful.
Focus on the emotion or need associated with the behavior. Are they agitated, confused, worried? Do they have an unmet need they can’t verbalize? Are they hungry, cold, in pain, or need to use the restroom? First offer reassurance regarding the emotion you observe, then suggest solutions to a possible unmet need.
Adapt the house to account for loss of vision, decreased peripheral vision/ tunnel vision, depth perception changes, and difficulty identifying objects and their correct use. For example, put items in locations for proper use, color code items that go with each other, and increase lighting. Dark shadows can often be perceived as a hole in the floor and may be avoided. Items such as keys, purse by the door, clutter, and even reptitive or annoying noises may all trigger behaviors.
Validate the feeling! Ignore the blame and sympathize with the feeling behind the accusation. If they continue to escalate, try taking them outside, change scenery, add/remove stimulation (like music, snacks), or introduce an activity they enjoy.
Allow extra time for them to answer questions themselves, try not to answer questions for them. In conversation speak in a soft tone, use mostly nouns and verbs, and allow extra time for them to respond before moving on to another question/topic. Phrase questions in a way that offers a sense of control, ie. “Would you like to do it yourself, or can we do it together?”
THE DON’TS:
Don’t try to make sense of DEMENTIA! As the famous Teepa Snow commonly teaches, “DEMENTIA DOESN’T MAKE SENSE!”
Never assume because they did it once, they can do it consistently.
Don’t argue. If you are the target of thier accusation or anger DO NOT defend yourself, show evicdence or use logic. Replace yourself with another caregiver for a brief time if possible. If not allow them some alone time where you can see them, but you are out of view. Let them calm down before reattempting conversation or necessary care.
Don’t correct them. Don’t correct disorientation to person, place, time, situation unless it is necessary for safety or reassurance. For example, if your wife states she had a bad day at work, don’t tell her she hasn’t worked in 20 years! Ask her to tell you about her day. If she says the police are looking for her, remind her that they “called off the search” and reassure her safety. Telling
“untruths” to calm the mind may be one of the hardest, but most caring things you can do to preserve your loved one’s dignity.
Avoid making decisions for them. Allow them to be a part of decision making without overwhelming them by limiting choices to two options. “Do you want the red shirt or blue shirt?”
Don’t ask direct questions that require language skills and short-term memory use. For example, instead of asking, “what did you have for breakfast,” try, “Did breakfast fill you up? Focus on the feeling, not the details.
Don’t test them! “Do you know who I am? What’s your husband’s name? and the infamous…. “You know me, Remember?” This forces them to expose their memory loss, adding unecessary stress.
Don’t reprimand them for repeating the same question multiple times. They don’t remember asking five times prior. Reminding them of their deficit is not productive, but demeaning.
Here at BIM we focus on the mind and body as a whole. Speak with your coach if you need more resources for caregiver education, or if you are noticing changes in your own cognitive skills. We have fun including cognitive exercise in our individual and group sessions. The aging brain deserves exercise too!
“Dementia doesn’t strip people of their dignity, it’s our reactions to them that does.” ~Teepa Snow
