S To Managing Difficult Dementia Behaviors
1. REASSURE the person
The hard truth: the person with dementia cant change the way he or she is. You have to change your reaction and the environment or situation.
So putting the person first in your thinking as you react is paramount.
Reassuring brings anxiety, upset, or other stress down a notch. It communicates Im on your side. I take you seriously. Not feeling understood makes anyone more distressed. For someone with dementia, you create a floor to what must feel like bottomless uneasiness.
The catch: To reassure someone else, we first have to collect our own feelings. This can be hard because these are almost always emotionally charged situations!
Its easy to feel annoyed when your parent is about to drive off yet another caregiver with false accusations. Or scared when your spouse lashes out or hits. Or embarrassed when Moms blouse comes off. Or worried Dad will fall or get lost. We want to REACT!
Showing emotional intensity only makes things worse. It puts the other person on the defensive and adds to their instability . Also, people with dementia tend to be very sensitive to others moods, mirroring their demeanor. If youre upset, theyre apt to continue to be upset or become more upset. If youre calm and reassuring, you have a much better chance of transmitting that state.
How to reassure:
Approach slowly and from the front. Youre less likely to startle, confuse, or provoke.
2. REVIEW the possible causes
How to try to understand the WHY:
All About Me A Conversation Starter
Sometimes all people need is a âsnapshotâ of you in order to start a conversation. At just three pages long, All about me â a conversation starter is a shorter booklet that focuses on your needs, likes, dislikes and interests.
Whether you’re completing the full booklet or the conversation starter, always keep in mind the main purpose: To give as clear a picture as possible of you. This will help others provide care when you, and others who support you, are unable to.
Should You Always Tell The Truth
One of the strengths of the report was recognising that ‘truth’ and ‘lies’ are not as simple as black and white.
A spectrum runs from Whole-truth telling through Looking for alternative meaning, to Distracting, Going along with and finally Lying.
As we move through this sequence the level of deception rises and we feel less at ease who likes lying to a loved one?
It feels uncontroversial that we would all want our default response setting to be telling the whole truth. But it is equally obvious that the whole truth can sometimes be a brutal truth. Who would support telling the whole truth when a person repeatedly asks after a long-dead parent as if the parent were still alive?
Why Not Try This
Challenging dementia behaviors can be super-stressful. This basic approach can help stretch your patience and move you both toward a more peaceful quality of life.
Best of all, you can start using the Why-This, Try-This approach right away, even if youve been responding differently before.
To make these steps simple to refer to, Ive compiled a free downloadable PDF, 7 Steps to Managing Difficult Dementia Behaviors Without Medication, A Surviving Alzheimers Cheatsheet.
Get Your Free Managing Dementia Behaviors Cheatsheet.
Questions, suggestions, or try tips that work well for you? Please post them below!
Paula Spencer Scott is the author of Surviving Alzheimers: Practical Tips and Soul-Saving Wisdom for Caregivers . You can learn more at survivingalz.com.
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When To Answer Honestly And When Its Okay To Lie
Its during mid-stage Alzheimers disease when most caregivers and family members struggle with how to respond to instances where their loved one cant recall significant events from the past, such as the death of a spouse, and whether to affirm their loved ones beliefs or gently correct them.
In some cases, correcting a loved one telling the truth may be distressing to your loved one. If your loved one asks to see their mother, for instance, who passed on years ago, reminding them that their mother is no longer with us could be devastating to them.
If the person says something that you know is not true or possible, try to see past what they are saying, and instead look at the emotions behind it, the Alzheimers Society suggests. For example, if they are asking for their mother, who is no longer alive, it may be that they are feeling scared or need comforting. By meeting the needs behind what is being said, it can be possible to offer emotional support while avoiding a direct confrontation over the facts.
Dont Say No Dont Or Cant
One of the biggest mistakes in dealing with patients and/or loved ones with memory loss is being negative and telling them that they cant do something. Words like no,” don’t, or can’t create resistance. This comes up regularly with family members when the patient and/or loved one might be still driving, and the caregiver and/or family member has made the decision to stop them from driving. One should never say, You can’t drive anymore. They can still technically drive , and they can get very combative when told no. A way to counter this is to say, I know you still can drive, that’s not even a question, but you know what happened the other day? I was out on the highway and this car cut me off, and I had to make a split-second decision it was really scary Its likely they will say, You know what? I’m having a little trouble with those decisions too. The issue isn’t the mechanical driving, it has more to do with comprehension, and many times this answer works much better than, You can’t drive anymore, which can be construed as confrontational.
You may find a patient and/or loved one up too early or confused about time. Instead of using messages such as, Youre up too early, you need to go to bed, try leading with statements such as, You know, I’m getting sleepy. Id like a little snack before I go to bed, and then gesture for the patient and/or loved one to sit with you.
When Inaccurate Beliefs And Memories Are Hurtful
Unfortunately, therapeutic fibbing isnt suitable for all situations in which your loved one has inaccurate memories or misguided beliefs. Sometimes, patients with Alzheimers disease experience paranoia and delusions. Coupled with the frustration of misplacing belongings and household items, its common for these circumstances to give rise to suspicion and even hurtful accusations. A belief that her grandson stole money from her wallet is not one that you want to affirm. Of course, there are circumstances in which caregivers and family members have taken advantage of loved ones with Alzheimers disease, but if youre certain an accusation is false, youll need to attempt to resolve the situation.
The important thing in responding to these beliefs and accusations is to not take it personally, and that the disease is the cause, not your loved one. Be tolerant and patient, and respond with kindness while gently explaining to your loved one what actually occurred. For instance, if your loved one is accusing her caregiver of stealing her jewelry, you can usually resolve the situation by locating the misplaced item and explaining that it was simply misplaced. If your loved one believes that a family member has stolen an item of clothing when they actually took it to the dry cleaner, explain clearly, but gently and with kindness, that the item is being cleaned and will be returned promptly. If possible, keep records and receipts that you can use to backup your explanations.
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Leave Your Medications In Plain View
- Leave your medications in a place you frequent, or a place that will act as a visual reminder for you to take them.
- For example, if you make coffee in the morning, leave your morning medications by the coffee machine. If you live with children, or if you have children visiting frequently, put the medications in a place where they cannot reach them.
Doctors Cannot Definitively Diagnose Someone With Alzheimers Disease Until After Death
Before researchers developed biomarker tests in the early 2000s, the only sure way to know whether a person had Alzheimers disease was through autopsy, a procedure that is performed after death. Now, lab and imaging tests are available to help a doctor or researcher see the biological signs of the disease in a living person. For example, it is now possible for doctors to order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in people with Alzheimers. Several other blood tests are in development. However, the availability of these tests is still limited. NIA-supported research teams continue to study options for faster, less-expensive, and less-invasive ways to diagnose Alzheimers.
Learn more about biomarkers and Alzheimers detection and research.
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Telling The Truth To People With Dementia
Get advice on how to deal with difficult situations around telling the truth to people with dementia.
Making decisions and managing difficult situations
Situations may arise where a person with dementia asks questions that leave carers feeling unsure about whether to answer honestly. This could be because the answer would be distressing to the person for example, reminding them that a relative or partner has died. In cases such as these, carers can look for different ways of handling the situation.
If the person says something that you know is not true or possible, try to see past what they are saying, and instead look at the emotions behind it. For example, if they are asking for their mother, who is no longer alive, it may be that they are feeling scared or need comforting. By meeting the needs behind what is being said, it can be possible to offer emotional support while avoiding a direct confrontation over the facts.
In some situations you may decide that not telling the truth is in the persons best interests. If you do decide that the truth would be too distressing for the person, there are other options available.
Each case should be judged individually and the course of action should be chosen to suit the specific time and situation. An ideal solution is one that you feel comfortable with and also considers the persons interests.
Should You Tell A Person With Dementia That Their Spouse Has Died
Upon his passing, I remember thinking, Dad died, Mom has dementia. How in the world are we supposed to handle this? Obviously, she had to know. It was only fair, and there was no avoiding it. I cleaned out his side of their room the following day, and Mom got a new roommate. Yet, every day she had to be told that Dad had died. In her mind, he was back in his private room down the hall where he had lived for so many years.
It was excruciating to have to tell her on a daily basis that her husband was dead. She experienced the same degree of shock and heartbreak over and over again. Eventually, though, she began asking me, Is he really gone? I would confirm the news and she would just shake her head and say, I cant believe it. She passed away five months after Dad.
I believe a surviving spouse should be informed of the death at least once no matter what. Every person, with or without dementia, should have the opportunity to mourn the loss of their significant other. In some cases, the news will sink in over time, whether you realize it or not, and it can have a surprising effect.
For example, there was a man with late-stage Alzheimers disease who lived in my parents nursing home. His devoted wife visited daily until she died from cancer. The man attended his wifes funeral, but he seemed, as always, totally unaffected by anything around him. Shortly after, for no particular reason, he died peacefully in his sleep.
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Preparing For The Diagnosis
The person undergoing the assessment for dementia should be allowed to decide if they want to know if the diagnosis is confirmed.
In general, if a person is aware that they are going for a diagnosis they will be able to make that choice.
It is recommended that a person with dementia be told of their diagnosis. However, a person has a right not to know their diagnosis if that is their clear and informed preference.
What Do You Think Is Wrong With You
I assumed that the participants had adequate insight if they were able to give the correct diagnosis or, at least, to describe adequately their main symptoms. Of the 30 participants, 14 fulfilled these criteria. Most complained of problems with memory. No participant used the word dementia, but a few were able to accurately describe their conditions. Examples are shown in the first box.
The rest of the participants either denied any problems or gave implausible explanations for their predicaments, such as: loneliness,old age,stomach upset, and the like. Four patients simply said don’t know without further elaboration.
Looking Down The Road As A Caregiver
As time goes on as an Alzheimers caregiver, find support for yourself. Especially if you are a team of one, consider additional caregivers to round out your team. Senior services agencies, your local Area Agency on Aging, and local private agencies are good options to check when looking for caregivers.
‘what Did You Do This Morning’
Avoid asking too many open-ended questions, as it could be stressful for a person with dementia if they cant remember the answer. While it might seem polite to ask somebody about their day, its better to focus on whats happening in the present. Its also important that people with dementia continue to make personal choices, but defining the options might be a helpful technique.
Try this instead:
Rather than what would you like to drink?, you could ask do you want tea or coffee? or more simply, do you want a cup of tea?.
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Ethical Theories And Telling The Diagnosis
Two schools of ethical thought address these dilemmas. Deontology assumes that lying and deception are wrong in themselves and that clinicians, like everyone else, have a moral duty to tell the truth. Competent patients have a right to know their diagnosis this information belongs to them, and they should be told the truth regardless of the consequences. Consequentialism insists that the decision to tell or not to tell depends on the details of the clinical situation, and the physician should decide which course of action might be least harmful and produce the best results for the patient.
Views Of People With Dementia
Pratt and Wilkinson examined the responses of people with dementia who had been given their diagnosis. The subjects were able to identify both the advantages and disadvantages to being given their diagnosis – some of the advantages are shown in Box 2. One of the positive outcomes seemed to be that patients finally had a context within which to place worrying things that were happening to them.
The disadvantages were likely to be diagnosis-related, rather than the result of disclosure. For example, subjects cited the limitations imposed on their activities of daily living and the negative effect on their confidence. All those questioned felt that people should be told their diagnosis, and that it should be given as early as possible. A final argument supporting disclosure of a diagnosis is the accuracy with which the diagnosis can now be made. Meyers reports that a greater than 90% accuracy of modern diagnostic criteria negates concern about unduly alarming people who have been misdiagnosed.
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Things To Never Say To A Person With Alzheimer’s
Yesterday afternoon, I walked into the spacious room belonging to Mary, a woman with dementia who has few visitors and with whom I’ve volunteered to spend a little time every week. I greeted her, complimented her on her beautiful turquoise sweater, and shook her hand.
Then I sat down at her little table that was overflowing with books, photographs, the newspaper and other items she wants to keep close at hand. I started off by picking up a small framed photo of Mary with her husband and three children — two sons and a daughter.
“Tell me about your daughter,” I said, using an open-ended question because they have no right or wrong answers. That’s a tip I picked up from The Best Friends Approach to Alzheimer’s Care by Virginia Bell and David Troxell.
“Oh, her name is Connie,” she told me. “She has four children — two boys and two girls.” She continued, giving me several details about Connie and her family. I then picked up a photograph of Mary and her twin sister, Bernice, and she told me about how they took piano lessons together when they were children. After a few minutes, I asked her if her daughter ever played a musical instrument.
“I don’t have a daughter,” she said matter of factly.
“Oh,” I countered, picking up the family photo again and holding it out for her to see. “You just told me you have a daughter. Here she is.”
Professional Dementia Home Care Services From Assisting Hands
If you have a loved one who has Alzheimers disease or another type of dementia, then we can help make sure they get the care they need to live a safe, healthy life at home. Assisting Hands Home Care provides professional dementia home care services in Hollywood, FL, and the neighboring areas. We employ professional dementia caregivers who are properly licensed, insured, and bonded to provide effective home care services to elderly individuals with dementia.
With help from our dementia caregivers, you can trust that your loved one will be properly cared for in their home.
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