Caring for someone with dementia can seem like a constant search for solutions to problems. It demands creative thinking, being willing to adapt and make adjustments and being able to make changes to our own reactions and behaviour.
It is paramount to keep in mind that what seems peculiar behaviour will always have meaning. The task is to discover what it means. The person you are caring for will be struggling to make sense of what is becoming a very bewildering world because of memory loss. Their behaviour - be it pacing, repeating the same question, or whatever - is an attempt to communicate something and represents a need. They may be frightened, feel isolated and lonely and experience frustration or feel angry.
Avoiding confrontation
This is mainly avoiding the temptation to correct something that is not important. They may be insisting that it is June when in fact it is March, that you did not tell or give them something, that it is Wednesday when in fact it is Friday. Better to accept the person may be disorientated and have forgotten and change the subject. If it is something important, get them back on the right track in a kind way that doesn’t directly contradict: ‘I keep thinking it’s Sunday too, but I’ve checked and it’s Monday. Your appointment is at 2:00pm.’
Inappropriate behaviour
People with dementia often do strange things that are inappropriate to the occasion, such as taking their teeth out in public or undoing their blouse. Instead of asking why they did it – keep in mind, they no longer remember what is appropriate – tell them what you would like them to do in a kind way. ‘It isn’t a good idea to undo your blouse here. You’ll get cold. Better to keep the buttons done up until we get home.’ Most other people quickly pick up that something is wrong and will react in a caring way.
Anger
There is the anger you feel. You are probably tired, coping with a sense of loss and may feel guilty, unappreciated or lonely. These feelings are not wrong; in the circumstances they are natural. Sit down and think about why you feel angry. List the reasons; understanding why will help you cope. Stress is a major cause. Therefore you need to take care of yourself. Perhaps the person could attend a day centre or relatives or a friend could look after them for an afternoon. Join a support group. If you don’t look after yourself you will not be able to look after your loved one.
Then there is the person’s anger. Show you understand by letting them express their anger. Try reacting by:
· Using a calm and soothing voice to make appropriate comments. Show you care by accepting the anger.
· Distracting them. Start a different activity, go into another room or take them for a short walk.
· Acknowledging the anger and taking a break. State something like: ‘I see you are angry. Can we stop doing this for a moment and take a break?’ or ‘I’m going into the kitchen for a moment to get a drink. Would you like one?’
· Doing something they find soothing. This might be listening to music, taking a walk, going for a car ride, listening to the radio or having a gentle massage.
Agitation
Causes of agitation can be tiredness, hunger, boredom, loneliness, grief for the losses of old age, fear that something is wrong or feeling useless and unwanted. Depending on the cause, solutions might include having an after-lunch nap, providing an energy snack, giving strong emotional support, distracting the person by entertaining or doing something with them. Agitation is a reaction to something. Stay calm while figuring it out. Don’t allow yourself to become infected by it. Reassure yourself that it is a mood that will pass and then be forgotten.
Incontinence
Frequently, incontinence is not the problem. The person has just forgotten to go to the bathroom. If this is the case, make sure they are regularly reminded - especially important before going out and when they have returned home. The reminder may be verbal or it could be added to a daily ‘to do’ reminder list. If this does not solve the difficulty, enquire about the different types of special clothing now available.
And finally
Many daily problems reduce if the person is kept fully occupied. This makes having some sort of daily activity plan to help them avoid boredom very important. Equally important is looking after yourself. Doing this keeps your mind clear and will help you find new solutions to daily problems that work for you and the person for whom you are caring.
Copyright – Robin Dynes April 2020