Feb 21, 2014

Failure to Initiate Does Not Necessarily Mean Failure

This difficulty in remembering how to begin even the simplest tasks is referred to as failure to initiate.

Tom and Karen Brenner
+Alzheimer's Reading Room

Failure to Initiate Does Not Necessarily Mean Failure
Here is a question that caregivers should think about:
How do you begin a task if you don’t remember the first steps of the task?
This could be something as simple as unlocking a door. If you don’t remember how to put the key in the lock, then you are stuck.

One of our tasks as caregivers is to help the people we care for find those keys they need to unlock the abilities to complete a task, and feel successful.

All of us, whether we are three years old or eighty-three years old feel good about ourselves when we are successful. But first, we have to be able to remember how to begin.

This difficulty in remembering how to begin even the simplest tasks is referred to as failure to initiate.

People living with dementia often deal with this very difficult problem. They would like to be able to dress themselves, or make themselves a cup of coffee but they can’t remember how to begin the process of buttoning a shirt or making coffee.

This is when we often see people leaving little notes for themselves, reminders of how to perform simple tasks, or reminders of where they parked the car, how to use the telephone, etc. These are sometimes the first clues to family members that the person they love is struggling with memory function.

Think about how difficult life becomes when you can’t remember how to begin the first step of so many activities.

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What if you couldn’t remember how to button your shirt?

When you stop and analyze this activity, it can become quite involved. There are many steps to buttoning a shirt. What would the first one be?

Interestingly, when we ask people who don’t have dementia to begin a simple task, such as buttoning a shirt, making a peanut butter and jelly sandwich, loading a washing machine with dirty clothes, we always, always, get different answers from different people.

Everyone has their own way of buttoning a shirt, making a sandwich and loading a washer.

For instance, what do you pick up first when you start to make a sandwich?

Visualize this in your mind: is it the bread, the knife, the jar of peanut butter?

Our point is that even the most simple, mundane, daily task can seem difficult and overwhelming if you can’t remember how to start, if you no longer know where to begin.

This failure to initiate, this inability to begin a task is the point where many people with dementia begin to give up. They don’t know where to start, so they don’t start. 

It is our job as caregivers to help them find a way to begin again.

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In our care program, The Montessori Method for Positive Dementia Care, we encourage caregivers to think about the tasks that their loved one are struggling with.

Is there a way to break down these tasks into smaller pieces so that the person they care for could do at least one part of the activity?

Breaking down tasks into smaller pieces allows the person living with dementia to still participate, still be part of life.

If your mom can no longer make the cookies that the family loves, perhaps she could do one part of this activity. She might still be able to pour in some of the ingredients or maybe she could stir the batter. Even something this simple might be challenging, but, if your mom can participate in making cookies, even if only one small step of the process, this keeps her connected and involved in life.

One other strategy that we have found to be very helpful in dealing with failure to initiate is isolating the difficulty that a person may be having with the task at hand.

If your husband struggles to dress himself, then you could give him just one part of dressing himself to work on. The Montessori Method offers dressing frames in which only part of dressing oneself is highlighted: There are zipper frames, button frames and tying frames.

These dressing frames isolate the difficulty and also offer the opportunity for practicing these skills so that a person could, in fact, teach themselves to button or tie again.

We know that it is possible for people living with dementia to teach themselves how to complete a task again because we have seen it happen many times.

In our program, we encourage caregivers to help the people they care for stay as independent for as long as they possibly can. Sometimes this takes a great deal of patience and is often not the most efficient way to get through the endless tasks that face caregivers every day. However, if we, as caregivers, can take just a moment and think about the tasks that our loved ones struggle with, we can often find the way to help them find success once again.

The smile that accompanies success is worth the time we spend to help our loved ones find success again; even if it is only buttoning one button.

Tom and Karen Brenner are Montessori Gerontologists, researchers, consultants, trainers and writers dedicated to working for culture change in the field of aging. They are the authors of  You Say Goodbye and We Say Hello: The Montessori Method for Positive Dementia Care. Learn more about Tom and Karen at Brenner Pathways.

Original content the Alzheimer's Reading Room