Redirection is a handy all-purpose tool for responding to many of the bothersome, inappropriate, or potentially unsafe behaviors of Alzheimer's and dementia patients.
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To redirect means to help the person move toward feeling better and acting more constructively — literally, to change the direction of things.
So how do you do it?
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Lets say your mom is restlessly pacing back and forth across the room, even though she's not terribly steady on her feet and you're terrified she'll fall.
Or, your dad likes to open his fly and touch himself while watching TV.
Or, your wife keeps insisting that "little men" under the sofa are snatching her snacks and tissues.
In each case, redirection involves using your attitude, your words, and your suggestions to gently shift the behavior.
1. Start with a calm and confident approach
When we see a behavior that warrants changing, our first reaction is often emotionally charged.
We want to shout for Mom to sit down before she hurts herself.
Or, we're embarrassed by Dad's hand in his pants.
We get frustrated when a spouse asks, for the tenth time, whether the mail has come yet.
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Don't be hard on yourself because emotionally charged responses are normal in these types of situations when dealing with a person living with dementia.
You can redirect more effectively, though, if you're less insistent, less upset, less direct.
You know that old expression, "You catch more flies with honey than vinegar?"
You redirect more successfully with honey, too. To redirect is to lead, and people prefer to follow someone they trust and enjoy, not someone who frightens or shames them.
Stick to a calm, friendly tone.
Make sure your body language follows suit.
A warm smile, eye contact, a light touch, and relaxed posture make the listener more open to your suggestions than if you frown or hunch your shoulders.
You can also use body language to guide the person — an arm around a shoulder, a hand outstretched in invitation.
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2. Ask questions to learn more
Although "redirect" is an action word, bide a little time gathering a better understanding of underlying feelings or the situation.
When you have a sense of where the person is coming from, emotionally and physically, you have a better idea of how to best redirect. You're also better able to be reassuring — and your empathy in turn makes the person feel understood, and therefore more receptive to you.
Questions you can ask yourself:
- Is she bored?
- Is he upset about something?
- Is there something about the room or the situation that keeps triggering this?
Questions you can ask the person:
- "Dad, do you need to use the bathroom?"
- "Can I get you something?"
- " Are you hungry (or tired, or cold)?"
- "Can I help you find something?"
- "What would you like to do about that?"
- "Tell me more about it."
3. Empathize, don't argue
Above all, avoid arguing or using reason. ("Mom, if you do that, you'll fall!" "Dear, the little men are all in your head!)
People with dementia lose the ability to follow logic, so this isn't an effective motivator. Instead, it only makes them defensive — they retreat, when your goal is to get them to move forward.
Better: Be reassuring and agreeable. It's okay to go along with a delusion.
You don't have to be as blatant as saying, "I see the little men, too!" But you can be empathetic: "Yes, I know they really upset you" or "Why do you think they're so pesky?"
4. Try bridge phrases
"Bridge phrases" are expressions that help to move things to a new place.
These turns-of-phrase are especially useful when someone is stuck in a particular conversational groove or asks the same question over and over. You might say something like:
- "The mail hasn't come — that reminds me when Grandpa said he had milk and ice delivered to the door. Did you have a milkman?
- "I like that story. I've also heard that…"
- "It's such a nice day. Why don't we walk to the bird bath?"
- "I know those little men are so upsetting. What I'd really like to know is why they're so quiet! Do you think the cat hears them?
The idea is to engage the person in something that's a slight turn from where he or she is now.
You can also use bridge phrases to redirect an activity.
Look for something you know is of interest to the person. Sexist though this may sound (and it's obviously different for all), many older women enjoy talking about weddings or babies, while men are diverted by sports.
What's your loved one's attention-grabber? Childhood reminisces? Food talk? Pets?
5. Introduce activity alternatives
Present something specific and different to attend to.
This might be a change of scenery, a different activity, a chore you need help with, or another experience —anything that breaks a pattern of behavior.
Moving outside or to a new room (or moving a chair to a fresh view) can be very diverting. So can offering a favorite snack or inviting the person to come to the window and watch a funny squirrel.
Introduce a diversion without belaboring the reason for it: "Hey, I have an idea. Why don't we…" "Look what I brought you…" "I need your help with…"
Know that boredom often fuels repetitive behaviors.
In this case, look for engaging activities, rather than passive ones like TV viewing — many people with dementia spark to things that feel purposeful, such as folding towels, picking up sticks in the yard, or sorting papers.
For habits involving the hands, like skin-picking or inappropriate touching, consider activities that keep the hands busy (worry beads, yarn to unwind and rewind, a drawer or tool box to organize).
If anxiety seems to be an underlying issue, try to engage the person in something pleasant.
Three successful themes for restless behaviors involve music (like playing an iPod), comedy (a slapstick old movie), or touch (such as a cat to pet, or your own soothing presence holding hands).
Paula Spencer Scott is the author of SURVIVING ALZHEIMER'S: Practical tips and soul-saving wisdom for caregivers. She is a contributing editor at Caring.com, a former Woman's Day magazine columnist, and a fellow of the Met Life Foundation Journalists in Aging program. Four close family members have had dementia.
Original content the Alzheimer's Reading Room