Aug 8, 2014

6 Simple Steps to Quality Dementia Care

The “Respect Your Elders” Approach to Dementia Care requires patience, understanding and development of these 6 skills.

By Elaine Pereira
Alzheimer's Reading Room

6 Simple Steps to Quality Dementia Care | Alzheimer's Reading Room

My mother always taught me to “respect my elders” although she didn’t use those exact words. Being respectful to everyone especially adults when I was a child was her message.

I was probably as guilty as anyone else trying to convince my mom with dementia, later diagnosed with Alzheimer’s, that her thinking or memory was flawed.
That “I didn’t have a baby” nor had I “left it in her closet.” (I was 56 years old at the time)

Or that no one had scaled the exterior walls of her third floor, courtyard view apartment to break in and steal “two pair of brown, petite size 4 pants!”

Or that “seven dollars worth of stamps” had been absconded from the back of a desk drawer so narrow that even her slender arms could barely reach in.

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Despite numerous and ever increasingly bizarre situations where my mother adamantly insisted that something – surely misplaced - was stolen or her version of an experience – if it happened at all – was unlikely, my well intended but misguided approach was to try to convince her of the “truth”.

Although my mother’s reality was anything but real,
Mom’s perceptions of her world were real to her!

My “truth” gave way to her “truths”. Eventually like most dedicated caregivers and family members, I got on board with the new and ever changing Mom and stepped into her world as she saw it.

“Respect your elders.” I remembered Mom whispering to me when my nasty, mean Uncle Leo visited. I either wanted to hide in my closet or give him a piece of my mind. Mom nixed both plans and I quietly ‘respected” him even as I growled under my breath at his horrible demeanor. It helped that my parents didn’t like him much either, but he was family.

I reflected on Mom’s tolerance of disagreeable Uncle Leo and recalled how she bobbled her head during his political rants and avoided confrontation by choosing her words carefully.

This was the model I defaulted to for optimal dialogue with my irrational mother, a dementia friendly model of respecting one’s elders. This approach is far more effective at maintaining a calm atmosphere than being unnecessarily blunt or direct.

The “Respect Your Elders” Approach to Dementia Care
  1. Take a deep breath and be patient.
    People with dementia issues may appear stubborn or obstinate, but they act differently due to the condition. They are not making a conscious choice to be difficult.
  2. Watch your non-verbal communication especially facial expressions.
    Someone with dementia may have diminished memory, changes in personality and a host of other problems, but they can and do recognize snide facial changes. Negative non-verbal communication often speaks louder than real words.
  3. Reality orientation approaches are ineffective.
    You can’t convince or rationalize with someone experiencing disorienting dementia. Their deteriorating awareness and memory skills don’t allow for higher executive functions and logical thinking.
  4. Politely agree or remain neutral to almost everything.
    If someone with Alzheimer’s says it’s a nice day when it’s raining outside, nothing is accomplished by attempting to tell them otherwise.
  5. Wait a few minutes and try again.
    Obviously individuals with Alzheimer’s need care they may refuse to cooperate with, such as bathing or a change of clothes. Refusals are common but sometimes can be managed by waiting and/or trying another approach. In waiting they forget what they were objecting to.
  6. Keep it simple.
    Caregivers, especially family members and friends, have a tendency to use too many words when talking to their loved one with dementia. I was guilty too of being overly chatty. Their ability to process language and formulate a response wanes significantly as the disease progresses. The more you talk, the less they get.
From I Will Never Forget, Chapter 33.
Her short-term memory was so unpredictable I couldn’t know what fragments of the conversation she might recall or how twisted her brain might rearrange them, from fact to fiction.
Please remember that individuals with Alzheimer’s have little control over what they say, how they behave or what they perceive. But as caregivers we do!
I Will Never Forget

Elaine C Pereira, is the Award Winning author of the Best Selling memoir, I will Never Forget: A Daughter's Story of Her Mother's Arduous and Humorous Journey Through Dementia.

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Original content Bob DeMarco, the Alzheimer's Reading Room