Jan 14, 2015

How to Solve Problems Associated With Mood, Cooperation and Behavior

Ask yourself is the problem a result of dementia, or is it a problem of the underlying personality that existed before a diagnosis of Alzheimer's?


Many of the emails I receive come from members of the Alzheimer's community worldwide who are looking for a solutions to a problem.

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The most common of course is repetitive questions, and then to problems like the inability to get a person living with dementia to take a shower, or to take their medication.

The list of common problems we face as caregivers fall loosely into the categories of mood, cooperation, and behavior.


By Bob DeMarco
Alzheimer's Reading Room

First, ask yourself is the problem a result of dementia, or is it a problem of the underlying personality that existed before a diagnosis of Alzheimer's or another type of dementia?

Personality type can make a difference. For example, a person who was naturally a "worrywart" might be harder to deal with because their level of anxiety is likely to be exacerbated by dementia.

Another example might be person who likes to be in control. Alzheimer's does lessen the fundamental ability to be in control. Nevertheless, the person might still have this need.

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Unresolved issues in relationships can also make the caregiving effort more difficult.

In order to deal with difficulties of mood, cooperation, and behavior, I usually suggest that the caregiver get a notebook and start keeping track of the problem or problems.


For example,
  • When is the problem occurring? At the same time of day. For example, in the morning, late afternoon, sundown, bedtime.
  • With whom is the problem occurring? With a you, spouse, child, hired caregiver or nurse, or in a particular location within or outside the home?
  • Where is the problem occurring? Same location every time, different location, all over the place?
  • In what context did the problem take place? In other words what was happening before the problem occurred? 
  • Were you gone for a while and then the problem occurred? 
  • Did you come up to the person living with dementia and abruptly ask them to do something?
  • Does it happen when you are trying to explain something in great detail, and by using a lot of words?
  • Why did it happen? Can you answer this question? 
If you start taking notes and examining each situation you will have a better chance of solving a problem or changing the behavior.

Here is a very simple example.

I could not get Dotty to take a shower.


Of course, like most beginner caregivers when Dotty would say no, or I don't need a shower, or I already took my shower today, I would try to explain to her why she needed a shower.

I would offer a long list of good reasons why she would enjoy a shower. Or, try to explain that she had not taken the shower. I tried this even though Dotty just told me she believed she had taken a shower. Explaining doesn't work well when a person with dementia says No.

Once I started analyzing our day and taking notes, I concluded I was not going to be able to get Dotty to take her shower in the morning no matter how hard I tried.

After a while, I decided I would work the shower into our daily routine around 3-4 PM in the afternoon.

By the afternoon, I had Dotty calmed down and into a set routine (pattern). For example, I had been moving her around our home, given her breakfast and lunch, and gotten her to pee several times.

Before I brought up the shower Dotty would usually be listening to music, and if things were going well she would sing. This gave me a chance to interact with her -- talk with her.

When the time for the shower would come, I would talk to her, then walk up to her and stick my hand out. If all was working well Dotty would ask, where are we going? I would respond up front to get a snack. And away we would go.

On the way, I would say, hey, after we have our snack lets go out. She would say, where are we going? I would answer to have some fun. She of course would say, oh sure.

Once we were in the right position I would say, hey, lets take a pee and a shower, put on our cloths and get ready to go out.

By this time I had her in full motion, had her attention, and had engaged  in several acts where she cooperated. Like taking my hand when the entire interaction started.

Start looking at each situation. Take some notes. Try to get very good understanding of what is going on at the time of the problem, and before the problem is occurring.

When you see a recurring problem, try to change the dynamic. For example, make sure the person living with dementia is fully engaged and doing something before a problem that occurs at the same time each day.

Don't be afraid to change it up. Try things at times of day that work better.

Most important. Don't walk up to a dementia patient from out of no where and start asking them to do something.

Get the conversation going first, make sure you smile and that they smile back, try getting them to cooperate, and then go for the big move.

Little acts of cooperation build up over time. Cooperation leads to trust. Trust leads to success.


About Bob DeMarco

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