May 22, 2017

How to Understand and Foster Self Esteem in People Living with Dementia

Self esteem relates to confidence in one's own worth or abilities.


Self-esteem is defined as a confidence and satisfaction in oneself.

By Marie Marley and Teepa Snow
Alzheimer's Reading Room

Self-esteem is defined as “a confidence and satisfaction in oneself.”

Synonyms include:

self-respect, self-regard, pride, dignity, morale, self-confidence, and self-assurance.




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Difficulties People Living With Dementia May Have With Self-Esteem

A healthy level of self-esteem is essential to our sense of well being and happiness. Problems with self-esteem are not uncommon among the general public, and people living with dementia typically have additional self-esteem difficulties. These can be worsened by those around them, and include:

1. Some people may treat a person living with dementia as they’d treat a child. This directly and negatively impacts the person’s sense of self.


2. People who are in the early stages of dementia and who are acutely aware they’re having cognitive challenges may be distressed, experiencing an internalized loss of self-esteem that goes unrecognized by those around them.

3. For some people with dementia, it’s important to remain in control. Others may try to help them too much or even try to take over. The intense emotional reaction can actually further impair ability and damage the sense of self.


4. Some people having changes in memory and cognition may be completely unaware of those symptoms. Others may point it out repeatedly. The person having the difficulties may feel he or she can no longer trust those who point it out, and this can lead to a decline in morale and a sense of being disrespected by former friends and family.

5. Sometimes people discount the intensity of feelings of people who are aware of having symptoms of dementia. This can easily cause frustration and a decline in self-esteem.

Tips for Fostering the Development of Self Esteem in People Living With Dementia

1. Offer appreciation and praise the person for a job well done, no matter how large or small

This is perhaps the single most important thing you can do. Remember to be honest in giving praise, however. If you compliment the person when it isn’t merited, he or she may realize it and be put off. You can almost always find something the person is doing well. Even if they just try something, that counts. Tone of voice matters. Celebrate with a colleague, not a child.


2. Don’t talk “baby talk” to the person

He or she may perceive it as patronizing. If the person doesn’t understand “normal” talk, then “baby talk” probably won’t be understood either. Simplify, don’t “babify.”

3. Generally speaking, when selecting activities, use ones that are adult in nature

This is a general rule of thumb, but think outside the traditional box. On a whim one day, I took my loved one who had Alzheimer’s a small stuffed animal. He loved it, and we had a wonderful time playing with it and others I took him. It became one of our best ways of having fun together.

4. When using activities, consider how you present a simplified option

If it seems like it is too easy, the person may become quickly bored or believe that you think they are stupid or are demeaning them. Consider asking the person to help you with something you are going to do with a child or another person later on and want to make sure it works OK beforehand.

How to Get a Dementia Patient to Do What You Want Them to Do

5. Don’t use activities that are too difficult either—even if they are ones at which the person previously excelled

It’s important to set the person up for success. Select activities at which you know the person can succeed. If an activity isn’t working out, switch to something else or simplify it. If it still isn’t working, back off and quit pushing.

6. Ask the Person to Help You Do Something

Most people derive satisfaction from helping others, and people living with dementia are no different from anyone else in this regard. An article published by Ellen Woodward Potts suggests that you ask the person to help you with daily tasks. Match the task to the person’s abilities and express your appreciation for their help.

7. Be Willing to Have Different Memories and Opinions. (Let them save face)

If you try to correct the person, especially during the early stages of the illness, it can just be a reminder that his or her memory and cognition have declined or they think you are lying, and self-esteem and relationships can suffer. Learn how to let it go.


8. Try a New Way of Finding out About a Person’s Memory of Something

Don’t ask if the person remembers something. Instead, try a question and sound curious. For example: “I can’t remember if I asked you about going to get ice cream or not.” This can either prompt a memory that is there, or offer a way to still share information that is missing without making it a challenge.

9. Help the Person Develop Ways to Compensate for Their Changing Abilities

When suggesting ways for the person to compensate, offer two choices of what could be helpful. People with dementia often respond well when given an “either/or” choice.

10. Offer the Person a Small Wrapped Gift

Gifts indicate positive regard and bring pleasure, creating a sense of value. It should be something personal selected just for that person, it should have some auditory, visual or tactile appeal, and it should be based on the person’s previous pleasures.

How to Get Answers and Solutions to Your Caregiver Problems

Marie’s Personal Experience with Dementia and Declining Self-Esteem

In 2013, Marie was tested and diagnosed with “symptoms consistent with dementia of the Alzheimer’s type.”  
She was experiencing serious cognitive decline, and after a short while, she realized she had to retire from her extremely stressful job as a medical grant writer and get treatment for sleep apnea, which had just been diagnosed.

When she repeated the neuropsychological tests two years later, however, the improvement was almost unbelievable. Her general functioning had also improved dramatically. The doctors decided that she did not have Alzheimer’s, but rather she’d had a period of decline from symptoms that mimicked the disease. Unlike with Alzheimer’s, her symptoms could be treated and reversed.

During the time before she retired and received treatment for the sleep apnea, however, sometimes she couldn’t perform the simplest, most familiar tasks at work, and she experienced a whole host of other problems with memory and daily functioning. Her self-esteem plummeted.

Although she didn’t have Alzheimer’s, she thought she did. People tried to help by telling her they didn’t think she had Alzheimer’s. No one would validate her feelings. She felt all alone in the world. And she reasoned that if she had Alzheimer’s, that would explain why she was having so many problems with memory and cognition. But if she didn’t have it, then she really was just an idiot. Their efforts to help only made her self-esteem plunge lower and lower.

What she needed was for people to accept the diagnosis, empathize with her about it, help her find ways to cope with her disability, and encourage her to focus on what she still could do—not what she couldn’t do. Those things certainly would have helped her develop and maintain a healthy level of self-esteem.

In conclusion, there are many ways to support a person with dementia to develop and maintain a healthy sense of self-esteem. Can anyone think of others not listed in this article?

Marie Marley is the award-winning author of ‘Come Back Early Today: A Memoir of Love, Alzheimer’s and Joy.’ Caregivers say it helped them a lot, and former caregivers say they wish they’d had it when they were caregivers. She is also co-author (with Daniel C. Potts, MD, FAAN) of ‘Finding Joy in Alzheimer’s: New Hope for Caregivers.’

Teepa Snow is one of America’s leading educators on dementia. Working as a Registered Occupational Therapist for more than 30 years, her wealth of experience led her to develop Positive Approach® to Care techniques and training models that now are used by families and professionals working or living with dementia or other brain changes throughout the world. She also developed the Gems model, to be utilized not just to classify a state or stage of dementia, but as a means to improve interaction and appreciation of individuals

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