Sep 10, 2010

Breaking the Vicious Cycle of NO

By Bob DeMarco
Alzheimer's Reading Room

Let's start with this premise. I am talking about Alzheimer's caregivers that are home, mostly alone, with a person that has Alzheimer's.

The problem simple -- No. The person with Alzheimer's says NO.

So ask your yourself, how meaningful is it when a person that has Alzheimer's says No. Is it the same as the way they said no ten or twenty years ago? Is it the same as when a person that is not suffering from dementia says No?

Let me ask you this. Did they even say NO ten or twenty years ago.

Let's add in another dimension. Is the person that has Alzheimer's saying No to activities that they enjoyed in the past. In the past before Alzheimer's.

Did you ever try to get an explanation from a person that has Alzheimer's about why they are saying No to something they previously enjoyed doing?

Well, I hope not. But if you must -- try it. Then go bang your head against the wall. Keep asking and keep banging you head until a little light bulb goes on in your head or until the wall cracks. Which ever one comes first.

I am pretty sure if you keep banging your head against the wall you will finally conclude something along these lines -- my head hurts I better try something new and different. Ready to try something different?

There were some very interesting comments under the article -- Why Let a Tiny Two Letter Word Deter You that encouraged me to continue along on this topic.

I want you to assume Alzheimer's World is upside down and backwards place. A place that is very different from the real world.

I learned this about Alzheimer's World after a few hundred simple observations.

For example. When its 90 degrees outside my mother will tell me its cold outside. How did she come to this conclusion? Because she feels cold inside. The air conditioning is on. It never occurs to her that we have air conditioning. So if she feels cold when it is 78 degrees inside, she assumes it is cold outside.

Now when its 62 degrees outside she will tell me its hot outside (under 72 degrees and my mother needs a coat). When we get to December my mother will be telling me its summer. In August, she will tell me its winter and she needs to put her coat on before we go out.

This is constant. It happens that same way year after year.

Now you might be wondering why this happens. I thought about it for a couple of years. Finally after banging my head against the wall I came to a simple conclusion. It doesn't matter.

I finally realized what is -- is -- in Alzheimer's World and there is one thing I know for certain -- you won't change anything in Alzheimer's World until you learn how to communicate in Alzheimer's World. So pretty much throw the real world out with the bath water.

Whenever an event is coming up like the pool, doctor, gym, a party, I start working on it in advance. Lets say doctor appointment. I start on this the night before.

I say to Dotty. We have a doctor's appointment tomorrow. She tells me, I am not going to the doctor. Guess what? This tells me we are off to a good start. She said exactly what I thought she would say.

Dotty said exactly what I thought she would say in? In Alzheimer's World. When she says it, I chuckle. I am not laughing at her, I am laughing at Alzheimer's. Why? Because I am thinking, gotcha Alzheimer's.

So the night before, I tell Dotty we are going to the doctor tomorrow. She says, No. I then tell her about all the benefits she is going to receive by going to the doctor. I smile and laugh as she continues to tell me NO.

The next morning as soon as we get up I start back in. Dotty says, No. I might ask if she likes our doctor? I tell her how much I care about her and how that is one of the reasons we are going. I tell her how great she is going to feel after she gets the b12 shot. I might even tell her how happy I am going to be because then I won't have to worry about her health.

Dotty says No, and I just keep the various conversations going and continue to layer on all the positives no matter what she says.

Here is the point I am making here. I am not dreading what is going to happen when it is time to go. I am not hiding from the difficult situation I most likely will be facing.

What I am doing is engaging Dotty in a nice conversation about what we are going to be doing. Each time we start up this conversation she say No. However, the No is less harsh each time and the conversation is much more productive.

Here is something else. I know that Dotty knows going to the doctor is a good thing. I also know that Dotty can't tell me this is a good thing because she is now in Alzheimer's World (most of the time).

So in some crazy convoluted sense I am going to convince Dotty that whatever event we are doing is a good thing. However, I am not going to sit her down and explain. I am going to explain this to her in several different segments (acts).

Think of it as reading a good who dunnit. You are reading along in your book and you are getting more and more information. All the pieces of the puzzle start to come together. At the end of the book you find out "who dunnit".

So, if you want to get someone that has Alzheimer's to do something they are resistant to doing you have to let them say No. Over and over, let them say NO. The more NOs the better.

And yes, it is likely that they are still saying No right before you walk out the door. However, if they are walking out the door then NO means Yes.

While they are saying No have a pleasant conversation with them where you spell out the benefits of doing something. Paint the picture for them. Use your own mental images to help you find the words to describe what you are envision happening. Share this vision with them. Nice and slow and easy. Like a good book.

No battles, no stress, no convincing, just a nice easy engagement between two people. Engage the person that has Alzheimer's in conversation even if you are the one doing all the talking. Tell your story that ends happy.

You get them laughing and smiling they will do it.

Remember they see the look on your face, they hear the tone of your voice, and this has a much greater impact then the words you are saying.

Try remembering this. While you are having all the conversations leading up to the event you are creating a wonderful positive environment and feeling. This is what is important. The feeling leading up to the event.

And here is the craziest part of all it. They won't even remember all those conversations leading up to the event. But you will. If you did a good job you will be feeling happy and energized and so will they. They feed off you.

Congratulations. You did it. You created a positive feeling and away you go.

This is how you end the vicious cycle of NO. It does take practice. When you finally find yourself laughing (mostly at yourself) the finish line is in sight. Or I should say the finish line for that event because you are going to have to start all over again tonight or tomorrow morning.

Don't let this deter you. It is kinda crazy funny when you think about.

Did you ever think you would have to learn how to do something like this?

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Bob DeMarco is the editor of the Alzheimer's Reading Room and an Alzheimer's caregiver. Bob has written more than 1,810 articles with more than 92,100 links on the Internet. Bob resides in Delray Beach, FL.

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Original content Bob DeMarco, the Alzheimer's Reading Room