Apr 22, 2012

No Is Just the Easiest Word to Say

Dear Pdy, my mother told me to get out, and told me she didn't need me thousands of times. I know how much it hurts to hear those words.

By Bob DeMarco
Alzheimer's Reading Room

Today we received the following comment from Pdy under the article, Communicating in Alzheimer's World.

Okay, so I get what I've just read. BUT - what do you do, and how do you handle it when the patient REFUSES to take her medications, consume fluids or do any activity. It's "HER" house and nobody is going to tell her what to do. So - I get into her world...but how do I convince her to do what is best for her when she doesn't know what that is anymore?

Pdy, I'll start by saying, I confronted the same problems. In addition, I have been asked this question hundreds of times -- why do Alzheimer's patients say NO (all the time).

I conducted a poll on the Alzheimer's Reading Room and seventy two (72) percent of the those who responded chose "Yes" when asked if they were confronted with this problem -- the dreaded "No".

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Let me start by saying this, as far as I know you can't convince an Alzheimer's patient to do anything. On the other hand, key word hand, you can lead them into do something.

Amazingly enough, Dotty explained to me one day why Alzheimer's patients say No.

Keep in mind, Dotty had an "official" diagnosis of Alzheimer's in 2004. She actually said this to me several years later.

Here is the scenario. I took Dotty to the pool here is Delray Beach for some exercise late on a very hot summer day. We were the only two people at the pool.

Dotty refused to go in the pool even though she was in her bathing suit, and I was in mine. I asked her smany times if she wanted to go in. She said, NO many times. Finally I gave up.

On the way out of the gate to the pool Dotty asked me, why didn't we go in the pool? I answered, because you said you didn't want to go in.

She looked at me with a perplexed look on her face. The same look you or I would have if someone said we did something and we did not remember or believe we did it.

I then said to Dotty, you said NO five times when I asked you if you wanted to go in the pool. I did not say this in an angry or threatening voice. In fact, I said it a low, non threatening voice.

Dotty then said,

Bobby, you know I didn't mean it, No is just the easiest word to say.

I was shocked, surprised, and pleased. This was not the first time Dotty had taught me something.

I already knew that Dotty didn't mean NO when she said it. She said NO thousands of times that she didn't want to go to the gym, NO when we arrived, and NO when we were walking in the door.

Dotty said NO thousands of times when I said, time to take a pee.

Dotty said NO hundreds of times when I said, you need to take a shower. The list goes on and on.

For years Dotty said NO to medication, No to drinking water, etc. And NO, to prune juice.

Dotty still says No quite often. I don't listen and now we both know she doesn't mean it.

Even at the pool when she has one foot in the water she says NO I am not going into the pool, and then continues to go in. I have a video on this one --

Watch and listen as Dotty says No over and over. Watch very close around the 55 second mark of the video as she NO I am not going in even though she has her feet in the water. Continue to watch as Dotty says the water was beautiful.

You can also go here to watch a nice short video of Dotty in the water.

From my point of view, you are rarely going to convince a person who is deeply forgetful to do something. In the pool example, I tried to remind Dotty that she use to go to the pool on her own almost every day. Well, if she doesn't remember, is that argument going to convince her?

The simplest way to get a person to do something is to say nothing, and hold our your hand.

If you want them to take medication. Put the water down in front of them, and hold out you hand with the palm up, and the medication in the palm of your hand. One pill at a time. Wait for them to take it. Sometimes it might seem like a very long time before they take the pill. You have to be very patient. Sooner or later the pattern will take hold and they will reach for the pill and take it every time. If they complain keep your mouth shut, and your palm out.

If you want to get a person to drink. Sit down right in front of them with two glasses of water. One for you, one for them. Take a drink of water. Put the glass down. Pick it back up, take a drink. Once you get the pattern established you will be able to hand them the water, say nothing and watch them drink.

Overall advice, lead with the palm of you hand in all situations and keep your mouth shut.

Let me put it this way, if you get all exasperated, angry, or narly because I won't do what you want me to do, I won't like you. I won't like you and I will show you who is the boss.

Alzheimer's patients don't cooperate for a million different reasons. Maybe you come at them to fast with a pill or water and they get scared.

Maybe you talk too fast and they get confused. Maybe they find the sound of your voice threatening. On and on.

So here is the deal. It is not about you. Its not about how you feel. It is about the person that is deeply forgetful and how they feel. You won't solve many problems by trying to do the same thing over and over that isn't working.

Since many people that are deeply forgetful can't tell you how they feel, you have to start assuming that YOU are doing something wrong from their point of view. Keep in mind, their mind (brain) is assimilating information in a very different way then you or I assimilate information. Slow down.

Sure this is hard to do. Yes, it can be exasperating at first. But, if you start getting some successes you will feel much happier and you'll be calmer and gentler.

Here is the best part. When you become kinder, gentler, and more understanding so does the Alzheimer's patient. On the other hand, if you continue to berate them when they won't drink or take a pill, they will continue to show you "who is the boss".

Dear Pdy, my mother told me to get out, and told me she didn't need me thousands of times. I know how much it hurts to hear those words.

She doesn't do it often anymore. Must be a reason why she doesn't? Find the reason.

Readers are welcome to add their insight, advice and tips to Pdy in the New Add Comment box below.

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Bob DeMarco is the Founder of the Alzheimer's Reading Room and an Alzheimer's caregiver. The blog contains more than 3,461 articles with more than 397,100 links on the Internet. Bob lives in Delray Beach, FL.

Original content Bob DeMarco, the Alzheimer's Reading Room