Aug 20, 2017

Embracing the Reality of a Person Living with Dementia

Embracing someone's reality in dementia care means that you not only accept where they are in their dementia-related world, but that you join them in it. You agree with what they say, even when you know that they are wrong. The world we live in may be very different from the world that someone with dementia lives in.

Learning how to embrace reality in dementia care and Alzheimer's care facilities.
By Rachael Wonderlin
Alzheimer's Reading Room

If there's one is one lesson that you can walk away with today after reading this article, it is this phrase:

“Embrace his or her reality.”

I once overheard a nurse arguing with a man who had dementia.

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“That’s NOT your wife, you can’t come in here while we are getting Mildred* changed,” she said.

The more the nurse told him this, the more frustrated and angry he became.

“That is my wife. That’s my wife, let me in there!” he said, slamming his walker into the door.

Granted, Mildred was not actually his wife, but that was not the point. I walked up and put my hand on his shoulder. “Hey, let’s wait out here for her.

She’ll be ready soon,” I assured him.

He calmed down immediately and sat with me. I looked to the nurse and suggested that she avoid arguing with him. She became defensive and stated,

“I don’t want to lie to him.”

If there's one is one lesson that you can walk away with today after reading this article, it is this phrase:

“Embrace his or her reality.”

It frustrates me when caregivers (especially those in the medical field) don't try and use this technique.

Topic - Memory Care

A caregiver wants to do the “right” thing, especially if the person they are caring for is a parent. So many people have expressed the same sentiment to me. They have spent their whole lives being truthful with their parents, and dementia isn't going to stop them now.

Ask yourself if this sounds familiar: Your mom is looking at the clock. “When are we going to mom’s house?” she asks you.

Your mom is eighty-five years old, and her own mother (your grandmother) has been deceased for quite some time.

In this instance, you could react in several ways. Sadly, many caregivers gravitate toward the wrong approach.

“Mom, you’re eighty-five. Grandma has been dead for twenty years,” 

you might explain, annoyed that she’s unclear about this.

This information, however, is completely new to your mom. She’s positive that she’s never heard this before. Some caregivers believe that a little “reminder” will be helpful, but your mom is devastated by this information regarding her mother.

“But when did she die?” she asks, tears in her eyes. Fifteen minutes later, she’s forgotten that you told her this, but she’s still upset and agitated— she just doesn't know why.

Here’s a potentially better solution.

Embrace her reality. You might respond in answer to her question, “I’m not sure, what were you thinking of doing at mom’s house?”

Or, maybe you could remind her of Grandma’s cooking, and how delicious her sweet potatoes always tasted.

Maybe you could try distracting her with something else. “I’m not sure, mom,” you say. “But I really need some help finishing up these dishes. Could you clean off these plates for me?”

Instead of taking away from her positivity, you’re adding to it. 

You are not lying; instead, you’re embracing the reality that she lives in. In this reality, her mother is still alive. Please don’t take that away from her because you feel like she needs a “reminder”.

I would like to add that redirection or distraction are not always effective. For some, a little more “embracing” goes a long way.

The best examples are those that involve someone’s health or immediate safety.

One woman I looked after had to take multiple heart medications. Every day that I went to check on her, and every day she was convinced that she had already taken her heart medication. Although she had not actually taken the medication, she refused to take them “again,” which made complete sense in her reality.

Try a solution like this one.

“Oh, I just called your doctor, he said you have to take a second dose,” I explained. This made sense in her reality, and she accepted the first of her medications for the day.

*Names have been changed.

Rachael Wonderlin is an Alzheimer's Reading Room expert. She has a Master's in Gerontology from UNC Greensboro and has worked in numerous long-term care environments in different parts of the US. Rachael's book -  "When Someone You Know is Living in a Dementia Care Community" - was published by Johns Hopkins University Press. She currently works as a dementia community designer and consultant.

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10 Things a Person Living with Dementia Would Tell You If They Could

The Effect of Emotional Super Glue in Alzheimer's Care

Elderly Dementia Care

Memory Care

Publisher Alzheimer's Reading Room
Author Rachael Wonderlin
June, 2014
Title: Embracing the Reality of a Person Living with Dementia

The Alzheimer's Reading Room