Mar 1, 2018

Two words that can immediately make any dementia behavior less stressful

The beauty of the "why-this, try this" approach with dementia patients is that it starts working the very second you decide to use it.

by Paula Spencer Scott
Alzheimer's Reading Room

How many times can one man take apart and try to repair an old clock? You can't imagine.

Or maybe you can, if you're dealing with Alzheimer's or another dementia.

Over and over in a single day, my dad would carefully take the antique off the wall, remove its back and sometimes a part or two, frown, leave the mess, and walk away.

  • What didn't solve the problem: Pointing out, "Dad, you already did that!" or saying, "Leave it alone; it's fine!" Or just getting mad.
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If someone in your life has dementia, curious behaviors are sure to follow. 

Repetitive actions. Repetitive comments or questions. Losing track of tools, glasses, threads of conversation.

Saying nonsensical things.

Doing nonsensical things—at least, things that seem not to make sense to us, like hoarding, wandering, shadowing, skin picking, resisting help, hitting, talking to the mirror, wearing inappropriate clothing, and all the rest.

You might, as a result, feel annoyed or frustrated. You might also be exhausted, frightened, or overwhelmed.

I've seen this firsthand. Five of my family members have had forms of dementia. What's more, as a dementia-care educator and health journalist, I've been privileged to interview scores of leading experts (doctors, therapists, social workers, advocates) on best coping practices.

From all of these experiences, I've learned two simple words that can be life-changing when dealing with someone who has dementia: why and try.
  • Together, "why" and "try" can transform the way you live with the many irritating behaviors of cognitive impairment—and the effects they have on you.

Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers

The "Why-This, Try-This" Approach

I call it the "Why-This, Try-This" approach to dementia care. It's a pathway to problem-solving that consists of two basic parts:

Before you respond (and that includes sighing, snapping, arguing, or fantasizing about running away from home), pause to consider why the person may be doing what he or she is doing. With dementia, behavior almost always has meaning. It's a reaction to a set of circumstances.

It is critical, before anything else, to think about the context.

What is it about the disease, the person's state of mind or body, or the particular situation that might be contributing to what he or she is saying or doing?

It's almost never intentional meanness or out-to-get-you stubbornness.

There may be one simple trigger or multiple things going on.

You can then use that insight to consider the best ways to respond. You can't change the fact of the disease itself.

You can, however, find clues about the situation to change things that you can influence: the setting, who's there, your reaction, what happens before and after, and so on.

There's seldom one single "right" solution to a challenging behavior or situation. There are usually a variety of things you can try until you hit on something that works.

"Why" and "Try" Open the Door to Solutions

Once you start the habit of thinking in a "why-this, try-this" way, you can get "unstuck" from unproductive responses that get you nowhere or make things worse.

You can head off trouble at the earliest signs. You can stretch your patience the tiniest bit farther.

Some of the relentless stress will ease up a bit, and in turn you'll pass on less stress to the person with dementia.

Stress is contagious, after all. Best of all, you'll find it easier to maintain a calm, supportive, and less contentious relationship with the person who has dementia.

"But how to know what's going on or what to do?"

The beauty of the "why-this, try this" approach is that it starts working the very second you decide to use it. 

Simply hitting pause and remembering that there is a "WHY" puts a little essential distance between the problem and you. It's so easy to take dementia behaviors personally and lose your patience or your temper. After all, we're often the receiver (or the target) of what can be distressing, embarrassing, annoying, or, let's face it, seem downright mean.

Recognizing that there's a "why" refocuses these complicated feelings back to the right spot: on the disease. It's not willful behavior on your loved one's part. It's not neglectful or insufficient behavior on your part.

Asking "why?" reminds you that the issue has begun deep in the brain of the person with dementia.

This makes it easier to "try" a way to deal. You'll find you react in a way that's less emotional, more constructive. And fortunately, there are many possible solutions to most situations—many different ideas you can try.

"Why-This, Try-This" in Action: Some Common Situations

Let's go back to The Case of the Broken Clock.

Tired of picking up the pieces and putting them back together over and over, I tried to figure out why my dad was so fixated on it. He wasn't using the wall clock to tell time; he wore a watch that he was obsessed with.

That's when it dawned on me that he passed the clock on his way from his favorite easy chair to the bathroom—and he used the bathroom many, many times a day. Each trip, he'd see that the clock time didn’t match his watch, which triggered his impulse to fix it.

A former mechanical engineer and life-long Mr. Fixit, this was a strong urge. But his moderate-stage dementia meant he no longer had the wherewithal to follow the complicated series of steps involved: Open the back, see the problem, identify the needed tool, figure out where the tool is and fetch it, and so on. Even if I'd helped him locate the tool, he wouldn't have been able to use it.
  • Solution: Take the clock down! Interrupt the trigger by removing it from his view. After I did this, he never once asked, "Hey, where's that broken clock I need to fix?" It was out of sight, out of mind.
"Why-this, try-this" works in countless situations

* Refusing to bathe or shower: Possible "whys" include modesty and embarrassment, feeling cold, and fear of falling or of the feeling of water on the face and head (common in dementia).

It's easier to just say "no!" Because of unpleasant past experiences, the very words “bath time” or "shower time" can trip a power struggle.

A few examples of things to “try”:
  • Avoid talking about what’s coming. 
  • Simply get the bath ready and lead the person there
  • Go bit-by-bit, starting with the feet and then the hands (stressing how relaxing it feels). 
  • Smile and talk about the weather or news about a fond relative—anything to distract from the personal nature of what you’re doing. 
  • And, try warming towels in the dryer for 10 minutes before they’re needed to build a positive association with bath time.

* Saying, "I want to go home": Thinking about "why" can help you look past a literal interpretation.

For people with dementia, who often speak figuratively, "home" tends to have the emotional connotations of the word, rather than meaning a specific actual place. My grandmother would say it, I realized, right after dinner, when she was tired and sad about her visitor's impending departure. Helping her settle for a nap, rather than leaving her seated in a chair, raised her comfort and calm.

* Wearing inappropriate or filthy clothes: Why would someone wear fleece in summer or a dirty sweater day after day? Because certain items are easier to pull on as coordination is affected by advancing dementia.

Having a go-to outfit requires less mental energy than choosing and matching other clothes.

Solution: Simplify. Put away seasonally-inappropriate or hard-to-put-on clothes. Replace them with interchangeable, easy-on choices, and swap out dirty things at bath time or while the person is sleeping. It can also help to buy multiple, identical versions of favorites, so one set can be washed while the other is worn.

More Clues to "Why"

As you think about what's behind a behavior, it can help to use the "5 W's" of information-gathering: Who, what, when, and where (along with why).

WHO are you dealing with? Reading up on your loved one's stage of dementia, and what that's like, can reveal important insights. So can your own knowledge of his or her background, moods, rhythms, likes and dislikes, and general health.

What's different today? Has she been ill? Is he usually upbeat but suddenly not? Does he like to fix things or have particular interests or obsessions?

WHAT else is going on that might be a trigger? Think beyond the immediate behavior to the overall scene.

Is it noisy and hard to hear? What's been playing on the radio or TV? Is it hot or cold? Did someone just say something that might have tripped a reaction? Is there a new aide around or a change in routine that particular day?

WHEN does it happen? Is this a one-off behavior or does it occur every day? If daily, is at the same time or at random times? Only after the sun goes down? Or after a bad night's sleep or a missed meal? When YOU are rushed and stressed yourself? Remember we all act different when we're bored, or frightened, or hungry, or tired, or rushed, or feeling insecure. Alzheimer's can magnify your loved one's response to these states.

WHERE does it happen? Out in public? In crowds? Indoors or outdoors? While sitting in a particular chair or room? Try to crouch down and assess the setting from their vantage point.

For example, is there something upsetting the person sees—a painting, a clock, a mirror, the way the afternoon light hits the window—that you could remove from the line of vision by repositioning a chair or closing a shade?

"Why-This, Try-This" is more than a problem-solving approach. It's a stress-relieving approach to dementia care in general. You can set your clock by it!

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers, now available in an expanded second edition. Five of her close family members had forms of dementia.

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