To Do.....What To Avoid
By Dr. Raymond Vickers M.D.
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The following dos and don'ts offer some practical suggestions:
Do avoid situations or events which might trigger catastrophic outbursts. If you can't avoid them, anticipate them. For example, if you take your loved one grocery shopping, avoid Saturday mornings and Friday nights. Go at times when the store is less likely to be a beehive of activity. If you go out to eat, avoid the prime-time hours when restaurants are crowded.
Do make life as predictable as possible. Most of us get tired of the same old grind, but people with dementia find a daily routine secure and comfortable. Marked schedule changes may precipitate catastrophic reactions. Plan your loved one's life as much as possible. This may become less a problem as the disease progresses.
Do limit choices. Remember that your loved one's ability to discriminate is markedly affected by Alzheimer's. If you are helping your mother or wife dress, for example, asking her to choose the blue, brown, yellow or white dress may overwhelm her. You might show her two dresses and ask her to choose one. Or you may simply have to choose one for her.
Use simple sentences. Offer one thought at a time. Let one task be completed before talking about another.
Do simplify the activities of daily living. In the area of clothing, consider substituting pullover dresses, shirts and sweaters for those that button; slip on loafers for shoes with laces; and velcro fasteners for zippers, buttons and snaps. Such replacements will help your loved one maintain independence for as long as possible while minimizing catastrophic outbursts.
Don't talk about your loved one's behavior problems to others in the presence of your loved one. Just because someone may no longer be able to communicate verbally doesn't mean he or she no longer understands what's going on or what's being said. Think about how you'd feel in a similar situation and be sensitive. Always assume more understanding and comprehension than you actually see.
Don't argue or try to reason. Remember that the disease affects the memory and the mind's ability to think logically. Spouses may not understand why it isn't safe for them to drive the family car. To believe that they will understand if someone just explains it enough times is an error in judgment. Arguments can also make your loved one more suspicious and defensive, attitude changes you don't need.
Instead of arguing and reasoning, acknowledge and validate. The disorientation and confusion that are part of Alzheimer's result in more than just bizarre behaviors. Dementia also stirs up deep feelings---for us and our loved ones. These feelings seem to have little to do with intellectual impairment. Beneath a belligerent exterior, our loved ones may be nursing a lot of fear, disappointment and hurt, just as we would if we were frustrated in our attempts to do something we'd always loved to do, something that was an important part of our identity. Helping our loved ones to verbalize those feelings, or even to cry, may be the best thing we can do.
Don't take personally the things your loved one says. You or other family members may be accused of stealing money, selling the family home or withdrawing your love. Attempting to deny the accusations may only make things worse. If accused of stealing money, for example, you might offer to help your loved one search for it. One caregiver I interviewed has a locked box for which she has the key. Inside the box are her mother's checkbook, recent bank receipts and a little cash. If her mother accuses her of theft, they search the box together. When they "find" it, her mother leafs through the bank stubs and the checkbook and usually concluded that all is intact.
Do avoid shouting or raising your voice. Don't correct or confront the bizarre behavior. A loud, accusatory voice implies that we somehow expect change in behavior. We need to remember that the behavior is not deliberate. Alzheimer's sufferers don't want to act the way they do.
Avoid the "why" question: "Why are you doing this?" or "Why did you do it"? "Why" questions can put others on the defensive. They feel they have to justify their behavior, which in this case they're not responsible for. The normal reaction to a perceived threat is fight or flight. Both are catastrophic outbursts. What our loved ones need most is our love and acceptance of who they are, just the way they are.
Speak softly, treating your loved one with the same dignity and respect you would want to be shown if you were in the same shoes. A proverb in the Bible says, "A gentle answer quiets anger, but a harsh one stirs it up." Soothing answers and soft tones can temper many reactions.
Do move beyond the event and forget it as quickly as possible. Defuse situations by using a technique called distraction. Distraction might include changing the subject, going for a walk to "search" for the missing item, offering a favorite food to eat.
Be thankful for your loved ones short-term memory and consider it a blessing in the case of emotional upsets.
Don't physically restrain your loved one unless it's absolutely necessary. He or she may feel fenced in and become more combative.
Instead, capitalize on the excess energy at this time. If your loved one is turning over the living room furniture, it might be the ideal time to clean the rug! Try to redirect the energy and them to help you.
Do consider the possibility of medication. Mild tranquilizers may help your loved one. Catastrophic reactions are often like dormant volcanoes; they suddenly erupt without much warning and are over just as quickly. But in some cases the catastrophe may seem continuous. If this is the case, talk to your physician about possible mediation.
Do remove yourself from emotionally charged situations. If you feel like you are going to explode, you probably will. It's no sin to walk away from your loved one if you think the situation is going to get the best of you or if you anticipate physical violence. If you can do so without endangering anyones safety, leave the scene for a time and return when everyone has calmed down.
Avoid emotionally distancing yourself. Reach out with a warm embrace, a kiss, a touch of your hand. Affection often can defuse a difficult situation. Touch can communicate that you care. It can offer reassurance and affirmation as well as affection.
"Perfect love drives out fear", says a verse from the Bible. Our love for our loved ones may not be perfect. In fact, we may feel very unloving at times. But it will ultimately be our love that will drive out the fears we have---and the fears that our loved ones have---in dealing with the various upsets due to Alzheimer's.
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