When working with patients with Alzheimer’s it is important to know that most of them will ask you the same question over and over. And you will give them the same response over and over, but yet it can seem as if they’re not listening. This can cause even the most patient person to become flustered after a while. Why are they asking the same question and what should I do if I find myself in this situation?
Lisa Skinner, author of Truth, Lies & Alzheimer’s: Its Secret Faces and behavioral expert in the field of Alzheimer’s disease and related dementias, has navigated the heartbreaking challenges of having a loved one diagnosed with Alzheimer’s disease or other dementias over her 20-year career as a community counselor and regional director of senior care facilities. She has helped thousands of families find the best care options for their loved ones, while also equipping them with the knowledge to make evidence-based informed decisions on their care.
“Typically, with Alzheimer’s disease, the first part of the brain that is damaged is the short-term memory. In the beginning stages of the disease, the short-term memory tends to continue to function normally with periods where it shuts down. When this occurs, the person pulls from their long-term memory, which remains functioning throughout the disease. As the disease progresses, the short-term memory will start shutting down more often, causing them to forget recent events, but remembering events from their past. By the end stage of the disease, the short term memory is almost completely, if not entirely shut down, so the person with dementia relies solely on their past memories and therefore believes they are existing in that past time frame,” says Lisa Skinner.
Lisa goes on to say that, “Because the short-term memory is malfunctioning throughout the stages of the disease and at various degrees, the person with dementia does not remember that they just asked a question, or just told a story, so they continue to repeat them over and over again, thinking that it is the very first time. This can prove to be extremely frustrating for the recipient, especially if they are not aware of the reason why this happens. The best approach to this situation is to listen to the story one last time, or answer the question one last time, then either try to change the subject to move onto something else, or to distract the individual with a new activity so they will move onto other thoughts.”
You can learn more in this interview.
Why is it important for caregivers to have strategies to help manage their emotions?
Taking care of someone suffering from dementia is one of the hardest jobs anybody will ever be challenged with. There are so many unpredictable situations that arise at any given moment on any given day, and it takes learning some very specialized skills to effectively manage the challenges. That said, it is very easy for a caregiver to experience what we refer to as “caregiver burnout”, or “caregiver fatigue”.
Some of the signs of burnout and fatigue are exhaustion (physical and/or emotional), feeling a lower threshold for sympathy or empathy, feeling dread or guilt Irritability, anger or anxiety, headaches, sleep trouble, self-isolation, feeling disconnected, indecisiveness, trouble finding meaning in caregiving, conflicts in other relationships, and depression.
What are some internal strategies caregivers can use to help manage their own emotions?
It is very important that caregivers make caring for themselves a priority by getting enough rest, maintaining a proper and balanced diet, getting regular exercise, and by setting aside time to do things that they enjoy outside of their caregiving role. Another helpful strategy is to have back-up help so you don’t feel the burden of the care is solely on your shoulders. It is also important to ask for help when needed and by joining a caregiver support group. It takes a village!
What are some things that caregivers can do when they are confronted with frustrating behavior?
First and foremost, understand that most of the behaviors that accompany dementia are part of the disease, and are more often than not their way of communicating that something is bothering them, or that they have an unmet want or a need. Learning effective response techniques and strategies to these behaviors will help minimize the situation from escalating into a more serious event.
Anger and irritability are common responses to triggers for people with dementia. They may have trouble remembering things, declined reasoning, declined thinking, and finding the right words to communicate.
It is important to be understanding and patient when a loved one becomes angry or irritable and to remain focused on what triggered the angry response. Some of the common triggers include: the person may feel threatened; he/she may feel misunderstood; he/she may be embarrassed. Also, look for a physical cause. A person with dementia may not be able to tell you that he/she is in pain or discomfort, or feeling ill. Look for a cause in the environment. Are they too hot or cold, etc? Are their clothes uncomfortable? Are they bored, or even overstimulated?
If you find yourself in this situation, remain calm, and use a gentle, reassuring voice. A calm and controlled approach will help diffuse the situation vs. aggravating it. It will encourage your loved one to calm down rather than becoming more combative. Acknowledge that you do understand that they are trying to tell you that something is wrong and reassure them that you are trying to determine what it is so you can take care of it. Additionally, try to shift the focus of the anger by playing some relaxing music, or suggesting a walk or another activity. Always reassure them that they are safe.
If nothing seems to be working, take a break and have another caregiver take over. Sometimes, a “change of face”, or bringing another caregiver into the situation will resolve it. If you feel like you are losing control, walk away for a moment. Breathe deeply to regain your composure before trying again to deal with an angry individual.
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