How should I respond when she doesn’t make sense?

pink dogwood flowersI often hear this question from family members. It makes us uncomfortable to find ourselves in a conversation with someone who is not making sense.

There are two reasons for why your loved one may make a statement that is nonsensical.

An altered sense of reality.

When people with dementia say something that doesn’t make sense or cannot be true, it may be sensible according to their personal sense of reality even though we know it is nonsense in our reality. The problem in this case is that they are losing rational thought and memory, which is skewing their ability to properly understand what is going on around them.

Without the ability to recall facts or events that have already happened, people experiencing dementia misinterpret what is happening in the present. Without the ability to use analysis, see cause and effect, or use comparison (rational thought skills), they arrive at even more erroneous conclusions.

If our response is to correct them, we are asking that they accept our version of reality – something different than their brains are telling them is true. But because they have dementia, they lack the very tools needed to consider and accept our version of the truth. That’s why their reactions are usually resistance and denial.

When people experiencing dementia are in error about reality or truth, it’s wiser to accept their version of the truth and try to work with it to make them more comfortable. It’s a kindness to refrain from asking them to use cognitive tools they no longer possess.

Loss of language skills.

Someone with dementia may also make nonsensical statements because dementia is affecting the part of the brain that enables them to use language to express themselves. If you’re in the grocery store shopping with a loved one who says, “You’re spending all my money,” she might actually be trying to say, “My, everything seems so expensive – we’re spending an awful lot of money right now.” The first statement is an overly simplified version of the second.

On the other hand, she may actually believe you have been spending her money against her wishes – a misinterpretation of reality. When you’re dealing with a false sense of reality, the best response is to not demand acceptance of your reality (i.e. “No, I am not – I’m doing everything I can to preserve your resources and spending my own on you!”). That would be trying to discuss facts with someone unable to do so. Better would be, “Oh, Mom, I worry, too. Everything seems so expensive.”

The better response is always to respond to the emotion behind the words. Someone who says, “They stole all my jewelry!” is expressing loss and indignation, whether factual or not. If you avoid the factual issues and respond to her emotions, you’ll avoid a fight. A nonfactual response would be, “Oh Mom, I’m so sorry… I felt so badly for you when that happened,” and then to move the conversation on to a happier topic.

When our clients’ ability to express themselves falters, we ignore their incorrect words or sentences and focus on their intonation and facial expressions. Their nonverbal communication displays the emotion they want to convey, which helps us discern intent and meaning.

When I respond to my clients in these two ways – accepting their version of reality and listening for the emotion and meaning hidden by their impaired vocabulary – they begin to feel safe talking with me, and feeling safer means less questioning or striving to be understood.

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Is diagnosing the specific type of dementia important?

mountain stream with spring runoffWhen I first start talking with families about a loved one who’s showing signs of dementia, they often are very concerned about what type of dementia their loved one might be developing. Sometimes families will put a great deal of time and money into trying to identify exactly which form of dementia they are facing. My first question to them is always, why do you need to know?

I think we believe we need a specific diagnosis because we are mistaking the condition of dementia for a disease. It’s important, however, that we understand when diagnosis is needed and helpful, and when it diverts our attention and efforts from what’s far more valuable: learning how to provide care.

When someone is diagnosed with a disease, we should know exactly how the disease is progressing so we can make educated and appropriate decisions regarding treatment. If I were to learn that I was developing cancer, I would want to know what type, how far it had progressed, exactly where it was growing, and all of my treatment options in detail.  I would need all that information to make a wise decision about which treatments to pursue.

The goal with diagnosis is to isolate the best treatment. But with dementia, we don’t have treatments or cures (yet). Once we know dementia is present, it’s time to focus on learning how to maximize quality of life for the person and his or her family and caregivers.

Here at DAWN, our dementia clients have come to us with a variety of dementia diagnoses. Of course, the most prevalent has been the dementia that results from Alzheimer’s Disease, but we also have seen vascular, mixed, frontal lobe, normal pressure hydrocephalus, Parkinson’s, Korsakoff syndrome and dementia that follows earlier traumatic brain injuries. Regardless of the type of dementia, however, we find that the DAWN Method helps us and their families provide care.

My goal has always been to help my neighbors (who became my clients) find ways to continue living at home with as much enjoyment and fulfilment as possible. When I turned to books on dementia and dementia care, I found a lot of supportive advice and commiseration – and the belief that dementia-related behaviors were unavoidable and inexplicable. It sounded like using drugs and locked doors were the only recourse, but I still wanted to find a way to make life better for these people I’d grown to love.

So, although the way they acted seemed random and unpredictable at first, I stayed focused on their emotional distress. Emotions cause our actions and reactions; if I could find a pattern of emotional needs, I knew I could help my clients feel more comfortable. What I found were three specific security needs and four well-being needs. The DAWN Method teaches families to recognize and meet these needs.

Once I began responding to my clients’ emotional needs, I began to see their abilities and disabilities in patterns also. It didn’t matter whether they had dementia due to Parkinson’s or an earlier head injury or Alzheimer’s, they were losing rational thought but not intuitive thought, and the remembering self but not the experiential self.

When we are responding to a condition, we need to provide care. Conditions are something we must learn to live with. Care supports the whole person, not just physical health.


Why is mood management so important?

pacific northwest rocky beach in fallWhen we are with people who have dementia, we should take responsibility for their moods. Actually, whether we realize it or not, we are already creating their moods because changing moods requires rational thought and memory. People with dementia are missing both.

Think about how you manage your own moods. If you are feeling sad, you might use memory to recall happier times. If you are feeling frustrated or insulted by someone’s behavior, you might draw to mind reasons for why they behaved that way or analyze why you should be patient with them. You could plan to give yourself a treat later or distract yourself with thoughts of an upcoming vacation.

People with dementia don’t have these tools at their disposal. As a result, negative moods from failure at tasks or embarrassment in conversations are predominant and persistent. Studies have shown that moods last longer for people with dementia and that the further into dementia the person is, the longer the moods last.

There’s another complication. With intuitive thought, people with dementia continue to be able to read the moods and feelings of those around them. Yet, without rational thought they are unable to analyze why their companions might be experiencing negative moods or feelings.

One of our clients, Mary, had two DAWN caregivers in her life as well as a daughter who lived nearby. All three women were kind, empathetic and very much attached to Mary. One day, one caregiver called me saying that our client was having trouble with back pain and needed an overnight caregiver. Lately, Mary had been complaining of pain almost every time this caregiver was with her and, when this caregiver prepared to leave, Mary became more anxious and begged her to stay. I told the caregiver that I would begin a review of our care plan.

When I spoke with Mary’s daughter, she was mystified. I checked with the other caregiver and she was surprised, too. When they were with Mary, Mary had no trouble with pain and was unconcerned about being alone when they left.

Our client was the victim of unintentional mood management. My empathetic caregiver was communicating concern and worry to Mary, particularly as her shifts drew to a close. Mary easily read her concern and, without analysis, assumed there was something in the present to be concerned and worried about. Once she was anxious, her aches and pains became more pronounced and she didn’t want to be alone.

I have watched loving and concerned family members do the same thing. They come to visit their loved ones and bring their own sadness, guilt and loss. We watch their loved ones absorb their pain and retain it after they leave – until we fill their presence with joy and love again.

People who have dementia have no skills to analyze the reasons for the moods we bring to them. Whatever we bring into their presence will be absorbed and mirrored back to us. We should use our own rational thought skills to put aside any negative feelings we might have about their situation and come to them with our joy and love instead.