Dad has Alzheimer’s disease. You are a loyal daughter (Jill) who visits often and brings his favorite foods. On one visit, Dad has a big smile when he sees you.
“Dad, I’m NOT Mary. (Mary is your older sister.) What’s my name?”
“Oh, gosh. Where’s Mary?”
“Dad, I’m Jill!! Why do you always ask about Mary? Are you trying to get on my nerves?”
If you were Jill, Dad’s words might make you want to scream. At times like this, there is a strong temptation to correct a patient who has Alzheimer’s disease. Please do not. Bite your tongue. Saying the wrong thing will backfire.
In a previous post, I emphasized that behavior management must be individualized. There are no simple guidelines about how to manage behaviors. An approach that works in one situation may not work in another. Today’s short post is about conversations that almost never work.
Three Important No-no’s
1. Testing a person’s memory.
I cringe when I hear caregivers “testing” a patient’s memory. The caregiver smiles and feels rewarded when the answer is correct. But the wrong answer results in irritation or sadness.
How does the patient with memory problems feel? Imagine you see someone you should recognize but do not. He asks, “Hey do you remember my name? Do you know who I am?” You do not know. You are left feeling “stupid.”
Caregivers sometimes use testing in the hopes of reinforcing memory. Another way to reinforce memory is to just state: “Hi Dad, it’s Jill.”
2. Making the person wrong.
A patient who is living with dementia is often confused. He/she may say things that are no longer or have never been true. It is easy to accept when a person says that the day is Tuesday when the day is Saturday. Other statements, especially if they are emotionally charged, are much harder to accept. There is a strong temptation to make the person realize that he or she is wrong.
But being told that you are wrong often feels like an accusation. It can cause arguing, hurt, or humiliation. No one wins when a person living with dementia is corrected.
3. Blaming the victim.
“You’re driving me crazy.” Sometimes it seems like the patient is selectively forgetting and misinterpreting. Please remember that he/she has a disease of the brain. Events that have an emotional impact are more likely to be remembered. However, connections inside the brain are disrupted. Details are lost and the memory can be inaccurate.
“You can’t remember because you have dementia.” Statements like this cause emotional pain. The victim feels unsupported and alone. The patient is not intentionally creating problems. The disease itself is the problem.
Dementia / Alzheimer’s disease results in memory problems and impaired thinking. People with these diseases suffer emotional and physical decline. Caregivers make a huge difference. The conversations caregivers have can increase happiness or cause pain.
The 3 No-no’s are easy to understand but harder to follow. It is impossible to be the perfect caregiver. However, words can cause a big “ouch.” A No-no conversation is likely to spiral downward. The result is emotional distress for both the patient and the caregiver. I hope that at least some readers, at the moment of temptation, will catch themselves and remember the 3 No-no’s. A person with dementia may not remember the conversation but will feel the emotions.
- Caregiving is challenging. To help, the 3 No-no’s are conversations that should be avoided.
- The No-no conversations can spiral into emotional distress for both patients and caregivers.
- The No-no’s are: 1. Testing a person’s memory. 2. Making the person wrong. 3. Blaming the victim.
PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.
3 Important No-no’s – Geriatrics with Aloha