COMMUNICATION
Communicating with the dementia patient presents some unique challenges. His brain does not process words and messages like it once did. His short-term memory loss prevents him from remembering what he hears for more than a few minutes – or even seconds.
He has trouble communicating his own thoughts as words no longer come to him freely and automatically.
The following websites discuss some of the more common communication issues of the dementia patient and provide some helpful ideas for navigating the communication frustrations of both the patient and his caregiver:
The family caregiver will face a wide variety of difficult behaviors from her memory-impaired loved one. His heightened anxiety, frustration and inability to understand his new world may cause him to become more easily agitated and hostile. He may say and do things in public that violate social norms. He may even become verbally and physically abusive to his caregiver or others around him.
The following websites discuss some of the more common difficult behaviors and provide some helpful ideas to help the caregiver deal with them:
There are so many sad aspects of dementia, and it would be hard to pick which one is saddest. But high on that list would be when the dementia patient is unable to express gratitude for his care.
The dementia patient usually has no awareness of all his caregiver is doing and sacrificing for him. His brain has simply lost its ability to process what is going on around him or how much help he requires. Like a child, he becomes completely self-centered, thinking only of his own needs. It never occurs to him to express gratitude to the family member who is devoting her every waking moment to his care.
Humans can endure a lot when they feel noticed and appreciated. But performing those tasks day after and day without ever once hearing “thank you” can make those tasks so much harder.
So, since you – the family caregiver – will likely never hear these words from your loved one, hear them now: THANK YOU! What you are doing is one of the most active expressions of love imaginable. You are a hero, and the rest of us do notice and appreciate what you are doing.
For many of its victims, the dementia-damaged brain will cause the patient to experience hallucinations. He may see or hear things that are not real. But they are very real to him. Some hallucinations are very peaceful, like imagining that there are nice people sitting beside him. Others can be very frightening, such as imagining that someone is trying to hurt him.
As discussed in these websites, some hallucinations can be handled by playing along or redirecting his attention to other topics. Other hallucinations may require anti-anxiety medications to calm his fears.
Click Here To Watch Hallucinations and Dementia Careblazers Video
In later stages of the disease, the dementia patient’s speech will be hindered by the inability to recall words or, in some cases, the brain failing to convert coherent thoughts into audible speech.
The following websites address some of the more common speech issues of the dementia patient and how to address them:
Because his short-term memory is failing, the dementia patient cannot remember either what he’s said or what someone else has told him. Consequently, he will ask the same questions over and over, or perhaps repeat an action like going to the bathroom or looking for food only minutes after doing it before. It can be maddening to the caregiver who wants to scream, “I just now told you, don’t you remember?” No, he doesn’t.
The following website offers some advice to the caregiver who experiences these frustrating behaviors everyday:
For some reason, many dementia patients simply refuse to bathe or change clothes. Persuading her loved one to bathe can be one of the caregiver’s biggest daily challenges.
The following website offers some helpful tips for overcoming (or sometimes accepting) the patient’s reluctance to bathe or change clothes:
As the disease progresses, the dementia patient’s brain loses its ability to remember or perform simple activities like getting dressed. Zippers and buttons become difficult. Orienting a shirt’s armholes or discerning between its front and back are no longer automatic. A winter coat might be chosen for a hot summer day or shorts selected on a frigid winter day.
The following websites discuss ways to help your loved one navigate the now difficult task of getting dressed for the day:
Late in the disease’s progression, the dementia patient’s brain forgets how to eat or swallow. The following websites discuss some ways to help your loved one overcome these frustrations:
At some point in the progression of the dementia journey, going out to eat at a restaurant will become a challenging exercise for the caregiver. The patient may have trouble handling his utensils or exhibit behaviors that create an awkward situation for wait staff or fellow diners. Here are a few tips that may ease the stress of the restaurant experience and postpone the day when going out to eat will become more trouble than it’s worth for the caregiver:
- Choose restaurants that offer a short waiting time for seating and food
- Go when the restaurant is not crowded
- Select menu options that don’t require utensils (e.g. sandwiches or pizza).
- Take a small card to hand to your server that reads “My companion has a cognitive impairment. Thank you for your patience.”
The dementia patient may forget how to brush his teeth or simply not want to do it. Poor oral hygiene can present problems for both the patient and his caregiver. The following websites give some ideas to help the caregiver deal with a loved one whose oral hygiene practices are unhealthy:
The dementia patient may choose to forego basic grooming activities such as shaving, combing hair, clipping nails, etc. The following website shares some ideas to help the caregiver navigate this reluctance, overcoming his objections, and sometimes just accepting that some battles are not worth fighting:
In the mid- to later stages of dementia, most patients eventually experience incontinence. It’s an unpleasant task, but a very natural progression of the disease.
A healthy brain sends messages to the bladder and bowel telling them when it is necessary to empty them. Being in control of these functions depends on an awareness of bodily sensations, such as the feeling of having a full bladder, and the memory of how, when and where to respond. As the brain atrophies in the dementia patient, these messages and sensations no longer guide the patient to respond, resulting in “accidents.”
Similarly, the confused dementia patient may have trouble finding the toilet (or remembering how to use it) and relieve himself in inappropriate places.
For many caregivers, incontinence (and the task of cleaning up the patient, his clothing, the bedding, or the floor) becomes the “bridge too far” for a caregiver who, up until that point, had been able to accept and perform most of the difficult tasks of hands-on caregiving. At this point, caring for their loved one at home is simply no longer sustainable.
For caregivers facing the unpleasant task of caring for an incontinent loved one, the following articles provide some compassion and helpful tips:
A dementia patient who is still mobile presents a 24/7 risk of wandering outside the home. Physical barriers that prevent exterior doors from being opened can present a danger during a fire or other emergency when occupants need to exit the home quickly. Thus, more creative techniques should be considered to thwart the patient’s unaccompanied exit, for example:
Dementia patients can lose their sense of balance and experience a “spatial disorientation” that distorts the distance between objects. This is why they carry an elevated risk of falling. The following website gives suggestions that caregivers can use to minimize the risk of falling:
Dementia patients can exhibit an abnormal degree of nervousness, and that nervousness may manifest itself in fidgeting behavior. The following website discusses some practical actions caregivers can take to help their fidgeting loved ones:
Dementia patients will often carry fears of losing things or having them taken away. They may address these fears by hoarding or hiding things, and those hiding places may be very unusual. The following websites address these behaviors and present some ideas for dealing with them:
Some dementia patients (especially men) may begin to experience some strong and inappropriate sexual urges. Because their minds are no longer able to filter away thoughts that are inappropriate, they may act on these urges by saying or doing inappropriate things.
The following website provides some advice to the caregiver on how to minimize the awkwardness of these interactions and diffuse them before embarrassing moments occur or feelings get hurt:
Dementia patients are especially at risk for mismanaging their medications. They may take them at the wrong time, not take them at all, or take medications that do not belong to them. The following website provides some helpful tips for managing the medications of a dementia patient:
Sundowning describes a phenomenon wherein dementia patients experience increased confusion and restlessness beginning in the late afternoon – around sundown. During this time of day, patients are more easily agitated, disoriented and fatigued. Although not clinically proven, it is suspected that sundowning is caused by the disruption of circadian rhythm, triggering a decrease in dopamine levels and an increase in melatonin production as the body transitions to sleep time.
Caregivers can minimize the sundowning effect by trying some of these suggestions:
- Turn on lots of lights.
- Reduce stimulation during late afternoon hours.
- Maintain a structured routine.
- Schedule doctor appointments, visitors, and other stressors for morning hours.
- Play soft, soothing music.
More commonly known by its acronym UTI, a urinary tract infection can cause some of the hallmark symptoms of dementia: confusion, incontinence, mental lapses, and fatigue. Having seen so many instances where this condition was initially misdiagnosed as the onset of dementia, many ER staff will test first for UTI before considering any tests for neurological disorders.
Not only can a UTI lead to an errant dementia diagnosis, it can also exacerbate the symptoms for a dementia patient. Best practice suggests that when dementia-like symptoms appear or worsen suddenly, have the patient tested first for a UTI before embarking on a detailed analysis of potential neurodegenerative failures.
