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Sunday, January 2, 2011

Recognizing Dementia Behaviors 1

The behaviors that are exhibited by someone with Dementia can be very confusing to family and friends. I'm going to tell several stories that demonstrate some of these behaviors with suggestions of how to manage them. I've changed the names and some features to help keep anonymity.

Adjusting to Living Away from a Spouse
After caring for his wife of 60 years for as long as he could, Joe had to finally put his wife, Cloe, into a residential facility. He never dreamed he would have to do this but his own health was declining and he just couldn't take care of her anymore. He felt incredibly guilty to "have to do this to her." On top of his guilt he had to contend with Cloe begging him to take her home every time he visited. She would vacillate between tearfulness to anger. Poor Joe was devastated. When I was at the facility I would make a point of finding her to see how she was adjusting when Joe wasn't there. She would be visiting with a caregiver, reading or just contentedly watching other activities. I made a point of explaining to Joe about "associative memory" and would tell him how I found Cloe behaving so that he didn't think she was pining away for him all of the time. Joe finally made the decision that he could no longer visit because Cloe's behavior was too upsetting for him.

Why does this happen? Memories often become spotty as dementia progresses but I have found that "associative memory" sometimes lasts a long time. Something the person with dementia sees triggers a particular memory and they react to it. The reaction has no reality to it and when the memory trigger goes away, typically the person will quickly calm down again. The memory trigger will often lessen and go away over time but it can take months. Here is a story that is a more amusing example of this:

A client of mine, Mary, was a smoker who lived in assisted living. Usually, as some point during my visits she would ask me to walk outside with her so that she could have a smoke, which I would do. This went on for several years. Then Mary's dementia got to the point that I knew I needed to move her to a dementia facility but I had a problem. She smoked. No dementia facility would take a smoker. While I understood the inherent liability issue, it was a real dilemma for me. Then, Mary got very sick. So sick that she ended up spending several days in the hospital. Low and behold she forgot that she smoked! I quickly got her moved into the dementia facility and told the staff that if she brought up smoking they should say something like, "I though you gave up smoking years ago." For months, every time I visited Mary she would at some point tell me that she was dying for a cigarette. I would say something about her giving up smoking and was able to redirect her to other topics. I talked to the staff who said that she never brought it up around any of them. I was that memory trigger. It look a good nine months for that memory to fade away.

When a Spouse dies.
I was contacted by a family who's grandfather had recently died. Visiting grandma was perplexing to the family because grandma would talk as though grandpa was still alive. When they would remind grandma that her husband had died, grandma would experience grief as though she had heard it the first time. The family didn't know how to best handle this situation.

When a person has dementia with memory problems, short-term memory is the first to go. Severe short-term memory can mean that hearing sometime distressing is just like hearing it the first time, each time. The best way to address this is to avoid reminding the person, in this case grandma, that grandpa has died. If grandma brings up the fact that grandpa isn't there have a simple explanation ready such as he went to the store and then redirect the conversation to something else. This may take some trial-and-error to find what works but it's far more compassionate than making your loved one experience the shock over and over.

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