Because the behavior this disease produces can be so difficult every person caring for a dementia victim sometimes feels at loose ends. But people who actively work at solving problems are better off than those who just throw up their hands. While handling alarming symptoms is hard, it is a skill that can be learned.
Psychologist Steve Zarit and his colleagues devised these steps to help caregivers find workable solutions to problems that might otherwise leave them gnashing their teeth. Though it is much better to have a trained counselor help you, you might try this approach on your own.
Identify the reasons for the behavior. The best way to do this is to keep a log recording the upsetting behavior, when it happens, your reaction, and anything else relevant to understanding its cause. For instance, your log might read: (1) “Those same questions a million times an hour” – “Happens after I have left her; worst nights when I leave for the day – Attention-getting mechanism? Way of keeping me in the room? Attempt to entertain me?” (2) “Night wandering» – “Worst when she has not gone out during the day. Sure to happen if she takes a nap.”
List several possible solutions. Brainstorm, coming up with several ways of stopping the behavior. Some solutions should flow logically from what you have noted in the log. For instance, if you are grappling with problem 1, you might write: “(1) When I go out for the day, I’ll ask Mary to come over. (2) Would it be so bad to take her on some of those trips? (3) Look into a day hospital so she won’t be so lonely on the days I do go out.” If you are struggling with problem 2, this might be your strategy: “(1) Never let her nap during the day! (2) Ask the doctor about changing that sleep-inducing medicine from after lunch to before bed. (3) Take an evening walk with her.”
Arrive at a best plan. Evaluate how feasible each solution is, weeding out alternatives that are less likely to work: “It would be hard to keep her with me or always invite people in; the day hospital seems the best choice.” “I cannot hover around to prevent her dozing off, but we might both enjoy a brisk evening walk.”
Carry out the plan in fantasy. Mentally walk through the plan to anticipate and get around possible roadblocks: ‘ ‘This is the way I will go about finding a day hospital and getting her in. I will sell her on the idea by methods X, Y, and Z so she doesn’t reject it out of hand.”
Carry out the plan in reality. Then act. If your plan doesn’t work, try another. Do not conclude that what is happening is uncontrollable – that you cannot change things.
Zarit emphasizes that sometimes modifying your feelings may be the answer, even if the person’s actions do not change. Behavior tends to be hardest to tolerate when it appears premeditated – when someone seems to be annoying or difficult on purpose.
When abilities fluctuate, the natural interpretation is that the person could do better with some real effort. Not true! For unknown physiological reasons, people with dementia have good and bad days. Another intensely irritating symptom that merely appears premeditated is insulting accusations. If your wife who has Alzheimer’s disease accuses you of stealing her money or her keys, remind yourself her real target is not you. Seeing you as the villain protects her from admitting the unthinkable: “I am losing my grip on life.”
When you are confronted with upsetting behavior, school yourself in this idea: the illness is responsible. People with dementia cannot help how they act.
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GENERAL HEALTH