Dealing with Dementia – How?

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Drawing comparing how a brain of an Alzheimer disease patient is affected to a normal brain

As we age our cognitive abilities may become impacted. Our ability to remember, to think, and to reason may decline and worsen over time. The word “Dementia” describes symptoms such as the following …

  • Memory loss, which is usually noticed by someone else.
  • Problems communicating or finding words.
  • Trouble with visual and spatial abilities, such as getting lost while driving.
  • Problems with reasoning or problem-solving.
  • Trouble performing complex tasks.
  • Trouble with planning and organizing.
  • Poor coordination and control of movements.
  • Confusion and disorientation.

This can lead to personality changes, depression, anxiety, and more.

In most cases the root cause is not reversible, and so over time there will be a steady decline. An example of this is Alzheimer’s.

There are also instances where it really can be reversed. Here are some examples of that ..

  • Infections and immune disorders can lead to dementia like symptoms.
  • Medication side effects
  • A lack of specific nutrients such as vitamin B-1 due to alcohol abuse
  • Even dehydration can lead to dementia like symptoms.

The risk is of course the obvious one – age. As you get older the risk increases. Having a family history of it can also suggest you have a higher risk.

Handing people with Dementia – what should you do?

You may have older relatives with dementia. What should you do when faced with a loved one who is both clearly confused about where they are and even who you are?

It can be quite distressing and frightening, not just for you but also them as well.

People suffering from dementia are often struggling with what is termed “competing realities”. There is where they are now, and also there is where they think they are. The person suffering from dementia may be locked into remembering their previous role as a parent and become convinced that they need to leave right now and go pickup a child from school. They may also be anchored into a memory of a previous time and become convinced that their parent will soon be coming to pick them up and take them back home.

If you are in some way responsible for caring for somebody who has dementia then it is worth knowing that there are strategies that do work, and forms of communication that just do not work.

When handling these competing realities that people may be struggling with there are four common strategies that most people use. Two of them don’t work all that well and two of them do work. Let’s briefly look at each in turn.

Confrontation

This is where you strive to correct their understanding of where they are. It’s an understandable approach. They are clearly disorientated and confused and so you try to correct that.

This generally does not work. You will not reach any agreement, but will instead raise the degree of distress. It is not an effective strategy.

Lying

You are hearing them tell you about something that is clearly not true. To avoid an argument that leads to further distress you simply go along with it and agree with them, “Yes, your father will soon be coming to pick you up“.

This can often calm the person down, and reduce the degree of distress being expressed, so telling lots of little white lies is often used.

One problem with this approach is that it can only ever be a short-term strategy. When the agreed upon event fails to happen then it can lead to further confusion and distress.

What other options do you have?

Find Common Ground

They have a reality, usually memory based, and so you can use that as a foundation. For example, if you are told, “My (deceased) dad will be coming soon to pick me me“, you can engage by asking questions such as “Do you miss Dad?“. You are not lying, nor are you setting unrealistic expectations, but instead you are engaging with the deep emotions that are in play. Feelings are being shared.

You can also find needs that can be met. If somebody insists that you need to take them home right now, you can ask “What would you be doing if you were home right now?“. This can often reveal very simple things such as having a coffee, going for a walk, or watching TV. Once you have identified that actual need being felt, you can then meet that need.

Redirecting with Diversions

Another effective strategy is called “redirecting”. When handing somebody distressed about something you can potentially draw them away from this distress by suggesting you take a walk, or instead by asking a question that can alter the conversation and take things in a different direction.

Even in a busy pressured environment where carers might not know the person in care all that well, this can be a very effective strategy.

Small adjustments in how you communicate can have a profound impact on the wellbeing and care of those living with dementia.

Let’s see it now

Within the following 2 minutes clips that has been extracted from a documentary, Louis Theroux from the BBC visits a facility where they take care of people with Dementia.

Watch how a patient who is clearly struggling with conflicting realities is handled via redirection …

The full documentary is called “Louis Theroux: Extreme Love – Dementia“.

In this next clip he meets Nancy who lives at home with her husband. Her husband first explains to Louis what goes on and how to communicate with Nancy, and then Louis tries it …

In this next clip Louis is in a retirement home that has a specialist floor for dementia patients. Here he meets Janet, a new resident who is telling staff that she has seen an intruder. We also meet her daughter who comes to visit and see how she is settling in. Her daughter also explain to camera why she had to make the hard decision to find this new home in the unit for Janet.

In this next clip we meet people planning for the future. Louis meets 49 year old Selinda and her family who are coming to terms with the devastating diagnosis for Selinda…

If you are concerned about yourself then what can you personally do?

There are no magic pills. The prevailing guidance is very clear and also rather obvious …

  • Adopt a good diet – fish, fruits, vegetables and oils. People on a diet that is rich in produce, whole grains, nuts and seeds have better cognitive function.
  • Exercise – You don’t need to go to a gym or become a marathon runner, but you really should get out and about and keep mobile every single day.
  • Alcohol – be aware that abuse of it is linked an increased risk of dementia.
  • Smoking – don’t. No really if you do, you need to quit right now.

The other items to tackle are also as expected – high blood pressure, and also high cholesterol.

You you are aware that you have either of these then you need to start adopting a strategy right now to start tackling these.

Yes, but what can you actually do?

  • Keep your mind active – never give up learning new things. Read, do puzzles, play word games.
  • Be socially active – volunteer to help out for something you care about
  • Quit smoking – yes, OK, I mentioned it above at the beginning, but here it is once again because this quitting can have a huge impact on your long-term health.
  • Pay attention to high blood pressure and high cholesterol and tackle it.
  • Get a good night’s sleep

It might indeed be tempting to start consuming over-priced supplements. Don’t. It is mostly a scam. You can far better off investing in a diet that is rich in fresh fruit and vegetables.

Don’t take my word on this, and also do not under any circumstances fall for the claims made by those trying to sell you supplements, they have no interest in your health and are just looking for a way to tap into your wallet.

Until (or unless) better oversight is available, supplements are likely to remain the Wild West of American health. At present, only a few are likely to help, some may do more harm than good, and most will be little more than expensive disappointments. But false hopes can be toxic in their own right if they keep you from taking good care of yourself or getting the medical care you need. So even if you take supplements, be sure to eat well, exercise regularly, and work with your doctor to keep your cholesterol, blood pressure, and blood sugar in good control.

Bottom Line:

  • For others with Dementia: Practise strategies that are effective.
  • For yourself: Start investing in yourself by taking care of yourself as best you can right now so that you reduce your risk of dementia further down the road.

Further Reading

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