Some carers suggested, from their experience, strategies for dealing with some of the distressing disturbances of behaviour commonly occurring in people with dementia. Many strategies are dealt with elsewhere in this website but a few more are included here.
One of the earliest forms of behaviour to draw attention to loss of memory is the tendency to ask the same question repeatedly, every few minutes. The question itself can be perfectly appropriate for the circumstances; it is just that the answer seems to get lost. While carers didnt actually offer any way of dealing with this behaviour, which can cause intense irritation to the person on the receiving end of the questions, there were suggestions as to how to be able to carry on a conversation with someone who has memory problems.
People with dementia, faced by a visitor who seems lost for words, may remember that there is some sort of social obligation to make conversation. A solution is for the carer, or visitor as the case may be, to help out by taking the lead. Several carers described developing a memory book or box of objects which would help to recall past experiences and using these to make conversation.
Creating a life book.
Another carer described how she would introduce clues into her conversation with people they met to save her husband from having to struggle to remember who they were.
Finding ways of including her husband in conversations.
Later, a new problem arises when the person with dementia denies having ever known certain bits of information and can get really angry when confronted with their failure to remember. In a normal situation it would not be unreasonable to correct someone who made such disconcerting statements as, for instance, that they are not the daughter they claim to be because such a person never existed or that it is necessary to return to a home which they last lived in 50 or more years ago. The wise carer learns to accept that it would be futile to argue.
Learning to avoid conflict when someone denies knowing something you know for certain they have been told.
One carer described his feelings about actually seeming to go along with a person’s delusions. He felt that it was the right thing to do because it avoided distressing conflict but he also admitted feeling uncomfortable that he was colluding with his mother’s delusions.
Realised that colluding with her mothers delusions was better than trying to correct her.
One carer described her concern when care staff objected to her husband’s desire to touch them, having realised herself that, since he could no longer speak, physical contact was his only means of communicating. She felt that care staff in nursing homes should understand this and not be afraid of it. Her husband was actually excluded from a day-care centre because the staff did not think it right to have to help him to aim his urine towards the lavatory bowl.
Care staff should not be afraid to touch people with dementia or be touched by them.
Another form of behaviour likely to upset the carer is the stubborn refusal to cooperate in quite ordinary tasks: eating, undressing and so on. One carer advised waiting and making the request again later when the original disagreement will have been forgotten. Someone else suggested that when he examined his motives for trying to persuade his mother to do something he was able to see that he should avoid putting pressure on her when the object to be achieved was not really important. This advice also applied to times when she would become anxious and agitated.
Don’t try to force someone to accept things. If you wait and try later you may have better success.
Backing away from conflict as a way of resolving it.
Many people living with relatives who are in the early stages of dementia have to decide whether its safe to let them go out on their own. They were able, for a time at least, to take the risk rather than have to enforce some sort of restraint, by being sure that they carried detailed information which could be used if they got into difficulties (see Wandering).
One carer described her attempts to restrain her husband, who displayed a restless agitation for days at a time. Her intention was to find a way to avoid the use of medication. She describes having to pin him down to get him to eat and the way she has tried to negotiate a strategy to allow him to relax at least some of the time. (See Treatment for dementia).