In 2014, a number of organizations across Canada came together to promote a campaign called Fall Prevention Month. During the month of November, this campaign encourages organizations and individuals to come together to coordinate fall prevention efforts for a larger impact. The goal is to collectively raise awareness about fall prevention strategies and to help everyone see their role in keeping older adults safe, active, independent and healthy.
How do falls impact seniors?
Unintentional falls are the leading cause of injury for Ontarians aged 65 and over. About 20 to 30% of seniors experience 1 or more falls each year.
85 % of seniors' injury-related hospitalizations
95 % of all hip fractures
50% of all falls causing hospitalization happens at home
Over 1/3 of seniors are admitted to long-term care following hospitalization for a fall
The average Canadian seniors stay in the hospital 10 days longer for falls than any other cause
Falls result in chronic pain, reduced mobility, loss of independence and even death
Recovering from a fall can be very difficult and with an increasing number of falls, it is important we take measures to prevent them.
How can you prevent falls?
The good news is that falls are preventable injuries! There are five key factors that caregivers and seniors should consider in order to prevent falls.
Eyesight– Vision is an important part of balance and good vision helps to prevent falls. Your elderly loved one could be experiencing vision loss or a condition, such as macular degeneration which is not a part of normal ageing. Everyone who is over the age of 65 should have their vision checked every year.
Your home – If you have clutter on your floors or stairs, it increases the chance of tripping and/or slipping. Make sure cords, scattered rugs, pet toys, books, etc. are in their proper place. Also, if your home is dark it increases the chance of falling, especially on stairs. Make sure to create a space that is well-lit!
Exercise - The most important thing you can do to prevent falls is to stay and remain strong! Walking, fishing, gardening, tai chi. Light yoga – whatever you enjoy! – do it to increase activity levels. At Warm Embrace elder care, our caregivers can help encourage and motivate your elderly loved one to stay active through our program called Tiered Exercise Program.
Medication – Some medications cause dizziness on their own, or when mixed with others. It’s important to properly manage your health! Always take medication as directed and ask your pharmacist to review them if you are taking more than 2 medications.
Eating a healthy diet – Vitamin D and calcium help to keep strong bones. A diet to include more greens, lean protein, and less sugar will help you in remaining strong. You may want to talk to your doctor about supplements or other alternatives.
Most of all, don’t do it alone!
It takes a community to prevent a fall and we all have a role to play. Here at Warm Embrace, we have a wonderful team of caregivers who can help you and your loved one to remain safe at home.
Do you know a senior who has suffered a serious fall? Likely you do, since approximately 30% of seniors who live in the community suffer a fall each year. The consequences of a fall can be quite serious—injury, hospitalization, even death from complications.
Did you know that falls are the cause of 90% of all hip fractures, 50% of all injury-relatedhospitalizations in seniors, and the 5th leading cause of death in the elderly?! These numbers also double when a senior has dementia. So, it is extremely vital in keeping seniors strong and steady on their feet.
Why do seniors fall in the first place?
“Falling isn’t as much about slips and trips. It’s about the failure to recover. Slips and trips happen at all ages” (Dr. George Fernie). There are various external factors at play that contribute to slips and trips; such as:
Poor footwear (e.g. slippers)
While some falls can be attributed to tripping—such as tripping over floor mats, pets or curbs—other falls seem mysterious. The person will report that they just went down and we're not sure why. In many of those mysterious cases, the fall is due to internal factors such as:
Visual and hearing deficits
Neuropathy (abnormal sensory feedback)
Low blood pressure
Pain and foot drop
Weakness and tightness
Slowed reflexes and balance disorders
What can we do to prevent falls?
Get rid of all the external factors that cause slips and trips!
Ensure that your living space has no loose carpets or rugs, the lighting is bright for increased visibility, all chairs are sturdy with armrests, everything needed is on the main floor (no stairs), and that proper footwear is worn in the house.
Improve balance and stability!
“She says she wants to keep living in her home. We say it starts by keeping her on her feet” (American Academy of Orthopedic Surgeons). The number one key to fall prevention is staying active!Physical activity has shown to mitigate the deathly consequences of falls – just walking, gardening or housework is enough for an elderly loved one.
However, when your elderly loved one refuses to do regular exercise the best option is to increase their base of support.
To remain balanced, there must be a stable base of support—the wider the base of support the more stable it becomes. The base of support is the invisible box that can be drawn around your feet when you are standing. Added to this is our centre of mass—which is approximately where our belly button is located.
When someone’s centre of mass is in the middle of their base of support, they are perfectly balanced. When their centre of mass begins to reach the outer edge of their base of support, they are more prone to falling.
For example, a ballerina narrows her base of support to be only one square inch when she is en pointe. Her balance is quite precarious because her base of support has been reduced. The only way that she remains upright is by perfectly hovering her centre of mass over her base of support. She is constantly adjusting to ensure that her centre of mass doesn't sway too far aware from her base of support.
In contrast, a football player crouches low and spreads his feet wide so that he has a wider base of support than he normally would. He may even put one hand to the ground adding a third point of contact and expanding his base of support further. He has a stable base of support, and his centre of mass is positioned in the middle of his base.
In the case of a frail senior, their feet may ache or have bunions, causing that person to only walk on the edges of their feet, which reduces their base of support and their balance. Instead of using the full surface of their foot, they have reduced their base of support more like a ballerina. As well, the senior’s posture may be more forward-leaning, pushing the centre of mass to the outer edge of the base of support, causing instability. A senior will not likely be crouching down to touch the ground for support, the way a football player does.
The best way to create a strong base of support is to use a walker. The four wheels of the walker expand someone’s base and provide the necessary support. Much like a football player, a well-balanced senior using a walker is less likely to fall than a senior who is precariously balancing on sore feet. If their posture is forward-leaning then the walker extends the base of support ensuring that the centre of mass remains in the middle of the base of support.
Encourage the seniors in your life to carefully assess their centre of mass and base of support to ensure that they are as safely balanced as possible. Every fall that is prevented is a great success and ensures a longer and healthier life for that senior.
You’re worried about your parents and you think they could use more help. You suggested homecare, but they wouldn’t hear of it. They told you: “we’ve managed just fine on our own this long, we don’t need any help.” What they're really saying is that they don't want to face change. That's because change is scary.
Change is scary for all of us, at some level. Each person has a different tolerance for change, and it might take a lot more change to scare some people than others. But if you introduce a drastic enough change, eventually, any of us would feel trepidation about that change.
It’s little wonder then, that for seniors in their 80’s or 90’s, the thought of even a small change can be quite scary. After eight or nine decades, they are likely pretty set in their ways. They want things done a certain way; they want to keep their environment the same. As long as everything remains the same, it feels more manageable. It might help your parents to understand that home care is all about reducing the amount of change that your parents will experience.
Warm Embrace caregivers are trained to match each client's specific preferences.
Caregivers DO NOT barge into a client’s home and just take over. Caregivers DO wait to be invited in, and they ASK permission to proceed. They ask how that particular client prefers the laundry or housekeeping to be done. They cook from the client’s recipes or directions to match their particular tastes. They help to keep clients’ lives consistent.
Homecare is one of the best prevention strategies for one of the biggest possible life changes: admission to a long-term care home. Moving to long term care is a HUGE change—absolutely every single element of someone’s routine is changed. From the time they get out of bed, to when they eat, and whether they wear pyjamas to breakfast—everything is adjusted to match the schedule of the long-term care home.
Homecare ensures that individual clients maintain their own personal routine, they maintain their home, they maintain familiar comforts. Caregivers match clients, rather than clients matching caregivers. It reduces the amount of change they must experience.
Since home care is completely client-focused, each client calls the shots. The client decides what they’re doing each day and how they want things done and in which order. It is very empowering for seniors to get to make all the decisions that impact their own day-to-day living. Homecare grants this level of autonomy and independence.
Help your parents see that home care will ensure the least amount of change and help to maintain the lifestyle that they know and love.
Top 10 Tips for Resiliency in the Face of Depression
Thursday, October 8, 2020
Maintaining good mental health requires just as much attention and care as maintaining good physical health. In reality, mental health is a continuum, a scale that ranges from mental wellness to serious mental health challenges. When someone experiences drastic stress in their life, their mental distress level rises. It is important to have adequate coping mechanisms in place to help reduce one’s mental distress level and maintain mental wellness.
The Canadian Mental Health Association defines mental wellness as “a state of well-being and the ability to function in the face of changing circumstances.” This includes handling stress and loss, relating to other people, and making decisions.
Dealing with stress though is not an innate trait in humans; it is a learned behaviour. Whether good or bad, we learn coping skills from our environment. Adding positive and healthy coping skills to our lifestyle is crucial to maintaining or gaining back mental wellness.
Depression is not always something that you can control—it may be related to a specific situation or it could seem to appear for no apparent reason. Depression may be triggered by loss—loss of a loved one, an important role in life, a job, loss of health or independence. Any of these losses create increased stress. Without coping mechanisms, someone’s mental distress level will climb and they may experience depression.
Depression after any type of loss is likely due to situational depression, and having the right coping skills will be highly beneficial. It is important to note that clinical depression is an illness that many people experience regardless of their coping skills. In either case, it is important that you speak to a doctor.
The Canadian Mental Health Association recommends a few key coping skills to help maintain mental wellness. By implementing these coping methods when you are feeling your mental distress level begin to climb, you may be able to maintain a higher state of mental well-being.
1. Read and Research
The more you know about depression and mental illness, the more empowered you are to protect your own health. You don't have to do this alone! Research can be overwhelming, ask someone you trust to help you learn more about mental health.
2. Change Your Thinking Patterns
Many depressed people have negative and anxious thought patterns. Learning to redirect your focus can improve your mental health. A great tool is to journal your thoughts and to track how you got to that negative thought. Remember to celebrate your successes; focus on your achievements rather than focusing on what you are unable to do.
3. Ask for Help
Requesting help is not a sign of weakness; rather, it requires courage to reach out to others when you are in need. Create a support system of caring people whom you can call when you are feeling low. Have a list of 5 close friends you can count on; if one person doesn’t answer, you have 4 more names you can call.
4. Use Problem Solving
Determine which problems are stressing you, explore possible solutions, try a new solution (as the same old solutions will yield the same old results), evaluate the effectiveness of your new solution, and focus on the progress of your problem solving rather than on the problem alone.
When you are depressed, the last thing you may feel like is exercise, but the results make the effort worthwhile. Exercise increases the blood flow not only through your body but also to your brain. Increased oxygen flow to the brain improves mental functioning and mood. Your endorphins are also elevated through exercise.
6. Eat and Sleep
Eat a properly balanced diet, even if you have no appetite. Aim to maintain a regular schedule where you eat healthy food at regular intervals. Sleep on a regular schedule as well. Ensure that you get enough sleep, but do not oversleep. Most adults need an average of eight hours of sleep nightly.
Schedule yourself time to rejuvenate. Prioritize activities that bring you peace and pleasure. This may include: meditation, being outdoors, various hobbies, caring for a pet, having a massage, etc.
Do not cut yourself off from social connections. If large groups are overwhelming, go out for coffee with just one or two people at a time. Isolation only perpetuates depression. Socialize with close, caring friends who are compassionate and supportive. Be sure to hug these close friends; physical touch should not be underestimated.
9. Relax Your Standards.
Many people experience anxiety and stress because they are holding themselves to unrealistic standards. Determine to not expect more of yourself than you would expect of anyone else. Be kind to yourself—sometimes, we are hardest on ourselves!
A sense of humour can go a long way. Sometimes, laughter truly is the best medicine. You don't even have to wait for a comedy act to come to town; through the internet, you can search endless comedies on YouTube and select comedies that suit your particular sense of humour.
If implementing these coping skills does not improve your sense of mental well-being or if you are currently experiencing other symptoms as well, you should see your doctor. Medication may be appropriate for you, or there may be a physical explanation for the mental distress you are experiencing. Your doctor can advise you best.
It is important to know that help is available. You do not need to live in a state of mental distress. To learn more about healthy coping strategies and ways to reduce stress, please visit the Canadian Mental Health Association.
Locally, in Waterloo Region, we are blessed to have Here 24/7 — a service that is available 24/7 to assist with addictions, mental health, and crisis situations. The number is: 1-844-HERE247 (1-844-437-3247)
Thanksgiving is a time for reflecting upon all of our blessings. Reflection and gratefulness are skills that we regularly see demonstrated by our wonderful clients. We are often reminded to be thankful for all that we have and to be appreciative for all of the small blessings that we unknowingly take for granted. Even during these unprecedented times, we are thankful for the opportunity to serve our wonderful clients.
Our elderly clients, many of whom lived through very difficult times, know all too well how lean years feel. Many lived through the depression era when even basic necessities were in scarce supply; they lived in Europe during the war and experienced shortages, rations, and were in constant danger; they immigrated to Canada and had to build new lives starting from scratch.
They learned how to savour every blessing, to be grateful for each miracle, and to never take anything for granted. We can certainly learn from our elderly clients!
When our clients tell us stories from their youth—stories of courage, determination and gratitude—there is always a common thread. The stories are never focused around possessions or money or things. The stories are centred around the people who mattered most—family, friends and loved ones.
The blessings that are most memorable, even decades later, are the blessings of the most beloved people in their lives. Honouring a friendship, caring for family, falling in love, raising a family, helping a sibling, being loyal above all else—these are the elements that truly matter. These are the blessings to focus upon; these are the blessings for which we should be most grateful.
Our clients teach us many important lessons, but gratitude and the importance of relationships would be at the top of the list. This Thanksgiving season, we want to take the time to reflect upon the relationships that are most important in our lives and to express gratitude to those people.
From the entire team of Warm Embrace Elder Care, we wish you a blessed and joyful Thanksgiving!
Does your family have any Thanksgiving traditions? Do you share memories of years past, and do you share what you’re grateful for this year?
If you have family members who have dementia, there are ways to make these traditions more inclusive and enjoyable for them too.
The wonderful thing about stating what you’re thankful for is that the answer can’t be wrong! No matter what you are thankful for, no one else can say that the answer doesn’t count. This is a great conversation starter for someone who has dementia. It does not depend on factual memory, there is no right or wrong answer, and any answer can spark new discussion.
To make it easier for your loved one who has dementia, be sure to provide an example. It can be a lot of pressure to ask them first—“What are you thankful for?” Instead, you can start, and then ask “are you thankful for anything granddad?”
To keep the conversation going, you can encourage reminiscing, but be careful to avoid making grandad feel that he has to justify his answer. Here are some examples that might echo someone’s automatic response, but are not recommended, followed by an example that is more dementia-supportive.
Granddad responds: “I’m thankful for you!” and you respond “and why are you thankful for me?” Your intent is to keep granddad engaged in the conversation, but instead, it may feel like he has to justify his answer. That can add stress and pressure to granddad and he may be less likely to answer any other questions if he has to justify his response.
You can affirm his answer by saying “why thanks Granddad, and I’m thankful for you too! I’m grateful we’re having Thanksgiving dinner together with you tonight.” You have affirmed granddad’s answer and kept your response in the present moment so granddad doesn’t have to rely on recent memory.
If your granddad’s short term memory is highly impacted, he may have clearer memories of his childhood and he may often talk about his childhood. He may state that he’s thankful for his mother or his younger sister, both of whom have long since passed.
“Granddad your mother has been dead for nearly 30 years. Surely you have something to be grateful for today.” This response tells granddad that his answer is wrong, and it shuts down further conversation. It eliminates the opportunity for reminiscing and revealing his state of mind or thought process. It may also rip open the wound of grief if granddad has briefly forgotten that his mother is deceased and he may grieve her as though it is a new loss.
“oh yes Granddad, your mother was a very special woman. Do you have a favourite memory of her?” This response validates Granddad’s answer and opens up the opportunity for more conversation. The follow-up question is completely open-ended—he can say “no” he doesn’t have a favourite memory and that’s okay. If he is reminiscing and can remember something special, he is free to share. You might be amazed where the walk down memory lane can lead!
When encouraging someone to reminisce, aim to keep your follow up questions open-ended or opinion-based. If you ask fact-based questions it can feel like a test with an inferred right or wrong answer.
A fact-based question might be: “your mother always baked pies for thanksgiving. Do you remember what type of pie she baked?” There is an inferred right or wrong answer and it feels like a test.
Instead, ask opinion questions that cannot be right or wrong. “your mother always baked pies for thanksgiving. Did you have a favourite flavour of pie?”
If Granddad responds “I liked mother’s strawberry pie at thanksgiving” and you know that his mother did not make a strawberry pie, do not correct him! It is NOT helpful to say “oh granddad, that can’t be right. Your mother only ever used fresh fruit from the farm. She made strawberry pies in June with fresh strawberries from the field. At Thanksgiving, it had to be apple or pumpkin.”
Your response may be factually correct, but does it really matter? How does it make granddad feel to be corrected? It tells him that his answers are incorrect and will likely shut down further conversation. Is the purpose of the conversation to exchange correct facts, or is the purpose to help granddad reminisce and share positive memories in a loving environment?
“Your mother’s strawberry pies certainly were delicious! Wasn’t there a time when you were a little boy and you stole the pie out of the window where your mother left it cooling?” You validated your grandfather’s response about strawberry pies without correcting his response. To keep the conversation going, you’ve supplied more information to possibly spark his memory.
This is a story you’ve heard him tell many times before, and each time his face lights up with a mischievous grin—just like he’s 9 years old all over again! You’re giving him the gift of remembering a story that he loves to tell, and instead of testing his memory, you spark his memory and let him tell the details of the story as he remembers it. If his details differ from the last time he told the story, it doesn’t matter. What matters is that he is the star of the moment, telling his story the way he remembers it.
When you're together with family this Thanksgiving, and you have the opportunity to reminisce with family members who may have dementia, aim to provide supportive responses that keep the conversation going.
Remember that the purpose of the conversation is not to exchange factually correct information. The purpose is to share quality time with loved ones, validate their feelings, and share a moment of open love and trust. You may just be amazed at the memories that surface!
Autumn is a wonderful time of year filled with fall colours, harvest crops, hearty comfort food, warm fuzzy sweaters, and long walks rustling your feet through the leaves. Really, all the sights, sounds and smells of fall time are lovely! Even during these unprecedented times, why not try a fun and festive activity with an elderly loved one.
Here are Five Fun Activities to try this Fall Season!
1) Prepare Homemade Treats
Baking, mixing and preparing treats are fun activities that many older adults enjoy. You can follow a family recipe or flip through some cookbooks to discover new recipes. You can make something as simple as apple crisp or a no-bake pumpkin cheesecake. Another idea is decorating sugar cookies with your loved one! If baking is too messy, you can always pre-bake the cookies and just decorate them with your elderly loved one.
To follow social distancing rules, you can prep and make these treats for your loved one and surprise them with a special delivery. Another idea is prepping and decorating premade cookies outside on a nice sunny autumn day.
2) Pumpkin carvings and painting
Pumpkin carvings are a must tradition every fall season. You can carve all sorts of patterns on pumpkins but if carving is too much strain on wrists and hands you can always introduce painting on pumpkins to your elderly loved one. You can have an assortment of paint colours to design a unique pumpkin and then you can put them on display so that everyone can see. This is a great activity you can do outside and from a distance with your loved one.
3) Enjoy the natural scenery and fresh air
Bundle up and breathe the fresh autumn air! You can go on a short walk in the park to admire the beautiful coloured leaves that fall brings. You can go to a local park like Victoria or Waterloo Park and walk a scenic trail hearing the crunch of the fallen leaves under your feet.
If you can’t take your loved one out too far why not go somewhere nearby? You can relax in the backyard, front porch, or go on a short walk to pick up the mail. If it’s too cold outside for your loved one, you can always go on a relaxing country drive to see all the colours or simply open up some windows and blinds to let the fresh air inside.
4) Get festive with fall decorations
Crafting and decorating are always fun activities! With proper social distancing rules, you can help an elderly loved one to decorate their home with fall colours. You can introduce neat craft ideas with dried up fallen leaves, such as collecting them to make cards.
5) Hang out online
If visiting your loved one in person is not an option, you should consider an online hang out! There are several ways you can connect online with your family member. You can video call your loved one, play an online game together, or watch a movie!
This autumn season introduce a new activity to your elderly loved on - it may be cooler weather - but it's a lovely season to spend quality time with friends and family.
If a picture is worth a thousand words, then what does the photo selection on our walls say about us? When you look around your home, what photos do you have prominently displayed?
Photos are one of the ways to personalize your living space, be reminded of your closest friends and family, or commemorate a favourite event. What if the photos on your wall no longer triggered happy memories? What if you didn’t recognize the people or places in the photos on your walls? How would you feel?
If you didn’t recognize any of the photos, you might feel like you’re out of place, that it can’t possibly be your home. You might feel disconnected, or perhaps even a little lost. You might wish to go home, to a place that’s familiar and recognizable.
That is exactly how someone with advanced dementia can feel. For some people with dementia, they will have a tough time recognizing photos of family members or even photos of themselves. In the early stages of dementia, it can be helpful to have recent photos of grandchildren available so they are more recognizable when they visit, especially because they grow up and change so quickly. But as someone’s dementia advances, keeping up with updated photos can be challenging.
For someone with advanced dementia, it can be quite abstract to look at a photo of a baby or a child and connect to that person as being your great-grandchild. Having recent photos of the latest great-grandchildren may not provide an anchor-point for identity. It may just be a nice photo of a cute baby, but no greater connection than that. In fact, I’ve had clients with advanced dementia tell me that the cute baby photo—which is indeed their newest great-grandchild—is just the sample photo that came with the picture frame and since they liked the photo, they never changed it out!
Photos of unrecognizable family members may be pretty photos, but if someone with advanced dementia does not realize it’s a family member, then the photo does not have much significance. It does not signal “you are home” or “you belong here”. It does not spark memories of happy times, it doesn’t connect to a sense of identity.
Instead, it can be helpful to understand what and who your loved one is thinking about most these days. Oftentimes, people with advanced dementia are thinking and talking about times that they can more clearly remember and understand. Since long-term memory is stronger, people often revert back to childhood or young adulthood memories. If that is the timeframe that is clearest, then provide photos to match the era that your loved one can remember.
If your loved one is talking about their parents, see if you can unearth an old photograph of their parents from decades ago—a photo of what their parents would have looked like when they were a child or teen. If your loved one is talking about their siblings, find old photos of the siblings together as children. You may have a recent photo from the latest family reunion, but if your father is remembering his brother as an 8-year-old child, he may not be connecting with the photo of the 87-year-old man who is his brother today.
Many elderly women have strong memories of having children. Their strongest memories are of their children as babies, toddlers or young children. Finding the old baby photos that might have adorned the walls over 60 years ago can be helpful. The photos will be familiar and will likely spark a smile and perhaps even some fond memories.
Another option, though much tougher to implement, is to adorn the walls with photos, pictures, or wall hangings that were in your loved one’s childhood home, or even their first home when they moved out. Of course, many of those photos and prints may be long gone, but if you can find anything stashed away in the attic, it may be worth bringing them out to see what reaction you get.
For someone with advanced dementia, adjust their environment to match their internal reality. Have photos to match their strongest memories. Select pieces that bring comfort or joy and spark a memory.
Whether modifying someone's home or decorating their new living space in a retirement home or long term care centre, provide photos that spark a sense of pride and identity for your loved one.
Humans are wired to be busy, to be productive, to be doing something. Even when we are intentionally taking a break, we have to consciously remind ourselves to relax and not default to our busy-mode.
This drive and desire to be productive is deeply ingrained, and for people who have heeded the productivity call their entire lives, it is a well-worn feedback loop. They feel the need to be productive, so they remain constantly busy, and the fruits of their labour are the visible reward for being constantly busy.
What happens when dementia interrupts that feedback loop?
When someone’s dementia has progressed, he has a harder time remembering how to do activities he did his entire life. George, a gentleman who enjoyed woodworking and fixing things around the house may no longer understand how to use his tools. He gets started on a task, and partway through forgets what he was doing, leaving a wake of unfinished projects behind him.
His desire to continually work on things around the house does not go away. His drive for productivity and doing something meaningful and important will far outlast his ability to operate his tools. George was never one to sit and relax, instead, he was always working away on something, and that desire can carry on even as his dementia progresses.
The fact that George can no longer successfully fix broken household items will not prevent him from trying to do so. In fact, he may be inclined to ‘fix’ items that he is certain are ‘broken’ because he’s now having trouble operating household appliances. Frustrated relatives might try to insist “just sit down and relax!” but since that was never in George’s nature, it’s unlikely he’ll be settled for long. George’s brain is sending him the signal to be productive. He has a strong sense that he should be doing something, he’s just not sure what that something is.
When George cannot easily find a task that meets his need to be productive, he will create one. Dementia has interfered with his ability to follow through with all the tasks he previously did. If the signals in his brain are scrambled, the output of his activities may also be scrambled. He is trying his best to ‘fix’ the ‘broken’ wastebasket and has dumped its entire contents on the floor. To an exhausted family member, this is just one more dementia behaviour that doesn’t make any sense and has now created a mess to be cleaned up.
What George needs are activities that he can manage. Dementia has impacted his ability to do the same activities in the same way he did them 20 years ago, but it has not taken away his ability to do all activities. What George needs is someone who can customize familiar activities to match his current ability level. He needs someone else to break down an activity into individual tasks, and do only one small task at a time. George is still capable of doing many things. He needs direction and he needs cueing to successfully manage a sequence of complex activities.
George is bored. And when he is bored, his brain will create an activity to do. Even if the activity doesn’t make sense to someone else’s brain, even if the activity creates a mess or breaks something, or causes a disturbance, his brain is desperate for activity and stimulation. In the lack of meaningful stimulation, the brain will create its own entertainment.
The underlying cause of many so-called dementia behaviours is boredom.
When someone with dementia is occupied with meaningful activities that create a sense of purpose and productivity, their ‘behaviours’ are often drastically reduced. Their need to be productive is met and they feel satisfied.
Providing meaningful activities for someone with dementia is one of the most effective ways to reduce undesired behaviours. It does not require medication changes and has no side effects. However, it can be incredibly time-consuming and does require an enormous amount of patience. Time and patience are two things that family caregivers often have in short supply—they’ve used up both!
Professional caregivers can fill the gap. Professional caregivers can take the abundant time and patience required to keep people like George engaged in meaningful activities. Caregivers help clients with dementia to connect to their passions and interests by making activities accessible. Caregivers modify activities to match their client’s ability level—that might be fluctuating by the day or by the hour—to ensure that activities are never too difficult or too easy and boring.
When people are enjoying hobbies that they love, and they are not frustrated or bored, their so-called behaviours are drastically reduced. What passions might we re-inspire in your loved one, to spark their desire for meaningful engagement and productivity?
Someone who is experiencing dementia may exhibit behaviours that we do not understand. These behaviours have been labelled ‘difficult’ or ‘disruptive’ or ‘challenging’, but is that really a fair assessment of these behaviours?
In caring for people with dementia, the focus often ends up being on the disease itself, rather than on the person who is experiencing the disease. Thus, their behaviours are often automatically assumed to be associated with the disease.
Sharon Stap, a Psychogeriatric Resource Consultant, contrasts older understandings of dementia with more updated approaches. In the past, it was understood that dementia was altering someone’s brain, resulting in different behaviour. All behaviour was assumed to be a result of the disease.
The newer understanding of dementia is that the changes in someone’s brain result in a different perception of the world around them, creating anxiety, fear and other emotions which then lead to different behaviours. Understanding that someone with dementia is experiencing a change in perception which causes behaviour should fundamentally alter how we interact with those who have dementia.
Dr. Sherry Dupuis, former director of MAREP (the Murray Alzheimer Research Education Project), feels that we need to reframe our view of these behaviours. Instead of merely seeing the ‘challenge’ or ‘difficulty’ that these behaviours cause for us, or assuming that all behaviour is attributed to disease, we need to reframe these behaviours as a form of communication. Dr. Dupuis views behaviours as a form of personal expression, a unique way of communicating needs. We should then seek to understand the meaning behind the personal expression.
We must remember that people who have dementia were all unique individuals prior to the onset of their illness. They continue to be unique individuals with different personalities, communication styles, interests, life histories, etc. Dr. Dupuis charges us to never lose sight of the fact that a person with dementia is first and foremost a person who requires love, care, and understanding, not just a disease or a ‘case’ that needs to be managed.
One of the greatest gifts that we can offer to someone with dementia is the gift of truly relating to that person—validating their personal experiences and feelings. Someone with dementia is experiencing the world around them differently than they previously experienced the world, and differently than you might be experiencing the world around you.
This experience may be frightening, overwhelming, or worrisome, and the feelings that are generated and their emotional response is fully valid. We cannot be dismissive of someone’s feelings or emotional responses just because we do not deem a situation to be frightening to ourselves. The kindest thing we can do is try to understand the emotional response and validate the feelings that someone else is experiencing. Only then can we attempt to change someone’s experience into something more positive.
If someone is distressed or having a negative experience, distraction can be helpful, but it is not the first step in the process. Stap emphasizes that you cannot jump immediately to distraction, otherwise you risk being dismissive of someone’s feelings. Stap proposes a four-step process where distraction is the final step, not the first option.
The Four Steps:
1. Show you care
2. Show you want to help
For example, Agnes has dementia, and she is upset and focused on wanting to return home. The first step is to acknowledge how Agnes is feeling. You might say: “You need to get home, Agnes? I can understand why you’re so upset.” Attempting to inform Agnes that she is already at home—known as reality orientation—is not helpful and only causes more distress; Dupuis and Stap agree that there is rarely if ever, a good time for reality orientation.
After acknowledging and validating Agnes’ feelings, you want to show that you want to help. You might suggest: “let’s go see if we can find someone who can help us, Agnes”. While on the hunt for someone who can help, you have the opportunity to redirect, the third step. You could say, “I’m tired. Before we look for someone else who can help, do you mind if we rest here by the piano?”. After this, you have the opportunity for distraction, the fourth step. You could then say: “You play the piano, don’t you, Agnes? Would you play me a tune?”
If you had jumped immediately to distraction via the piano when Agnes first approached you, she likely would have felt even more frustrated that her needs were not being addressed. Acknowledging Agnes’ feelings and needs, then assisting her to focus on something that is more comforting, allows for a positive experience overall.
Interpreting all behaviour as a form of personal expression shifts the focus off of the disease of dementia, and refocuses attention on the individual person. Suddenly, behaviours are imbued with meaning and purpose, a form of communication. It is then our responsibility to enable the best possible form of communication and understanding, setting people up for success, regardless of dementia or other illnesses.
I think you are talking about my mother. Her name was Agnes, and she always wanted to go home. And she played the piano. This 4 step process worked for her. You had to acknowledge her feelings and help her, before distracting.