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Why do Seniors Fall?

 

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-related hospitalizations 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:

 

  • Loose carpets/rugs
  • Poor lighting
  • Unstable chairs
  • Steep stairs
  • Poor footwear (e.g. slippers)

 

elderly lady seated holding her knee because she is in pain

 

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
  • Vestibular dysfunction
  • Cognitive impairment
  • Neuropathy (abnormal sensory feedback)
  • Low blood pressure
  • Edema/swelling
  • Pain and foot drop
  • Weakness and tightness
  • Decreased flexibility
  • 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.

 

couple walking outside

 

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.

 

ballerina on her toes

 

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.

 

elderly man walking and caregiver supporting elderly man

 

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. 

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Change is scary but it doesn’t have to be

 

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.

 

older lady looking worried as she stares

 

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.

 

caregiver helping elderly lady from the couch

 

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. 

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Top 10 Tips for Resiliency in the Face of Depression

 

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. 

 

elderly people, husband is holding wife's face near to him as she is in distress

 

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. 

 

someone wearing an orange sweater doing research on their laptop

 

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.

 

5. Exercise

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.

 

three women walking together with dumbbells' in hand. They are laughing and having a good time

 

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.

 

7. Enjoyment

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.

 

8. Socialize

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!

 

10. Laugh!

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.

 

a couple riding a bike laughing

 

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)

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Happy Thanksgiving!

 

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. 

 

a picture of someone holding old vintage black and white photos

 

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.

 

A photo of a family smiling and taking a group selfie.

 

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!

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The Season of Thanksgiving & Reminiscing

 

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.

 

a family eating a holiday mean together at the table

 

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.

 

NOT Recommended:

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.

 

SUPPORTIVE:

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.

 

Father, son and grandson enjoying an autumn walk

 

NOT Recommended:

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.

 

SUPPORTIVE:

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.

 

NOT Recommended:

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. 

 

picture of someone rolling pie dough

 

SUPPORTIVE:

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?

 

NOT Recommended:

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?

 

SUPPORTIVE:

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. 

 

Elderly man laughing joyfully

 

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!

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A Picture is Worth 1000 Words

 

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?

 

Older lady looking at a photo album

 

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.

 

Elderly father and adult daughter looking at family photo album

 

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.

 

Wall of old timey photos in vintage frames

 

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.

 

Wall decor and art in vintage frames and styleAnother 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.

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Boredom is the Cause of Behaviours

 

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.

 

Old man wearing glasses and wearing a plaid shirt wood working with hand tool

 

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.

 

older man with white hair seating in a chair looking very bored

 

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.

 

old man wearing glasses looking focused as he works on his puzzle

 

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? 

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Exploring Responsive Behaviours

 

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. 

 

Photo side by side. First photo, older woman wearing a blue sweater is looking very sad and confused. Second photo, older woman covering her face with her hands.

 

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. 

 

Black old married couple walking arm and arm.

 

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

 

3. Redirect

 

4. Distract

 

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.

 

older woman wearing a light scarf smiling

 

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.

 

If you have questions about dementia or dementia care, contact our office today to speak to one of our experts. 

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Dementia and Communication: 5 Typical Mid-Stage Challenges

 

Mid-stage dementia or moderate Alzheimer’s is marked by increased communication challenges.  Language is increasingly affected; though speech remains quite clear.

 

 

In the mid-stages of dementia, the affected person is less self-aware of their communication challenges.  In the early stages, the person is highly aware that they cannot find the words they are seeking; but in the mid-stages, they don’t perceive their communication as problematic.  They may be inclined to blame others for not comprehending what they are saying.

 

Here is a list of 5 communication challenges

 

Circumlocution

 

This is your new word of the day!  Circumlocution is the fancy way of saying “talking around what you are trying to articulate.”  In the early stages, precise noun naming is difficult, in the mid-stages, nouns are frequently substituted with pronouns such as ‘he’, ‘she’, and ‘they’.  Instead of identifying an item, you might hear ‘thingy’ or ‘thingamajig’.  Sometimes, the person with dementia becomes frustrated when you don’t know what the ‘thingamajig’ is, and they become mad at you for not knowing.

 

Disinhibited

 

Your sweet little granny who never so much as uttered “darn” her entire life is now swearing like a trooper.  She can’t tell you what she wants, but she can tell you off just fine!  She may be inclined to tell someone “I don’t like your hair. You should have left it the way it was before.” The part of her brain that tells her what is socially acceptable has been affected by dementia, and the language she is using reflects that. 

 

An elderly lady wearing blue and smiling

 

Repetition

 

In mid-stage you will hear more repetition.  The person with dementia may become set on a few words and repeats those words frequently, or they may be focused on a particular idea/question/worry and continue repeating those ideas incessantly. If repetition deters you from engaging in conversation with your loved one, try out our 5 conversation starter tips

 

Digress & Ramble

 

The conversation becomes more conceptually linked rather than following a linear pattern.  For someone with dementia, his conversation may not follow a specific ‘train of thought’.  Especially when word-finding becomes difficult, he may be inclined to substitute an unrelated word for the one he cannot find; he then rambles about the new word he has substituted.  The conversation can take a sudden leap in a different direction complete with a long rabbit trail rambling.

 

Multi-person conversations

 

Group settings become increasingly difficult, and multi-person conversations are hard to follow for someone who has dementia. The mental stimulation of various conversations happening simultaneously can be too much to handle for someone with dementia.  You may notice that your loved one with dementia tends to sneak off during family visits or larger events, self-excusing from the crowd. 

 

Group of seniors engaging in happy conversation

 

Understanding the limitations of communication for someone with moderate Alzheimer’s or mid-stage dementia is important.  It is easier to set reasonable expectations and plan to be supportive.

 

Interested in learning more about Dementia and communication? Read our blog on the difference between speech and language.

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Why is it so challenging to communicate with my loved one?

 

What is the greatest challenge for a family caregiver of someone with dementia?

 

Likely, the number one challenge is communication.

 

Why is communication so difficult?  The person with dementia is still able to speak—in some cases, the person with dementia may talk incessantly.  His or her ability to speak is not affected.  Uttering sounds, pronouncing words, even using complex vocabulary is still quite possible, and yet, communication is an enormous challenge.

 

When someone has dementia, speech is not hampered, but language is affected. 

 

 

What is the difference between speech and language? 

 

Speech is the physical ability to produce meaningful sounds.  It is the complex interaction of muscles and nerve endings all interacting together to produce sound.

 

Language is not about the sounds being produced; language is the meaning behind the words.  In any language, there is a set of rules about how to use words: grammar dictates that words must agree with each other, syntax ensures meaningful placement of words into sentences, semantics is a mental dictionary of words that have meaning to us. 

 

When someone has dementia, their language can be affected. Their dictionary of words may become scrambled and finding the right word is impossible.  When the correct word cannot be found, people with dementia often substitute the next available word…but because the dictionary is so scrambled, the next available word may not be related at all to the word for which they are searching.  Interpreting the conversation can become difficult!

 

 

Language and the words associated with it are not the only element of communication that is affected for people with dementia.  Communication relies on extensive non-verbal cues as well, such as posture, body language, facial expression, etc.  Understanding and interpreting all of these signals can be difficult for someone with dementia, and their ability will fluctuate over time.

 

The person with dementia or Alzheimer’s is communicating in the only way that he/she is able to, at that moment.  Throughout the various stages of dementia, there are different strategies that can improve communication between family caregivers and those with dementia.

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