The end of the school year is almost here and students everywhere are cramming for exams. It’s the season for all-nighters as some textbooks are being cracked open for the first time all semester! 

 

After a year of learning, students are tested to see just how much they’ve learned—or how much they can retain at the end of the year.  But there is a group of people who should never feel like it’s exam time, and that is anyone who has dementia.

 

 

People who have dementia should not feel that they’re being tested.  You’re probably thinking “most people with dementia don’t go to school, so what are you talking about?!?”

I’m talking about every day conversation.

 

For people with dementia, ever day conversation can start to feel like an exam.  Much of our basic conversation is comprised of questions and answers.  But those questions typically rely upon memory.  Sometimes, there is even an implication that the answer can be right or wrong….and guessing the wrong answer can make someone feel embarrassed or not very smart.

 

For someone with dementia, a typical conversation starter such as “what did you do last weekend?” suddenly becomes a test.  It relies upon short term memory from a few days ago.  It is a fact-based question where the typical response recounts an itinerary or agenda.  But if you can’t remember what you did yesterday or three days ago, or an hour ago, suddenly this typical conversation starter feels like a test.

 

Questions such as “did you go to the market?” imply a right or wrong answer.  Someone with dementia might recognize that answering “yes”, tends to lead to the follow up question “what did you buy?” which becomes another test of short term memory.  Sometimes people resort to saying “no” to such questions just to avoid being asked any follow up questions.

 

When having a conversation with someone who has dementia, aim to ask opinion based question. The beauty of an opinion based question is that it cannot be right or wrong—it is your opinion.  Instead of saying “did you go to the market?” you can instead ask “do you enjoy going to the market?” Once you get a conversation started about the market, you might help to trigger the memory for your loved one who can suddenly remember “I went to the market the other day!”  When not faced with the “test” of trying to remember, they may be better able to access the memory.

 

Asking about opinions or feelings keeps the conversation open and in the present tense.  Opinions are always in-this-moment, as we all reserve the right to change our opinions over time. Opinions don’t rely on short or long term memory. Opinions are not inherently right or wrong.  Expressing opinions and feelings rather than talking about facts and dates will allow someone with dementia to more fully participate in the conversation without feeling like they’re being tested.

 

So while this may be season for final exams, leave that to the students who are cramming, and let your loved ones with dementia have a free pass with no tests!

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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.

 

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? 

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