Tag: depression

5 reasons they sleep or watch TV all day

Do you often ask your loved one or residents living with dementia if they “want” to do something…and get turned down? I’ve met a lot of caregivers who make the assumption that their loved ones living with dementia “don’t like to do anything.” “No, she just likes to watch TV and sleep all day,” Marie told me. “My mom was always really active…but I guess with her dementia she just doesn’t want to do the things she used to do.” This really wasn’t true: Marie’s mom, Barbara, did want and like to do things, but she just didn’t realize that she had an option. If you ask someone with dementia if they “want to” do something, you’re probably going to get a “no.” That “no” is most likely because your loved one didn’t understand the question, not because they actually dislike doing activities. Here are a few reasons why people living with dementia will sit in front of the TV all day: They don’t realize that there’s anything else to do. People living with dementia have a hard time taking “initiative” to start a new task: you know this if you’ve ever watched someone transition from brushing their teeth to combing their hair. Starting a new task can be confusing if you aren’t sure of the steps. Just like this, your loved one didn’t realize that there was anything else to do besides watch TV, and they wouldn’t know how to start doing it, either. They are worried they’ll “do it wrong” if they attempt something new. No one wants to feel stupid, look silly, or seem incompetent. If what you were asking was too complicated, try breaking it down into steps. “First, we are going to paint this birdhouse together.” When it’s done, explain the next step. “Now, we are going to put it outside and sprinkle some birdseed!” They didn’t understand what you were asking. If you asked someone if they “wanted” to do something, you probably got a “no thanks.” Instead, ask them FOR HELP with the task. I can’t stress this enough: do not ask if they “want to help you” but instead ask, “CAN YOU HELP ME with….” Make them feel necessary and important to the task. You can also just offer a hand. “Here, come with me,” you say. You were asking them to do something that was too difficult or confusing. Like in number two, break it down into steps. Make it seem like you need them to help you with it. They are depressed. Depression and dementia often go hand-in-hand. Fortunately, depression is often quite treatable with the right medication and behavioral interventions like exercise and social activities. Ensure that a physician checks into your loved one’s potential depression.

July 11, 2021

Why the loss of control motivates most “behaviors”

Are you enjoying my blog posts? Grab a free download of one chapter from my audiobook here and also receive any future helpful tips and posts right to your inbox! Cecilia was having a hard time. Suddenly, she couldn’t do all the things she used to do. She had once owned her own business, handled all her finances, made her own daily plans, raised children, and more. Now, with dementia, she couldn’t manage those tasks. Now, her family was doing everything for her, and it made her angry. “Stop messing with my checkbook!” she yelled at her son. “When did you last take the trash out?” she asked her husband with a tone of frustration. Often, she stayed in bed, saying she didn’t “feel well.” This was very new for her family—they’d never seen her like this! It was no wonder that Cecilia seemed annoyed, detached, and anxious! She was once a woman who handled everything in her life, but now, with dementia, she had lost a lot of control. A feeling of control is important to most everyone: we want to know that we have the ability to make choices and change things in our lives if we want to. When we feel like we have no control, we start to panic. It makes a lot of sense that Cecilia was so agitated and irritable with her family: it stemmed from fear. Many of the “behaviors” we see in dementia (hoarding, irritability, accusations, etc.) come from a place of fear, and that fear is usually based on a loss of control. How do we help someone who feels this way? The best thing to do is to give them back some of that control. Obviously, you can’t let your confused loved one fill out the checkbook, but you can let them help you make a budget. Ask your loved one “for help” when completing a task, even if you don’t need (or want) help with that task. This is another reason why chores are such a great thing to try with people living with dementia: they are task-based, often simple, and part of daily life. Even in late stages, most people are able to fold a hand towel or match up socks with some assistance. Ask “for help” (not if they WANT to help, but rather if they CAN help you) and see the change in your loved one’s behavior. No one wants to feel like they lack control over the most basic parts of their existence. Have you signed up to receive my blog posts?

March 10, 2019

5 reasons they’re watching TV or sleeping all day

I’ve met a lot of caregivers who make the assumption that their loved ones living with dementia “don’t like to do anything.” “No, she just likes to watch TV and sleep all day,” Marie told me. “My mom was always really active…but I guess with her dementia she just doesn’t want to do the things she used to do.” This really wasn’t true: Marie’s mom, Barbara, did want and like to do things, but she just didn’t realize that she had an option. If you ask someone with dementia if they “want to” do something, you’re probably going to get a “no.” That “no” is most likely because your loved one didn’t understand the question, not because they actually dislike doing activities. Here are a few reasons why people living with dementia will sit in front of the TV all day: They don’t realize that there’s anything else to do. People living with dementia have a hard time taking “initiative” to start a new task: you know this if you’ve ever watched someone transition from brushing their teeth to combing their hair. Starting a new task can be confusing if you aren’t sure of the steps. Just like this, your loved one didn’t realize that there was anything else to do besides watch TV, and they wouldn’t know how to start doing it, either. They are worried they’ll “do it wrong” if they attempt something new. No one wants to feel stupid, look silly, or seem incompetent. If what you were asking was too complicated, try breaking it down into steps. “First, we are going to paint this birdhouse together.” When it’s done, explain the next step. “Now, we are going to put it outside and sprinkle some birdseed!” They didn’t understand what you were asking. If you asked someone if they “wanted” to do something, you probably got a “no thanks.” Instead, ask them FOR HELP with the task. I can’t stress this enough: do not ask if they “want to help you” but instead ask, “CAN YOU HELP ME with….” Make them feel necessary and important to the task. You can also just offer a hand. “Here, come with me,” you say. You were asking them to do something that was too difficult or confusing. Like in number two, break it down into steps. Make it seem like you need them to help you with it. They are depressed. Depression and dementia often go hand-in-hand. Fortunately, depression is often quite treatable with the right medication and behavioral interventions like exercise and social activities. Ensure that a physician checks into your loved one’s potential depression.

November 27, 2018

Don’t ask someone with dementia if they “know your name” or “remember you”

If I can, I always opt to ditch my name tag in a dementia care environment. I let my friends with dementia decide what my name is: I’ve been Susan, Gwendolyn, and various peoples’ kids. I’ve been so many identities to my residents, too: a coworker, a boss, a student, a sibling, a friend from home, and more. Don’t ask your friend with dementia if they “remember your name” — especially if that person is your parent, spouse, or other family member. It’s quite likely to embarrass them if they can’t place you, and, frankly, it doesn’t really matter what your name is. What matters is how they feel about you. Here’s my absolute favorite story about what I call, “Timeline Confusion”: Alicia danced down the hallway, both hands steadily on her walker. She moved her hips from side to side, singing a little song, and smiled at everyone she passed. Her son, Nick, was walking next to her. Nick was probably one of the best caregivers I’d ever met. It wasn’t just that he visited his mother often, it was how he visited her. He was patient and kind—really, he just understood dementia care. He got it. Alicia was what I like to call, “pleasantly confused.” She thought it was a different year than it was, liked to sing and dance, and generally enjoyed her life. One day, I approached the pair as they walked quietly down the hall. Alicia smiled and nodded at everyone she passed, sometimes whispering a, “How do you do!” “Hey, Alicia,” I said. “We’re having a piano player come in to sing and play music for us. Would you like to come listen?” “Ah, yes!” she smiled back. “My husband is a great singer,” she said, motioning to her son. Nick smiled and did not correct her. He put his hand gently on her shoulder and said to me, “We’ll be over there soon.” I saw Nick again a few minutes later while his mom was occupied with some other residents. “Nick,” I said. “Does your mom usually think that you’re her husband?” Nick said something that I’ll never forget. “Sometimes I’m me, sometimes I’m my brother, sometimes I’m my dad, and sometimes I’m just a friend. But she always knows that she loves me,” he smiled. Nick had nailed it. He understood that, because his mom thought it was 1960, she would have trouble placing him on a timeline. He knew that his mom recognized him and he knew that she loved him. However, because of her dementia, she thought it was a different year. And, in that year, he would’ve been a teenager. Using context clues (however mixed up the clues were) Alicia had determined that Nick was her husband: he was the right age, he sure sounded and looked like her husband, and she believed that her son was a young man. This is the concept that I like to call timeline confusion. It’s not that your loved one doesn’t recognize you, it’s that they can’t place you on a timeline. What matters is how they feel about you. Not your name or your exact identity. Are you receiving my emails? Sign up now!

July 24, 2018

What do I say when mom asks where my dad is?

It’s a question I hear often. I’ve heard it many different ways, from many different people, in many different scenarios, but it’s always the same type of question: “My ____ has passed away, and my loved one with dementia keeps asking about where they are. What do I tell my loved one?” No one wants to feel like they are “lying” to their loved one with dementia. I encourage you, however, to take the word “lying” and to throw it right out of your vocabulary in dementia care. When we take the time to get into someone’s else’s world (embrace their reality) we aren’t lying to them. We are just meeting them where they are. Many people with dementia will, at some point, have trouble remembering that the loved one they miss is dead. It’s not our job to remind them. In fact, it’s much nicer if that person doesn’t realize that their friend or family member has passed away, don’t you think? In order to get in that person’s world and answer their question correctly, I usually tell people to ask this: “I don’t know, where do YOU think that ___ is?” You’ll probably get an answer like, “I think he’s at work,” or, “I think she’s out with her sister.” Agree with this answer. “Yes, I think you’re right, he must be at work,” or, “You’re right, I remember now, she’s with her sister.” You don’t need to be creative—you just need to be a good listener. Your loved one with dementia wants an answer, they don’t want the runaround of a redirection or a distraction! You can provide them with an answer that satisfies both of you. And, recall that “lying” is not something you need to worry about. Embrace your loved one’s reality, and you’ll both be happier for it.

November 7, 2016

Fear & Dementia

I received an interesting email from a woman who follows my blog posts. She wrote, “There is one thing I have not found much information about that I am hoping you might address in a future blog [post]: fear. Not fear of Alzheimer’s, or abandonment, or even dying. My husband has started to fret about things which neither concern him nor over which he has ever had any control…things like other drivers being pulled over, how the grocer displays merchandise, what type of shoes another person is wearing. I have read articles regarding fear, anxiety and anger in caregivers but can not find much on fear and anxiety in the patient.” Fear in people with dementia is common. We usually call it “anxiety,” but I suppose it all comes back to fear: fear that they won’t “get back home,” concern about where loved ones are, anxiety about where they are and what’s happening next. “Hey, where is my daughter?” Christina asked, standing in my office doorway. “She abandoned me, I know it!” Christina began sobbing suddenly. Christina regularly enters these fits of fear. She decides that someone has abandoned her, that her children are dead, or that she can’t find her cat (who lives at our community). I’ve found that the best solution for this type of fear is a combination of two things: anti-anxiety medication and a calming, reassuring caregiver and positive environment. For many of my residents, just calming or reassuring them doesn’t work. Anti-anxiety medication can work wonders for people who need extra help. As I often explain to caregivers who are leery of “drugging” their loved ones, it’s not about “quieting someone”: it’s about taking the edge off of someone’s anxiety and fear so that they can breathe easy. If someone with dementia is so upset and fearful that redirection and calming measures don’t work, there’s a problem there. Medication exists for a reason. All the reassurance and redirection in the world won’t work if the person with dementia is so upset she can’t even hear you. As we know, people with dementia won’t remember what we said, but they will remember how we made them feel. They’ll be able to feel better, and focus on your words of positivity and reassurance, if they aren’t feeling as though the world is crumbling around them.

May 19, 2016

Death & Dementia.

“What happens when your residents die? Do your other residents get upset? Do they remember that person?” many people have asked me. Angela* has fairly advanced dementia and lives in our community. One day, we received some bad news. Her family emailed us to let us know that her husband, who lived outside the community, had died. They didn’t know what to do—should they tell her? I emailed back and said that, no, they should definitely not tell Angela. Although it seems cruel to “keep her in the dark,” telling her the terrible news wouldn’t do any good. Her dementia is advanced enough that hearing this news would no doubt confuse her. Angela is beyond the point of being able to completely comprehend or deal with something this traumatic. Inevitably, she would soon forget what she’d been told, but she would still feel upset—she just wouldn’t know why she was feeling that way. Angela remembers her husband. When he would come to visit her, she’d go and greet him at the door. It was nice to see them sitting close on the couch, holding hands. It’s not fair, though, to force her to come to terms with the fact that he’s died: in her world, he’s still alive. Hearing it once wouldn’t count for anything, either. She would never recall that he’s passed away after hearing it once, twice, or two hundred times. In other words, it’s just not worth causing this woman any unnecessary pain.

November 12, 2014