My father is in the moderate severe stage of Alzheimer’s disease. I am fortunate that, at least for now, he is able to remain at home where he is well cared for by my mother. But despite the fact that my Mom has ample respite during the week, I am well aware that, at times, caregiving can be overwhelming and frustrating.
Recently, I asked my mother what part of my Dad’s care she finds most challenging. I fully expected her answer to be her role in assisting my father with his personal care, including dressing, bathing, etc. But I was wrong. What she told me was that my Dad’s frequent state of confusion—confusion about the time of day, day of week, where he lives, etc.—was hands down the most challenging. She explained how my Dad will repeatedly ask what day it is…what time it is…where he lives, etc. And while he seems satisfied each time she responds to his questions, he tends to “forget” an hour or so later, and will repeat the same questions again.
It is well established that the underlying cause of loss of sense of time is related to short term memory loss and confusion related to the progressive damage to brain cells caused by Alzheimer's disease. In the case of repetition, the person may simply not remember that she or he has just asked a question, nor do they remember the answer. However, recent studies also note that they may be trying to express a specific concern, ask for help, or cope with feelings of frustration, anxiety or insecurity that often accompany memory loss.
Here are some important steps to remember when dealing with repetitive dementia behavior:
1. First, stay calm. Being asked the same question over and over can be trying, but do your best to not show your frustration.
2. Focus on their emotions or the reason behind the repetitive questioning. Rather than reacting to what the person is asking, think about how he or she may be feeling. Try to imagine not knowing what day, month, or year it is. Are they bored, lonely, anxious, worried? Knowing the time may not be as important as the need to be reassured that they will not be late. Reassuring the person that you will ensure they are not late may be more effective than constantly reminding them of the time. The overall goal should be to create an environment that feels very safe and very secure.
3. Avoid arguing or scolding for repeating the question or attempt to correct them. This is important. Avoid saying, “Don’t you remember what I just said?” Alzheimer's disease affects memory and the person may not remember that he or she asked the question already. Also, the person with dementia may become angry and upset with the caregiver when they are told that they are repeating themselves, which can lead to further behavioral expression.
4. Try distraction or reassurance. If the person seems bored or lonely, sit with them and try to redirect to a new activity or conversation. A gentle hand massage and offering reassurance in a calm, gentle voice may be enough to allay their anxiety or frustration.
5. Provide an answer to the question that he or she is asking for, even if you have to repeat it several times but remember to keep the answer simple and brief. If the person with dementia is still able to read, write it down and post it in a prominent location.
6. Use memory aids such as clocks, photographs, calendars, and notes. Make it a habit to refer to the day and month every day. Displaying a daily or weekly schedule is also helpful.
7. Engage the person in an activity. The questioning may simply be boredom and needing something else to do. Try engaging the person in an enjoyable activity.
8. Travel with the person to where he or she is in time. If the person's memory is focused on a particular time in his or her life, engage in conversation about recollections with an understanding that this is his or her current reality.
9. If all else fails, ignore the question. If none of the above suggestions work, you may find that the only solution is to simply ignore the questioning. The person may eventually realize that he or she will not get an answer and stop asking the question.
10. Share your caregiving challenges with others. There are many caregiver support groups that can offer support and advice. Finally, try not to take it personally and if needed, take a break and leave the room for a few minutes.
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NewBridge on the Charles offers the Gilda and Alfred A. Slifka Memory Care Assisted Living Residences to seniors with early stage and mid-stage Alzheimer's Disease and/or a related dementia. The Memory Care Assisted Living Residences at NewBridge on the Charles provides a personalized and meaningful assisted living experience for residents based on the history, preferences and goals of each individual. Short-term stays now available.