By: Todd Wagoner, LCSW
What’s predictable about Alzheimer’s disease and other types of dementia is that the disease itself is unpredictable. For many care partners who observe the progression of dementia, it’s not unusual to see changes in the care recipient’s ability to process and remember the information they receive as well as experience an overall decline in their functional abilities (bathing, dressing, eating, and sometimes, walking). Care partners routinely wake up knowing that not every day will be the same. Some days a care recipient will reflect the spouse or parent they were twenty years ago, leaving the care partner to think the disease doesn’t exist. However, care partners may wake up only to observe the personality is completely different and displaying behaviors they would never think to see. In these moments, care partners benefit in knowing key strategies to help guide them through difficult moments that can rise to the level of a possible crisis. Here are some ideas to keep in mind:
- Differing Realities – As noted, the care recipient perceives the world differently, so their ability to communicate their needs (hunger or pain) and understand why they are anxious requires the care partner to be prepared to know how to respond when difficult moments arise.
- Personal Inventory – As a care partner, be mindful of your temperament. Does your face or actions express stress and frustration? If so, the care recipient will reflect your feelings, so it will be important to be patient, create a calm atmosphere, and be aware of your feelings and actions.
- Slow Down – Approach the care recipient with a smiling face and know your nonverbal tone sets the tone for the interaction. Speak calmly, approach from the front, and meet them at eye level. Speak using short sentences to not overwhelm the care recipient with too many thoughts or instructions.
- Don’t Argue – If behaviors begin to escalate, it is best not to argue. What the care recipient is thinking and feeling is very real based on their perception of reality. Don’t challenge their thinking as this may worsen the situation. For instance, if the care recipient says he/she needs to get ready to go to work, the care partner can respond with, “Okay, then let’s go have breakfast first.” The response is supportive, using a pleasurable task without being argumentative.
- Validate Feelings – Respond to the care recipient’s emotions, and not their words. Express how sorry you are if the care recipient is upset. Voice how you think they are feeling to allow the care recipient to feel heard. For instance, the care partner can say, “I know that can be frustrating. I would be upset too.” It’s very important for the care recipient to feel understood as you try to join their point of view.
- Reflect Thoughts and Ideas – As you connect, begin to mirror their actions and consider an activity to distract or redirect their actions — for example, pace alongside if the individual is pacing. Or, use a serious and indignant tone if the care recipient is upset about some injustice. Also, food is a prime motivator and can be used to distract in these moments, as noted in Strategy #4.
- Structure and Routine – Individuals with dementia benefit by receiving a consistent structure to their day. Structure and routine help lessen the care recipient’s feelings of stress and anxiety, which can lead to increased irritability and agitation. Also, helping the care recipient to engage socially serves as a healthy distraction while giving the care recipient a place to spend their anxious energy. Consider connecting with a local adult day program where the care recipient can participate in a social environment designed for cognitively impaired individuals. Adult day centers offer opportunities for individuals to enjoy activities while providing the care partner a brief break to rest, run errands, or finish other tasks.
- Medical Assessment – If the observed behaviors don’t improve by utilizing the above approaches or the behaviors worsen with the addition of auditory/visual hallucinations, consider having the care recipient seen by your primary care physician. An increase in behaviors may be the result of some form of infection, such as a urinary tract infection, which is treatable. If the primary care physician is not available, a local med check or urgent care office can be a good secondary option.
- Crisis Intervention – If the behaviors continue to escalate where the care recipient is becoming aggressive (physical or verbal), and safety for all parties becomes a concern, a formal crisis evaluation may be necessary. To complete a crisis evaluation, contact your local mental health crisis center or transport your care recipient to your local hospital emergency room. Now, it’s important to note some crises are too dangerous to transport to an emergency room, so it is best to call 911, where first responders can help deescalate the situation and begin a plan to secure everyone’s safety. If you do call 911, make sure to tell the responders the person is living with dementia, which may cause them to act aggressively. **Please see disclaimer below
- Final advice – As Jeff Puttkammer and Keri Fitzpatrick wisely state, “Communication with a person who has dementia can be rewarding and frustrating within the same five-minute time span. Fear is a prevailing feeling for those with dementia, and providing a sense of safety can be the number one response they need.”1
Reference:
Dementia De-escalation: Proven Verbal De-escalation Strategies for People with Dementia – https://hss-us.com/getmedia/d94b237d-db55-4e69-a3b6-528a75f0a0e8/Dementia-Deescalation-WhitePaper.pdf.aspx
Medical & Crisis Intervention Disclaimer
While the Gayle Wells Foundation for Early Onset Alzheimer’s & Care (GWF) makes every attempt to ensure material provided on this site is accurate, current, and complete, the information in this post and on our website is not designed to, and does not, provide medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis or treatment. Municipalities, cities, counties, and states vary on crisis intervention training, policies, and procedures. Please contact your physician, healthcare provider, local dementia clinic, mental health clinic, and/or emergency room to determine the best action to take should you be faced with a crisis.
You are encouraged to confer with your doctor with regard to information contained on or gathered through this website. You are encouraged to review the information and develop a crisis plan with your professional healthcare provider.
Todd Wagoner is a Master’s level clinical social worker with over 25 years of health care experience in hospital discharge planning and, most recently, serving as geriatric social worker for the Touchpoint Healthy Aging Transition Services, a geriatric specialty clinic through the Community Health Network in Noblesville, Indiana.