Autonomy is the ability to make choices in our lives according to our own freewill. Some choices we don’t get to make. Driving on the wrong side of the road, not paying taxes are two great examples. Nevertheless, that still leaves us with an infinite number of choices we can and do make throughout our day.
Within its very design, autonomy allows us to express our own values and interests. Letting each of us be distinctive individuals with our own unique preferences. It is important to everyone. It strengthens our sense of value and self-worth. Conversely, it causes depression in those who feel it has been restricted or taken away.
Maintaining a healthy sense of autonomy is vital to us all. However, it is crucial for a person with memory loss. It promotes a sense of success while preserving a common routine in the midst of a continually declining cognitive process. As a result, a loved one can feel successful through a real or perceived sense of normalcy. Just as they have grown accustomed to doing their entire life.
ONE OF THE FASTEST WAYS TO PROMOTE
UNWANTED BEHAVIORS IS TO GIVE YOUR
LOVED ONE THE IDEA YOU HAVE USURPED
THEIR AUTONOMY. REAL OR IMAGINED
An alert mind can tell if they are autonomous or not. A person with dementia no longer has that same ability. Yet ironically, they absolutely know when someone is usurping their autonomy. They intuitively sense it.
Sensing their autonomy wall to have been breached (whether it has been or not), generates unwanted behaviors. Often catastrophic responses, regardless how benign the situation may seem.
Maintaining autonomy
How then, is a sense of autonomy maintained? Many preferences the loved one used to decide for themselves are no longer possible. Now it becomes necessary for you to give them a sense of autonomy. “Manually” restore those decision-making options back to them. Some being real choices and many others as perceived.
A loved one might say, “I’m tired. I’m going to lay down for a bit.” That is a real choice they made. You in turn say, “Okay Dad. Want me to close the curtains in your room or leave them open,” illustrating a perceived sense of choice. Perceived because you are directing their options as opposed to letting them set the perimeters. Small difference, but critical to understand.
Ordering a loved one to accomplish a task completely usurps their sense of autonomy. “Put on your shoes while I wash the dishes,” for example. It will cause them to act out with agitation, aggression, depression. Even carry its weight to the point they may develop failure to thrive syndrome.
“Do you want to put your shoes on or brush your teeth while I wash the dishes?” Here the loved one is given the perceived choice. They get to design their day.
Thinking linearly is beyond the loved one’s scope. Pre-onset dementia goals have shifted somewhat compared to the “goals” they now have today. In fact, most likely they no longer think in the terms of daily goals. .They have become instead the urges in the moment. That’s exactly why we need to give them real and perceived goals throughout their day.
Redundantly ask them questions. Anything you can think of. “Are you warm enough or do you want a sweater?” “Do you want to wash the dishes or dry them?” “Can you hear TV okay or do you want me to tun it up a little.” “Want a cookie for a snack or an orange?”
Reparation
A great indicator you have been or now are usurping their autonomy can be evidenced in their responses.
Already sensing their autonomy has in some way been breached, they become resistant to anything you have to say. Not always able to discern whether you are asking as opposed to telling them, elicits a negative or declining response. Just in case.
A sound autonomy is an important part of their psychosocial well-being. And a healthy psychosocial well-being eliminates many if not all unwanted behaviors. Most importantly, accomplishing these behaviors without the addition of harmful medications to “enforce compliance.”
Two great methods you can use separately or collectively in getting them to break the defiant cycle:0
- Keep asking questions until they finally give a positive response. Maybe something like this: “Would you like to watch your favorite TV program?” “No.” “Want a chocolate covered cherry?” “No.” “Laundry is done. Want to help me fold some nice warm towels?” “No.” “Do I still owe you $20? “Yes,” with a giggle. You just broke through.
- Use redirection of thought. Redirect a negative or damaging thought pattern which is currently being entertained. In essence offer an exchange of one idea or task for another. Short term memory lasts maybe 60 seconds or so. This allows you the opportunity to begin segueing their thought process on to something more advantageous to their quality of life.
Psychosocial encouragement
- Give them a small gift to unwrap, showing your love. Simple things like a package of Kleenex, a couple cookies in a beautiful bag. How about a pack of colored markers or a deck of playing cards?
- Ask them how to do something. “How do I check the oil in the car?” for example.
- Play little games. “Pick which hand has candy in it!”
- Learn their favorite topic then ask them about it regularly. “You used to take pictures of Pluto? How’d you know where it was in the sky?!”
