Welcome to the “Tool Shed – top shelf!”  Tool Shed is helpful in those moments when you need a quick problem-solving idea.  It’s an ongoing, ever-expanding project.  Think of it as a “what to do when….”

In the near future I’ll be adding “Tool Shed – middle shelf” and “Tool Shed – bottom shelf,” as problem-solving tips increase.  Let’s go see what’s inside…

Eating with fingers

You find your loved one has switched from using utensils to using fingers.  This includes soups, gravies, even casserole dishes.  What’s going on?  Could be a couple things:

• Their depth perception is off.  As dementia increases, depth perception decreases.  They may be frustrated with the repeated attempts to simply pick up a utensil. This is followed by another frustrating time of trying to get a bite on it.  Too many failures produce irritation.  Best way they know to rid the irritation is to skip the utensils and use their fingers to eat.

TO OFFSET THE PROBLEM:  a) Gently guide their hand to the utensil or drinking vessel.  b) Put their food on utensil and guide their hand to their mouth.  c) Literally assist them with eating – as in feeding them.

• They have cognitively declined to where they no longer remember how to use utensils.     

TO OFFSET THE PROBLEM:  a) Model the eating behavior.  That often triggers a kind of automatic response.  They will copy you and begin feeding themselves.  b) Try switching to finger foods.  Nutrition won’t be a problem.

They’re telling “untrue stories”

It almost seems as though your loved one has lived a dual life by what’s coming out of their mouth lately.  The life you know about and the one they’re now sharing.

• Their reality may have shifted.  As the brain slowly dies it can create its own slant on reality.  It does this in part to make sense out of what is happening.  In fact, one of the main functions of the brain is to maintain a certain level of sanity.

TO OFFSET THE PROBLEM:  a) You will need to go to their reality.  They are not coming to yours.  To converse in a caring, nurturing manner, validate their feelings while ignoring the content of their statements.

For example, they say something like “I got fired today!  I simply can’t believe it, but they fired me!”  (Yet the facts are they retired decades ago.) You correctly respond with, “You can’t believe it, I see that!  I see you are in disbelief and shock.”

b) Never correct the storyline.  Work around it.  Respond with something like, “Oh, you must feel horrible, maybe even a little confused right now!  Have you ever been fired before?”  c) Sometimes the dementia allows them to completely play out a traumatic or PTSD moment over again.  This time, however, they can talk about their feelings.

More reasons for tales…

• THEY MAY BE AT A LOSS FOR WORDS.  One of the first signs of dementia is the struggle to recall nouns.  Decline in language ability and skills increases as time progresses.  Sometimes they turn to Word Salad.  Other times they make noises in place of certain words.  I remember Mary at one locked dementia facility.  Forgetting the word “bathroom,” she made a “pshhhhhhh-“ing sound.  I immediately knew her need was for a restroom!

TO OFFSET THE PROBLEM:  Follow the clues given within their intonations, facial expressions, and body language.   They are mood indicators that will guide you in your validating responses.  Content of shared information is not important.  Feeling validated is.

• May be expressing their problem within a completely different storyline.  They will tell a completely different story that, somewhere within it, lies the need they cannot verbally express.  For instance, in response to, “How did you sleep last night?”  They might say, “I couldn’t stop dancing all week long.”  In reality that could mean many different things.  Restless Leg Syndrome.  They tossed and turned.  Bathroom runs were abundant…. and so on.

TO OFFSET THE PROBLEM:  Ask questions to clarify.  “You didn’t sleep well?”  “Were your legs shaking last night?”  Once response is identified, validate their feelings about it and tell them what will be done to fix it.

Refusing to bathe

Probably the number one problem between caregiver and loved one is bathing issues.  Regardless of past history, and for a plethora of reasons, the loved  one stops bathing.  Let’s look at a few possibilities.

• FEARFUL THEY WILL SLIP AND FALL.  TOO NOISY.  DIMLY LIT.  WATER SPLASHING IN FACE.  NO DEPTH PERCEPTION.  All these deal with fear of harming themselves or dying.

TO OFFSET THE PROBLEM:  a) Reassure them while validating their feelings.  This will help them better understand you have got their back.  b) Let them “decide” to shower… “Mom, you want to shower now or after one more cup of coffee?”   Repeat their own words back to them,  “Ok mom,  You want one more cup of coffee and then you’ll shower.  That’s great!”  c) Hire in-home care to come and bathe them.  d) Take them to a care facility to be bathed, using activity program as a pretext.

Exit seeking

Your loved one may be getting lost frequently now yet they thoroughly love to walk, investigate new places, sounds, and smells.  Specific to dementia, you may find they love passing in and out through doors.  Telling them they can’t go out on their own doesn’t work, trust me.

• Dementia comes with a certain amount of anxiousness.  That amount depends on each individual.  But regardless of amount, walking it off is really a very therapeutic way to relieve some of the tension.  Safety, however, is another matter altogether.

TO OFFSET THE PROBLEM:  a) If they live at home, add locks to all doors. Poles for sliders and chain lock for regular doors.  Put chain lock up as high as possible on doors,  b) Alarm all doors and windows.  They will alert you if they are in the process of exit seeking.  c) Get a GPS bracelet or necklace for them to wear,  Check regularly to make sure they are wearing it.  d) May be time to consider facility care,

Sundowning

Mid afternoon-ish you see their mood-state dramatically change.  Maybe irritated and agitated with everyone and everything around them.  It can be a horribly distressing time for them.

TO OFFSET THE PROBLEM:  a) Keep all rooms well lit.  b) Validate their feelings.  They may struggle to say something with it coming out to be “I DON’T, I DON’T, I DON’T!!!” Be affirming.  “You don’t have to,  You’re right.”  c) Speak calmly,  d) Keep stimuli to a bare minimum.  e) You needn’t always figure out what they’re saying or meaning during this time.  Just remain nurturing and use that validation.  f)  Check with physician, maybe Valerian Root supplements may offer some relief.

Calling others by incorrect names

Confusion increases as mom refers to “Uncle Harry” as “William, one of her kids.”  You gently correct but instead of a thank you, you find you are in the midst of a tirade focused directly on you.

• What’s happening is the loved one is losing their learned assimilation labels for things.  This means proper names for everything is slowly disappearing.

TO OFFSET THE PROBLEM:  a) If you know who they’re talking about, don’t correct…. “I’m so glad William could come over today.”  “Mom, that’s not William,  That’s Uncle Harry.”  That will only create anger and frustration.  To do so would be an affront to them.

Instead, just simply acknowledge with something like, “Oh, Uncle Harry, yes.  I see you are very glad he made it over today.  Me too.”  Then move the conversation along.  b) If you don’t know who they are referring to, validate their feelings like we did in “a)” by echoing back their feelings,  c) Give them plenty of verbal cues:  “Hi dad, it’s me, your son, Garth!  And I have your granddaughter, Lucy here with me.  She wanted to see you today.”  d) They’re not sure what’s going on, tell them.  “We were missing you so we thought we’d come and see how you’re doing,

Remember, short term memory is poor and information must be refreshed every 60 seconds for them to stay on task.