You Can Never Win an Argument with an Alzheimer's Patient

"He tells me he wants to go home. We've lived here for 35 years, and when I try to explain to him, he gets mad at me." "I've told her time and time again not to put things in the waste basket, but she doesn't listen." "My Dad asks, 'Why don't the buses run by here anymore?' or 'How far is it to the river?' When I tell him it's 3000 miles to the river he gets mad, and says I am a fool. He thinks he's in Cleveland. He hasn't been there in 50 years."

We have a hard time letting go of the old habit of reasoning with our spouse, parent or friend who has been moved beyond reason by dementing illness. Rather than "teach" the woman not to hide things in the waste basket, we, as caregivers, must learn to accept this behavior as harmless and to check the waste baskets before emptying them. The woman whose husband wanted to go home learned that she only frustrated both of them when she tried to "explain" that they were at home. Rather, what worked was to go outside and walk to the corner and back. Upon entering the house a few minutes later, her husband was content. His short term memory was poor, and he would ask the same question again later, but there is an important lesson here: there is no reason why the patient's reality must conform to ours. We must not let our discomfort with our patient's condition lead us. If Dad thinks he is in Cleveland, what is the harm in that? If an Alzheimer's patient expresses a request that is obviously impossible, we may be tempted to respond with a "reasonable" explanation of why it cannot be done. A caregiver told me of the time her husband woke at one in the morning and wanted to go to San Francisco. Rather than explaining to him all the reasons why it wasn't a good idea, she said, "All right, but we'll have to get dressed first." And ten minutes into this process she suggested having some ice cream and then watching television, and then going to bed. His poor short-term memory allowed her to redirect him. No one underestimates the stress of being awakened at 1:00 a.m. and kept up for 40 minutes, but it could have been worse if the patient had become agitated in an argument about the appropriateness of a visit to the city. It sometimes helps to become a co-conspirator. Perhaps you have hidden the keys to the car, and Dad wants them. Or you've come to visit Mom and she accused you of taking the checkbook she mislaid. Instead of responding to the real situation, why he can't drive or Mom's history of losing things and the hurt of accusations, we might agree that the items are lost and offer to help look for them. After looking for a bit, suggest that "Well, we'll find them, but let's sort clothes right now. We really need to get this done." Wait for an opportunity to redirect, and always talk positively about the future. "It's going to be all right." Remember, you can never win an argument with an Alzheimer's patient. Of course, all this is easier said than done. We take a great deal of baggage into these interactions with members of our family. Perhaps you thought he was manipulative when he was well, and now you think he really knows. It takes time to internalize our knowledge about dementia and it is stressful. Support groups can help. These issues are a common theme and you can discuss your feelings and coping skills in an accepting atmosphere. Courtesy Alzheimer's Association -San Francisco Bay Chapter

Not Too Much Notice Recommended

Families and friends often wonder how much advance notice should be given to a forgetful patient when they want him to attend a certain function. Families find that when they let him know a day or so in advance, he spends most of this time asking if it's time yet. It is not advisable to give the forgetful person too much advance warning, but it is equally inappropriate to omit all notice of a trip or event. This notice, however, can be as brief as 30 minutes or less. This would be sufficient time to prepare the person physically and offer him the emotional support that is needed. Such an abbreviated warning also decreases the time in which the person can become anxious or resistant. An occasion for stress may occur when the forgetful patient is advised of a future event, such as a family celebration or a visit from a relative in a few days. Although helpers may think they are offering the individual something to look forward to, the person's ability to put the information into a future time frame is impaired. he may recall the words but he will continually relate those remembered words to the present. He may repeatedly ask, "Is my sister her yet? Is it time for dinner?" Understanding that these responses are caused by an extreme disorientation to time, and are not simply annoying devices or bids for attention, helps the caregiver avoid another occasion for stress.

Courtesy Alzheimer's Association Western North Carolina Chapter