Blog #13

A few years ago, one of my biggest fears in memory care came to pass. A resident made a comment about my weight. I knew it would eventually happen, I just didn’t know when or who would do it. It came out in a sideways comment, “You are about as big as a car! You could stand to lose 100 lbs!” It is not lost on me that it was said while I was asking this gentleman questions from the Mini Mental State Exam; I believe he felt embarrassed and threatened by my questions about what day of the week it was or what season it was, so I understood the context and read the room, professionally. I calmly completed the assessment and when I was finished, I walked to my office and took a few deep breaths, reminding myself not to take it personally.

It is so important to know your triggers. For years I have taught memory care staff to be aware of their triggers and what they are passionate about. Some examples of these triggers may be regarding self-image, race/ethnicity, gender, sexuality, political views, religious views, etc. When we know our triggers, we know to take extra care when the subject comes up so we can respond professionally.

We can’t take it personally. When we start to understand how dementia affects the brain, we learn that a person with dementia can’t help the changes to their social filter and inhibitions, and therefore we can’t take their unkind comments personally. When they go low, we need to professionally go high.

There must be zero retaliation. Healthy and knowledgeable caregivers know to let it go. This is where the “three deep breaths'' come in very handy! Do not respond to unkind statements or attempt to use logic to make your point. Reasoning and logic are often some of the first skills lost in a dementia diagnosis. Arguing or responding in-kind will only escalate the energy in the room, which leads to nowhere good. Simply redirect to a different topic of conversation. Giving triggering comments zero attention is the very best response.

In the words of a recent audience member at one of my presentations, “Sometimes being kind is SO hard! I get SO angry!” That is so honest and so well said! I think it is safe to say that being aware of our anger is the first step in attempting to take a new course of action.

It may be helpful to remember that the person with dementia can feel angry too. Often,anger translated sounds a lot like “I’m losing control.” “I’m scared.” “I’m lonely.” “I’m hungry.” or “I feel lost.” It’s important to know that when a person with dementia says unkind things, it may be due to a lack of filter but it may also be a coping mechanism. They are trying to hold on to any ounce of control they can and attempting to communicate as best they know how with limited vocabulary and self-insight.

As a person navigates memory loss, they may be losing control over a lot of aspects of their lives but as we all know, words CAN hurt as badly as sticks and stones. Hurtful and unkind words are one of the last tools a person uses to exert power and control. More on that to come in future blogs!

So what does the alternative response to their anger sound like? Try these phrases out sometime and see how it goes.

“I know you are upset. I can see that you are angry. I’m here to help.”

“I’m angry too. What can we do to make things better?”

“I get it. I would be angry too if that happened to me. I’m wondering if you could help me with something…” (redirect to a pleasant project like setting the table, walking in the garden, etc.)

“I know you are upset and I’m here to help. But before we go outside, let’s go to your room and get your shoes and jacket.” (ideally redirecting to a different topic as the physical direction/location changes)

“I love you and I care about you. I want to help you make things better.”

“I heard they are making homemade ice cream in the dining area. Let’s go see what flavors they have!”

“Let’s sit down and take a breather. We are both upset and neither of us is winning here.”

It is important to know that some people living with dementia have extremely challenging behaviors for which redirection, validation, and empathy do not always work. In these cases, I recommend that you speak to their primary physician to discuss alternative options to bring a bit of calm and comfortability to their body and mind. Please note that sedation is never the goal. Comfort is the goal for them and us.

An important disclaimer: It is important to note that chemical sedation/restraint is a form of elder abuse. Any attempt to change or control a person by chemical or physical restraints is reportable to the local Adult Protective Services. Always work closely with a medical professional when medications are used or changed.