Ways to Cope

So much can happen in a week. I learned the sad news that a gentleman I worked with, died on Monday. He became a friend in the short year and a half that I knew him and he was an amazingly talented musician who lived 93 years. It occurred to me that I only knew him for 1/90th of his lifetime. It was a miniscule amount of time in comparison to how long he lived, but long enough to leave a very strong impact on me. I’ll miss his views on life, his stories and his very gentle ways.

Another portion of the week was spent at an education forum put on by our local Cleveland Chapter of the Alzheimer’s Association during which time I was mesmerized as I listened to Dr. Maria Carrillo, Ph.D. discuss Alzheimer’s research and the effect of this disease on the brain. Over the years I have heard many descriptions of what the plaques and tangles are doing in the brain but something the Dr. said in answer to a question made me contemplative about who we each are as individuals. She discussed the fact that our brain cells are a network of communication. Then she talked about each of us having our own individual programmed code in those cells that make us who we are.

Alzheimer’s disease can steal away that code when it devastates and kills brain cells. Because of that, memories are lost and sometimes personalities change or behaviors begin that are new and challenging to understand and/or handle.

We have been addressing behaviors in the past several posts. Today, instead of going into a particular behavior, we’ll look at management skills from A to E that can help in general with most behaviors.

Assess: Take a step back and see if something is being communicated through the behavior. Is the person cold or tired or becoming sick? Could it be new medication or a urinary tract infection? Is someone new involved in care or is there a change in environment? For the person with dementia, it can take a long time to transition to new living arrangements or new care providers. It is helpful, if a person needs to move to a new place, to take pictures of their old bedroom and try to make the new bedroom as close to the old as possible to make the transition easier.

Bolster: Help them feel reassured. Talk in calming tones, use a comforting touch on the shoulder, arm or hand. The person will take their cues from the emotions they experience around them so calm and slow is soothing. It is often hard for the person with dementia to remember what, why, when, where and who. Therefore you become those answers for them. You are their comfort, security and safety net. Words like "I will take care of you." or "You are safe." are short and to the point and said in a reassuring tone can be very helpful.

Channel: Find ways to channel the behavior. You need to use a lot of energy to provide care, so instead of using up a lot of energy trying to stop what is happening, find an activity that might channel it in a different way. Activities like sorting through recipes, rolling and folding socks, rummaging in a drawer, looking at pictures, playing solitaire with letter cards or using pentominoes like a jigsaw puzzle, can take a behavior and “twist” it enough to redirect it. We had a person who used to love to smear the leftover food from her plate all over the table. Giving her a cloth to wipe the table channeled the same movement into something helpful. I also had a man who used to like to take things apart. He was destroying alarms and electrical equipment. We channeled his behavior by asking maintenance to give him things they were going to throw away. He could take them apart and then they got tossed.

Distract: Divert their attention to something else. This is different from channel in that channeling is taking what they are doing and trying to find a way that they can continue but in a different way, Distracting is trying a whole new tactic. Food is often a very good distraction. Singing or dancing is a distraction. Pets or a lifelike baby doll can be a distraction. Going for a walk or a drive is also a distraction, when possible. I would distract that same man who used to like to take things apart by telling him I needed his help in my office. We would walk to the office and I would give him bolts and hardware to sort while I worked on paperwork. We were side by side and for awhile his focus was distracted from taking anything apart.

Finally, evaluate: If a behavior is harmful to the person or to others then it is important to consider immediate action so that danger is avoided. It is always best to look at our attitudes in any situation because sometimes a behavior can be allowed to play itself out in a controlled environment, but not if there is any peril. It is very difficult to let a behavior play itself out because we would rather it just stop. However, safety always comes first, so that is a determining factor in what to do.

Skills for coping and for managing are learned over time and as many can attest, just as something is learned, often the situation changes and the learning begins again. But through it all, these are five guidelines that may be of help throughout. Mary Ann