Have you ever been in a bad mood and can’t put your finger on why?
Have you ever been pissed off but are unable to say why you’re mad if someone asks?
Have you ever told someone you had a bad day but upon further questioning couldn’t explain why your day had been so bad?
Have you ever had an argument with a friend or family member that had you all riled up–although you couldn’t really remember what the argument was actually about?
That’s because emotion often lasts longer than cognition. Something puts you in a bad mood, and you stay in that bad mood long after you’ve forgotten what put you in that bad mood.
(I recently read something that asked: “Did you really have a bad day or did you have a bad five minutes that you allowed to ruin your whole day?” For me, the answer is usually the latter, but I’m working on it.)
Nowhere is this more true than Dementialand. This is why it’s important to start an interaction with someone who has dementia in a positive manner.
If I approach an individual with dementia and startle them…if I get upset with them for misidentifying me…if I raise my voice because they don’t respond to my greeting…if I do anything to increase their level of anxiety at the start of the interaction…the emotion this evokes stays with the person long after the memory of the moment is gone. Emotion lasts longer than cognition.
The “start-up” of an interaction is important (and this isn’t just true in Dementialand). Keep in mind that increased anxiety is related to decreased cognitive clarity. If we agitate someone, we should expect that their ability to think clearly will be compromised (again, not only true in Dementialand). If I yell at my college students before they take a test, I would expect them to not do well on the test. If I approach someone with dementia in a way that provokes anxiety, I would expect that they might be unable to respond to my questions. If I cause someone anxiety, they struggle to think clearly–even if after they’ve forgotten exactly what caused that anxiety.
Keep in mind that emotions are chemical reactions. The chemical reactions don’t stop when an individual can’t remember what caused them.
A few ideas for positive “start-ups” when interacting with someone who has progressing dementia:
- Approach from the front to give someone the maximum likelihood of recognizing you.
- Move slowly. The dementia brain takes longer to interpret visual data. You can make it easier for someone with dementia by avoiding spastic and sudden movements, which can provoke agitation.
- Say your name even if you think they know who you are. Many people with dementia have anxiety when they can’t remember who someone is but are too embarrassed to admit they don’t know the person.
- Wait for a cue (verbal or non-verbal) before moving into someone’s personal space.
- Remember that a person may struggle to understand words but can likely still interpret non-verbals. A smile goes a long way.
- If you greet someone and they don’t respond immediately, be patient. Don’t raise your voice in an attempt to get their attention or elicit a response. People with dementia take longer to interpret a greeting and formulate a response. Also, make sure you accept both verbal and non-verbal responses.
- When walking into someone’s house or bedroom, consider knocking as a courtesy. (This is an especially good idea when walking into someone’s room at a nursing home. We don’t generally take kindly to visitors walking into our bedrooms unannounced–people living in nursing homes are no different.)
- If the person seems distressed, appear concerned rather than overly happy. You want to show you are paying attention to their emotions. You can start with something like, “You seem angry to me” or “It sounds like you’re sad today.”
- Resist the temptation to get right in someone’s face if they are struggling to acknowledge you. It’s intimidating. (Do you like people up in your face?)
When I give tips like these, please don’t think my advice is from the perspective of a person who has these skills mastered. Sure, I know them and teach them. Yet, every time I interact with someone who has progressing dementia I could do something better.
In fact, I’ve started working on a series of posts that I might title something like “epic fails” and focusing on my own contributions to negative interactions with people who have dementia. When it comes to dementia, I’ve said the wrong thing only a million times. I’ve triggered meltdowns. I’ve caused stress and anxiety. I’ve made people cry. I’ve been cursed at and called names that would make frat boys blush.
Much of this could have been prevented had I changed my approach.
And in future posts you will get to read all about it….