When Responding to an Alzheimer's person . . . always start with the 4 "R"s.

Reassess

Rechannel

Reassure &

Reconsider

REASSESS:

When you work with a dementia person exhibiting an undesirable behavior Ask yourself the following things:

1) Is there a reason for this behavior?

2) Are they frustrated because of their inability to do something?

3) Are they uncomfortable about a situation?

4) Is there to much noise?

5) Too much activity going on around them?

6) Or TO LITTLE stimulation?

Remember, inactivitiy as just as bad as too much. So don't be afraid to reevaluate! Especially if a behavior develops.

RECHANNEL

In other words . . . distract. If the person is doing something annoying then try to redirect them. How?

** Give them something they can do.

** Fold clothes

** Straighten magazines

** Push in chairs . . . wipe off tables And if it's an annoying habit, like throwing out the newspaper, then, hide todays . . . . and leave out yesterdays. The key . . . is having a Creative imagination and using it often.

REASSURE

Living in a world that they don't understand, they need lots of assurance. After all they are living in a world where people:

** Do things to them without giving them time to understand why.

** They are among people they may not recognize.

** The environment may be to noisy

** To busy

** To hurried.

So they constantly look for reassurance. And how can you give it? With soothing words, or a tender touch. Even a pat on the back or a hug can make all the difference in the world. Because it offers comfort . . . and assurance, that everything is ok.

RECONSIDER

** Try seeing things from their point of view.

** Every thing is a misconception.

** The world around them is increasingly abnormal.

** Everyone they see . . . is a stranger . . . And yet, they are forced to live in a world that is incomprehensible. Always remember for them, reality is like living in a world where everyone speaks a language they don't understand.

COMMUNICATIONS

First and foremost: ALWAYS introduce yourself, even if you've just seen that person 5 minutes ago. Because in that 5 minutes, they may have forgotten you! Begin only when you have made eye contact. (This allows to you judge how much they are absorbing.)

** Choose short simple sentences, but always address them in an adult manner.

** Give the person extra time to respond to your questions. It takes them much longer to process information.

** Carefully monitor your tone of voice. While they may not understand the context of what you want, they are very skilled at reading emotional messages like irritation or anger.

** If you cannot understand what they are saying, try to respond to the emotional aspect.

** When explaining something, always use the same tone and same gestures . . . everytime.

** Give the person one instruction at a time. If necessary, break down the instructions into separate steps.

** And never ever talk about the person while they are present.

REPETITION

I call it the "struck in the rut" symptom because they'll ask the same question, or do the same thing. . . over and over and over again. After a while, it can drive you bonkers . . . So what can you do? DISTRICT!

** Take them for a walk.

** Give them a snack

** Play music,

** Give them something physical to do like

** Rolling coins,

** Fold towels

** Or sweeping.

** If all else fails, just do your best to ignore it.

HALLUCINATIONS

Another common problem that develops in dementia is hallucinations. This is kind of a tricky one because we don't see what they see, or hear what they hear. But that still doesn't make it less real to them. So how do you deal with an hallucination? First:

** Never argue with them. It does no good to tell them what ever it is . . . isn't real. So if someone says "my mother is coming" say Really? "I know you'll have a wonderful time". BUT! If it is something that is frightening them, then you have to address it. So if they say " there's a mean dog in my room"

** Instead of saying "No there's not", say: "Really!, Well I can see why you're afraid. But don't worry, I won't let it hurt you."

** And if nothing else, give a noncommittal answer.

SUNDOWNING

It's a symptom that occurs in the afternoon and evening. Why does it happen? No one really seems to know, but at a guess I would say fatigue has a lot to do with it. So how do deal with it?

** Be adaptable.

** Reduce the number of things going on.

** Keep distractions at a minimum.

** Keep activites during that time of day as simple as possible, and even simpler after the sun sets.

** If they begin to pace, then just keep an eye on them because to try and stop them, will only bring about a catastrophic outburst.

CATASTROPHIC OUTBURSTS. . .

Believe it or not, the most common form of catastrophic outburst is crying, although it isn't limited to just that. For some people though, a catastrophic outburst causes violence. And that's what I'm going to address. If someone becomes verbally abusive

** Try to just ignore it.

** Also, look for the reason it's happening. Is there to much noise? To much activity?

** Try to distract the person. (by changing the subject. . . offer a treat.)

** Keep your voice calm and soothing,

** And do not argue. For a physical outburst:

** If you feel threatened, walk away.

** If you need to remove the person from an area, call for assistance. Because your first obligation is to protect yourself and anyone who might be in harms way.

** Remove any objects that may be used as a weapon. (This can be a book, a wheelchair or walker)

** Give them plenty of space and when you approach

** Do it slowly and very very cautiously.

** Make eye contact with them.

** And if you don't know whether it's safe, stay back and hold out your hand in a non-threatening manner. And that is where the 5th "R" comes in. If you feel you are in danger . . . "RETREAT"!

ACTIVITIES of DAILY LIVING

On the other hand, problems also appear in ADL's. When their abilities begin to decline, things like bathing and dressing becomes a dilemma. So how do you overcome . . .these problems? Let's start with bathing;

BATHING

To begin with,

** Always bath the person first thing in the morning because that is when they are most agreeable.

** Always prepare for the bath ahead of time.

** Have the tub filled and waiting.

** Have the towels layed out. etc.

** Take the task of undressing, one step at a time. (First we're going to take off your robe. Now we're going to take off your gown.)

** Do it in an unhurried manner, taking as much time as they need.

** If they do not want to remove their clothes. Then don't insist. Allow them to get in the tub with their clothes on.

** Once the clothes get wet, they are going to want to take them off because they're uncomfortable.

** If they are embarrassed about their nudity. Drape a towel around their neck. And then reassure them they are no longer naked.

** Have them help as much as possible.

** If they can bathe themselves somewhat, then let them. And just use directions to help the process along.

** If they can't do it, then have them hold the washrag for you. And offer lots of praise for being such a big help.

** If they become fidgety and you're not done. Distract them. Say something like; "Doesn't it feel good to be clean? Gosh you smell nice. Just like a rose". Or even . . . "boy are you ever pretty. What lovely hair you have. I wish I had hair like that."

Again . . . be creative. And if nothing else works . . . SING! So what if you're not a good vocalist, it won't matter to them, especially if they are joining in along with you.

As for DRESSING.

That can be a challenge sometimes. Especially if they are overwhelmed by to many choices, or if they can't find what they are looking for. A few simple tricks?

** Reduce or eliminate choices, by hanging only one or two outfits in the closet.

** Label drawers (as in "this is where your socks are, this is where your underwear is".)

** Have the family select different clothing. Things that don't have buttons and zippers.

** You can also try putting out clothing one piece at a time. And in the order of how they are put on.

** And above all else, provide step by step coaching.

SEXUAL BEHAVIORS.

That is probably THE most misunderstood symptom. What we see as misbehavior . . . may be something else entirely. What do I mean? When someone comes to me and says, " so and so is removing their clothing" the first thing I think is "what's causing it?" If Maddie removes her blouse, I think

** Is the bra to tight? The shirt uncomfortable? Maybe the tag in the back is scratching her. If Joe exposes his penis

** I find myself wondering if he has to go to the bathroom. They may also do something because of visual agnosia. Which is the inability to comprehend what they see. When that happens, they might very well urinate in a trash can or sink because they misinterpret it as a toliet. However, as the disease progresses, they do become active masturbaters. Now, while that may make a lot of people uncomfortable, the simple truth is, it is one of the few pleasures they have left and we just have to accept it. So if a person starts to masturbate, simply remove them to a private area. And finally, if you can't figure out the reason they are removing their clothes or exposing themselves, simply cover the person with a butcher apron. If they can't get to the clothing . . . the problem stops.

The 5 Things To Remember:

** Always introduce yourself

** Distract (when necessary)

** Look for the reason something is happening

** Be willing take things one step at a time, explaining everything as you go along. And finally . . . .

** Be creative.

**footnote**

I developed the 4 'r's from using Harriet Hodgsons methods, who designed these approachs to dealing with unwanted behaviors from experiences with her mother. For more information on how and why she developed these techniques, please look for her book called "Alzheimer's, Finding the Words".

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