Imagine you’re snuggled in bed having a great sleep, and at about 7:00 a.m., a stranger walks in your bedroom, turns on the light, and begins rifling through your clothes. As you cower under the sheets, she grabs the covers out of your hand, ripping them off you, and starts to perform some extremely personal acts on your body.
How would you feel?
Frightened? Disrespected? Violated? Angry? Would you scream? Hit someone?
Yet in places where elders are receiving care, this happens every morning.
“Now wait a minute. I say, ‘Good morning, and I’m not a stranger. I’m helping her every morning.'”
But if someone has dementia, they may not recognize you. Even if you go in every morning. Even if you are related. And the natural reaction is fear, leading to aggression.
Try this scenario instead. (Knocking on the door) “Jean, can I come in?” (no answer, enters the room and quietly rubs Jean’s arm until her eyes open.) Smiling, speaking softly, “Good morning, Jean, it’s Judy. I’ve come to help you get ready for breakfast. Are you ready to get up?” If the answer is “No,” Judy leaves and comes back later.
The approach is key elder care, but especially with people with dementia. We refer to “behaviours” that occur at times when people have dementia. When we say this, we mean actions like aggression, crying, hitting and punching, screaming and sometimes loud, inappropriate laughter. There is a nasty cycle where elders exhibit one or more of these behaviours over a period of time, and the solution is often to medicate them. Problem solved. No more behaviour–they are asleep.
Let’s look at approach. It’s not magic. Sometimes there is still agitation, and there are times when medication is needed. However, many times, the right approach can change the entire atmosphere, and bring calm, pleasure and even humour. Here are some tips:
1. Slow down. Rushing increases agitation and sends the clear message, “I don’t have time for you.”
2. Smile. A genuine smile is hard to disregard.
3. Watch your body language. Did you know most people with dementia can read body language perfectly, even if they can no longer read words, or even speak? Check your attitude at the door. One of my co-workers impressed me with the way she greeted people. She made it sound like meeting them was the best part of her day. I’m sure they picked up on that.
4. Communicate. Ask permission if you want to do something that involves touching them. “Could I just push your glasses up for you, Mary?” I’ve seen people come up from behind and hike an elder’s pants up or move their wheelchair without saying anything. Next time you see a teenager on the street with his pants hanging around his bottom, come up from behind, don’t say anything, and hike them up. Then send me a note, and let me know how it went.
5. Focus. Don’t have a conversation with someone else, or interrupt what you are doing to greet another person. When you are with an elder, they are the most important person.
6. What is the unmet need? Often, if you can find this and meet it, the problem dissipates. I observed an elder just this morning who often comes to the breakfast table angrily. She talks loudly, accusing others of lying. When she begins to eat her breakfast, the anger disappears. She’s hungry. (Later in the day, the same behaviour occurs, and it’s not hunger. The same person may have several unmet needs.)
The approach is all about respect. No matter what they do or don’t understand, each elder is a person. Give them the gift of respect, approach them with gentleness and joy, and many times behavioural problems will vanish.
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