This May Be the Most Useful Alzheimer's Advice


Last updated: November 07, 2008
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Here's the first step to solving countless behavior problems presented by someone with Alzheimer's: Ask, "Why is this happening?"

I'm not referring to the rhetorical question, "Oh why is this happening to me?" although it's sure understandable if that one crosses your mind. But when you're faced with upset, a refusal to cooperate, or even a catastrophic reaction, don't write it off to the craziness of the disease. You can usually solve the matter by stepping back to consider, "Why is this behavior happening? What might be triggering it?"

I first grasped this concept from Joanne Koenig Coste, whose insightful 2003 classic, Learning to Speak Alzheimer's, describes her theory of "habilitation care." Her basic idea: You can't rehabilitate someone with Alzheimer's, but you can habilitate them -- step into their world and adjust things accordingly in order to help them be as capable as possible. (Coste's husband developed early Alzheimer's at 44, when she was pregnant with their fourth child, and she cared for him until his death four years later.)

Then this week came this insightful account of Cameron J. Camp, an experimental psychologist in Ohio who's spent 20 years adapting the learning principles of Montessori preschools to people with Alzheimer's. Because the mind's first-developed abilities are the last to go, cognitive similarities exist between adults with dementia and preschoolers. (Both respond well to sensory input, for example.) This insight illuminates the path to many solutions.

As Camp says, "We don't say they're crazy, we say this is where they are in the developmental sequence...you only come up with the fix if you say, 'Why is this happening?'"

Some examples of this idea in action:

* A man stops using the toilet and has an increase in accidents.

Why is this happening? Depth perception fades for someone with Alzheimer's. A white commode fades into a beige wall and is easily overlooked -- therefore not used.

Solution: Instead of concluding incontinence, paint the wall behind the commode a bright red to make it stand out. (from Coste)

* A person becomes upset, claiming that she's being watched, especially in the bathroom.

Why is this happening? The person has lost the ability to understand that the mirror is showing a reflection of herself, not of another person.

Solution: Instead of trying to soothe the distraught individual over and over, cover the mirror or install a shade over it. (from Cameron)

* A woman continually asks why her daughter never visits -- beginning five minutes after her daughter just left.

Why is this happening? She's lost her working (short term) memory and truly doesn't remember.

Solution: Instead of trying to explain the truth, the daughter can keep a logbook of her visits, writing loving notes about each and when she'll visit next. When the mother feels abandoned, her caregiver can direct her to the sit in a comfortable chair with the logbook. This not only calms her in the short term, but eventually builds a positive association with that comfortable chair -- a kind of learning Cameron says people with dementia are still capable of because it builds on remaining cognitive strengths.

Alzheimer's may be maddening, but it can be made less mysterious.

Image by Flickr user annnna, used under the Creative Commons attribution license.

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12 Comments So Far. Add Your Wisdom.

8 months ago

I like this approach, if nothing else it gives me time to step back from the emotion and rethink how to deal with the situation.


about 1 year ago

Alzheimer's is in a way, a progression of behaviors leading back to infancy. It helps to realized where in this continuum your relative lies. The tips given are excellent. Remember what childhood is like and be prepared to have forgiveness and endless patience; then give yourself a hug for being there.


about 1 year ago

These are all great ideas for dealing with seniors with dementia. I had heard quite a while ago, in a talk by the Alzheimers Association of Northern California, that you can best determine what 'age' a person has regressed to by which pictures in the photo albums that they most identify with (and can identify others in the photos). Currently, Dad is most comfortable looking at a picture of my Mom in the mid-70's, which was about the time they retired (they retired at 55 years old). I think it keeps Dad a bit young as well looking at her like that. Of course, he never thought of himself as being older than about 60. Currently he is two months away from being 92 years old.


about 2 years ago

My husband was diagnosed with Alzheimer's four years ago. He has progressed slowly and I am able to care for him myself. He has enjoyed returning to playing his clarinet which had remained unused for many years and spends time each day listening to programs on his IPod. Physically, he has remained strong even through radiation treatment for prostate cancer because daily exercise, indoor or outside is a part of every day. I appreciate Caring.com suggestions a lot. Understanding that the regression to childhood behaviors is a part of the disease allows me to respond more appropriately.


over 2 years ago

You seemed to be on my page. I have wondered at what age my 75 year old wife might be manifesting.


almost 3 years ago

When the person you are taking care is your parent, it can be difficult to understand that the cognitive levels are going backward in time. This really helped me to think of some better ways to think about the situation. Thanks.


Anonymous said almost 6 years ago

Because humor is so important for both the carepartner and the person with Alzheimer's, I am sharing this story with you in hopes it will bring a smile. I accompanied an 82yo AD-person to the Emergency Room of our local hospital. MArjorie had fallen in her home & her wrist was curved like an 's' in an obvious fracture & dislocation requiring immediate medical attention. The young intern came over to MArjorie and delicately held her injured arm. "My goodness" said the sweet young man. "How in the world did this happen?" Marjorie gazed at him with great consternation and muttered "How would I know. I wasn't there when it happened!" I smile as I share it with you a decade later. Joanne Koenig Coste author: Learning To Speak Alzheimer's


almost 6 years ago

Thanks for the comments -- I'd be interested to hear if you find out more about the bathing. Also I hope you all note the link for Discussion Groups at the top right to find other carers to talk to, and check the Alzheimer's and Dementia section for other insights into problems and solutions. Something specific that's missed? Let me know--


Anonymous said almost 6 years ago

I am caring for my elderly aunt who has Dementia. She is very forgetful and repeats herself over and over again. I am using this information to plan for the future. I can see it will just get harder and harder to do. Thanks!


Anonymous said almost 6 years ago

Its excellent article to understand AD. Pls give us more insight on AD and Dementia,it will help us as Not for Profit in India - Silver Inning Foundation. Thks. Sailesh Mishra www.silverinnings.com


Anonymous said almost 6 years ago

is ther a chat room for carers


Anonymous said almost 6 years ago

This is well worth the effort. No one can get my mom to take a shower. She says she only need sponge baths. She lives in a wonderful assisted living facility with a special wing for dementia patients. The staff is excellent. My mom always took baths. She does not like getting her face wet. I wonder if she is embarrassed about a 'stranger' helping her do something so personal. However, even I, her daughter, can't get her to shower. It is a hand held nozzle and she has a shower bench, but nothing doing. I might have to figure "Why this is happening" with some further investigation. I learn so much from this site. I wish I could convince my dad to try some of the wonderful advice given here.


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