Caring Currents

This May Be the Most Useful Alzheimer's Advice

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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 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.