How to Respond to Grandma's Hurtful Comments When She Has Alzheimer's
Recently in our Alzheimer's About.com forum, a reader described hurtful comments made by his or her Grandma who has Alzheimer's disease. The question asked was, "How should I respond to Grandma?"
A couple of other people wrote in with some great ideas. One suggested coming prepared to steer the conversation towards "safe" subjects and topics of interest to Grandma. Another encouraged the reader to continue to visit regardless and to try not to take those remarks personally. It's powerful when readers share their own in-the-trenches experiences and others come along side to encourage them.
I was thinking about that question of how to respond to those rude or careless comments made by people with Alzheimer's, and wrote an article with 6 tips that I hope are helpful for others in that same situation: Living with Alzheimer's: What to Say When Grandma's Not Nice
Related Articles
Conversation Starters for Talking with People Who Have Dementia
Tips for Positive Visits with People in the Early Stages of Dementia
Ideas for Meaningful Activities in Dementia
How Can Video Games Be Good for Your Brain?
If you were a fly on the wall of my house, chances are you'd hear, "Too much tv and video games will rot your brains!"
Turns out, I may have to revise that opinion.
A study published online in the journal Plos One has demonstrated a pretty surprising (at least, it's surprising to me) effect of a video game on cognition.
The study involved 681 participants who were categorized according to their ages: 50-64 and age 65 & over. They were then randomly assigned to one of two different groups:
- A control group of people who worked on crossword puzzles online for a total of 10 hours
- A group of people who were split into 3 different groups and played the video game Road Tour which focuses on improving visual processing speed
Of those who played the video game, some received onsite training on playing the game at the university labs for 10 hours, and others received the same onsite training along with an additional 4 hour booster training. The participants in the third subgroup were given a copy of the video game to use at home on their own computers for 10 hours.
The results were startling. All three subgroups in both age categories experienced a significant cognitive benefit from playing the video game, while those who participated in the online crossword puzzles experienced normal cognitive decline as expected per their age.
Cognition was measured by several different tests including the Useful Field of View test, the Trail Making (Trails) A and B Tests, Symbol Digit Modalities Test, Stroop Color and Word Tests, Controlled Oral Word Association Test, and the Digit Vigilance Test.
The researchers concluded that the brain training in this video game offered between 1.5 and 6.6 years of protection on the participants' age-related cognitive decline. The variance is due to the results on the different tests, from a low of a benefit of 1.5 years demonstrated on the Trail Making B test and a high of 6.6 years on the Symbol Digit Modalities Test.
Achieving results like this from only 10 hours of training, and training that can be completed in your own home, is pretty remarkable. And no, I don't have any financial or other ties to the makers of the video game.
The video game Road Test is now called "Double Decision" and is available online. A free trial is available at https://brainhq.positscience.com/default/start? under the "Attention" heading. Out of curiosity I did try it, and I definitely have room for improvement!
Feeling Guilt or Grief After Placing Someone in a Nursing Home?
Have you ever heard someone say, "I can't wait for the time when I can't care for myself so I get to live in a nursing home!"? Nah, me either. Yet, that's the reality for many.
Emotions can swirl at the thought of turning over the care of a loved one to a facility like a nursing home. For some, that's their worst nightmare. For others, it's an evil necessity- a last resort. Some feel a relief in getting help with care that was too taxing. For still others, it becomes a blessing that allows them to return to the role of a wife or son. Sometimes, it may feel like it's a mix of all of the above, and more.
Having been in the role of both a clinical professional and a family member, I think it's safe to assume we all want the best possible care for our loved ones. One way we can help our loved one adjust to a facility is to help ourselves with that adjustment, and that may mean coping with some of the guilt, grief, loss, relief and other emotions generated by such a life change. Of course, that doesn't mean it'll be easy and you won't have any difficult times, but hopefully it'll lighten the emotional load as you continue to care for and visit your loved one.
Further Resources:
8 Ways to Cope with Guilt and Grief Following Nursing Home Placement
How to Know If and When It's Time for Nursing Home Care
How to Research and Choose a Nursing Home
Home Health Care for People with Dementia
5 Ways to Help a Loved One with Dementia Adjust to a Nursing Home
Does Alzheimer's Disease Affect Personality?
Alzheimer's disease can affect memory (both short-term and long-term), word-finding abilities, and the decision-making ability of the person with the disease. But, does Alzheimer's change someone's basic personality?
The answer? Sometimes. In some cases, the person who has always been easy-going, gentle and caring remains so, even as Alzheimer's progresses into the middle and later stages.
Others with Alzheimer's develop significant changes in their personality which can make it especially difficult for family and friends to cope with and watch. It can feel like their loved one is being taken away from them but by bit. Remembering that these changes in personality are due to the disease (which actually changed the physical structure of the brain) can be helpful, rather than interpreting challenging behaviors as deliberate actions designed to hurt or frustrate others.
Learn more about the causes of these personality changes and how to cope with them here: Personality Changes in Dementia.
Why Share Life Stories of People Who Have Dementia?
Back when we started our dementia unit at the facility where I work, the one thing we wanted at the top of all the priorities was the people who would live there. Yes, the environment was important, the staffing and activities were critical, and the dementia training for the employees had to be top-notch. But, how to keep the residents at the center of it all?
While there are several ways to do this, we chose to assist the residents and family members in developing life stories. A life story is a way to share some of the important aspects of someone's life with others around her. It often contains those pieces of information we might share in conversation with others as we get to know them, such as:
- Who are the members of your family?
- What did you do for your job?
- What are your hobbies and interests?
- Who and what are important to you?
- What other meaningful events would you like to share with others?
The benefits of sharing life stories are many, but a critical one is that the staff members are continuously reminded of the unique gifts and abilities of the person for whom they're caring. When staff members learn that the gentleman that they're caring for took apart and rebuilt engines, designed one of the beautiful buildings downtown, or has six children, this information serves as a reminder that although this person has Alzheimer's disease or another dementia, there's more to the story and the person than their current disease.
For more information about why to share life stories, different ways to create them, and the many reasons they benefit people with dementia, their caregivers, family members and visitors, please see my complete article on life stories:
What Causes Forgetfulness?
Ever forget something? Nope, me either. Unless I'm forgetting that I forgot where I hid the early birthday present I bought, where I parked my car at the mall or the name of the new neighbor I met last week. Nah, not me.
But, if I were to forget something, it turns out there's many causes for that phenomenon. Some, like stress and distraction, are things that we can manage or reduce, and thus improve our memory's functioning. Others, like Alzheimer's and other diseases, are more difficult to curb.
It's important to recognize the symptoms of Alzheimer's disease, receive an early diagnosis and begin treatment accordingly. Just as important, however, is recognizing that not every memory gap is caused by this disease. There are many different physical and mental conditions that cause memory loss, and many are fairly benign and treatable.
In light of this, I've compiled an extensive list of possible causes of forgetfulness, with several links to further resources about particular topics, in the article below. Let me know if I've forgotten any!
Why Do We Forget Things? Some of the Many Causes of Memory Loss
A Surprising Early Sign of Lewy Body Dementia
What's a sign that you may be more likely to develop Lewy body dementia? Some might think that a symptom like memory loss or poor judgment would be on that list. Actually, according to researchers at the American Academy of Neurology annual meeting, acting out your dreams may be a key early symptom of Lewy body dementia.
Researchers presented a study at about REM sleep behavior disorder where people not only vividly dream but actually physically act out their dreams by moving their bodies, getting up, shouting, hitting and more. They found a significantly high correlation, especially for men, of acting out dreams and developing Lewy body dementia.
If you or your loved one has REM sleep behavior disorder, learn more about what Lewy body dementia is and how it's different from Alzheimer's disease.
Do Consistent Caregivers Benefit People with Alzheimer's Disease?
If you or a loved one with dementia lives in a facility such as a nursing home, one question that may arise is whether the staff members have consistent assignments or whether they rotate around to care for different people. This issue can arise with home health care as well, depending on the number of different staff members available to provide in-home care.
While there are reasons that can explain both sides of those staffing arrangements, research has shown that consistent staff assignments benefit not only the person receiving the care, but also those around that person, including the facility and family members.
Read about 9 benefits of consistent caregivers for people with Alzheimer's disease and other dementias.
How to Identify Depression in Alzheimer's Disease
Do you know how to tell if someone with dementia is depressed? Depression in someone with Alzheimer's or another type of dementia might look a little different than depression in someone whose memory and communication abilities are functioning well. Knowing the signs is important. In addition to the more obvious effects of depression such as sadness and a lack of interest in people and things around you, depression can also increase confusion and masquerade as delirium.
There are a couple of screenings that are commonly used to determine if someone with dementia is experiencing depression. One is the Cornell Screen for Depression in Dementia. This screening test evaluates some of the physical and emotional signs of depression, such as appetite, weight loss, and mood. The Cornell Screen is used frequently in the middle and later stages of Alzheimer's because it allows for a caregiver or family member, as well as the person, to answer the screening questions.
Another common screen for depression is the Geriatric Depression Scale. The GDS, while not specifically designed for people with dementia, can be an effective way to test for depression in older adults without any dementia as well as those with dementia in the early stages.
For further information and research findings, here are the complete articles:
The Cornell Scale for Depression in Dementia
The Geriatric Depression Scale
The Use of Validation Therapy vs. Reality Orientation for Alzheimer's
What's the best way to respond to someone with Alzheimer's or another type of dementia if she's anxious and yelling out for her mother who passed away many years ago? The short but true answer is that it depends on the individual- which stage of Alzheimer's disease she's in, what approaches are typically helpful in reassuring her, and how much distress she's experiencing.
The longer answer includes a discussion on a couple of theories: reality orientation and validation therapy. Historically, reality orientation has been fairly dogmatic about continually reminding the person that she is 89 years old and that her mother passed away 20 years ago. The reasoning with this approach has been that frequently reminding the person of reality is beneficial for her cognitive functioning.
Validation therapy, however, places more emphasis on the possible feelings and thoughts behind the person's behaviors, and rather than trying to force her to be in our reality, it suggests that we join with the person in her reality. Validation therapy would recommend that we ask her questions about her mother, such as what she misses most about her mother and which of her mom's dinner recipes was her favorite.
So, which is the best and most helpful approach? And, what does research say? The pendulum has swung from reality orientation to validation therapy and a little more back towards a more gentle reality orientation. In the end, there's no "one size fits all" for responding to people's confusion. However, there are a few guidelines that usually remain constant about how to talk with people who have dementia, such as responding with genuineness and compassion.
For more information, please see the following recent articles:
Validation Therapy for People Living with Dementia: What Is It and Does It Work?
Using Reality Orientation in the Treatment of People with Dementia