"He Knows What He is Doing"
Understanding Alzheimer's Behavior Changes-Uncooperative Behavior
"He knows what he is doing"
If only I had a dollar for every time a caregiver or a family member has said that when someone with Alzheimer's disease (and other types of dementia) is behaving in an uncooperative manner.
Stress increases as behavior in Alzheimer's deteriorates
The idea that behavior changes associated with Alzheimer's disease are intentional and planned can cause enormous stress to everyone providing care. However it is especially stressful to spouses and family members. You have spent a lifetime relating to each other, even predicting someone's behavior and reactions to events. When this familiarity stops stress levels can climb.
Case study about uncooperative behavior and Alzheimer's
George's wife had looked forward to their afternoon out. It was a beautiful day and a neighbor was taking them for a drive and to a great coffee shop. Since George developed Alzheimer's she hardly got out. The trip would be a welcome change, a life-line. She got George washed and dressed. He looked great but his behavior became more and more difficult. Never a sociable person his reluctance and vocal protests grew. Then a few minutes before the neighbor was due George was fecally incontinent.
Past behavior, Brain damage and Dementia
Does he know what he is doing? Think about this.
It is true that when the brain becomes damaged through disease or trauma that each individual responds differently. The speed and the progression of disease differs from person to person. Parts of the personality, coping mechanisms, stress levels, social values and behavior (to name just a few things) differ. But as Alzheimer's progresses and damages the brain the individual's behavior becomes highly variable and control diminishes. The person's abilities diminish until Alzheimer's disease changes that person who we knew forever.
To do something we have to know what we are doing
Intentional behavior says to us-
Alzheimer's reduces the person's capacity to reason, to plan and to carry out that plan. On top of this the person with Alzheimer's find they are-
Reflecting back to the case study
A number of different things may have contributed to George's behavior. He may have been shouting and behaving awkwardly because he wanted to use the bathroom, he may have been anxious about going out, he may have become frighted at dressing, being made to dress, to being helped into his clothes, to being washed, or he may have simply reacted to his wife's excitement. There are any number of explanations that will not be communicated for any number of reasons.
George's wife will experience it negatively. She desperately wants a trip out. Caregiving puts, at times, an unbearable stress and burden on most caregivers. Disappointment and frustration can often come out as 'he knew what he was doing', 'He did it on purpose'.
Don't go there!
It is often impossible to judge at what stage of functioning and ability a person with Alzheimer's is at. Communication can be reduced to interpretation of behavior. Variability of mental capacity in people with Alzheimer's means it does not help to make a moral judgement about intention and ability.
Don't go there. Believe that your loved one is doing the best they can. It will make you feel lots better.