January 10, 2024

Quote of the Week:

"When we are no longer able to change a situation,

we are challenged to change ourselves."

— Viktor Frankl

Caregiving for a loved one with dementia or cognitive decline calls for a very specific skill set. The previous relational model no longer proves adequate as cohesive communication declines. The gap in coherent verbal communication gradually increases. Each party becomes progressively confused and bewildered. Connection through language proves increasingly foreign. As caregivers gradually cease to understand their loved one's verbal expressions, so, too, loved ones struggle to comprehend the once familiar communication. Two members in a close and familiar relationship are, in some ways, becoming strangers to one another. Communication is key, and now significant challenges pose the potential for progressive estrangement. 

Although countless books, lectures, and the consulting of experts in the field can be enormously helpful, when faced with a loved one evidencing mental/cognitive decline, behavioral issues common to the disease process begin to emerge. Communication, or the lack thereof, becomes increasingly confusing. The familiar relatedness becomes strained and disconnected. Now, the situation becomes personal.

"Remember, no matter how hard you try, you can never separate the emotional connection to your loved one from the irrational behaviors, but you can try your best to respond in a manner that won't worsen the situation." 

Home Watch Caregivers of Oakland.

It becomes evident that logic and reason have a diminishing effect. "Normal" communication, the previous mode of connection, is deteriorating, frustrating both parties. Aforementioned "behavioral" acting out comes to the fore. 

The term "behavioral problems" actually misrepresents the incidents of opposition with its potential for aggression. The more accurate term, UNMET NEEDS better addresses the antecedent to disruptive and potentially negative, often harmful acting out. The inability of the loved one to express and articulate these needs exacerbates the anxiety and frustration that precedes the "behaviors". This inability to clearly communicate problematic stressors calls forth a need for diligence and problem solving on the part of the caregiver. 

Tips and strategies are designed to support and encourage caregivers in the midst of this most difficult time in their respective lives. A willingness of caregivers to practice "stepping into their world" allows for an intention to better understand and bridge this communication gap. This has proved quite helpful in de-escalating distressing or troubling behaviors as they surface.. "When instead of reacting against a situation, you merge with it, the solution arises out of the situation itself." Anonymous

A kind of "detective" mentality can uncover a variety of unarticulated unmet needs on the part of their loved one. The potential for effectively meeting the resolution of that need before it becomes problematic becomes possible.

Common among uncommunicated stressors can include: feeling hungry, thirsty, being overly tired, constipated, bored, needing to use the bathroom, UTI's, too little/too much stimulation, loud noises, frustration while attempting a task, the presence of strangers, or undetected physical pain (such as a headache). The frustration relative to an inability to communicate can be evidenced as a behavioral outburst, as one is unable to effectively express, address, or resolve the present stressor.  

Having a strategy in place prior to a loved one's stress responses allows the caregiver to separate from the emotional impact of behavioral issues that can arise when a loved one has dementia. The practice of detachment can greatly reinforce the awareness that none of this is personal.

Emergency Psychological Tool Set:

1.  Remain calm, breathe deeply 

2.  Respond (rather than react) with empathy

3.  Reassure (use soothing voice)

4.  Remove yourself calmly if behavior escalates

5.  Return (allow cooling off) then rejoin with neutral energy, without a "rehash" of previous events

As with practicing any "skill set", one must focus on the desired outcome. All the more so when the desired outcome results in a more peaceful, calm, and loving (re)connection.

Karen Kelleher MA

DayBreak Family Caregiver Support Coordinator

Together, we can make a meaningful difference in the lives of

elders and family caregivers who selflessly support them.

DayBreak is committed to empowering elders and supporting caregivers. If you know a senior in need of our care and coordination services, or a family caregiver seeking assistance, encourage them to reach out to us at:

510-834-8314