When caring for a person suffering from dementia, a crisis can occur at any time. If that crisis creates the need for an intervention, if often involves the opposite of what you might think. I’m not talking about a medical emergency, but a behavioral intervention. When a patients behavior changes, we usually need to slow down, take a deep breath, and step back.
Typical behaviors in dementia care that create a need for intervention include:
1. Anger in response to a frightening situation — such as bathing or simple confusion;
2. Agitation and becoming upset in response to a distressing situation;
3. Resistance and anger in response to being told what to do;
4. Stress in response to be being rushed through a task or hurried;
5. Hitting or expressing combative behaviors in response to frightening invasion of their space;
6. Fear, agitation and confusion when the patient is taken out of their familiar environment;
When we know the person we care for, whether in a facility or at home, we usually know what upsets them. If we know what upsets them, we can then modify our own response and behavior in a way that helps to diffuse the situation. The key is to actually “know” the person. In a facility, this requires a comprehensive intake procedure that includes a lot of open-ended questions. At home it requires drawing upon past experiences and remembering outcomes that were successful. Although there are no guarantees that this knowledge will work 100% of the time, it is important to use whatever knowledge you have to prevent the emotional crisis from escalating.
Some examples of how to manage an emotional crisis sometimes begin with an apology, as in the following situations:
1. “I’m sorry, George is it okay if I give you a hand here, I know your arthritis makes it hard for you to shower easily”;
2. To a resident getting angry, “How about you and I go find (those cookies, birds in the tree, the cat) and leave these folks behind.” Distract and redirect.
3. To a woman crying because she wants to go home, “I’m so sorry, Mary, I know you really miss your family at this time of day. Let’s take a little walk together.” Distract and redirect.
4. To the woman who repetitively asks, “When is my husband coming home? “I’m sorry Mary, I forgot to tell you that he called and said he has to work late tonight.” Distract and redirect.
5. To the patient that wants her mother, “Mary, she is at the grocery store”. Or at work, or wherever she might be based on the information you gathered at the time of intake or that you know from your own family history.
People often ask me if it’s okay to tell “little white lies”. If it calms the patient, reduces caregiver stress and stops the emotional crisis from escalating to a full-blown emergency, of course it is. Our job is to remember that they cannot remember and then try to do whatever we can to restore their emotional balance. Other techniques that often work include using non-verbal communication skills. Never underestimate the power of touch, eye contact and a smile.