Management of Disorientation among Demented Elderly Persons
Fr Theodore Ihenetu*
Catholic Archdiocese of Owerri, Imo State, Nigeria
Submission: September 25, 2017; Published: September 27, 2017
*Corresponding author: Fr Theodore Ihenetu, Director, Raphe Adultcare Center, Catholic Archdiocese of Owerri, Imo State, Nigeria; Email: email@example.com
How to cite this article: Fr Theodore Ihenetu. Management of Disorientation among Demented Elderly Persons. OAJ Gerontol & Geriatric Med. 2017; 2(5): 555600 DOI: 10.19080/OAJGGM.2017.02.555600
Caring for an elderly loved one living with dementia poses many challenges for families and caregivers. People who are deeply forgetful caused by conditions such as Alzheimer's and related diseases have a progressive biological brain disorder that makes it more and more difficult for them to remember things, think clearly, communicate with others, and take care of themselves. In addition, dementia can cause mood swings and even change a person's personality and behavior. This short communication provides some practical strategies for dealing with the troubling behavior problems and communication difficulties often encountered when caring for a person living with dementia.
Dementia is the gradual deterioration of mental functioning that affects memory, mood, thinking, concentration, and judgment. These changes often affect a person’s ability to perform normal daily activities. It is an illness that usually occurs slowly over time, and usually includes a progressive state of deterioration. It includes decline in memory, and at least one of the following cognitive inabilities: ability to generate coherent speech and understand spoken or written language; ability to recognize or identify objects, assuming intact sensory function; ability to execute motor activities, assuming intact motor abilities, sensory function and comprehension of the required task; and ability to think abstractly, make sound judgments and plan and carry out complex tasks. The decline in cognitive abilities must be severe enough to interfere with daily life. It occurs primarily in people who are over the age of 65, or in those with an injury or disease that affects brain function. While dementia is most commonly seen in the elderly, it is not a normal consequence of the aging process .
Elderly people living with dementia find it difficult to do such things as remember what has happened to them, communicate with other people, and undertake different skilled social behaviour. Dementia is usually seen as a memory disorder comprising forgetfulness, primarily about recent events; disorientation regarding time, place and person; grasping items of new information; communication with other people; personality changes and behaviour disorders. However, it is more accurate to think of it as a wide range of physical, emotional, behavioural and social impairments that progressively undermine their ability to undertake socially accepted activities of everyday life.
The earliest signs of dementia are usually memory problems, confusion, and changes in the way a person behaves and communicates. Cognitive symptoms of dementia can include poor problem solving, difficulty learning new skills, and impaired decision making. Behaviour changes can include fear, insecurity, anger, and often, depression like symptoms. Dementia is caused by various diseases and conditions that result in damaged brain cells. Brain cells can be destroyed by brain diseases, such as Alzheimer's disease, or strokes (called vascular or multi-infarct dementia), which decrease blood flow to the brain. Alzheimer’s disease is the most common cause of dementia.
In most cases, the symptoms of dementia occur gradually, over a period of years. Symptoms of dementia caused by injury or stroke occur more abruptly. It affects emotional behaviour or personality, language, memory, perception, thinking and judgment (cognitive skills). It usually first appears as forgetfulness. Difficulties often begin with memory, progressing from simple forgetfulness to the inability to remember directions, recent events, and familiar faces and names. Other symptoms include difficulty with spoken communication, personality changes, problems with abstract thinking, poor personal hygiene, trouble sleeping, and poor judgment and decision making. Dementia is extremely frustrating for the patient, especially in the early stages when he or she is aware of the deficiencies it causes. People with dementia are likely to lash out at those around them, either out of frustration or because their difficulty with understanding makes them misinterpret the actions of others. They become extremely confused and anxious when in unfamiliar surroundings or with any change in routine. They may begin a task, such as cooking, then wander away aimlessly and completely forget what they had been doing. It is also often accompanied by depression and delirium, which is characterized by an inability to pay attention, fluctuating consciousness, hallucinations, paranoia, and delusions. People in advanced stages of dementia lose all control of bodily functions and are completely dependent upon others .
Management of THE disorientation
Once you accept that a demented person is a disoriented person, then you begin to adapt yourself to the new world of disorientation, unless this fact is known and accepted you cannot be of any help to the person suffering from this illness. Thus one has to learn how to communicate in this "new world" which can be referred to as "Dementia World". When one accepts this dementia world, one learns that opposites can indeed attract. And stick together like glue.
Imagine communicating with someone for 50 years or longer. Suddenly the person changed. He or She is no longer the person you always know. If not, then who is he or she? This person you always know starts acting and coping with the world in new and different ways that is strange, bizarre and unsettling. Many of these new behaviours make you angry, they drive you crazy, you feel out of sorts. You just cannot understand it. You continue to try to make sense of what is happening in the way you always have. It does not work. Every day, many times a day, you are at wits end. You do not know what to do. You know that something needs to change and that something is you.
Communicating and accepting Dementia World takes a lot of energy, learning, and patience. In order to begin the process of dealing with communication in a world filled with dementia you first need to make a simple important decision - you want to decrease both your stress as a caregiver, and the stress of the person suffering from dementia. Because what you believe to be true, and what the person living with dementia believes to be true are often diametrically opposed sometimes the exact opposite. Here is the one thing you need to understand. Your view of reality and your loved one's view of reality might be very different. They are different.
Ask yourself, what are you doing and how are you reacting when someone living with dementia says something you know to be incorrect or untrue? What are you feeling when this happens? Are you constantly correcting them? If you are constantly correcting a person living with dementia you are heading for the big stomach ache in the sky and anger, stress and angst will always be your routine.
However in order to overcome these emotional outburst you need to start accepting that when a person living with dementia says something they believe to be true it is in fact a reality. It is their reality. In dementia world, reality takes on a different shape. Reality is a reflection of what the person living with dementia thinks and believes. It is this reality that you must focus on, not the way you think things are, or should be. The suggestion here is to develop a frame of reference, a new and different behaviour pattern that is one hundred percent diametrically opposed to the way you think and act - the way you thought and acted for your entire life, though this is not easy. It could be one of the hardest things you have ever tried to accomplish.
When you accept the Dementia World you start a process of redefining reality, that is, instead of trying to place your loved one back into your reality, you start to interact with him/her based on his/her own view of reality. This new form of life style or communication technique adopted will lead to less stress, anger and angst over time. Less stress build up across a series of situations, leads to less anger and nutty behavior from the person living with dementia. When this new reality is accepted Dementia World becomes a place of peace and understanding.
The goal in all communications with a person living with dementia should be to connect with the person in a positive, constructive and effective way. To establish a positive pattern of communication requires you to develop calm, effective responses that are easily accepted by the person suffering from dementia. By establishing positive patterns of communication and lifestyle over a series of situations you learn how to deal with the new reality that is at the core of what is called Dementia World. The more you practice this, the better you understand it and the sooner it becomes another dimension in your life .
It has to be noted that while a person living with dementia cannot remember, they are still full of feelings and emotions. Therefore, as a caregiver, when you try to correct a person living with dementia you are likely to bring out a negative emotion in him/her. How would you like to be told over and over - you are wrong? How would you like to be corrected over and over? How would you like to be an object of scorn or exasperation over and over? How would you feel? What emotions would you likely express? Would you like the person that is constantly treating you in the way I described above? Would you be nice to him/ her? I'll let you decide the answer!
Effective communication with someone suffering from dementia requires you to identify the emotion behind the person's words and to learn the ways to address what they are feeling and to validate those feelings. It is likely that when a person living with dementia says something that is opposed to reality as you understand it - that you immediately feel an urge to correct him/her (or worse). This is a normal feeling and reaction. It is okay. But only to the extent that you understand this (Dementia World) is the way you communicate in the other world. Coming to an understanding that you must develop new and different ways to communicate in the new world "Dementia World", is an essential step towards effective care for the person living with dementia. Although change is never easy, you will need to practice this every day. If you are caring for someone with dementia you will need to go into his/her world - Dementia World. The first steps are to start listening to what he/she says. To accept what they are saying as a "reality". They believe it to be true, why would you not? Understanding that Dementia World's reality is different is a big and important step, a necessary step to communicating effectively with someone that lives with dementia. However while you are on it, try and remember that they have dementia. You are the caregiver. It is really up to you to change. It is up to you to adjust. The person living with dementia would adjust if they could but he/she cannot. That is just the truth about their condition.
The lesson we have to learn when caring for persons living with dementia is that we are not born knowing how to manage or communicate with them - but we can learn. Improving your communication skills will help make care giving less stressful and will likely improve the quality of your relationship with your loved one. Good communication skills will also enhance your ability to handle the difficult behavior you may encounter as you care for a person with a dementing illness.
The journey towards caring for personal living with dementia sometimes could turn out to be a long and arduous journey, a journey which might always begin and end with fear and frustration. This is because of the fact that the person you have known and loved has suddenly changed and for the worst dementia has taken hold of him/her. But one must always know that the person living with dementia himself/herself does not understand this new and horrific change that has taken hold of him /her. It can be quite difficult therefore, to separate out the causes of dementia from the person living with it. Sometimes we tend to blame the persons living with dementia for their actions, instead of trying to understand the causes of their actions and how dementia causes these often hard to understand difficult behaviours. The most difficult things you will ever have to do as a caregiver is to separate out the disease from the person. It can really be a very difficult thing to do. But to reduce your frustration you care with empathy.