THE 4Rs: REASSURE, RECONSIDER, REDIRECT, and RELAX.
Although many specific problems in dementia are best managed by equally specific
solutions, there are some general approaches that can be used in a wide
range of situations.
Care, Compassion, Courage, Commitment, Competence and
Communication carry many different meanings within the care setting. They
are our building blocks for improving care and collaboration amongst the
multi-disciplinary teams that we work with.
You can’t control memory loss – only your reaction to it.
For people with dementia, their disability is memory loss. Asking them to
remember is like asking a blind person to see. (Common questions like
“Did you take your pills?” or “What did you do today?” are the equivalent of
asking them to remember something.) A loss of this magnitude reduces the
capacity to reason. Expecting them to be reasonable or to accept your
conclusion is unrealistic. Don’t correct, contradict, blame, or insist.
Reminders are rarely kind. They tell a person how disabled they are –
repeatedly.
People living with dementia say and do normal things for someone with
memory impairment. If they were deliberately trying to exasperate you, they
would have a different diagnosis. Forgive them…always. For example, my
mother or your loved one isn’t purposely hiding her wallet. She thinks she’s
protecting them by putting them in a safe place…and then forgets.
Here are some basic Do’s when it comes to communication with
someone with dementia:
* Give short, one sentence explanations.
*Allow plenty of time for comprehension.
* Repeat instructions or sentences the same way.
* Avoid insistence. Try again later.
* Agree with them or distract them from a different subject or activity.
* Accept the blame when something’s wrong (even if it’s fantasy).
* Leave the room, if necessary, to avoid confrontations.
* Respond to the feelings rather than the words.
* Be patient and cheerful and reassuring. Do go with the flow.
*Practice 100% forgiveness. Memory loss progresses daily.
Here are some Don’ts:
* Don’t reason.
* Don’t argue.
* Don’t confront.
* Don’t remind them they forgot.
* Don’t question recent memory.
*Don’t take it personally.
I’ve put together some specific examples of good and bad communication
below, keeping these do’s and don’ts in mind.
1. “What doctor’s appointment? There’s nothing wrong with me.”
Don’t: (reason) “You’ve been seeing the doctor every three months
for the last two years. It’s written on the calendar, and I told you about
it yesterday and this morning.”
DO: (short explanation) “It’s just a regular checkup.”
(accept blame) “I’m sorry if I forgot to tell you.”
2. “I didn’t write this check for $500. Someone at the bank is
forging my signature.”
Don’t: (argue) “What? Don’t be silly! The bank wouldn’t be forging
your signature.”
DO: (respond to feelings) “That’s a scary thought.”
(reassure) “I’ll make sure they don’t do that.”
(distract) “Would you help me fold the towels?”
3. “Nobody’s going to make decisions for me. You can go
now…and don’t come back!”
Don’t: (confront) “I’m not going anywhere and you can’t remember
enough to make your own decisions.”
DO: (accept blame or respond to feelings) “I’m sorry this is a tough
time.”
(reassure) “I love you and we’re going to get through this together.”
(distract) “You know what? Don has a new job. He’s really excited
about it.”
4. “Joe hasn’t called for a long time. I hope he’s okay.”
Don’t: (remind) “Joe called yesterday and you talked with him for 15
minutes.”
DO: (reassure) “You really like talking with him don’t you?”
(distract) “Let’s call him when we get back from our walk.”
5. “Hello, Mary. I see you’ve brought a friend with you.”
Don’t: (question memory) “Hi Mom. You remember Eric, don’t you?
What did you do today?”
DO: (short explanation) “Hi Mom. You look wonderful! This is Eric. We
work together.”
6. “Who are you? Where’s my husband?”
Don’t: (take it personally) “What do you mean – who’s your
husband?” I am!”
DO: (go with the flow, reassure) “He’ll be here for dinner.”
(distract) “How about some milk and cookies?… Would you like
chocolate chip or oatmeal?”
7. “I’m going to the store for a newspaper.”
Don’t: (repeat differently) “Please put your shoes on.”…You’ll need to
put your shoes on.”
DO: (repeat exactly) “Please put your shoes on.”… “Please put your
shoes on.”
8. “I don’t want to eat this! I hate chicken.”
Don’t: (respond negatively) “You just told me you wanted chicken. I’m
not making you anything else, so you better eat it!”
Do: (accept blame) “I’m so sorry, I forgot. I was in such a rush that it
slipped my mind.
(respond positively) Let me see what else we have available.” Leave
the room and try again.
range of situations.
Care, Compassion, Courage, Commitment, Competence and
Communication carry many different meanings within the care setting. They
are our building blocks for improving care and collaboration amongst the
multi-disciplinary teams that we work with.
You can’t control memory loss – only your reaction to it.
For people with dementia, their disability is memory loss. Asking them to
remember is like asking a blind person to see. (Common questions like
“Did you take your pills?” or “What did you do today?” are the equivalent of
asking them to remember something.) A loss of this magnitude reduces the
capacity to reason. Expecting them to be reasonable or to accept your
conclusion is unrealistic. Don’t correct, contradict, blame, or insist.
Reminders are rarely kind. They tell a person how disabled they are –
repeatedly.
People living with dementia say and do normal things for someone with
memory impairment. If they were deliberately trying to exasperate you, they
would have a different diagnosis. Forgive them…always. For example, my
mother or your loved one isn’t purposely hiding her wallet. She thinks she’s
protecting them by putting them in a safe place…and then forgets.
Here are some basic Do’s when it comes to communication with
someone with dementia:
* Give short, one sentence explanations.
*Allow plenty of time for comprehension.
* Repeat instructions or sentences the same way.
* Avoid insistence. Try again later.
* Agree with them or distract them from a different subject or activity.
* Accept the blame when something’s wrong (even if it’s fantasy).
* Leave the room, if necessary, to avoid confrontations.
* Respond to the feelings rather than the words.
* Be patient and cheerful and reassuring. Do go with the flow.
*Practice 100% forgiveness. Memory loss progresses daily.
Here are some Don’ts:
* Don’t reason.
* Don’t argue.
* Don’t confront.
* Don’t remind them they forgot.
* Don’t question recent memory.
*Don’t take it personally.
I’ve put together some specific examples of good and bad communication
below, keeping these do’s and don’ts in mind.
1. “What doctor’s appointment? There’s nothing wrong with me.”
Don’t: (reason) “You’ve been seeing the doctor every three months
for the last two years. It’s written on the calendar, and I told you about
it yesterday and this morning.”
DO: (short explanation) “It’s just a regular checkup.”
(accept blame) “I’m sorry if I forgot to tell you.”
2. “I didn’t write this check for $500. Someone at the bank is
forging my signature.”
Don’t: (argue) “What? Don’t be silly! The bank wouldn’t be forging
your signature.”
DO: (respond to feelings) “That’s a scary thought.”
(reassure) “I’ll make sure they don’t do that.”
(distract) “Would you help me fold the towels?”
3. “Nobody’s going to make decisions for me. You can go
now…and don’t come back!”
Don’t: (confront) “I’m not going anywhere and you can’t remember
enough to make your own decisions.”
DO: (accept blame or respond to feelings) “I’m sorry this is a tough
time.”
(reassure) “I love you and we’re going to get through this together.”
(distract) “You know what? Don has a new job. He’s really excited
about it.”
4. “Joe hasn’t called for a long time. I hope he’s okay.”
Don’t: (remind) “Joe called yesterday and you talked with him for 15
minutes.”
DO: (reassure) “You really like talking with him don’t you?”
(distract) “Let’s call him when we get back from our walk.”
5. “Hello, Mary. I see you’ve brought a friend with you.”
Don’t: (question memory) “Hi Mom. You remember Eric, don’t you?
What did you do today?”
DO: (short explanation) “Hi Mom. You look wonderful! This is Eric. We
work together.”
6. “Who are you? Where’s my husband?”
Don’t: (take it personally) “What do you mean – who’s your
husband?” I am!”
DO: (go with the flow, reassure) “He’ll be here for dinner.”
(distract) “How about some milk and cookies?… Would you like
chocolate chip or oatmeal?”
7. “I’m going to the store for a newspaper.”
Don’t: (repeat differently) “Please put your shoes on.”…You’ll need to
put your shoes on.”
DO: (repeat exactly) “Please put your shoes on.”… “Please put your
shoes on.”
8. “I don’t want to eat this! I hate chicken.”
Don’t: (respond negatively) “You just told me you wanted chicken. I’m
not making you anything else, so you better eat it!”
Do: (accept blame) “I’m so sorry, I forgot. I was in such a rush that it
slipped my mind.
(respond positively) Let me see what else we have available.” Leave
the room and try again.
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