Here are some examples of questions that we ask caregivers to consider when trying to determine if it is no longer safe to leave their loved one alone in their home:
- If a stranger came to the door and asked to come inside, would this person let them in?
- Is this person capable of calling 911 or neighbors if an emergency occurs?
- In case of emergency, is this person able to leave the home and seek shelter outside or with someone near to them?
- Does this person routinely experience emergencies, which places their life in jeopardy? Do they suffer from epilepsy or shortness of breath that may need to be monitored at all times?
- Is the person likely to wander away from the house if left alone?
- Has this person recently mentioned “going home” or expressed concern about looking for or “finding” someone or something?
- Does this person recognize their home setting? - How does this person’s behavior and temperament change from when you leave to when you return?
Do they appear angered or scared at the first sign of you leaving the house?
- Can this person distinguish friends and family from strangers if they are faced with answering the door or having someone enter the home?
- Has the use of appliances become difficult for this person?
- If this person turned on the stove, oven, or any other potentially dangerous appliance in the home, would they remember to turn it off?
- Is this person aware of smoke alarms and unusual noises, which may trigger danger and panic, or are they likely to overlook all such noises?
- Are there any other safety hazards due to this person’s condition?
People with dementia often do not remember that they have just asked the same question or told a certain story. It may be due to: Anxiety or fear they have forgotten something This can be a sign of fear, insecurity or worry, and often they need comfort and support. The person could be looking for something comforting and familiar. The individual may want to have something to be involved in and control.
Stay calm, take three deep breaths and try your best to be patient.
Reassure the person with a calm voice, and with a gentle touch when appropriate. Do not argue or force logic and reasoning. Remember, many types of dementia especially Alzheimer’s affect memory, judgment, and reasoning, and more. The person may not remember they have asked or said it already.
Focus on the Feelings rather than the behavior, explore reasons as well as emotions behind the behavior. If the person asks about a child or grandchild, talk about the child or grandchild and look at pictures together. Did someone close to this person recently move, or pass away? Does the repetition occur at a certain time of day, when a particular person visits, calls, or leaves the home?
Address and Respond to the Emotion behind the behavior. Is the person trying to communicate something such as fear, worry, loneliness or boredom?
Provide the answer they need, even if you must repeat it. If the person is still able to read and comprehend, it could be helpful to write it down and post it in a central location.
Sometimes the repetition is a form of action or boredom. Provide structure and engage the person in a pleasant activity. But First, you must validate the emotion they are displaying. If it is a repetitive question, answer the question and then redirect to another activity.
When you find a successful approach and strategy, make sure you shared it with everyone on the care team, consistency is key!
If the behavior is not harmful or dangerous, accept the behavior and explore ways to work with it.
This may be caused by the person trying to tell you something, but they are unable to communicate it clearly or in the same way they once did before. Are they hungry, thirsty? Maybe the person needs to go to the bathroom, is constipated, or in pain. Is the person out of their familiar surroundings? Other causes may include boredom, anger, sadness, being anxious or worried about something. It could also signify a possible need for more exercise, more interaction, and fresh air.
Pay attention to physical needs such as pain, hunger, need to go to the bathroom. Stick to a routine and add new activities to the routine. Prepare a ‘fidget kit’ which includes items of different textures and materials. Have them help with more day-to-day activities. Doing so can help the person feel a sense of purpose and being involved, and decrease the feeling of uselessness and hopelessness. Some examples include safe aspects of meal preparation, cleaning, folding laundry.
Consider providing stimulating games and activities to distract and occupy their time. These could include word searches, singing, and looking at photos. Take the person out for regular walks. When choosing activities, Keep in mind the person's strengths, personal preferences, and level of ability.
Losing the independence and the identity that driving provides can be upsetting and feel life changing. However, due to the progression and effects of dementia in the brain, at some point driving will no longer be safe. It is important to acknowledge the person’s feelings and try to preserve the person's independence and sense of self while ensuring the persons safety and the safety of others.
Initiate a dialogue to express your concerns. Keep in mind that this may be the first conversation of many conversations about Driving. Emphasize the positive and offer and explore other alternatives.
Some people give up driving easily, but for others this transition can be exceedingly difficult. SO, BE PREPARED, this may be just the first of many conversations about driving. Be prepared that the person can become upset and angry with you, but do not take it personal. Remember, many types of dementia especially Alzheimer’s affect memory, judgment, and reasoning, and the person may not understand that there driving is no longer safe. Be patient and firm while demonstrating understanding and empathy.
Address the resistance while also re enforcing your unconditional love and support for the person. React with empathy and understanding and acknowledge the pain of this change, but also the person’s desire to act responsibly.
Help take the blame off you:
Consider evaluation by an objective third party.
Ask a respected family authority figure, or close friend of the person to reinforce the message about not driving.
Ask the physician to write a letter stating that the person must not drivee. Or ask the doctor to write a “No Driving” prescription. If the doctor understands and is willing, you can then reinforce when needed and can take the blame off of you. As we know, you don’t need more!
The bottom line is Safety of the person for whom you care and others. So when necessary, as a last resort, remove the car completely, or disable the car and or take the car keys away.
Don't take offense, argue or try to convince. Listen to what is troubling the person and try your best to understand their reality. Allow the person to express their thoughts and opinions. It is okay to offer your thoughts with the person but do not overwhelm, keep it simple. Do not provide lengthy explanations or reasoning. If the person is routinely searching for a specific item, try to have several of that item available, for example if the person keeps losing a belt, or purse, maybe have several on hand.
When responding, respond in calm supportive manner. Consider responding with, "I'm here, don't worry, I'll protect you. You are safe with me." acknowledge the feelings behind the episode and what it may mean to the person. Consider stating, "I see you're worried, I know this is upsetting (or frightening) for you."
Try to move with the person into another room, suggest going for a walk together. Often, frightening hallucinations can subside in well lit places where other people are present. Turn the person's attention to music or an activity you all enjoy together.
Look at the environment to see if there are any contributing factors that need to be modified. Check for sounds that could be misinterpreted, such as noise from a television or a cooling unit. Look for lighting that could potentially cause shadows or reflections on the surfaces of floors, walls, and furniture and turn on lights to reduce those potential shadows and reflections.