Why People Amongst Dementia Nation No (And What To Produce Almost It)
There are ways you lot tin interact with someone who has dementia to minimize the role of the discussion “No”, as well as to acquire them to cooperate to a greater extent than easily.
People with dementia state “NO” to nearly every query or request.
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In this article, I explicate i argue for the non-stop no’s … and offering strategies for preventing as well as managing the negativity.
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Patterns of Memory Loss as well as Retrieval Problems
All dementias portion this same mutual feature: moving backwards inwards time.
- The newer memories croak away first, followed past times older memories.
Persons with dementia “unlearn” tasks as well as abilities inwards opposite order. The tasks learned earliest inwards childhood, such equally feeding oneself as well as removing clothing, are the concluding to last lost.
Some memories are buried deep inwards the brain. Retrieval, or the might to acquire memories as well as convey them to the surface, gets worse. Singing as well as music, past times the way, are retrieval paths. If the front end door of the describe solid is locked, ever endeavour the dorsum door … it may last unlocked. Or endeavour a side window.
Music uses dissimilar paths to acquire to buried memories, which is why someone who no longer talks all of a abrupt sings along with a favorite hymn or song.
“Mama” as well as “NO!”
The earliest words uttered past times babes are ordinarily “mama” as well as “no.” Any nurture tin relate to the “NO” word.
“NO” is how nosotros protect children from harm as well as learn them how to behave. Even if nosotros brand the dwelling surroundings equally security equally possible, “NO” remains of import equally our children acquire older as well as croak exterior into the world.
They acquire to role “no” to found boundaries. “Just state no” as well as “No agency no” are at nowadays embedded inwards our culture.
When the toddler start uses the discussion “no,” he or she is non refusing anything. They are precisely trying out their teeth as well as tongues, repeating this cool novel matter they learned to do. When my youngest was learning to talk, as well as “no” was i of his earliest words, his older sis loved to tease him past times asking him questions -- knowing his response:
Older sister: “Want some H2O ice cream?”
Little blood brother (smiling as well as reaching for the spoon): “NO!”
Older sister: “Sorry, niggling guy, you lot said ‘no.’” (Older sis puts spoon of H2O ice cream inwards her mouth.)
Little blood brother starts to outcry as well as wail.
Mom: “DO NOT MAKE ME COME OVER THERE! STOP TEASING YOUR BROTHER!!” (and diverse other things that I likely should non receive got said but other parents volition understand).As adults, nosotros croak along to role the discussion “no.”
Sometimes, nosotros role it to protect ourselves from negative choices: “No, I am NOT going to (make that purchase, consume that food, tell my supervisor that this newest stance is actually stupid, etc.).”
Sometimes, nosotros create do to role the NO discussion to avoid beingness over-committed or to gear upwardly boundaries, for fearfulness that nosotros may last disappointing others. The bottom describe is that our role of the discussion “no” starts around the same fourth dimension nosotros are learning to feed ourselves with our fingers as well as is used multiple times a twenty-four hours throughout our adulthood as well as older age.
The role of the discussion “no” eventually becomes a procedural memory. H5N1 procedural retentiveness is the retentiveness of how to do something. Procedural memories, which include feeding oneself as well as brushing one’s teeth, volition rest fifty-fifty afterwards nosotros lose other memories, similar why or when nosotros should do something.
Dementia as well as “NO”
As people with dementia motion backward inwards time, it makes feel that the role of the discussion “no” remains. The might to state “no” volition last alongside the concluding memories as well as abilities lost past times a someone with dementia.
Just similar my representative above, the noesis of the important may croak away fifty-fifty though the might to brand the discussion remains.
Beyond Yes/No Questions
When working with persons with dementia, nosotros instantly acquire NOT to inquire yes/no questions. We alter our tactics as well as say, “Time to accept a bath,” or “Here are your medications.” The dreaded NO withal happens. Why?
Too Many Words Not Enough Memory
- People with worsening dementia tin exclusively “hold onto” a few words at a time.
We oft role sentences that are likewise long. Or nosotros endeavour to “explain” why medications are important.
Logic as well as explanations do non work. There is non plenty available retentiveness to procedure this information. When the issue of words are greater than the encephalon capacity, the encephalon falls dorsum on the procedural retentiveness of “no.”
Shrinking Temporal Lobes Cause Receptive Aphasia
The temporal lobes (under the ears) shrink inwards Alzheimer’s dementia as well as frontotemporal dementia.
These same lobes are oft damaged afterwards strokes, which causes the receptive aphasia nosotros encounter with post-stroke patients.
The temporal lobes link sounds to words. As the temporal lobes shrink, people with dementia no longer empathize speech.
In fact, I receive got observed that many people with moderate dementia start to deed equally if they receive got a hearing problem: “Huh?” “What?” “What did you lot say?” “I can’t understand.”
The hearing industrial plant but the might of the encephalon to push clit the discussion out of the encephalon lexicon as well as link it to the audio is broken.
Our words, then, lose meaning. The result? Automatic “no.”
Strategies to Minimize “No”
There are ways you lot tin interact with someone who has dementia to minimize “No.”
Start with Your Appearance
During a recent dwelling visit, i of my nieces took my pic without my knowledge. I was listening intently to something my sis was telling me. The pic surprised me. I looked therefore serious as well as somewhat … mean. I was frowning as well as wrinkling upwardly my forehead. I had no stance I looked similar that. This made me think: when I’m working with people with dementia, do I await similar this when I’m focused?
Gently smile. Relax your forehead. These 2 pocket-size steps volition soften your features as well as brand you lot appear to a greater extent than relaxed as well as friendly. People with dementia, particularly inwards the moderate to severe stages, rely to a greater extent than on nonverbal cues than spoken language.
Gestures
Support what you lot desire to state with gestures. I volition brand a “come with me” gesture with my hands. I also NEVER concur or push clit someone with dementia. The resultant is a tug-of-war, as well as you lot volition lose.
Instead, I gently house their hands on my wrists as well as I walk backwards or side-by-side. Try it. Also, nod your caput as well as grinning when you lot are getting the answer you lot want.
Make it Vague
Instead of saying, “Let’s croak brush your teeth,” endeavour “Let’s croak receive got fun.”
Don’t judge, I know it sounds super weird (and creepy). For reasons I receive got non yet figured out, I receive got gotten people to the bath with the fun sentence.
Putting It All Together
At first, some of these ideas volition experience weird. Play with the techniques, as well as encounter what industrial plant best for you lot as well as your describe solid unit of measurement member.
I receive got some patients with whom I barely speak because the spoken words trigger unwelcome or hard (for me) behaviors.
I receive got other patients with whom I sing the entire fourth dimension I’m providing care. It is somewhat lawsuit as well as error, but the results are worth the experimentation!
More on Dementia Care from Rita Jablonski
10 Commandments of Alzheimer's Caregiving
Sleep Medications for Alzheimer's as well as Dementia Patients
My Father with Alzheimer's Stares at Us as well as it Feels Creepy
Caregiver Alert: The Connection Between Gum Disease as well as Alzheimer's Disease
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Rita Jablonski, PhD CRNP is an internationally recognized practiced inwards dementia behaviors. She is tenured professor at the University of Alabama at Birmingham as well as a funded researcher, with over 50 publications as well as mass chapters to her credit. Rita blogs at Make Dementia Your B*tch. She offers caregivers coaching as well as guidance for caregivers at DementiaCentric Solutions.
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Author Rita Jalonski
July, 2018
Title: "Why People with Dementia Say No (And What to Do About it)"
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