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Understanding Dementia from the Inside

understandingdementiaIn my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia.  If you have a loved one who has Alzheimer’s or one of the other types of dementia, you know all too well that they are not the same person they once were.  But have you actually spent some time trying to understand who they are?  Have you tried to understand what it is like inside dementia?

Try this hypothetical situation.  As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night.  You have just enough time to walk them and then have breakfast and get to work.  As you go downstairs to the kitchen, the crates are not there, the dogs are not there.  In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are?

If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel?  …probably confused, anxious, frightened, and then sad – very sad.  That used to be what professionals recommended to caregivers of individuals with dementia – a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation.  So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them.

A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events.  So, affirming their feelings and then helping them to shift to something more soothing can be very helpful.  This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner.  By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it.  Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:

  1. First, ask questions that will help you understand what has triggered the response.  I had a client who saw little people around the perimeter of the room painting the baseboards.  Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
  2. Don’t think that it all has to be logical.  It is more about how your loved one feels than it is about if it makes sense.  Just go with it.
  3. Especially if your loved one is upset, try to gently find out what makes for the upset.  Then, validate by agreeing that you would be troubled also if its happened to you.  You will find that the anxiety for both of you will subside.
  4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago.  Please email your questions to


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