It is easy to misunderstand or misinterpret the actions of someone with dementia, to wonder why he is saying hurtful things, or to feel offended when his interpersonal behavior and communications are so uncharacteristic for him. Whether in a residential setting or a nursing home, the effects of dementia can produce unpredictable and often offensive emotions, behaviors, and attitudes. Regardless of how long we may have known, loved, and cared for someone, there will be occasions when a coarse, crude comment, a striking out with a clenched fist, or a distasteful act like spitting is directed at the caregiver.
The damaging effects of the dementing illness can present an even greater burden if we take these unpleasant or aggressive behaviors personally. How could the patient be so unkind and ungrateful, after all I have done for him? Why would he try to hurt me, when I’m only trying to get him to finish his meal? Where did that foul language come from – I never heard him say things like that before! Questions like these reflect our disbelief and puzzlement about the sudden changes. But, we have to remember that the loss of emotional and emotional controls that accompany this illness is usually not intentional or purposeful. Yes, these outbursts can be provoked or triggered, as discussed in previous articles, but we can’t expect the outburst to be tamed just because we care so much.
The controls are gone, or at least weakened and erratic. As a result, our interpretation or explanation of the event should be more realistic and objective. To interpret the event as intentional is to perceive the person as capable of controlling his own behaviors. Generally, this is not the case.
Yes, it does bother or hurt us, as caregivers, that the patient has lost these emotional and behavioral controls. There is even some sadness as we see the real person slipping away from our grasp. Someone once described Alzheimer’s disease as a funeral that never ends. Being an effective caregiver means to never lose that sense of caring and empathy for the patient. But, it also means understanding that the threats and problem behaviors are not intended to hurt us, but rather they surface simply because we are there.
For more insights into these issues, see the CoHealth online courses on differentiating among depression, dementia, and delirium and on managing problem behaviors in dementia patients. Nurses and other health care providers may be interested in leaning more about S-BAR as an effective tool when communicating with other caregivers. Visit our website at http://www.cohealth.org/.