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Dementia And Peripheral Awareness

 REGINA D. Posvar LPN,RNA
REGINA D. Posvar LPN,RNA

Q: I AM frustrated! My dad needs help dressing. He wears the same clothes every day. When I try to help him get dressed, he pushes me away and is very upset. How do I get him to understand what I am trying to do?

A: I understand the frustration and so do many others in your situation. Let’s stop and back away from your dad and think about this. Your dad is experiencing many brain changes that we are not. Take a moment and try to imagine what he is thinking when you try to remove his clothes. Understand that people with dementia lose their peripheral awareness. When they are looking at you, they are focused on you. They are not able to notice your hand coming at them to touch or remove their clothes because their focus is on you or whatever they are doing. Your hand coming at your dad is a surprise and to him an invasion of his personal space. Get his attention. Make sure you are eye to eye and in front of him. Use gestures to show him what you want him to do. Show him your shirt and then point to his. When you notice he recognizes what you are doing, motion to pull it off. He will give you the clue that he understands. Your dad may need visual cues to communicate. And just because he has dementia, does not mean you do not need his permission to dress him. If he is a private person or someone who has always been in an authoritative position, give him the respect he is accustomed to.

Q: My mom is repeating things she has told me several times, and this is not like her. I mentioned to her about going to the doctor and she nearly bit my head off. She says I am trying to put her away. How can I help her see a doctor?

A: This is a tough one. Understand your mom has a strong will. Be patient and keep spending time with her and engage with things she likes. She will go when she sees a physical need. Document all the changes that are happening for the doctor. Some of the changes she is experiencing are embarrassing to her and she may be trying to cover it up. Be sensitive. More people are becoming aware of Alzheimer’s and other dementias but the negative stigma with it is slow to change. If her doctor says she is ok, go see a memory specialist who can help you get the information your doctor will need to order the appropriate test to rule out other illnesses. Sometimes doctors do not have enough information from you to suggest testing, so taking your documentation will help them. Infections and deficiencies will contribute to memory, behaviour changes and cognitive impairment. Many times these symptoms can be reversed with proper treatment. If it is dementia, please seek support for you and your mom. There is life under the umbrella of dementia

Q: My mother has had Alzheimer’s for 10 years now, and she has always enjoyed going to our family gatherings on Sundays. Lately, her behaviour has been more anxious and we have to leave early. She continues to be anxious the rest of the night. Should I stop bringing her to the gatherings? Is this the right decision?

A: First, you have identified when the behaviour changes happen and you have understood that this is something SHE has always enjoyed. Family functions can be too much stimuli for her right now. You and the family can tone down the noise level and she still may need to go home early. People with dementia often experience their world is shrinking. Their level of comfort awareness is closing in. As the disease progresses the frontal part of the brain does not allow them to see or be aware peripherally. Sound coming from outside their own vision and awareness can frighten them because it does not make sense to them. This makes them want to get away, go home or somewhere where they feel safe. This is the anxiety you see. Some people will calm down quickly when brought back home and others like your mother will still be anxious and that is due to stimulation. You can use soft music to change the mood. This usually works. Sing with her soothing songs she knows. The other option is that your family can come and visit your mom in smaller groups at a time. Outings for your mom will change. Reducing her anxiety will reduce your frustration. You are still meeting her needs and passions.
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