Thursday, September 4, 2014

What's Your Orientation?

This is a subject that comes up often in caregiving discussions, thank goodness! The question of whether you should re-orient your loved one if they get confused about where, or when, they are. I saw the essay I've linked to below and it reminded me of what I used to do with Dad and how important it is to keep talking about this, even though practices have changed a lot in the last ten years.

When I started caring for Dad, the prevailing wisdom was to continually remind your loved one with dementia about who they were, where they were, what year it was, and that the people they might be talking about having just seen had, in fact, been dead for forty years. It was called 'reality orientation' and it meant that family members and facility staff corrected people with dementia all the time. Even before I knew anything about dementia, and how you should treat people with it, it seemed like the cruelest thing in the world to keep making them even more confused and anxious by forcing to think or remember a certain way.

Years ago, I watched my aunt and my father deal with my grandmother, who had vascular dementia. My aunt insisted that what my grandmother said was wrong, that the people she was talking about were dead, that is was a different year from the one my grandmother thought it was, etc. I knew nothing about dementia, but this seemed so pointless and mean to me. Who cared where she thought she was, or who she thought she was talking to? When I took over for Dad, I decided early on that I was going to go along with whatever he said or did.

And I did, and it was fine. He would tell me wild stories about having been on his sailboat on Lake Washington during a huge storm that trashed the boat, and how lucky he'd been to stay alive. I knew the boat had gotten loose in the wind five years before and crashed into a dock, but I didn't remind him of that. He told me that my mother had died while giving birth to my sister, who was too big (I think he was thinking of her as a full-grown adult), and I just listened. I don't think he ever mistook me for someone else, but then he kept a lot of what he was experiencing to himself, so I don't know how he saw me. I do know that it kept him relaxed and unstressed that I didn't try to make him think something he couldn't, and I got to hear some interesting stories!

Now we know that people with dementia are unable to make current memories - snapshots, if you will, of what is happening in the present. All they have are snapshots from the past, and a lot of empty pages in the present. Lacking these recent snapshots, they try to make sense of current events and people using old memories. So a waiting room might look like the airport they used to fly into as a pilot. Or they think a caregiver who they see all the time and who cares for them intimately is their mother. Seems logical to me.

Dad and I are past the point where he's even talking, let alone mistaking me for his mother or thinking that he's somewhere, or somewhen, else. I no longer know what is going on in his mind or what he is thinking or feeling. I'm proud of how I dealt with his dementia, though, and that I made his life as comfortable and enjoyable as possible - largely by trying not to remind him he had dementia!

I'm so glad that practices have changed in the last few years and that good people have studied dementia and what it is doing to the brain and behaviors. Wonderful people are developing new techniques to deal with those with dementia in a compassionate and low-stress way. I tell all my caregivers not to try to keep their loved ones in "reality" because what is reality after all? Reality should be a relaxed, non-stressed care receiver!

Learning to Speak Alzheimer's. Joanne Koenig Coste
Contented Dementia. Oliver James

1 comment:

  1. Its really nice article.Thanks for sharing.