As dementia progresses , people with the disorder require more and more help with their daily activities. But to the frustration of caregivers who are providing dementia care, patients may not welcome that help, for various reasons.
Understanding why your loved one is resisting your assistance will help you find ways to effectively provide dementia care, says Shawn Herz, MSG (MS in Gerontology), director of programs at the Los Angeles Caregiver Resource Center, a program of the University of Southern California in Los Angeles.
However frustrating this becomes - and whatever you choose to do - "It's always important to keep personal dignity," Herz says.
Reasons for Resisting Help
Here are some reasons why your loved one may resist help:
- Pride. Worsening dementia symptoms do not override a person's sense of pride. For an adult who has taken care of herself for decades, it can be difficult to accept help getting dressed or maintaining personal cleanliness.
- Timing. People with dementia may need more time to carry out their daily routines, even with your help. Make sure that with each activity, you build in lots of added time for it to be accomplished. If you need more time to finish it, and you get frustrated, you might increase the patient's level of agitation.
- Changing perception. As dementia progresses, patient's perceptions change. For example, says Herz, "Shower water may look like falling glass." Try to understand what is bothering your loved one about a particular activity.
- Depression. " Depression runs high. You're not feeling well; you know that you are not feeling well," says Herz - and this can make it harder to be cooperative. Antidepressants can help.
- Dementia symptoms. Irritability, restlessness, confusion, sleep problems, agitation, and difficulty remembering how to carry out activities of daily living can all contribute to a patient's inability to cooperate with dementia treatment. Remember that up to half of all patients are physically aggressive towards their caregivers.
- Changes in routine. If something disrupts the normal schedule, your loved one may become distressed and uncooperative.
- Stimulating surroundings. Dementia patients tend to do well in soothing environments. Too much noise, harsh light, or activity can cause distress.
How to Increase the Chance of Success
You can help your loved one be more open to accepting help even as her dementia symptoms worsen.
- Join a support group. Caregivers are a tremendous resource to one another, says Herz. A well-run support group can give you emotional support - so you are more patient with your loved one - as well as ideas on how to make things go more smoothly at home.
- Assess your attitude. The problem at hand is that your loved one is resisting help - but Herz says you may be contributing to the situation by telegraphing your anger, resentment, and frustration through your body language. Many caregivers are not aware of the power of nonverbal communication even with dementia patients, she says.
- Remember safety. You may need to adjust routines, not just so they are easier for the patient, but safer as well. For example, a soak in the tub is not an option for a frail, confused dementia patient - opt instead for sponge baths or a handheld shower head and a shower seat.
Dementia Medications That Increase Cooperation
Medication may be an option if your loved one is very uncooperative, delusional, or physically aggressive. Antidepressants can ease the depression and anxiety of dementia while antipsychotics may be prescribed to control dangerous behaviors. There are both benefits and drawbacks to these types of dementia medications.
For antipsychotics, concerns are:
- Risk of premature death. There is some indication that antipsychotic medications effectively reduce agitation and aggression; however, a recent study found that long-term use of antipsychotic medications significantly increases the risk of premature death.
- Risk of stroke. Another study showed that dementia patients who took antipsychotic medications had a greater risk of nonfatal cerebrovascular events, such as strokes.
- Weight gain. Certain antipsychotic medications have been shown to cause significant weight gain in patients, adding to other health concerns.
That said, there are no alternative treatments that have been shown to be as effective as antipsychotic medications, so caregivers and doctors may be forced to make difficult decisions.
As for the antidepressants, these may also increase weight gain. Dizziness and daytime sleepiness are also possible side effects.
If you are considering medication, make sure you understand what type of drug is recommended and how long your loved one will be taking it. Opt for the lowest effective dose possible for the shortest amount of time.
Find more information in the Everyday Health Alzheimer's Disease Center .
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