As Alzheimer’s or another dementia grips a person’s mind and they progress from what we define as early stage to mid-stage of the disease progression, we often see our loved one living in their own version of reality. They are in another time and place for longer periods each day, or perhaps the entire day.
What often accompanies this state is a fixation on something such as the location of their vehicle or the idea that someone is trying to steal their money. As caregivers, we want to help them see that their thoughts are not grounded, so we often attempt to reason with them by making a factual statement such as “remember honey, we were concerned that you might have an accident so we gave your car to our grandson two years ago and he has driven it to college.”
In short, we use the art of reasoning, where we employ our skills in logic and critical thinking to give our loved one a cause and effect for why their version of reality is incorrect due to short term memory loss.
There is a problem with our method however: There is no reasoning with a person who has Alzheimer’s.
Author Jolene Brackey’s book Creating Moments of Joy—A Journal for Caregivers helps us understand that we will not be able to make our loved one live in our reality. The technical term for this approach is reality orientation, and it simply doesn’t work with someone suffering from dementia.
Instead, it is essential that we change. Our new technique must be to enter their reality. When your loved one can’t understand why their car is not parked in the driveway, your mission is to give an answer that makes sense to your loved one. You might say, “Our son took the car to have the oil changed and will bring it back tomorrow.”
We wrestle with this idea because under normal circumstances, it feels like you are lying to someone you love. Brackey reassures us that this technique is not lying, but “living their truth.” It is very real in your loved one’s mind that the car is missing. By agreeing that the car is not in its usual place and giving a reason that makes sense to him or her, you are allowing your loved one to relax and be at ease. They can go “off duty” and not worry about making sure the family’s key possessions are in order.
They may repeat the concern, but if the previous answer worked, you can keep stating the same answer as if it is the first time you were asked. If that answer didn’t work the first time, you get the opportunity to try a new answer because they have forgotten the answer you gave them previously. This time you might say, “our daughter needed to borrow the car so I loaned it to her. She’ll return the car tomorrow.” Keep thinking of reasons for why the car is only temporarily missing until you find a reason that works.
We gain greater conviction in this method when we realize the harsh consequences of bringing someone into our reality. Imagine a person who is 85 but believes they are 24, who for ten days in a row asks where their sister is, when in fact their sister has been deceased for ten years. If you continually answer that the sister died ten years ago, you will cause them to grieve the death day after day as if it was the first time they learned of the death. We don’t view this as humane.
In caring for someone with short term memory loss, our goal is bring them to a place of joy and peace, because the critical moment of their asking a difficult question will not be remembered later.
Amy Carmichael wrote long ago the simple phrase, “in acceptance lieth peace.” If we accept that we cannot reason with our loved one to transport them to our reality, and we instead simply enter into their world, we can increase the moments of joy and peace we have together.
Scott Schultz, President of Morningstar Care Homes