Turning no into yes – reaching underlying issues of disempowerment.

No one likes being told what to do, and that doesn’t change when dementia appears. When someone demands that you do something, isn’t your natural response a momentary “Why should I?” or “Who are you to tell me what to do?” When dementia has taken away rational thought, those innate responses aren’t followed by reasoning and acceptance. They remain.

Even worse, people experiencing dementia are often unaware of their impairments, a condition we call anosognosia. When people are unaware that they lack memory or good judgment, they are even more resistant to taking direction from others – even though it’s often to their detriment.

What can we do to help our loved ones and clients choose to willingly do the things we know are in their best interests?

Create independence. There are ways to enhance someone’s feelings of empowerment. When dementia takes away memory and rational thought functions, it becomes difficult to make decisions. If we ask our loved ones or clients open-ended questions we are compounding that difficulty by requiring that they use recall and analysis to come up with an answer.

It is much easier for someone with dementia to choose between two options or two items, or to choose whether to do something or not. So, a kind caregiver will ask “Would you like a cookie or piece of pie?” rather than “What to do you want for dessert?” And, “Would you like to go for a walk?” rather than “What would you like to do?” Asking open-ended questions inhibits the ability to exercise choice while presenting options enables it. In essence, the caregiver is using his or her own rational thought and memory skills on behalf of the loved one or client. Presenting simple options and choices are ways we can empower someone with dementia.

Make options visible. Another empowering technique for caregivers is to be thoughtful about what is visible and what is not visible in the home. Clutter, or too many options (whether in the kitchen, bedroom, or bathroom), inhibits the ability to choose. Clear off surfaces and put out just the items you want used or selected. Lay out a favorite or appropriate outfit on the bed, or put away everything except for the toothbrush and toothpaste by the sink. Set a place at the table with a sandwich and finger food visible under plastic wrap; pour the glass of milk or cup of coffee. Making options visible removes the need for recall and consideration, giving more opportunities to exercise choice.

Don’t mention the end goal. Does your loved one or client routinely refuse to shower or dress or get ready for doctor appointments? There are several emotional needs that can cause refusals (see my page on the DAWN Method), but when an activity is consistently refused we need to revamp our approach.

One of our clients does not like going down the hall to the bathroom, most likely because she’s susceptible to urinary tract infections and often has pain on voiding. She associates pain with using the toilet. So, her caregiver never asks her directly. Rather, she suggests that they go look in the mirror so she can fix her hair. Our client loves having her hair done and will often use the toilet without complaint once there.

When we feel out of control, our need to regain control in even small ways increases. Conversely, when we are routinely presented with options and given the ability to choose, we feel less need for control overall. Good dementia care means proactively thinking about ways to increase our loved ones and clients’ sense of control. We will experience less stress, as well.


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