One of the most disconcerting losses when dementia strikes is becoming unable to track time, understand the calendar, or keep appointments.
Can you remember an occasion when you were struggling to understand a concept and suddenly comprehension dawned? That welcome rush of understanding – of mastery of an idea or the way to do something – is one we enjoyed daily as we progressed through childhood. But by adulthood we become so used to understanding what we see, read, and hear that we forget how frustrating and scary it is to not be able to. If you’ve ever traveled in a country where you don’t speak the language, you’ve had a reminder of how it feels to not be able to make sense out of what you see or hear.
Our loved ones and clients experiencing dementia are traveling in a land becoming increasingly foreign to them. And, hard as it is to not understand written or spoken information, they are also becoming unable to imagine how quickly the clock hand moves from 12:00 to 12:05, or how much longer it takes for it to go from 12:05 to 3:00. And, they are becoming unable to hold two facts in their minds at once, unable to see cause and effect, unable to make plans, unable to initiate an activity on their own.
Without these skills, how can we expect them to calmly accept our assertion that we can go out for lunch and make it back in time for a 3:00 p.m. hair appointment, or go to a doctor’s appointment this morning and be home again by 1:00 p.m.
The inability to keep appointments and read clocks or calendars becomes a great cause of stress for caregivers. How can we help our loved ones and clients maximize their sense of knowing what’s happening and feel more comfortable as they lose these functions? Here are a few tips from what we do with our clients here at DAWN.
Expect experiential learning only. Experiencing dementia means losing rational thought processes but keeping the intuitive ones, so people become unable to learn by memorization or reasoning but continue to learn from experience. If you let keeping appointments become a source of conflict, you’ll have escalating behaviors around time issues. Instead, keep in mind that when someone has dementia, it is always possible that you’ll make it to an appointment on time, but never probable. Focus your attention on one preparatory task at a time – and primarily on your loved one. You’ll be more able to keep appointments. More importantly, though, your loved one will learn that it’s always fun to do things with you, rather than learn that you become agitated when the clock is involved.
Keep it simple. Find a large calendar that shows no more than one month when laid open on the counter. Each morning, cross out yesterday so that the first square not crossed out is always “today.” Watch to see whether your loved one can interpret “3 pm,” “3:00” or “3 o’clock” and use that format only. Always put the time first and follow it with a succinct description of the activity. Use whiteout, not scribbles. Keep notepaper and a pen nearby for your loved one to attempt to write their own notes, because copying something out gives a feeling of mastery and security.
Schedule one activity per day. When people are in the early stages of dementia, they are able to manage more than one activity in a day without becoming stressed. As they progress, it’s best to cut activities back to one each morning and afternoon, then to one per day, and eventually to provide sensory and social stimulation with brief interactions rather than activities.
Helping our loved ones and clients feel safe even though they cannot read the clock or make sense of the passage of time is an important way we provide support as dementia caregivers.