Transitions from one life stage to another are always complicated. As teenagers become adults, their parents maintain a delicate balance between continued supervision and granting increasing responsibility. The process is rarely smooth. It goes in fits and starts, with spectacular failures interspersed with glowing successes. And, it’s the same with dementia.
The transition from being a fully capable elder to someone experiencing dementia is very stressful. It’s not a smooth ride for elders or their families. Dementia begins imperceptibly, at first looking like nothing more than the unreliable memory of normal aging. When family members visit for a weekend, they often don’t realize the true degree of confusion their loved one is coping with. It’s hard to know whether the house is dirty because of low energy, changing preferences, fading eyesight, or loss of the ability to understand the need for basic hygiene.
Most people experiencing dementia can mask their deeper problems when family visit for only a day or two. If you really want to know how well a parent or loved one is functioning in the home, stay at least four days. On the fourth day, coping skills will begin to falter and you will see the actual level of performance. Understand that people in the earlier stages of dementia can rise to the occasion and function at a much higher level when faced with the risk of a visit to the doctor or a forced move. This postpones an accurate diagnosis and puts safety at risk.
Worse, people experiencing dementia are often not aware of their growing cognitive impairments. Usually, our clients are aware that they have memory problems, but remain convinced that their decision-making abilities and judgment are just fine. As caregivers, we find ways to keep them safe, even though they think we are meddling unnecessarily.
This is one of the most difficult tasks families and dementia caregivers face: balancing safety needs with their loved ones’ desire to make their own choices. Becoming impaired by dementia does not take away the desire to live life in a way that feels fulfilling. It just takes away the ability to do so.
It’s tempting to think that moving a confused parent into an assisted living facility or memory care unit will solve all safety problems, but it won’t. Moving a loved one with dementia merely exchanges one set of problems for another. If you consider the dangers inherent in housing a large number of cognitively impaired people in a building with constant staff turnover, keeping someone at home with personalized care is safer. It’s not possible to keep everyone at home, but in a private home it is easier to control the environment and ensure personal safety, given proper supervision and support.
When people can continue to live at home in familiar surroundings, muscle memory and automatic thinking scripts (the mindlessness tools) help them carry on with basic functions, like finding a snack in the kitchen or getting to the bathroom in the night. And, being at home with caregivers who ensure continued involvement in favorite activities preserves quality of life and a sense of selfhood longer than participating in group activities aimed at the average senior’s needs.
Next week, let’s take a look at some techniques for providing care that will preserve a sense of independence and selfhood, while maintaining safety.