Anyone who has spent time with someone experiencing dementia knows that dealing with dementia-related behaviors causes tremendous stress. For families caring for a loved one, caregiving is in itself debilitating because of round-the-clock demands and the difficulty of finding someone who can step in to give the primary caregiver a break. However, it’s behaviors such as exit-seeking, pacing, excessive talking, combativeness, hallucinations, and repetitive actions that can reduce even the most rested and devoted caregiver to tears before breakfast is over.
Appropriately, when I look at books on how to provide dementia care, I find entire sections devoted to behaviors and how to deal with them. Advice is organized by situation, or task, such as how to deal with behaviors that occur when bathing, eating, dressing, or using the toilet. The consensus is that behaviors have multiple causes and are difficult to understand—that dementia-related behaviors are the real problem in dementia care.
Dementia-related behaviors are symptoms
I agree that behaviors have multiple causes, but that’s all. I see a pattern that makes dementia-related behaviors predictable and resolvable. I think they are no more than the symptoms of unmet emotional needs. When we think of behaviors as symptoms, we can look deeper for their causes and respond in a way that alleviates the behavior. For example, both a refusal to shower or an attempt to leave the home or care facility could be the result of fear. Or the same two behaviors could be caused by the need for autonomy, the desire to feel in control, or the insecurity that results from confusion. Thinking of behaviors as understandable expressions of emotional needs—symptoms of an underlying problem—allows us to deal with them. As symptoms, behaviors are no longer inexplicable.
My background is in literature, languages, and law—not medicine or social work. I learned when studying languages that I should expect to find logic behind errors. I learned from my study of the law that although a set of facts may seem random or unrelated, looking deeper will often uncover a unifying principle or rule. So, when I began working with people experiencing dementia, I expected dementia-related behaviors to be expressions of something underlying and logical.
What all my clients had in common was feeling emotionally distressed due to undergoing progressive cognitive impairment—specifically, the loss of their rational thought processes. What I began to do was to meet their emotional needs and support their rational thought processes. When I did this, my clients became happy and relaxed and their behavior problems melted away.
Meeting the emotional needs of dementia
The DAWN Method is a set of seven tools which help us support someone’s rational thought losses and the emotional needs that accompany progressive cognitive impairment. My method is unique in that it identifies the problem caused by dementia as being the emotional distress a person experiences when undergoing progressive cognitive impairment, and provides caregivers with precise tools matched to those emotional needs. When we look at emotional distress as the problem and the person’s behavior as a symptom, being a caregiver becomes companionable. That’s the magic of the DAWN Method.