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Tips for Preserving Both Selfhood and Safety

by Judy Cornish

Dementia causes memory and rational thought losses. Losing rational thought means losing skills such as the ability to perceive cause and effect, prioritize information or actions, or follow a sequence or steps in a task. The result is poor decision making and inadequate self care, putting safety at risk.

How can we help our loved ones who have dementia stay safe? Here are a few techniques that we use here at DAWN.

Pick your battles

Whether it’s a toddler, spouse, friend, or someone experiencing dementia that we’re spending time with, no one enjoys being repeatedly told what to do. As dementia caregivers, we need to find ways to support our companions’ autonomy. It helps to keep in mind that not everything is truly a danger. Many things are merely undesirable, unpleasant, or unnecessary.

Decide at the start of the day that your goal is to give your loved one maximum freedom to do what she or he wants, and to intervene only when essential. Is she determined to wear a flimsy t-shirt on a snowy day? Allow her to experience being chilly and later choose to accept the sweater you brought along “just in case.” Is he bent on going out to work in his shop? Be enthusiastic, then distract him minutes after he gets there with a snack or plea to help you with something back at the house. Is she determined to go for a walk? Let her start out, then happen by with the car and suggest a hot chocolate together down at the mall.

Rather than refusing immediately and trying to explain why the idea is a bad one, be supportive in the moment and then supply a distraction later if there really is danger.

Present the lesser of two evils

When something really needs to be done for safety or health and you know that your loved one is likely to balk, present what needs to be done as an option—having carefully chosen a less desirable alternative to present with it.

Bathing invariably becomes a problem with dementia, primarily because people experiencing dementia lack the ability to see cause and effect. Yet not staying clean results in skin problems that are very difficult to reverse. Our clients often believe they bathe or shower daily, although they would never choose to bathe on their own. Or, they may have lost their sense of smell and don’t realize they have body odor, or may have had a bad experience being bathed, or simply feel the need to regain a sense of independence through refusal.

Sometimes it works to agree with the client that showers are unpleasant, then show her a bathtub filled with scented bubble bath in a carefully preheated bathroom with lights dimmed. Or, we might suggest shampooing in the kitchen sink, which many of our elders remember from their childhoods. Then, later we can suggest a bath or shower “because it feels so good if you don’t get your hair wet.” When our efforts to instigate good bathing habits at home fail, we suggest a soak in the hot tub at the local wellness center. There, the caregiver can model showering before they enter the pool and when leaving, and can do a skin check at the same time.

Keep in mind that, no matter what technique you’re using to preserve both autonomy and safety, the factor that will best increase your chance of success is your nonverbal communication. Be truly empathetic. Your genuine concern for your loved one’s welfare will be apparent and have effect, for we read other people’s feelings using intuitive thought—a skill not lost in dementia.