Can you imagine not being understood, even though you feel you make total sense? Wouldn’t it be frustrating if no one got what you were saying? What would your mood be, if this happened to you constantly? This is where we begin with our story of Cathy, a lovely lady, with mid-stage dementia, living at a care home. Her behaviour was very typical of the confusion and lack of clarity of present life that’s experienced by someone with mid-stage Alzheimer’s disease. In this stage, some will jumble words, speak with improper sentence structure, and concoct stories that may be conjured up past memories.
When I saw Cathy coming towards me, very annoyed, I knew there was something wrong. I stopped to say hello and asked her how she was. Her response to me in a very irritated voice was this:
“I made costumes; out of the bulk. And they are there and all dolled up with freshly made dresses and the boys had freshly starched hats. So everyone is throwing their money in the hat. And this is my hat and this one is my other hat.”
Her statements were as puzzling to me as they are to you, but I know the importance of showing understanding (even if you don’t) to make the person feel safe and validated. Looking for clues as to what may have triggered her imagination, I saw that she was carrying a commode pan that did look like a hat. I wondered if that had triggered a memory for her involving dressed up people and putting money into hats.
This is when I know, from best practice you go with the flow and build trust and confidence. I complimented the hat and said, “Wow… that’s a lovely hat!” I showed interest and smiled and made eye contact.
She seemed to perk up and in a more positive tone she said, “Yes… and at night you can put your stuff around it and pull it on the backside; it won’t cut very…” she trailed off. She seemed to be searching for more words. Seeing her struggle, I knew it was my cue to keep the mood positive and change her thought pattern, so I asked, “Is that plastic?”
She responded with a grin and seemed to be proud of herself when she said, “Yes, and I cut it. It was a corner hat.” Again, building on any information she gave, I continued the conversation.
She explained further, in her broken and incoherent way, a situation where at a school the kids were asked to come up with fundraising ideas, and a little boy stood up and said ‘my mommy has a half a hat! My mommy and daddy made me half a hat; one sewed it and one cut it’ She spoke in a child’s voice when she did the child impression. In a sarcastic way, and laughing heartily she said, “kids don’t go around saying I got half a hat?!
Again that was my cue to laugh with her to make her feel I understood. It was clear that she was remembering some form of memory that the hat-like object had triggered. Perhaps the little boy she was speaking about was her son. No one can be sure, but what we can be sure of is that Cathy, like anyone with Alzheimer’s dementia wants to feel understood.
Now, imagine in this situation, where a care staff, for example, tried to pull away the toilet item and say, “no, this is not a hat.” To let her know that she is imagining things, or to say, “sorry, I’m not sure what you’re talking about.” The result of this kind of reality check would be clearly more distressing and upsetting to a person with dementia. If Cathy thinks she made this plastic hat and she cut it, then let her think it. Play along. It’s the best way to get her to be in a happy and positive mood.
If you’re having trouble understanding your loved one’s sentences and ideas, and are truly stuck not knowing what to do, please call me at 778-789-1496 for guidance. My life’s work has been interpreting and understanding people with dementia.
Karen 🙂
Karen Tyrell, CDP, CPCA
Personalized Dementia Solutions
