One day at the Alzheimer\u2019s day program he attended, Herman suddenly got up and left the room. As he charged down the hall and out the front door, Wendy, the program\u2019s director, ran after him calling, \u201cHerman, stop!\u201d<\/p>\n
She caught up with him at the edge of the parking lot. When she grabbed his arm, Herman swung around and punched her in the mouth.<\/p>\n
This could be the quintessential tale of how not to approach someone living with dementia (not from the back and not by grabbing him), but it is also the tale of an innocent misperception.<\/p>\n
The incident took place in the late 1980s when not as much thought was given to the best way to approach someone living with Alzheimer\u2019s. Wendy was otherwise a natural in relating to people in the group.<\/p>\n
A member of the church where the program was held had volunteered to bring her two toddlers to visit once a week. The children engaged freely with the clients and were an immediate hit. Herman was one of those who gazed most tenderly at the youngsters.<\/p>\n
It was right after the children and their mother had departed that morning that Herman abruptly left the room. It turned out he felt such love for the children that he believed they were his own and \u201cthat woman\u201d was abducting them. He was rushing to rescue them and certainly wasn\u2019t going to let Wendy impede him. Herman reacted just as many of us would have in the situation he was imagining.<\/p>\n
Our view of reality is only as accurate as our perceptions and our ability to interpret them. The person living with Alzheimer\u2019s may have many perceptive impairments and a decreased ability to retain facts and make good judgments. All that can make it hard for him to interpret his world correctly.<\/p>\n
Some misperceptions in dementia are caused by failure to recognize faces or objects.<\/p>\n
When my mother had Alzheimer\u2019s and was living with me, she came to me one day and told me there was someone in her bathroom. Given that she and I were the only ones at home, I was puzzled and followed her to the bathroom to have a look.<\/p>\n
\u201cSee?\u201d my mother said as she pointed to the raised toilet seat with tubular aluminum arms. \u201cThey left their walker there!\u201d<\/p>\n
It was a toilet seat she had been using for several months. It hadn\u2019t changed, but somehow her perception of it had. I knew then that I couldn\u2019t count on her to reliably recognize it as a toilet seat, so I replaced it with a raised seat without the aluminum arms that misled her. I wanted to avoid consequences that would have embarrassed her and made more work for me.<\/p>\n
A woman in one of the support groups I lead told us that her husband had taken to urinating in the corner of their bedroom. She discovered why when she followed him one morning to the bathroom. He entered, but as soon as he saw himself in the mirror, he turned and went out, telling her, \u201cSomeone\u2019s in there.\u201d He no longer recognized his own face. She solved the problem by covering the mirror.<\/p>\n
Misperceptions can be a result of visuospatial deficits, such as when people with dementia are afraid to step onto a patterned rug because the design looks three-dimensional to them. They\u2019re afraid of stumbling on the objects they see there.<\/p>\n
Memory loss and a tenuous grip on facts can also cause the person with dementia to misinterpret situations.<\/p>\n
The most common occurrence in this category could be called \u201cSomeone stole my wallet!\u201d<\/p>\n
The sense of insecurity that most people living with dementia feel prompts them to hide their most precious belongings\u2014and a lot of other things too. Their memory loss means they can\u2019t find them again. Most of us have done something similar\u2014found such a good place for something that we have trouble finding it. We need to mentally retrace our steps to retrieve it.<\/p>\n
But people living with Alzheimer\u2019s have no memory of hiding the thing they value, so they are unable to retrace their steps. If you don\u2019t remember hiding your diamond ring, what\u2019s a good explanation for why it\u2019s missing? It\u2019s logical: someone must have stolen it.<\/p>\n
It doesn\u2019t help to say that \u201cNobody stole your ring\u201d because they know someone stole it.<\/p>\n
Caregivers can help the most by offering empathy. Say, \u201cI know how much you love that ring. I\u2019d be upset too. Let\u2019s look for it together.\u201d<\/p>\n
And never automatically discount the version held by someone with dementia.<\/p>\n
Elsie raised a ruckus every day in the dementia unit at the nursing home where she was a new resident. She would go out in the hall and shout, \u201cSomeone stole my clothes! Help! Someone stole my clothes!\u201d<\/p>\n
One of the resident assistants would come, lead her by the hand into her room and open the closet. \u201cSee? There are your clothes.\u201d This seemed to satisfy her for a little while, but then she would do it all over again.<\/p>\n
The head nurse finally decided to call Elsie\u2019s family. She told her daughter-in-law, Kim, what was going on.<\/p>\n
\u201cOh! It\u2019s my fault!\u201d said Kim. \u201cWhen we were getting her ready to come to the nursing home, her clothes were so old fashioned and shabby, I went out and bought her all new clothes. I thought she wouldn\u2019t notice.\u201d<\/p>\n
Elsie was right. Someone had stolen her clothes\u2014and more.<\/p>\n
It was everyone else whose perceptions were wrong: the staff at the nursing home, who initially assumed that, because she had Alzheimer\u2019s, Elsie must be mistaken; and, most egregiously, her daughter-in-law, who, though intending to be generous, was operating under the unconscious assumption that Elsie was now less than a person, no longer someone with preferences of her own and rights. Kim treated her more like an object she could do with as she liked.<\/p>\n
Luckily Kim hadn\u2019t yet given away Elsie\u2019s clothes, so she packed them up and brought them in to her. The joy and relief on Elsie\u2019s face made clear that she was still a person who could feel, prefer and care.<\/p>\n
Thirty years ago, caregivers were advised to orient their loved ones to reality as a way to improve their cognition and behavior. This advice is now controversial. Some studies have shown positive results, others not. When I tried it with my mother, it backfired and made her more anxious.<\/p>\n
I think focusing on cognition is inevitably a losing game. I suggest a different kind of reality orientation.<\/p>\n
What if we tried harder to orient ourselves to the reality of people living with dementia? What if we tried to see the world through their senses, their perceptions?<\/p>\n
Like the wife who followed and observed her husband entering the bathroom, we might come to understand their interpretation of events. We might learn what frightens them and why, or discover why they sometimes resist what we want them to do.<\/p>\n
Then maybe we\u2019d be better at helping them navigate a world that challenges them in ways we only partly understand.<\/p>\n
At the very least, because we would be more present and engaged with them, they\u2019d know that they count and know we care. And that, in the end, is what they want.<\/p>\n","protected":false},"excerpt":{"rendered":"
One day at the Alzheimer\u2019s day program he attended, Herman suddenly got up and left the room. As he charged down the hall and out the front door, Wendy, the program\u2019s director, ran after him calling, \u201cHerman, stop!\u201d She caught…<\/span><\/p>\n