My former mother-in-law was always polite as I remember her. But when she developed dementia many of her behaviors changed. Her dentures began to bother her, particularly after she ate, and it was not uncommon to see her pop out her trays at the dinner table to clean them off with her tongue. In the past, this would not have occurred to her to do this but at some point this behavior became a source of embarrassment for her family; they could not make her understand that cleaning dentures at the table was poor manners.
In the nursing home where I worked, there was a resident who was quite violent upon admission. She hit, bit, and kicked the nurses who tried to help her transfer in and out of bed, or dress her, or give her medication. She was verbally abusive and yelled often. Her daughter was completely stymied by her mom’s behavior. “She was always so sweet and funny. She never used to act this way.”
A gentleman with Alzheimer’s has caregivers in his home. He is bothered by the race of one his caregivers. He doesn’t want her to touch him or help him. His family knows he was never a racist in the past. Why would he act like this now?
Dementia and brain damage from strokes or other mental illness can cause strong personality changes or regression to younger and uninhibited phases of the person’s life. These personality changes can be dramatic and unpleasant for caregivers and family members. It is important to remember that the individual is not the same person you have known in the past. He often cannot reason the way he used to. He is usually not trying to embarrass you. The brain functioning has changed. This fact requires new strategies on your part to cope.
- Try to distract the person with conversation or an item when she is doing something that seems inappropriate.
- Be careful if the person is violent. Watch your own body positioning and protect yourself. Never hit back.
- Try humor or singing when working with an agitated person. I recall watching a male nurse approach a violent resident whose shoe had fallen off. He bowed low in front of her, shoe in hand, and said, “Cinderella, may I please put your slipper on your foot?” She beamed instead of kicking him.
- Try to accommodate the person’s caregiving choices. It isn’t always possible to respect her wishes, but try to enlist only the caregivers she trusts and likes.
As dementia and brain disorders progress, you may feel like you are dealing with a stranger, and to a great extent you are. Keep your memories of the person’s former self but approach her and accept her today as she now is. There is a reason caregivers are called heroes. You are battling an ever-changing landscape of disease and aging. Keep fighting; you can do this.