Wednesday, 6 November 2013

Caregiver Wednesdays--Tackling the triggers

Barbara was devastated.

Her gentle, refined auntie, who she had always loved and looked up to, had just "bitten her head off." Barbara had entered her room for a visit, and had hugged her as she had done with every visit since she was a child. Auntie had drawn back with a scowl and growled at her, "Get your hands off me!" Stunned, she backed out of the room and went to talk to the nurse. While in the medical office, she'd burst into tears. She knew her aunt had dementia, but in the two years since her diagnosis, she'd never acted like this. What had she done wrong?

Barbara had done nothing wrong, especially since she'd never seen this kind of behaviour from her aunt before. But now that she knew it was possible, she needed to learn how to deal with it.

Barbara learned from the nurse that although this wasn't common behaviour for her aunt, it had occurred before, and it seemed to be escalating. The staff was monitoring it, and if it continued to happen, they would mention it to the doctor. For now, they were documenting each time it occurred, and looking for patterns. Was it a certain time of day? Was there a trigger? Was she tired, ill or over-stimulated when the incident occurred?

Over the next several months, Barbara became a student of her aunt, as well as learning
 how to deal with aggressive behaviour. Here is what she learned:

1) It was a big help to know what kind of a day her aunt was having. She checked in with the nurse or the caregiver and found out how she slept the night before and if there were any problems.

2) She approached her aunt with a big smile and a cheerful greeting, identifying herself before auntie had to wonder who this was. Most times, this brought immediate joy to her aunt's face. She didn't touch her, though, until her aunt's body language invited her to do so.

3) If Auntie got angry for any reason, she learned to take a deep breath and back off. Sometimes this meant changing the conversation, distraction, or even Barbara leaving the room for a few minutes.

4) She learned not to show fear or even much reaction at all when Auntie got angry. She would lower her voice and make sure her face was bland and undisturbed.

5) She never argued. Sometimes Auntie said the most outlandish things, or seemed to be living in another time, but arguing with her or correcting her only made her angry. Instead, Barbara went along with the conversation. Sometimes she learned some interesting history through these conversations.

6) She learned to acknowledge her aunt's feeling. Feelings aren't right or wrong, but they are real.

7) Barbara learned her aunt's behaviour wasn't about her. Sometimes that mad it easier to take.

8) She learned to listen. Sometimes, although it was seldom clear at first, she could discern the problem if she listened to her Aunt's concerns.

9) She learned to put aside her agenda. She may have envisioned them having a cup of tea and a treat at the coffee shop, but remained open to what her aunt wanted or needed. There were times when a walk in the hall or even outdoors was exactly what was needed. If she'd tried to force the coffee shop, Auntie probably wouldn't have cooperated.

10) Barbara knew her aunt forgot about the anger as soon as it was over. She learned to, also.

Barbara was surprised, because what had begun as a huge problem, led her to greater insights. There were still difficult times when Auntie snapped and frowned and even shouted, but there were just as many times of laughter or reminiscing and smiles.

Most importantly, Barbara knew that her aunt was more than the behaviours she exhibited. Auntie was still there, and she learned to enjoy the person she was.

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