Say this, not THAT

Sometimes you just have to take your own medicine, and that is what I am doing right now. There’s a section in my book, The Dementia Field Guide, titled “Say This, Not THAT”. It offers alternatives to some of the common phrases that come out of dementia caregivers’ mouths – ones which better promote well-being and sense of dignity in the person with dementia.

“Don’t you remember?”

You and I say this to each other all the time. But a person with dementia simply cannot remember, asking you repeatedly, “When are we going to the dentist?” Short term memory is usually the first cognitive function to betray them. To the person with dementia, every time they ask is the first. So responding with “Don’t you remember?” is useless.

But worse, it’s counter-productive. You’ve just pointed out the memory lapse, which jeopardizes the person’s dignity. You answered with a question rather than an answer, leaving the person’s need unmet. Negative emotions associated with loss of dignity, coupled with the anxiety of unmet need, can easily cause the situation to escalate.

“We talked about that yesterday.”

This phrase is sister to “don’t you remember?” it usually doesn’t follow repetitive questions though. When I said it to my mother (who does not have dementia, but does suffer memory lapses) yesterday, I cringed at myself. The conversation we’d had the day before was one I didn’t want to have again (driving in winter weather conditions) – you know how mothers can be… But even so, I more or less said the same thing as “don’t you remember?”

The situation did not escalate, perhaps because my mother did recall the conversation in the end. As her age advances (87 this spring!) I expect more frequent memory lapses. Although saying “we talked about that yesterday” is something that would have been totally harmless five years ago, it’s not that way anymore. And so, I’m making a refrigerator-sized NOTE TO SELF to listen for and eliminate phrases which could appear as “error notifications” or corrections as her brilliant brain ages.

Say this instead

For repetitive questions – The next time the person in your care asks you the same question again and again, don’t answer right away. Breathe. Count to three. Then answer the question as if it was the first time that person asked (to them, it is). It may be helpful to try to simplify your answer or to speak more slowly, or to position yourself to ensure that the person can see your lips (do not raise your voice however, repetitive questions are not related to hearing loss).

For redundant conversations – When your loved one brings up a conversation you’ve recently had, instead of “We talked about that yesterday” try to find a response that gets directly to the outcome (if you agreed the last time you spoke of it) or a response that summarizes, and perhaps reconciles, differing viewpoints (if you disagreed).

If my mother and I had agreed, for example, that it was best I wait a day to drive home due to potentially icy road conditions, the dialog might be…

(Mom) “I am worried about you driving home in this storm.”

(Me) “You are right. Is it okay if I stay until tomorrow?”

But if we had disagreed (the interstate highways were not icy; the temperature had been steady at 36 degrees since before dawn.

(Mom) “I am worried about you driving home in this storm.”

(Me) “I appreciate your concern. I’ve been thinking about it, and instead of my favorite back roads, I think I will be overly cautious and stick to the interstates, which are clear. Then, neither of us has to worry.”

In the former example, I celebrated my mother’s wisdom. Then I gave her control over our decision. In the latter, I gave her permission to think like a mother, and also validated her concerns, then offered a reasonable compromise.

In your caregiving role, be thinking about phrases you can use to communicate effectively while helping to protect the dignity of the person in your care and experiment with them.

“Say This, Not THAT” – and an abundance of other tools for dementia caregivers – can be found in my manual for dementia caregivers, The Dementia Field Guide. Click the title to learn more.