Care partners of people living with dementia must often cope with their loved one asking the same question many times a day. Why does this happen? How can a care partner respond helpfully while keeping their sanity?

Case Study: “Where’s James?”

Twelve, Anita thought to herself. This was the twelfth time today that she would have to explain to Mom that her son, Anita’s little brother, died of a heart attack years ago at the age of 45. This question came so frequently that Anita had numbed herself. “James is gone, Mom.”

She watched her mother’s face as she absorbed the news. “Oh,” her mother said, looking overwhelmingly sad. “That’s right. I forgot.”  Anita sighed with relief. At least this wasn’t one of the times that the news hit like it was the first time. There was no weeping, no disbelief, no shock. Just resignation and sadness.

Why is This Happening?

 To understand repetitive questioning, we must understand a few things about dementia.

• The memory of the event is truly not accessible to your loved one in that moment. There may be other times that they do remember, and this can be confusing to you, the care partner.
• It can be tempting to believe that the question is being asked to intentionally annoy or manipulate. Remember that manipulating another person requires a very high level of cognitive functioning that is not likely to be available to your loved one with dementia.
• A person living with dementia will often have a self-image based in a previous time in their life. “Where’s James?” might be a question arising from a sense of herself as the mother of a young child. She is responsible for knowing where he is.
• People living with dementia often experience an increase in anxiety as they feel their control over their environment slipping away. Without being able to rely on their memories or perceptions, daily life feels out of control. They may ask repeated questions in an attempt to calm their anxiety.
• Simply providing an accurate answer may not satisfy this urge to question. When June heard, “James is gone,” this did nothing to calm her anxiety. Within a few minutes she may have no memory of this interaction. With the anxiety still present, June’s mind looks for a reason for her to feel that way. Then she realizes that she has no idea where her small son James is. And again, she asks for his whereabouts.

 The Truth is Not Always Kind

Imagine how your body and mind felt when you first learned of a loved one’s death. Grief produces a tremendous amount of physical and psychological stress. Even if the person doesn’t remember the news a few minutes later, their system will still have responded to that shock with a flood of stress hormones.

A person living with dementia has few internal coping skills to help them manage this stress. When stress increases, repetitive questioning and other challenging behaviors may also increase.

It can be terribly hard to lie, especially to a parent who taught you not to lie. This is where the gift of the “therapeutic fiblet” comes in. Your goal as a care partner is not to reinforce reality. Your goal is to promote calm and comfort through a frightening disease process. “James is at school today,” might be the kindest answer you can give.

 Address the Emotion Behind the Question

 But don’t stop there. When asked a question, we tend to respond to the content without addressing the emotion behind it. In this case, the emotion is far more important. Try using the following method:

1. Respond to the content. Give a plausible answer that addresses the surface concern. “James is at school today.”
2. Reflect the emotion. “You seem worried about him.”
3. Empathize with the emotion. “I’m sorry you’re worried. That’s a terrible feeling.”
4. Offer comfort. “He’s safe.” Offer a hug or a hand to hold.
5. Redirect. “Could you help me clean these vegetables for dinner tonight? You’re always so thorough!”

By truly acknowledging the emotion, offering comfort, and then redirecting to a valued and meaningful activity, you can reduce the stress your loved one feels. Since this can reduce challenging behaviors, it has a strong potential to reduce your stress as a care partner as well.

Contributed by:

Emily Gavin, MS, OTR/L, CDP

Emily S. Gavin, MS, OTR/L, CDP is a dementia care expert, occupational therapist, and coach, supporting dementia caregivers in the Philadelphia area.

In her private practice, she helps clients understand how their loved ones perceive the world, decreasing the stress and strain in caregiving relationships.

She is also available for public speaking engagements. Learn more at www.phillycarecoaching.com, PhillyCare Coaching on Facebook, phillycarecoaching on Instagram, and Emily S. Gavin on LinkedIn.

 

 

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