People living with dementia can cause significant distress for their caregivers by exhibiting strange or difficult behavior. This could take the form of repetitive questions (“When am I going home?”), delusional thoughts (“I have to take care of the baby!”), exit-seeking, agitation, verbal aggression, or physical aggression can all appear. These behaviors can seem random and unmanageable.

We’re often told to redirect our loved ones to another activity to distract them from their behavior, but this runs the risk of passing over the real emotion they are expressing in the only way they are able. Instead, use the pneumonic RECReate.

The first four letters of the word “recreate” stand for “reflect,” “empathize,” “comfort,” and then “redirect.” Use this tool to recreate a different response to your loved one’s challenging dementia behaviors, creating more connection and lowering the stress level for both of you.

R – Reflect

The first step is to think about the emotion behind the behavior and reflect that emotion back to the person. Let’s say your mother is asking you repeatedly throughout the day, “When am I going home?” She’s in the house she’s lived in for 50 years and has no other home.
Our first temptation is often to say, “You are home.” While literally true, this statement is not as helpful as you might think. By contradicting her understanding of reality, you’re placing yourself in conflict with her.
Ask yourself, “What feels like the emotion behind the questions?” Is she lonely? Could she be tired? Is she sad? Is she craving comfort in a world that feels constantly foreign?

Once you have an idea about the emotion, reflect it back to her as if she were looking in a mirror that named the emotion she showed it. When she asks, “When are we going home?”. You might say, “We’re not going yet. You sound like you’re feeling sad. Is that right?” Reflecting her emotions helps your mother to feel seen and heard.

Don’t be tempted to take a shortcut here and just ask, “What are you feeling?” Your mother might not be able to name her emotions. Asking her to choose from all human emotions and decide which one she’s feeling may confuse and frustrate her.

E – Empathize

If you seem to have hit on the right emotion, show her that you know what it’s like to feel sad. Then tell her you’re sorry she feels that way. Say something like, “I’m so sorry you’re sad. That’s a terrible feeling. I want to go home when I’m feeling sad, too.”

C – Comfort

Offer comfort in whatever way feels right for your relationship. Maybe it’s a hug or holding her hand. Maybe she has never derived comfort from physical touch but takes great comfort in listening to classical music. In this case, you might offer to put on her favorite piece.

R – Redirect

People living with dementia can get stuck in “thought loops” and have a hard time breaking out of them. Now that you’ve made a real connection with your mom and shown respect for the thing she’s worried over, you’ll want to help her move away from her fixation on “going home” by offering something else to occupy her.

It might be taking a walk, reading a book, playing a game, helping cook dinner, or any other activity that offers just the right challenge for her cognitive ability. Work with your occupational therapist to brainstorm a list of activities you can have at the ready to distract and engage your loved one.

We hope that learning about RECReate (“reflect,” “empathize,” “comfort,” “redirect”) was useful to all those who are caregivers for a loved one with dementia.

 

Contributed by:

Emily S. Gavin, MS, OTR/L, CDP