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Memory loss and dementia can make dental care difficult. In the early stages of memory loss or dementia, most people continue to take care of their teeth and brush regularly. As dementia progresses, however, they may not remember to brush their teeth or recognize the importance of good oral hygiene. Eventually they may refuse to have someone put a toothbrush in their mouth or remove their dentures.

Good mouth health may be lost in this struggle. That’s unfortunate, because good mouth care is essential to healthy teeth, gums and overall health in elders. With healthy teeth and gums, eating is more enjoyable and tooth decay and loss are avoided. Without regular brushing, people are at risk of infections, chewing problems, weight loss and increased vulnerability to other health conditions.  Risks are especially high for people with chronic illnesses such as diabetes, or whose medications cause dry mouth, making it uncomfortable and sometimes painful to chew and swallow food.

A dental professional can be an important partner in keeping your relative’s mouth healthy.

Partner with a professional

While your relative’s dentist will be a familiar face, he or she may not be right for your relative. Although many dentists care for older adults, they may not be trained or experienced in providing dental care to people with dementia. Call some of the assisted living homes and nursing homes in your area and ask for the names of the dentists who see their residents with dementia. Your local dental society may also be able to furnish names of dentists who work with people with memory issues—who know, for example, that giving instructions one step at a time will help people who have difficulty processing a whole sequence. Dentists and dental hygienists who work with special needs children often are good with people with dementia.

It can help to develop a dental care plan for your relative shortly after the diagnosis of dementia. Make an appointment for a thorough check-up to identify any problems that need attention—gums, broken or missing teeth, infection, etc. Ask your dentist about how often your relative will need dental visits.

Especially if your relative is struggling with mouth care, schedule professional cleaning appointments as often as you can, for as long as you can. A dentist or dental hygienist is able to examine and clean teeth and gums in a way that you or your relative might not be able to.

Before the dental appointment

  • Notify the dentist ahead of time about your relative’s diagnosis to make sure the dentist is comfortable and qualified to care for your relative.
  • Tell the dentist if your relative is able to maintain her own dental care or if she needs reminders or assistance.
  • Report any concerns that you or your relative might have: pain, tooth decay, irritated gums, etc.
  • If your relative will be seeing a dental hygienist, ask about her experience with patients who have dementia.
  • Listening to calming and favorite music may help your relative relax during a dental examination. Some dental offices will provide an ipod® and ear buds for patients who are nervous or tense during examinations. If not, ask if you can bring one. If your relative needs assistance turning the device on, ask whether the office staff can help or you need to do this before the dentist starts the examination or procedure.
  • If dry mouth is a concern, give the dentist a complete list of medications and ask if any could be causing dry mouth. Ask for products that can help relieve symptoms.
  • Tell the dentist about any dementia-related symptoms that might occur during the appointment: inability to report symptoms or locate pain, restlessness, inability to follow instructions or answer questions, etc.
  • Ask the dentist about the expected length of the appointment. If you are concerned that your relative might be unable to sit in the dental chair for the required length of time, ask if the needed procedure can be completed in two appointments. Some dentists may suggest a mild sedative for patients with dementia when a lengthy or invasive dental procedure is necessary. Consult your relative’s primary care doctor about the dentist’s recommendation.

On the day of the appointment

  • Avoid possible wait time by calling ahead and asking if the dentist is on time.
  • Consider how long in advance to tell your relative about the dental appointment. If you think advance notice will cause her to be anxious, consider telling her the day before or the day of the appointment.
  • Ask the dentist if you can stay in the examination room during the procedure if you think your presence will help calm your relative.
  • After the appointment, praise your relative for a job well done. Prepare for your relative – and you – to be tired, as it is likely a great deal of energy went into preparing for and getting through the appointment. If possible, try to plan the rest of the day to be quiet.

Grace began to notice that her husband Otto was not brushing his teeth regularly. One day he began rubbing his jaw and wouldn’t eat. Grace looked in his mouth and saw that his gums were swollen and red. She was worried about getting him to the dentist and how he would do once he was there. She called the dentist, explained the situation and told the dentist that Otto had Alzheimer’s disease. She cautioned that Otto might not be cooperative. Otto did quite well during the abbreviated appointment. Grace felt that the dentist was more comfortable because of the background information she gave him.

More information on oral hygiene and strategies to try to keep your relative’s teeth and gums healthy can be found in our book, Coping with Behavior Change in Dementia: A Family Caregiver’s Guide, available at dementiacarebooks.com.

Beth Spencer and Laurie White

Behavior in people with dementia is a form of communication. When it’s no longer possible to express feelings through words, behavior speaks for them.

As dementia progresses, your relative may be unable to find the right words to say what she wants to say or ask. She may lose her train of thought or withdraw from conversations and social events because she can’t keep up or comprehend what other people are saying. And multiple conversations, loud noises or activities can be overwhelming. We knew one woman who would hold her head and moan whenever there were too many people in the room. Without using any words to describe the problem, she made her feelings perfectly clear!

The bottom line is: behavior is the language to learn as your relative with dementia loses communication skills. Pacing, wringing hands, moaning, are telling you something. Likewise, angry outbursts, anxiety, or aggression.

Learning to observe behaviors can help you understand what is behind them. When you understand the root cause of a particular behavior, you can try various strategies to address it. We call this the Behavior Detective approach. You can learn more about how to practice it here and here.

What are these behaviors?

Anxiety appears to increase among many people as they grow older. It’s easy to understand why your relative might be feeling anxious. Imagine not being able to hold onto memories or keep track of what’s happening, to have the world gradually become an unfamiliar, confusing and unpredictable place. Anxiety is not the same as anger, but especially when untreated, anxiety can lead to agitation, which in turn may lead to anger and aggression.

Agitation expressed through behaviors such as pacing, wringing one’s hands, crying or making loud repetitive noises, or trying to go home can indicate distress. Physical illness can cause or increase agitation. Many of us are anxious, agitated or irritable when we are sick and this is even more pronounced in people with dementia.  Pain can cause agitation. Sitting too long can cause it! Both anxiety and agitation can be a side effect of medications or changes in medications. Being tired, bored, frustrated, needing to go to the bathroom—all of these can trigger agitation.

Anger and aggression can be caused by the disease or by untreated depression.  People who had tempers earlier in life may have more trouble controlling their tempers now, especially when they feel threatened or are having trouble doing a task. Loss of control is another trigger. We like to be in control of our lives and schedules. Dementia gradually takes that control away. Feeling that one is being treated like a child or that control is being taken away can lead to anger. So can being told no.

Bathing, dressing and going to the toilet can be ground zero for anger and aggression. Frequently the person misunderstands the situation. She may feel threatened by someone trying to remove her clothes or touch her private areas, or feel humiliated that she needs help.  This often leads to feelings of frustration, loss of control and fear….which can lead to anger. Poor care partner communication—using too many words, a condescending tone, or approaching a person out of a person’s range of vision—can lead to angry responses.

Those angry responses are usually directed at the family member or caregiver. What can you do? Work on prevention! After a certain point, the person is probably not able to control his or her behavior. It will be up to you to observe the behavior, try to find a pattern, and then craft a way to respond that lessens or prevents anxiety, agitation, anger, and aggression. Your career as a Behavior Detective is beginning.

Beth Spencer and Laurie White

helping relative memory loss bathing

Bathing is often the first personal care task that a person with dementia needs help with.

Bathing is often the first personal care task that a person with memory loss needs help with. But helping a relative with memory loss to bathe can be touchy, difficult, and easily lead to aggressive, angry behavior. And why not, when someone needs help with a task he or she has done independently for decades? The loss of privacy and dignity is just one of many triggers that can make bathing very difficult.

That’s why we shared our chapter, “Why won’t she take a bath? Helping your relative with memory loss with bathing”on our website. This blog offers some tips to get you started thinking about bathing. Much more can be found in the online chapter and in our book, Coping with Behavior Change in Dementia: A Family Caregiver’s Guide.

What’s the problem?

To start, approach the bathing problem by putting on your behavior detective hat. Ask yourself questions about the possible physical, cognitive, medical and emotional causes of your relative’s bathing problems:

  • She may have forgotten when she took her last bath.
  • She may be in pain: joint pain, for example, can make it difficult to get to the bathroom, and in and out of the shower.
  • She may be tired: not sleeping well, or asked to bathe when she is tired.
  • She may be depressed: often people who are depressed do not see the need to take a bath or may not have the energy to take a shower.
  • She may be afraid of falling, or getting in and out of the bath or shower.
  • She may be asked to bathe at a time that is not familiar to her.
  • Water might not feel good on her skin; having water come over her head and face may be frightening.
  • She may not remember how to do all the steps in bathing: wet the washcloth, put soap on the washcloth, etc.

“Why won’t she take a bath? Helping your relative with memory loss with bathing” offers strategies for each of these situations.

Talking about bathing

  • Watch your tone of voice. In particular, avoid sounding bossy! Without meaning to, care partners often sound bossy, especially when they are tired or frustrated. This tends to breed resentment and resistance to being told what to do.
  • Think about how you are going to approach this conversation ahead of time. How can you use a hook or reward? Can you mention an upcoming visit, a trip to church or synagogue, or a dish of ice cream afterwards?
  • During the bath, explain things clearly. If your relative doesn’t understand what is going on, it may increase her fear or anxiety. You may need to give step-by-step instructions.
  • If the answer is “no”, ask your relative why she doesn’t like to bathe. If she is upset, in pain, or fearful, she may be able to tell you the reason herself.

Strategies for ensuring privacy

  • Try to give your relative as much control as possible over the decision and the process. Instead of asking, “would you like to take your bath now?” try, “would you like your bath now, before you get dressed, or tonight before bed?
  • Try to schedule bathing at the same time she is used to —but pay attention to fatigue levels. If she has always bathed at night but is now exhausted or more confused by early evening, you might try a different time of day.
  • Drape a towel over your relative’s shoulders or lap. Some families have the person shower in her underwear or bathing suit to protect modesty.

Pay attention to the environment

  • Try to make the bathroom as comfortable, warm and inviting as possible before the bath begins.
  • Use non-slip washable bathmats inside and outside of the tub or shower.
  • Use towels and other bathing supplies with colors that contrast with the bathing area. A white bathtub, white washcloth and white bar of soap may all blend in together, making it hard for your relative to locate the washcloth and soap.

Putting it all together

Joan McCay hated having anyone assist her with bathing and became quite angry whenever it was attempted. Her daughter Alice began to think about the whole bathing experience from “setting the stage” for a bath to sharing a pleasant experience with her mother after the bath was finished. She decided to try a new approach. First, Alice got the bathroom ready and turned on the heater. Then she and her mother looked at a favorite photo album together. Next Alice said, “Mom, the shower is ready. Let me help you off with your shirt and give you a hand into the shower so you don’t slip.” Joan started to get angry and Alice replied, “Mom, John is coming to visit later and I know you want to look nice. I’ll help you.” After she had her mom seated in the shower, Alice used the handheld sprayer to help her get the water the right temperature. Then she put a towel around her shoulders, gave her mother the washcloth and had her wash while Alice held the sprayer the way her mother wanted it. When Joan was dressed again, Alice had a snack waiting for her. Although there were some tense moments, the bathing process went smoothly. Alice practiced remaining calm and ignoring angry outbursts.

If your relative particularly dislikes receiving help from a family member, consider hiring a home health aide to assist with bathing. If you do, you might want to have the aide help with other things as well, such as changing beds or laundry. You might not want to introduce bathing until your relative has established a relationship with the aide.

Beth Spencer and Laurie White

 

writing the red bookOur “red book” on coping with behavior change in dementia was published in the early 1980s—a time when people who cared for someone with memory loss had few resources.

Unfortunately, when these energetic, courageous and wise folks faced repetitive actions, agitation, incontinence, sleep problems, and other behavior changes in their relatives, the primary recommendation from professionals was medication. It was almost a knee-jerk response: Problem, medication. Another problem, increase the dosage. And so on.

While medications were sometimes necessary, we viewed them as a last resort.  Side effects could be serious, and sometimes medications could make care even more difficult.

We always recommended that caregivers and professionals try non-pharmacological approaches first, because we had seen so many instances in which using strategies other than medication actually made care easier. We recommended that caregivers use systematic problem-solving to analyze the situation (we call it becoming a behavior detective), understand what is causing the distressing behavior and develop responses that target the underlying causes.

For example, a nursing home resident was being sedated because of his agitation in the middle of the afternoon.  He would pace the halls, knock on doors and generally appeared very worried.  Medication made him drowsy and much more confused and he started falling. His family requested that the medication be stopped. When staff and family investigated possible causes of the behavior, they found that he was hungry and tired by midafternoon.  A light snack and encouragement to rest in his recliner calmed him and most of the agitation disappeared.

In the 1980s this approach was rare.  With funding from the State of Michigan, we worked with our colleague Anne Robinson to develop Understanding Difficult Behaviors, a manual to help families understand possible causes of common behavior changes at various stages of memory loss, so they could respond more effectively without resorting to medication.  Over the years it became known as “the red book” and was used by thousands of professional and family caregivers throughout the world.

After 26 years in print, a new “red book” was created by Beth Spencer and Laurie White aimed particularly at family caregivers, though many staff and facilities are using it as well.  Coping with Behavior Change in Dementia: A Family Caregiver’s Guide is still red, and it contains many more case examples and additional behaviors and strategies.  Coping includes new sections on physical intimacy and sexual behaviors, challenges and strategies for mouth care in people with dementia as well as a glossary, an updated introduction to dementia and an extensive resource list.  We’re pleased that one of our readers calls it “a ‘must have’ book and guide for anyone facing dementia as a caretaker” and we hope that you too will find it a useful resource for your family.

Beth Spencer and Laurie White

move relative memory losAs people move through the stages of dementia, more dementia care is required. Some people in the early stages of memory loss recognize their need for more assistance with personal care and activities. However, many other people with memory problems don’t, because their insight into their own behavior and needs has been impaired due to brain damage caused by Alzheimer’s disease, small strokes, or similar illnesses.

That means it’s usually the family of the person with memory loss who will recognize the need to move, find a place, and make the final decision to move a relative. Our book Moving a Relative and Other Transitions in Dementia Care can help you think about the issues involved in moving a relative to residential care, and give you practical ideas for making this an easier process.

But how do you know when it’s time to consider a move? Although there are no magic signs to tell you “this is the right time,” care partners often move a relative with memory loss to residential care for one or more of the following reasons:

  1. It is no longer a one-person job and no other family members are available.
  2. The care has become too overwhelming and exhausting, frequently due to incontinence or being up at night.
  3. Your relative with memory loss is no longer safe in her current residence.
  4. You are unable to keep up with both family and work responsibilities.
  5. Emergency and crisis situations for you or your relative have arisen.
  6. You or your relative has become ill or injured.
  7. The current level of services is not enough, is too expensive, or is too difficult to arrange and sustain.
  8. Your relative no longer recognizes her home or family.
  9. Everyone is telling you that it’s time to move your relative.

If you and your family are having one or more of these experiences, it may be time to start investigating other care options, including residential care homes. Even if none of these things is happening in your family, advance planning can give you the widest range of alternatives. You may find that selecting a place gives you peace of mind, even though you may not need it for a long time.

Many kinds of care are available, and your choice may be complicated by the fact that names and licensing categories of residential care vary from state to state. Your Area Agency on Aging (find yours here) can help you sort out what kind of care you are looking for and what it is called in your area: skilled nursing, assisted living, a small group home or some other arrangement. They can also help you clarify whether you need to find a general setting for older adults, or a setting that is specifically designed for people with memory problems or dementia. When you have narrowed the field, you can start contacting residential care homes that you think will meet your family’s needs.

Moving a Relative and Other Transitions in Dementia Care offers a useful worksheet, “Choosing a Residential Care Setting: Things to Look for, Questions to Ask.” Among the criteria it helps you evaluate are the environment, the cost, staffing and activities, medical care, discharge plans and care plans, family programs and support, and end of life care. This tool from California Advocates for Nursing Home Reform can help you evaluate skilled nursing homes.

Moving is not easy! Our book can guide you through the challenging process of visiting prospective care residences, talking to your relative about the move, planning and making the move, coping with after-move reactions…and it will reassure you that yes, you are doing the right thing.  Our goal is to help you make a choice that works for everyone, and helps your relative have a happier, more engaged life than before.

Laurie White and Beth Spencer

Authors, Moving a Relative and Other Transitions in Dementia Care and Coping with Behavior Change in Dementia: A Family Caregiver’s Guide

managing challenging dementia behaviorsIn Part 1 of Becoming a Dementia Behavior Detective, we talked about how observing and logging challenging behaviors can help you discover the reason for distress in a relative with dementia—and then begin to figure out how to make changes that prevent or lessen a challenging behavior.

This is a key concept of our book Coping with Behavior Change in Dementia.  Because people with dementia who cannot clearly articulate their thoughts and feelings use their behavior to communicate, we caregivers need to become detectives. Like detectives, we need to observe, investigate, and draw conclusions from what we are seeing. We watch a challenging behavior over several days, taking notes in a simple record or log, to try to identify a pattern that helps us figure out the cause.

Previously we discussed the story of George and Ann.  Ann often gets agitated in mid-afternoon, frustrating both George and Ann and making them lose their tempers. To help understand what was happening and try to see whether he could devise a solution, George began to take notes on where and when the behavior occurred.

 

When Who was there? Where and what was going on? What was the behavior? What I tried and what happened
Saturday 3:00 I was with Ann Watching TV with me in my office while I read a book. Anger and agitation I yelled at her. She yelled back and threatened to hit me.
Sunday 2:00 I was with Ann We were in my office. I left Ann sitting on the sofa and moved to work at my desk. Ann became upset and started pacing. I ignored her, but Ann became more agitated and started crying.
Monday 4:00 I was with Ann I was taking a nap in our bedroom. Ann became upset and yelled at me because I would not get up. I asked Ann to lie down with me. I stroked her back and she calmed down for a short while.

 

From George’s behavior log, we were able to come up with a number of possible causes for Ann’s behavior and strategies for responding to it. Violent or disturbing TV shows may be one reason. Based on what we know about a typical day for Ann and George, she may be hungry, or not be eating enough protein. Perhaps George needs to limit Ann’s caffeine intake, or give in and give her more sugar!

Other possible strategies to consider:

  • George might try working in his office in the morning when Ann is calmer. If he can focus on his work, he may have more patience for Ann because he is not worried about getting his work done.
  • He could hire a companion for Ann at that time of day. Ann’s behavior is understandably stressful for both of them.
  • He could ask a friend or neighbor to be with Ann.
  • Ann might enjoy attending a day program where she could be with other people and participate in activities.

If all else fails, George should consult a doctor. If the level of agitation continues or increases, and puts both Ann and George at rick, it may be time to talk about a medication to reduce the agitation and anger.

Ask for help

If keeping a log is not feasible for some reason, or if it doesn’t yield clear results, find someone to help you systematically analyze the behavior. A friend, family member or a health care professional may be able to assist with this. Your local Alzheimer’s Association chapter may have someone available who can help.

The more minds the better!  Brainstorming with others can help identify many possible causes and solutions. Some, of course, you will rule out, but your list will lead to a number of strategies to try.

When you sit down together, make a list of possible causes of the behavior. Think broadly. Perhaps it would help to categorize causes. In this story, George could sort the causes into physical, emotional, and environmental causes.

We firmly believe that many of the most challenging behaviors may be minimized when caregivers learn how to identify root causes and try strategies that are known to help some people with dementia much of the time. For us, medication is the last resort. By becoming a Dementia Behavior Detective, you will find strategies that work to prevent or lessen the behavior—and lessen your relative’s distress as well as your own.

Beth Spencer and Laurie White

managing challenging dementia behaviorsAs a Dementia Behavior Detective, you can start to understand and address challenging behaviors with your loved one with dementia.

People with dementia often lose their ability to communicate their feelings using words. Instead they communicate through behavior. What does it mean when someone is pacing, wringing hands or moaning? Finding out is our task!

In our book Coping with Behavior Change in Dementia  we suggest becoming a behavior detective. Like detectives, caregivers need to observe, investigate, and draw conclusions. We watch a challenging behavior over several days, taking notes in a simple record or log, to try to identify a pattern that helps us figure out the cause.

For example, Ann was diagnosed with Alzheimer’s disease 5 years ago. Her husband George has been caring for her alone in their home where they have lived for many years. Ann is self-sufficient in eating and using the bathroom, but needs reminders and assistance to shower. She does not like to change her clothes and has been wearing the same clothes for several weeks.

Ann sleeps about 15 hours a day, going to bed around 7:30 pm and getting out of bed between 10 and 10:30 in the morning. Mornings are the calmest time of day, anchored by their habit of going out for pastry, coffee and juice to a nearby bakery. George and Ann split a sandwich for lunch around 1 pm with ice tea and a cookie. Ann has developed a real sweet tooth. To keep her from eating only cookies, candy and ice cream, George locks the sweets in the pantry.

Lately Ann has become very agitated in mid-afternoon. She walks around their home screaming at George, pounding on the table and walls and going in and out of the kitchen slamming cupboard doors. Ann has hit George several times when he approached her to try to calm her. At this time of day George feels like hiding in his office to read or pay bills and just stay out of Ann’s way so he won’t lose his temper and yell “shut up!”

With encouragement from a fellow caregiver, George began to keep a behavior log to see if it would shed any light on Ann’s behavior.

 

When Who was there? Where and what was going on? What was the behavior? What I tried and what happened
Saturday 3:00 I was with Ann Watching TV with me in my office while I read a book. Anger and agitation I yelled at her. She yelled back and threatened to hit me.
Sunday 2:00 I was with Ann We were in my office. I left Ann sitting on the sofa and moved to work at my desk. Ann became upset and started pacing. I ignored her, but Ann became more agitated and started crying.
Monday 4:00 I was with Ann I was taking a nap in our bedroom. Ann became upset and yelled at me because I would not get up. I asked Ann to lie down with me. I stroked her back and she calmed down for a short while.

 

What could it mean? 

This behavior log gives us some information and some ideas of why Ann might be acting this way. Now it’s time to put on your detective cap. What is Ann’s behavior trying to tell us? What might George do to help Ann?

  • There is a consistent pattern related to time of day. Mid-afternoon is difficult for Ann. We need to think about possible reasons for this.
  • Ann may be feeling alone and insecure. She wants George’s attention. George does not understand that Ann’s behavior is a symptom of how she is feeling. He is finding her behavior so stressful that he reacts by yelling, which only escalates Ann’s anger and agitation. It may help George to know that agitation and anger are caused by the disease, and that Ann is not able to control her behavior. George might try planning an enjoyable activity that Ann can do, such as washing dishes, looking at a photo album, or dusting. Going for a drive or taking a walk before mid-afternoon when Ann’s agitation usually begins may help. It is often easier to prevent a behavior by changing a routine rather than respond to the behavior once it has begun.
  • The TV might have upset her. On one occasion the TV was on. Was she watching something she might have misunderstood or misinterpreted? Could she be confusing TV with reality? News programs that report violence or disturbing events, action or ‘thriller’ shows may be difficult for Ann and causing her distress.
  • Her sugar craving may be increasing her agitation. As the brain changes, people with dementia may crave more sweets. Although by locking up sweets, George is doing what he thinks is best for Ann, giving her an afternoon snack of yogurt, fruit or a cup of cocoa may help reduce her cravings and her agitation.
  • Ann may simply be hungry. She has not eaten much for breakfast or lunch. Starting the day with toast, eggs or cereal or something with less sugar may sustain Ann longer. A larger lunch might help too. George could document whether eating larger meals affects Ann’s level of agitation in the afternoon. Or he could try giving Ann a snack a couple hours after breakfast rather than waiting 3 or more hours.
  • What beverages is Ann drinking? We know she has coffee with breakfast and tea with lunch. George could try decaffeinated coffee or tea or substitute another beverage for tea. Caffeine can make anxiety and agitation worse.

Part two of Becoming a Dementia Detective covers other possible strategies, but our takeaway here is:  A log that helps you track behavior is the first step to understanding the behavior—and then finding ways to change things up that can head off or lessen the behavior. Good luck!

Beth Spencer and Laurie White

 

Refuses to take medicationPeople with memory loss often refuse medications for many different reasons.  A place to start is by trying to figure out why your mom is refusing to take them.

 

 

Possible reasons might include:

  • She doesn’t understand why she needs to take them.
  • She is afraid they might hurt her.
  • Saying ‘no’ is a way to have some control of her life.
  • She has never liked taking medicine.
  • She doesn’t trust the person who is giving them to her.
  • She is having trouble swallowing them.
  • The medications don’t taste good.
  • There are too many medications.

What can you try?

You can see that your approach to this is going to depend, to some extent, on why she is refusing to take them.  Sometimes a simple reminder of what the medicine is for is all that is needed. “Mom, Dr. Jones says this pill is what is keeping your heart beating regularly.  He wants you to take them.”

If it is a control issue, think about ways to give her a little more control: “Would you like your medicine now or after breakfast?” If this is where she is taking a stand, can you make it more casual and less of a power struggle? “Mom, your pills are in the cup on the counter when you are ready for them.” Sometimes putting the medications in a cup near her meal is a good reminder that she needs to take her pills. Keep in mind if she has to take her pills before, after or with food.

If she is afraid or a little bit paranoid, you will need a different approach.  Use the Behavior Detective Approach to pinpoint the times of day when she is most likely to be agreeable and try to give them to her then. You might need to back off and try again later.

Other things to think about:

  • Does she need all the medicine she is taking? Can it be simplified? Are the pills prescribed for multiple times of the day? If so, you might want to talk to the doctor or pharmacist to see whether it’s possible to take them once a day or in a different form. The doctor for one elderly woman with dementia dropped her cholesterol medication, her vitamin and her calcium because she was overwhelmed by the number of pills and refusing to take them. He felt these were the least important in the long run, unlike her blood pressure pills.
  • Ask the pharmacist if the medication comes in a different form. A liquid or patch might be easier than a pill, if available.
  • Can the pill be taken with food or crushed in pudding or ice cream? Sometimes it can be hidden or disguised if it’s something the person really needs but refuses to take.
  • Is this becoming a battleground between you? Is your body language and frustration adding to the problem?

While our book Coping with Behavior Change in Dementia: A Family Caregiver’s Guide offers many strategies for addressing challenging behaviors like this, sometimes there is no good solution.  All you can do, as your mother’s caregiver, is your best.

Beth White and Laurie Spencer