Last week I was at Abe’s Garden where and we got to talking about how distressing it can be to see individuals with dementia behave in ways that are not acceptable or say things that make no sense.

By Steve Moran

Last week I was at Abe’s Garden where and we got to talking about how distressing it can be to see individuals with dementia behave in ways that are not acceptable or say things that make no sense. Like this:

  1. “Who are you?” to a son or daughter.

  2. Saying the same thing or asking the same thing over and over again.

  3. Saying they can do something they are not able to do.

  4. Accusing someone of doing something wrong like “You stole my wallet” or “Someone stole my wallet.”

  5. Asking about someone who has died as if they are still alive.   

This has become an acutely personal issue for me in the last few months. My mom is 85-years-old and six months ago suffered a stroke. She is very forgetful and her brain is continuing to deteriorate. I am finishing this article from her house and in visiting with her today she is telling me things that are simply not true.

Who’s problem is it when a resident has out-of-norm behavior?

I got to chatting with fellow board member and world class dementia expert John Zeisel, the president and cofounder of Hearthstone, about out-of-norm behavior and he offered some great insights.  

An Example

If a resident says to a community team member, “you are my son,” which, of course, is not factually accurate, the question then becomes this: Do you see this as an opportunity or a problem?

The opportunity way to approach this is to realize and celebrate the specialness of her relationship with her son. To be okay with it, to even role play being her son. From her perspective, she is remembering fondly and reliving old lifetime patterns that worked for her.

I love this Brett Eldredge video of how that can work:


Some Other Ideas

This is probably a more difficult problem for family members than it is for team members here are some suggestions John offered that can help family members turn these “problems” into opportunities.

  1. Asking about the same thing over and over again — Six months ago, my wife and I traveled to Turkey and each time I see my mom she asks me about the trip. Rather than get frustrated I tell her about it again. Sometimes it is the same old story and other times I talk about new or different parts of the trip. It just provides an opportunity for me to relive a great trip.  

    I sometimes even view it as a Groundhog Day movie experience where I get to practice getting my storytelling right.

  1. My mom doesn’t recognize me — This has to be one of the hardest things for family members and yet it is not really true. They know you are someone they know, someone special in their lives. There are lots of possible responses that can turn it into a conversation. The only bad response is that you say it means mom is sick. Not true, she is different.

  2. Repeating things over and over again — This becomes another opportunity to start a conversation. You might almost think of this as an improv theatre type game. What new conversation can you start on the same old thing?

  3. When someone says they can’t do something — Even simple things become overwhelming for dementia residents, but when you break a big task into tiny steps, you can then ask which of those steps can the resident do? Even something like making tea requires 35 steps, some can be done by the resident.

  4. Accusing someone of stealing something — Rather than denying it, you might try a “let’s go look for it” approach. Often the missing thing is right where it is supposed to be and together you can go rediscover it.

  5. Talking about someone who passed as if they were still alive — No confrontation needed. Just use it as a time to tell stories, happy stories, positive stories. It is often okay to remind the resident that that person has passed.

Three Core Principals

John, again and again, came back to three core principles:

  1. Focus on what the individual can do not what they can’t do.

  2. Don’t lie to people. Don’t, as a for instance, say someone is alive when they are not.

  3. Don’t get mad or beat people over the head when they have an altered sense of reality. It is their reality at that point in time.