4 Rs of dementia care – tips from the experts
It’s comforting to know that experts in the field of cognitive and behavioural neurology, Andrew E. Budson, MD and Dr. Maureen O’Connor, acknowledge first and foremost, that caring for someone with dementia is extremely difficult and stressful.
Whether it’s an older parent, grandparent or spouse, there will be moments of frustration, embarrassment and sadness, especially if your loved one does not recognise you, behaves in an unfamiliar or bizarre way, or becomes angry and aggressive towards you.
It’s particularly difficult for older people caring for spouses. “I am 75 years old and have arthritis,” explains Mrs G. “Dealing with him (my husband) makes me miserable, unkind and sad, because there’s no one to help me. Our family cannot face the fact that we are old and needy now.”
Caring for someone with dementia is exhausting
If you are caring for someone with dementia, you are likely to be physically and mentally exhausted. From continually having to repeat yourself, to lifting, bathing and dressing your loved one – and possibly having to make sure they don’t wander off – it’s a full-time job.
Common behaviours, such as refusing to wear clothes, hiding things and being suspicious of others (paranoia) can cause a great deal of friction. But it’s pointless to get angry, argue or ask your loved one to stop the behaviour. They can’t. It’s important to understand that it’s not the person, but their cognitive decline, that causes them to act in unusual ways.
When you are in the midst of dealing with a difficult situation, Drs Budson and O’Connor advise carers to focus on what they call the 4Rs – reassure, reconsider, redirect and relax.
The 4 Rs of dementia care
Reassure
Memory loss can make familiar people and things seem strange, leading to anxiety and fear. Your loved one might be worried or scared when they can’t see you – thinking you’ve been gone for hours even if it’s only been a few minutes.
It’s important to reassure your loved one that everything is alright and that they are safe. If he or she is shouting or acting aggressively, it can be helpful to remind yourself that this behaviour is probably related to these feelings of fear. Phrases like, “You’re safe,” “Everything is OK,” and “I’m here for you” can provide comfort. Use other communication methods, such as gentle touching, to help them calm down.
Reassurance often needs to be repeated, but it can effectively diminish many difficult behaviours.
Reconsider
Whatever the problem, reconsidering it from your loved one’s point of view can be very helpful. Because of their impaired memory, their perception of situations might be completely different from yours.
For instance, if a carer arrives to help with bathing and your spouse reacts with anger, try to understand their viewpoint. They might not recall the need for a bath, or why help is necessary. To them, a stranger asking them to undress might lead to feelings of outrage, confusion and anxiety.
Reconsidering the situation from your loved one’s point of view can improve your empathy and help you find better ways to reassure them.
Redirect
Merely asking your loved one to stop an unwanted behaviour is unlikely to work.
Instead, redirect their attention to something they enjoy. Their memory loss means they may quickly shift focus if given a new activity or distraction. Move them to a different room, engage them in a new conversation or activity, point out something interesting, or give them a comforting object to hold.
Always use a calm tone of voice. Shouting or showing anger only makes things worse.
Relax
Interacting with a person who has Alzheimers or dementia is most successful when you are relaxed yourself. Over-reacting, arguing or allowing your frustration to show only makes matters worse. Difficult though it might be, try to remain calm and patient.
Your loved one may use your emotions and demeanour as a guide to how they should be feeling and responding. If you are anxious and upset – whether because of their behaviour or something else – your loved one may become agitated as well. Even if the words you are using are reassuring, if your voice or body language reflect frustration or anger, your loved one is likely to mirror these nonverbal signals. This is why it is so important for you to relax, especially when faced with difficult situations.
Of course, it isn’t easy to remain relaxed in the face of aggressive or agitated behaviours. Relaxation techniques, such as deep-breathing or counting to ten, can help you manage your emotions in difficult situations.
Unique set of challenges
Caring for someone with dementia presents a unique set of challenges that can be emotionally and physically draining. By applying the 4 Rs—Reassure, Reconsider, Redirect, and Relax—you can better navigate these challenges with empathy and patience.
Remember, self-care and seeking support are also crucial in this demanding role, helping you to maintain your own well-being as you provide compassionate care.
As we approach World Alzheimers Day (21 September), we congratulate Commonage on its publication of the ‘Dementia in the Commonwealth’ report, launched at the International Dementia Conference in Sydney, Australia on 6 September 2024.
View the report and benefit from insightful progress, innovation and challenges relating to dementia across the Commonwealth.
