Sometimes routines need to be shaken up. The need arises because there is a time schedule which has to be adhered to. It could be a doctor’s appointment or a scheduled activity by a particular time. Earlier alarms might need to be set. Effort needs to be made. Under normal circumstances that’s no big deal. However for the dementia mind (DM), that’s a task that it may not want to undertake.
Whenever such situations happen it’s hard to predict whether the DM will cooperate. Ultimately it comes down to what is expected of the DM. If the effort is one that the DM does not wish to undertake then the DM comes up with excuses that often catch the caregivers off guard. The DM will not cooperate and it becomes a struggle to stay on schedule.
As caregivers we often wonder if there is awareness in the DM. Does the DM behave based on its own preference? As in, if the DM does not wish to do what is asked of it then is it capable of acting according to its own preference? Can it fake dementia in order to do what it wants to? Yes absolutely! And the DM does exactly that. It is capable of behaving a certain way in order to get out of doing what is asked of it.
The issue is that the DM’s behavior is never consistent. It cannot be predicted. In fact just when we think this is the way things will unfold we are surprised by a new course of action. The DM is capable of being selective in its behavior. It’s also capable of being influenced by its own emotions. How is that possible? The mind preserves emotional intelligence longer than memory and reasoning. Therefore, in that moment, if it is not feeling good then no matter what reason is presented it will not cooperate.
With emotional intelligence still intact, when something is expected of the DM it senses it immediately. The DM senses the pressure to be dressed by a certain time or the physical effort that it will have to undertake to make that particular activity happen. In such cases, if the DM does not want to, does it fake dementia? Does it act as if it doesn’t understand and doesn’t remember? Despite it feeling like that for the caregivers, that may not necessarily be true. The DM feels pressure. It senses it’s being told what to do. It thinks it’s losing the independence to make its own choices. All these feelings are still being felt. In such cases, the way the DM behaves may just be a reaction in order to protect their own decision making power. The DM’s behavior may actually be a sign of all those emotions it is feeling.
So the caregiver is struggling to wake up the DM in order to make it to the doctor’s office on time and what’s happening in the mind is, “there’s nothing wrong with me, I don’t need to go to the doctor and therefore I will refuse to get up and get ready.” No matter how long the caregiver struggles the DM will stand its ground.
But at its core dementia is a fluctuating condition. What’s happening in this minute could change in the next. When that change happens there is no memory of how the DM behaved minutes or hours earlier. If there is no memory then confronting the DM about it is absolutely useless. We, as caregivers, also need to understand that the resistance we encounter with the DM does not indicate that the DM understands why it’s resisting. It’s simply resisting because emotionally, in that moment, it wants to.
And finally, we caregivers need to learn to let go. Instead of trying to persuade and reason with the DM, just let it be. In that way there will be no confrontation. If we can, we should just simplify the routines and activities even more. If you can’t get the DM to the doctor maybe you can get the doctor to the DM. If the DM does not want to partake in a particular activity, just add that to the list of things that no longer need to be a part of the DM’s life. Less expectations maintains the dignity of the process and the lives of all persons involved.