Tips for Caring for a Memory-Impaired Person

Memory Aids (clocks, calendars and written notes) help a person stay oriented.

Much of what you say to the person may soon be forgotten. Be prepared to repeat yourself sometimes often.

Speak in a calm voice. Make brief, simple statements. Try using touch and direct eye contact  when responding to emphasize what you say.
       
Avoid presenting the person with more than one thought at a time, and limit choices(“Either/or”, rather than “multiple choice”).

Distract the person from an irritating or repetitive topic by using a word from the conversation to re-direct  them or change the subject. Try such pleasurable distractions as taking a walk or drive, looking at family photos, playing music or giving the person a simple, repetitive task to perform, such as folding towels.

If distractions fail, try to ignore repeated questions. This may initially anger or agitate the person, but the questions may stop if they are not reinforced by your behavior. Ignoring is an especially good tactic when you are irritated. It may prevent the person from picking up on your irritation.

Most memory-impaired persons function best when following a familiar routine in familiar surroundings. Avoid abrupt or frequent changes of routine, activities and location. Avoid discussing plans for non-routine activities/appointments with the person until just prior to the event to avoid agitation and repeated questions days in advance.

Praise and positive reinforcement helps a person maintain dignity and self-care skills. When correcting or directing them, avoid negative commands ("Don't do that”).  Use a  positive focus ("Let's do this”).

 If the person's cognitive skills continue to worsen, closely monitor their ability to perform tasks and be prepared to lower your expectations for their performance. Allow the person to do as much for themselves as they possibly can, even if they are slower and less efficient. Take over a task completely only when they cannot perform it even with step-by-step instructions or help. Complex or risky tasks (such as driving, using appliances or managing financial affairs) may have to be assumed by others sooner.

To include the person in social conversations, refer to positive memories of the past. Encourage reminiscence, as the person is able to remember past events better than present.

Suggest a word or name the person is searching for in conversation, but avoid correcting mistakes already made. Contradicting or arguing with the person may only cause upset and humiliation.

Anticipate and avoid activities and discussions that will provoke anger or agitation. Prevention is the most effective approach to reduce behavior problems.

Look for a reason behind troublesome behavior. Is the person frightened, in pain, hungry or needing to toilet?  Respond to the need or emotion you feel the person is trying to express.

If the person becomes extremely agitated or aggressive, remove them from the stressful situation or place. Avoid quick gestures and try to calm the person with a soothing and reassuring voice and gentle touch. Do not try to reason with the person, as their ability to understand logic and reason is impaired. If you feel threatened, remove sharp or dangerous objects from the area and stay out of reach. Leave and seek help if needed.
 
Make note of when a catastrophic reaction occurs. Is there a pattern (ie. time of day,  type of activity, interaction with a specific person) that can be identified? simplify the environment by reducing extra people, clutter, noise and activity. Soft music, or holding a doll or a stuffed animal may ease agitation and calm fears in a severely impaired person.

While use of medication to control behavior should be a last resort, medications may be necessary to control depression, hallucinations, paranoia, sleeplessness and extreme agitation. Discuss this with your doctor.

Honestly acknowledge to the person that they have a memory problem, but confronting them with their loss of ability may lessen their sense of dignity and self esteem. Try to remind the person how much they can still do for themselves. Reassure them that they are still loved and valued. Try to discuss openly the person's memory and behavior problems with family, friends, neighbors and others who will have regular contact with him/her. People tend to respond more appropriately and offer assistance when they understand the situation.

Emotional support and respite from care giving responsibilities are essential to helping you cope.  Arrange for someone else to assume your care giving duties for several hours at a time on a regular basis so you can get out and "recharge your batteries".  You cannot provide good care for your loved one if you neglect your own needs.

Consider joining a self-help or support group. These offer an excellent setting in which to express your feelings and learn creative approaches to solve the challenges you face in providing care. Your local Area Agency on Aging or regional chapter of the Alzheimer's Disease Association can direct you to such groups.

Be patient with yourself. Recognize that you will make mistakes and will become angry and impatient at times. Know your own limits and try not to feel guilty when you have to say "no" to others. Remember, you are only human! 

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