If you have ever cared for someone with dementia, you are most likely familiar with repetitive questioning or behaviors. For even the most patient of caregivers, this behavior can result in frustration, stress, and exhaustion.
Repetitive questioning and behaviors are common for those with dementia. What do caregivers do to manage these behaviors to avoid reaching the breaking point?
We know that without the good health of a caregiver, the quality of life for the person cared for also suffers. Reducing stress should be the goal for the caregiver. If we can better understand the behavior (like repetitive questioning), we stand a better chance of relieving stress.
When my father was in a long-term care facility, he focused on the house where we had lived as a family and his questions surrounded that topic. I did not understand at the time that he was not in need of information but in need of reassurance. He had spent over fifty years in that house, meticulously caring for every square foot of it.
It was not until I physically brought him to the home after his insistence that he just needed to see the house that I realized what the real issue was. He did not actually recognize the house when we arrived. In fact, when I asked him if he was going to come into the house he replied, “No, you go ahead. I’ll just wait till we get to the farm.”
My father was recalling his childhood home. That long-term memory entangled with thoughts of the home where he raised his family.
Going forward, I felt more prepared for his continued questions about his home. It did not help him to explain countless times the difference between the homes and locations. Until I started living more in his world, I often found myself saying, “Well you remember; we talked about that already.” I shudder to think how those statements must have only confused him more. I wish I knew then what I know now. I could have managed his behaviors and my reactions more successfully.
With any dementia, brain cells are deteriorating and that means a decline in the individual’s ability to make sense of the world. In the case of repetitive questioning, the person does not recall that they have already asked the question because of their short-term memory loss.
Those with dementia cannot process tasks in logical order. Repetitive questioning makes sense when you think of it in these terms. It is not hard to imagine that if you did not know what day or what time it was, you would be confused, anxious, unsettled, and seek reassurance.
New information does not get stored for the person with dementia; therefore, there is no recollection. In turn, there is a lack of memory of an event. Dementia damages the part of the brain that allows us to change to a new activity or subject. The person is “stuck” on one word, or topic or activity and is unable to stop repeating it.
There are techniques for the caregiver to help manage the stress of repetitive questions and behaviors.
- Identify the cause behind the repetition. Does it occur at a certain time or around certain people? Is the person afraid of separation from the caregiver?
- There may be unmet needs. Is the person trying to express a need? Hunger? Pain? Thirst? Need to use a bathroom? If there is an unmet need that will increase anxiety and the repetition is relieving that agitation.
- Engage in an activity. This may help divert the anxiety. Redirect to something pleasant. Diversions like music, taking a walk, looking at photos, bring relief from repetitive actions and verbalizations.
- Focus on emotion, not the behaviors or question. Someone repeatedly asking where their mother is may need comfort, touch, and reassurance.
- Provide an answer. Keep it simple. The fewer the words, the better. Give the answer the person is looking for. Answer as if it is the first time you are answering.
- Stay calm and be patient. A calm voice and gentle touch will be more effective than demonstrating exasperation.
- Limit multiple stimuli but keep the environment stimulating. More than one noise or action at a time can result in confusion, loss of concentration, and can cause repetitive questioning.
Never does it help to tell the person that they just asked that question or that you have already told them the answer. Arguing with the person or using logic is ineffective.
It is highly recommended that you not alert the person with dementia of an upcoming event. Reveal planned events when it is time to get someone ready. Learning about a future task produces anxiety and will cause repetitive questioning and behaviors. The event can become stuck in the mind.
Accepting the fact that the person’s short-term memory is gone helps caregivers understand that the person with dementia will repeatedly ask questions. Living in the world that those with dementia do means you have to change and adapt rather than trying to bring the person back into your world. You need to start developing new and different communication strategies that work for someone with dementia. If you can create an environment that says “I care” and that is safe and secure, then you not only will feel good about yourself, but the person you are caring for will start feeling good also.
There are several valuable resources on the topic of communicating with a person who has dementia.
Caregiver Support groups are a helpful resource to learn techniques that other caregivers have tried and found successful. NSES offers a daytime and evening support group twice a month. Check our website www.nselder.org/resources/options-advising-family-caregiver-support-programs/ to learn more about those times or call Kathy Perrella at 978-624-2214 for more information.