This article was written by Carol Bradley Bursack, Minding Our Elders. The original article can be found here.
One sign of the aging brain is repeating things more often, especially stories and questions. There are reasons for this that are not related to progressive conditions like dementia, but in either case, repetition can get old very quickly. Even the most experienced and patient family caregivers occasionally struggle to hide their frustration. While there is no easy fix for this trying side effect of aging, a change in attitude and some proven strategies can help you keep your cool and preserve your loved one’s dignity.
Seniors Without Dementia Repeat Themselves, Too
As we age, our perspective on life changes. There’s a human need to make sense of what has happened in one’s past and to contemplate what one’s legacy will be. Added years give us a chance to reflect on our past from a distance and provide a unique point of view that only elders can fully understand and appreciate. Recounting old stories is one way that many seniors work through this process. Sharing experiences with those we love helps us derive meaning from our successes, failures, joys and hardships. This is also the way countless generations have secured their legacy—by passing down lessons learned and words of wisdom.
If an aging loved one retells the same stories every now and then, and you think to yourself, “I’ve heard that a hundred times!” please have the patience to let them continue. They are working through the past to find a sense of meaning. Whether it’s consciously or unconsciously, elders often want to figure out how these events shaped their present and will play into their future.
When family members and friends understand the importance of an elder retelling personal stories, they tend to be more tolerant of the repetition. Furthermore, it’s important to realize that just because an elder repeats some things doesn’t necessarily mean they have dementia. Their minds may not be as sharp or fast as they used to be, but some rumination and forgetfulness isn’t unusual in elders.
Coping with Repetition Caused by Cognitive Decline
My heart goes out to the many family caregivers who must listen to the same statement, question or story 20 times in one hour because a parent or spouse has some form of dementia. Short-term memory loss makes it impossible for dementia patients to remember what they just said, so they say it again and again and again. Anyone who has been in this situation will tell you that there’s a limit to how many times you can muster a genuine response. It’s enough to drive a person mad. So, what can dementia caregivers do about these seemingly endless loops?
Try to understand that your loved one isn’t repeating stories or questions to irritate you. Remember that you may exhibit this same behavior one day. How would you want others to react? Your loved one’s brain is damaged, and they can’t remember asking you what time their doctor’s appointment is at or telling you that they need more tissues at the grocery store, so these things happen over and over again. If you understand the reason behind this behavior, you will likely find you can better control your irritation and be more patient.
I rarely advise comparing elders and children because I feel that too much of this can skew our thinking, but in this case, it can be enlightening. Rather than using this comparison to justify treating a senior like a child, use it to modify your attitude and expectations. Children repeat things often to better grasp and memorize new information. Most people are very understanding of this learning process and children’s limited capabilities.
While the underlying reasons why children and elders repeat things differ, the similarity here is that both groups are functioning with limited mental faculties. We have more patience for younger individuals because they are growing mentally and we know that their questions and one-track statements will eventually wane. Logically, we feel that this behavior is inappropriate for seniors who have amassed decades of knowledge and experience. The truth is that dementia patients’ brains are incapable of remembering things that have already been said. If cognitive decline is a factor, it’s likely that the repetition will only get worse, so mastering empathy and self-control is paramount for dementia caregivers.
Handling Repetition Coupled With Dementia Behaviors
Dementia can cause patients to say and believe some pretty incredulous things, and many caregivers struggle with how to handle them properly. Depending on how a caregiver reacts, a patient may become fearful, paranoid, depressed, angry or even violent. Navigating these situations is particularly difficult and takes a great deal of practice, but there are three specific techniques that are recommended for coping with difficult dementia behaviors: validation, distraction and redirection. On their own, these strategies are useful, but when a caregiver can learn to use them all together, it’s a gamechanger.
The Validation Method for Dementia Patients
Validation simply refers to hearing out what a person is saying or feeling and responding in a supportive and empathetic way. Rather than reorienting a patient to reality or refuting their warped perception of things, you acknowledge their version and gently dispel any anxiety or discomfort they may be experiencing.
For example, if your loved one says the grass in the front yard is blue, what does it hurt if you agree with this statement rather than argue that it’s actually green? An appropriate validating response might be, “Yes, it does look kind of blue from this angle.” Acquiescing doesn’t affect anyone negatively and your elder doesn’t end up feeling like they’re always wrong. Just keep in mind that validation is not tantamount to shrugging off the things a care recipient says.
Validation usually works, but Alzheimer’s disease and other forms of dementia are unpredictable conditions. Nothing ever works 100 percent of the time. It becomes more difficult to practice validation when an elder’s thoughts are causing a great deal of anxiety or agitation. For example, during a certain stretch of my dad’s dementia, he thought there was a war taking place in our town because he’d seen news footage of a foreign conflict on TV. I had one heck of a time handling this persistent delusion. I obviously couldn’t just agree with him and say there was a war here, because he was frightened. Instead, I entered his version of reality, acknowledged his concerns, explained that the violence was not taking place in our immediate area and assured him of his safety. I promised him that I wouldn’t let anything happen to him. Eventually, he let it go. In these scenarios, we caregivers end up repeating ourselves, too, which can be exasperating. But we do what we must to keep our loved ones calm and content.
Distraction from Repetitive Thoughts
The next step is to try to distract your loved one. After the second or third repetition, try changing the topic of discussion. Mention their grandchildren and what they have been up to. Talk about an old friend who has done something interesting recently. Use anything you can think of to pique their interest and change the subject. Depending on the extent of a loved one’s memory issues, they may not remember these things you bring up, but it can help them break out of the loop they are caught in.
Redirecting Someone with Dementia
Closely related to distraction is redirection. Sometimes changing the subject isn’t totally effective, so many caregivers redirect their loved ones’ attention to a different activity that they can focus on. The point is to provide an alternative option that will break the loop and keep an elder fully engaged.
Crafts, chores, snacks, watching movies or recordings of old TV shows, and listening to CDs of their favorite music are especially effective. Old photo albums are excellent for redirection as well. Just try to use an album that contains photos from the distant past rather than more recent pictures. A dementia patient’s short-term memory is usually very weak and sometimes presenting them with documentation of recent events they do not remember can be upsetting. Long-term memory stays intact longer throughout the course of the disease, so older photographs tend to be a safer bet. Point out people in the pictures and ask your loved one to explain who they were. The chances are very good that they will remember the photos and may even entertain you with a related story.
Take a Deep Breath
I don’t mean to minimize the irritation that arises from elders repeating the same questions and stories from their youths. I also don’t want to imply that looking at an old photo album will solve the problem. However, these steps do work for most people, most of the time. Remember that validation is valuable and kind whether dementia is present or not. It is often worth your while to carve out a few minutes to distract and redirect. Keeping a loved one engaged will improve their quality of life and keep your efforts from becoming too tedious. If you find yourself getting overwhelmed, just step into another room for a few moments, take a few deep breaths and then try again.