Dear Dementia Solutions- November 2016

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Appetite Anxieties – What do I do when an assisted living community resident keeps asking when the next meal is?

Dear Dementia Solutions:

“I’m worried about one of the residents at the assisted living community where I work. Despite having just eaten breakfast, she always returns shortly to ask when the next meal is. We explain when she had breakfast and inform her that lunch will be served later, but she keeps returning with the same question. We know this is likely due to her dementia but don’t know what to do to stop the behaviour. Please help!”

 ~Hungry for Advice

Dear Hungry for Advice:

An empty stomach, as we all know, is an uncomfortable state to be in. Some of us cope by sprinting to our fridge, speed-walking to the nearest vending machine, or calling to order a pizza. For those with dementia, however, communicating discomfort due to hunger can be far more challenging. Simply saying “I’m hungry!” may not come easily and instead someone with dementia may adopt other behaviours to express an unsatisfied appetite.

In your case, it is key to uncover whether the resident may still be hungry after breakfast or whether her anxiety is caused by something else. To unearth the clues, wear your ‘detective hat’ and start asking as many questions as possible. Is she not eating enough during breakfast or is she used to a pre-lunch snack? If so, a quick snack between meals may be best and monitoring her food intake may also be required to ensure she doesn’t just take a couple of bites during meals. Is lunch her biggest meal of the day? Does she exhibit similar behaviour before or after dinner? An assessment from a dietician may also be helpful in identifying whether her diet is lacking in any way.

Boredom could also be at play. Having a daily routine that only centers around meal times could be resulting in the resident being overly preoccupied with food. Participating in recreational activities can help distract her from meal-focused thought patterns.

Concerns about food could also be rooted in the past. If the resident grew up in an environment where one struggled to put food on the table, she may be reliving old worries. Perhaps she just needs some reassurance that there will always be plenty to eat.

Confusion when it comes to telling time is another possible culprit. She may not know that lunch time is only in an hour or that she ate breakfast only thirty minutes ago, and may worry about missing meals. If you feel this could be the reason why, perhaps you could work with your team on coming up with creative personalized solutions for her. For example, maybe having a large clock for her to easily view might help, or people regularly adding a comment about the current time when interacting with her.

Keep asking “Why?”, and keep digging for clues on the meaning behind her behaviour as we all know there’s always a reason behind the behaviour in dementia care.

TV Drama & Dementia – What do I do when my mother forgets that what she watches on TV isn’t real?

Dear Dementia Solutions:

“I’m worried that for my mother, who has dementia, the line between reality and a fictional TV show seems to be blurred. It’s as if she takes on the roles played by the actors. Recently, after watching a medical show, she asked twice to check whether blood was stored in the fridge. Is this type of behaviour common among those with dementia, and what should I do about it?”

~TV Tension

Dear TV Tension:

The simple answer is, yes, this type of behaviour is common among many with dementia. In fact, even those of us without dementia can become so engrossed in a TV show that we forget we’re watching a screen in the first place. That disconnect from reality can be intensified by the effects of dementia and lead to someone acting as if they live in a TV show.

Before exploring possible solutions, ask yourself first if there is any real harm in your mother asking the questions she does. If it’s hampering her ability to get a good night’s sleep or eat her meals, for example, then the TV may need to go. However, just because a behaviour is strange or unreasonable doesn’t mean it’s harmful or a problem that requires solving. If your mother is worried about the blood in the fridge, as you mentioned, maybe you just need to tell her that it’s gone because it was put to good use. This will allay her concerns and keep her in a good mood. On the other hand, trying to enforce a “solution” may result in more negatives than positives. Taking the TV away from your mother, for example, could cause her unnecessary distress.

One idea could be to gently introduce her to other activities with more therapeutic benefits, such as taking a walk outside, doing a puzzle or listening to music. If she remains attached to the TV, encourage her to watch non-fiction programs, such as nature documentaries or cooking shows.

Finally, try keeping a log of what your mother is watching and reacting to, and if there are other caregivers for your mother, share it with them as well. Communicating with others about what works and what doesn’t can be very valuable.

Remember that watching TV may be an activity your mother looks forward to. However, if it is causing her anxiety, then this trigger will need to be removed until these delusions end. Rather than take it away entirely, look for ways to limit and mitigate any negative impacts. I wish you both the very best!

Do you have a specific question relating to dementia that you need answered? Please submit your questions by email to: [email protected]

Karen Tyrell CDP, CPCA, is a Dementia Consultant, Educator & Author, and Founder of Personalized Dementia Solutions Inc. (www.dementiasolutions.ca). Karen offers her expertise on dementia care through speaking engagements, workshops and by working one-on-one with families and caregivers to provide emotional support and practical solutions.

DISCLAIMER:

The contents of this column are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional. For any health related issue, always seek medical advice first from a trained medical professional.