Dementia Solutions – Caregiving Advice, December Update

Dementia expert, Karen Tyrell, offers answers to visitors for their situation-specific questions. Karen is a dementia consultant who can point you in the right direction, giving quick insight and personalized answers to help you with dementia care challenges.

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

December, 2014 Update

1. Non-Drug Approaches to Dementia – Solutions and Strategies ?


“Pharmacists are often quick to recommend drugs for dealing with dementia, but antipsychotic or antidepressant medication, usually accompanied by serious side effects, can worsen behaviours such as anxiety and agitation. What are some of the non-pharmaceutical options available to treat dementia?”

 ~ Looking For Options


When it comes to a first-line of defence for dementia, though medications can be useful, non-pharmaceutical interventions should be the “go to” approach. A 2004 study titled “Non pharmacological interventions in Dementia Care” outlines several of these therapies.

Creative non-drug strategies are also highlighted in my book Cracking the Dementia Code. As I explain in the book, the key to implementing these strategies is a change in mindset. You must take on the role of detective and ask “WHY” the behaviours are occurring in the first place. There are reasons for all behaviour and pinpointing them leads the way to helpful non-psychotropic solutions.

Start your detective work by gathering the Ph.A.C.T.S.™ (Ph=Physical; A= Ask Them; C= Consider Cognitive Concerns; T= Triggers; S= Scan the Environment). Physical reasons for behaviours may include a toothache; constipation or even an infection. Cognitive concerns commonly refers to their worries (real or perceived) and even misperceptions. Triggers could be things like a loud noise, or even a caregiver’s approach.  Lastly, the environment can also contribute to behaviours such as clutter; lighting and crowds.

Effective strategies to manage behaviours apart from using antipsychotic drugs can include addressing the physical needs and making environmental changes according to their needs. For cognitive concerns and/or triggers, you will want to start off by validating the person’s feelings and using interpersonal therapy and effective communication techniques when connecting in order to initiate calm. Using Therapeutic Reasoning™, a form of reasoning that makes sense to the individual with dementia that provides reassurance and calming benefits (More on this topic can be found in my book.) as well as redirecting attention to activities of interest, can also help with reducing anxieties.

Every situation will be different. Therefore, I cannot stress enough the importance of asking “WHY” the anxiety or agitation is occurring in the first place. Once you have determined the “WHY”, think about implementing some of the ideas above or feel free to contact me for suggestions on creative solutions that can be personalized to your situation.

2. A Holiday Dilemma – Should I Bring My Mother to Our Christmas Party?


As the holidays approach, I’m wondering whether I should involve my mother, who has advanced dementia, in our family get-together by taking her out of her care facility. She came over for Thanksgiving but didn’t seem to have fun and neither did I. The holidays won’t be the same without her but may not be the same with her either. What should I do?”

~ Holiday Angst


It is natural for you to feel conflicted. On the one hand, you have many wonderful traditions and memories with your mother and hope to make new ones. Yet replicating those memories or traditions may not be possible due to the new reality of her dementia. Remember, however, that you can still create special moments with your mother that may not resemble the past, but can still be equally meaningful.

Despite your best intentions, trying to bring your mother into a world of traditions and festivities that she no longer recalls or understands may make her feel more disoriented. For those with advanced dementia, an unfamiliar setting that is overly stimulating can trigger feelings of fear, anxiety and even anger.

If not bringing your mother to the party will make you feel guilty, I suggest you explore your feelings a bit more. Think about whether bringing your mother into a setting that would cause her stress, only to have to take her back after a short while, would benefit her. Perhaps you may decide to celebrate the holidays with your mother by spending time with her in her familiar environment of the care facility instead.

Also, you do not have to shoulder your feelings alone—communicate concerns to family members in deciding what’s best. Ask everyone to put themselves into your mom’s current shoes to weigh out the pros and the cons.

It is very common for people with advanced dementia to not understand when or why Christmas day is significant. Thus, you may decide to start making new traditions this year. Or you may decide to spend quality time with your mom on another day making that visit along with all your other visits going forward feel like Christmas for her. This will make the time you spend with your mother truly special. Wishing you a wonderful holiday season!

3. Arguing Over Missing Items – How Do I Stop the Constant Fighting With My Wife?


“It’s becoming increasingly difficult for me to get along with my wife who has dementia. Whenever she loses something she blames me for taking it, even if it’s items such as jewelry or make-up which I never wear. I try to explain that the reason for the missing item is her moving it rather than me taking it, but we always end up fighting. How can I stop the constant arguing?”

 ~Frustrated Husband 


As a husband and caregiver it can be very difficult to avoid getting emotionally triggered by your wife’s changed behaviour. To keep calm try veering away from a reactive response and instead taking the time to take a breath and respond based on the facts you know.

A strategy for preventing her distress could be locking up items that are important to her in a safe drawer, cupboard or box after she uses them. Remember however that you need to be the keeper of the key.

If your house is large and full of clutter, downsize items as much as you can and close off rooms that are not needed when you are not home. This will leave fewer places for items to be hidden and go missing.

To prevent very valuable items, such as ID cards and money, from going missing, ensure that she is not carrying them around with her. If her purse is full of significantly valuable items, they could easily be misplaced or lost. If she likes to wear jewelry but the items are expensive, you may want to replace them (as gifts) with less expensive imitation or costume jewelry that resembles the originals.

When objects do make a disappearing act try to maintain your own sense of calm and do not let your wife’s agitation cause a similar response in you. It won’t’ be easy; but may make a world of difference for both of you.

Remember it is very common for missing items to show up eventually. Also remind yourself that dementia is at the root of your wife’s behaviour, inhibiting her ability to think logically. Accept her reactions without letting them affect you negatively. This may help you shift from reacting to reflectively responding. Most importantly take time for yourself whenever you feel overwhelmed. Share with others who are in similar situations may also help you. It is not easy for caregivers but know that you are important so be mindful of your stressors…insert a deep breath here. 🙂 

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 for Personalized Dementia Solutions ( and the author of the book “Cracking the Dementia Code – Creative Solutions to Cope with Changed Behaviours.” She offers her expertise on dementia care through speaking engagements, workshops and by working one-on-one with families and caregivers.