How to handle loved ones who struggle with dementia and repetition

Becoming repetitive, especially in telling stories or asking questions, is a sign that the brain is aging. While not exclusive to progressive conditions like dementia, repetition can be frustrating for even the most experienced relatives and caregivers of dementia patients to deal with, especially when the condition causes patients to say and believe some incredible statements or situations. Depending on how their audience reacts, a patient may become fearful, paranoid, depressed, angry, or even violent. Navigating these responses 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.

Validation

This strategy involves communicating with people who have dementia in a way that acknowledges their words and actions with respect and empathy, rather than with embarrassment, anger, or dismissiveness. Validation is intended for elders with moderate to severe dementia who are nearing the end of life. For example, if your loved one says the grass in the front yard is blue, an appropriate validating response might be, “Yes, it does look kind of blue from this angle.” Acquiescing ensures that your elder doesn’t feel as though they are always wrong. It should be noted that validation is not tantamount to shrugging off what a care recipient says.

The theory behind this strategy suggests that people in this situation are driven by basic needs that are hard for them to express. Those needs can include feeling loved, safe, useful and ultimately, at peace before they die. The most important part of validation is listening. By listening attentively and responding respectfully, you offer validation by showing your willingness to enter their world, rather than trying to force them into yours.

Distraction

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 loss, they may not remember what you bring up, but it can help them break out of the loop they are caught in.

Redirection

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, recordings of old movies or TV shows, and listening to CDs of their favorite music are especially effective.

Old photo albums are excellent for redirection as well. Because a dementia patient’s short-term memory is usually very weak, presenting them with documentation of recent events they cannot remember may be upsetting. Long-term memory stays intact longer, so older photographs tend to be more effective.

Recounting old stories is one way that many seniors work through the process of reflecting on their past from a distance. 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, respond with patience as they work through the past to find a sense of meaning. Whether it’s consciously or unconsciously, you loved one may be trying to figure out how these events shaped their present and will play into their future.

While there is no easy fix for this trying side effect of aging, some of these proven strategies can help you stay patient and preserve the dignity of your patient or loved one through this final stage of life.

— Jamie Lim