Coping with dementia and Alzheimer's does not end with memory loss. As the disease progresses, the ability to communicate, judgment, understanding of social situations, and emotional control are also damaged. Simple and seemingly routine actions, such as showering, eating, taking medication, or a family conversation, are liable to become a focus of tension, frustration, and even conflict.
In many cases, the source of the difficulty is not "problematic behavior" on the part of the person living with dementia, but a gap between the way their brain interprets reality and the way the environment responds to them. The good news is that changing the approach and using simple tools can significantly reduce tension and improve the quality of life for the sick person, their family members, and their caregivers.
First mistake: Arguing about reality
One of the most common situations occurs when the person insists on a fact that is not true. They may say that they have to go to work, that their parents are still alive, or that the house they are in is not their home.
The natural response of family members is to correct, explain, or present proof. However, these arguments almost always end in a loss for both sides. The person with dementia is not necessarily convinced, and instead is liable to feel confused, humiliated, threatened, or more anxious.
Instead of arguing, it is worth trying to understand what is hidden behind the statement. The desire to go to work may express a need for routine or a sense of meaning. Searching for parents may stem from longing, fear, or a need for security. It is recommended to respond to the emotional need, gently divert the conversation to another topic, and avoid memory tests or attempts to prove to the person that they are wrong.
Second mistake: Speaking in too many words
As the disease progresses, information processing becomes slower and more complex. Long sentences, several questions in a row, multiple instructions, and background noise are liable to create overload and confusion.
It is advisable to speak slowly and in short sentences, ask one question at a time, and wait for an answer. Instead of asking an open question such as "What do you want to wear today?", it is better to offer only two options: "The blue shirt or the white one?".
It is important to make eye contact, speak at eye level, and turn off the television or another noise source during the conversation. Sometimes a small change in the way information is delivered can prevent great frustration.
Third mistake: Interpreting resistance as stubbornness
Refusal to shower, dress, or take medication is sometimes perceived as a lack of cooperation or as stubbornness. In practice, resistance may stem from pain, fear, embarrassment, a sense of threat, or a lack of understanding of the action that is about to take place.
Before applying pressure, it is worth checking whether something hurts, whether the room is too cold, whether the person is tired, or whether the action is being carried out at a speed that stresses them.
It is recommended to explain each stage in advance, not to rush, to offer a choice between two options, and to perform complex actions during hours when the person is calmer. Maintaining a regular routine may also reduce resistance, because the expected and familiar provide a sense of security.
Fourth mistake: Responding to anger with anger
Outbursts, shouting, and suspicion are not always an expression of a changed personality. Sometimes these are ways in which the person expresses distress that the brain already finds difficult to translate into words.
An angry response or an attempt to silence the person is liable to escalate the incident. It is better to speak in a calm tone, reduce the number of people in the room, lower noises, and try to identify repeating triggers.
Sometimes attention can be diverted to a familiar and pleasant activity, such as listening to music, looking at old photos, or taking a short walk. The goal is not to "win" the confrontation, but to restore a sense of calmness and security.
Fifth mistake: Thinking that the caregiver has to cope alone
Family members and caregivers often cope with immense emotional burden, chronic fatigue, loneliness, and feelings of guilt. Studies show that caregiver burnout affects not only their health, but also the quality of care for the person with dementia.
It is important to ask for help and not carry everything alone. Tasks should be divided among family members and relatives who are willing to assist, use support groups, and dedicate set time to rest and personal activity.
The Emda Association operates support groups as well as an information and advice line at *8889. When the load becomes unbearable, it is important to seek professional advice and not wait for a collapse.
Sixth mistake: Expecting a foreign caregiver to know everything
Foreign caregivers spend many hours beside the person with dementia, but do not always arrive with dedicated training for the disease. Even a devoted and experienced caregiver is liable to struggle if they do not know the appropriate communication principles.
Short guidance that includes correct communication, identifying signs of distress, coping with resistance, and familiarity with the patient's personal history can significantly improve the quality of care and the sense of security for both sides.
The Emda Association offers training sessions for foreign caregivers as well. Research reviews point out that focused training improves communication skills, especially when it includes practical practice and not just theoretical explanations.
Not correcting the person, but adapting the environment
Dementia changes the way a person experiences the world, but does not cancel their need for dignity, security, love, and a sense of belonging. When family members and caregivers stop trying to correct the person and start adapting the mode of communication to the new reality in which they live, many of the daily conflicts decrease and sometimes even disappear.
The best care does not end with administering medication or physical assistance. It also includes the ability to see the person behind the disease, listen to the need behind the behavior, and remind them, ourselves, and also the caregiver, that even when memory fades, the need for compassion and human connection remains forever.
Dr. Nati Blum is the CEO of the Emda Association and holds a PhD in psychology from Sacramento State University in the United States. The Emda Association is the address for Alzheimer's and dementia patients in Israel and their family members.