Communicating with your Loved One Who is Experiencing Dementia.

Communicating with your Loved One Who is Experiencing Dementia

If you’re reading this article, chances are you are close to a loved one who has recently been diagnosed with – or you suspect may have – dementia. While every person experiences dementia differently, there are common symptoms of dementia that can be found in almost everyone who experiences this journey. While your loved one will have moments where they seem like their usual self, there is no cure for any of the known dementias, and the type of dementia your family member or friend is experiencing will not get better over time. Medications can assist in managing symptoms and give your friend or family member a better quality of life, but they won’t reverse the disease.

So, how can you be prepared to best serve your family, friend, or neighbor with dementia? One of the most ideal ways you can support someone with dementia is to understand that their behavior, what they say, and how they react to you may have almost no link to the topic or concept you are talking about – they may be responding to you from a thought they are having that may seem unrelated to you. Still, their response makes sense to them based on their current train of thought, which has been rerouted due to dementia.

What is Dementia?

Dementia is not a specific disease but rather a general term used to describe a group of symptoms affecting cognitive functions such as memory, thinking, and social abilities to the extent that it interferes with daily life. It is a syndrome, usually of a chronic or progressive nature, caused by various brain illnesses that affect memory, behavior, and the ability to perform everyday activities.

It’s also not a “normal” part of aging. Getting older does not mean you will eventually have dementia. Forgetting where you put your keys or what day of the week it is, or taking a bit longer to remember details or facts are parts of aging. Dementia is not being forgetful – losing the memories you’ve experienced and mixing up the pieces of what’s left into one giant pile of thoughts. 

While each person with dementia experiences different symptoms – and one person with dementia may have different symptoms than another (because it’s not an all-or-nothing symptom checklist ) your loved one may outwardly express a variety of behaviors that come along with the cognitive challenges of communicating with someone who has dementia.

When to Shift a Conversation with a Person who has Dementia

Just because someone doesn’t remember details doesn’t mean they understand why they can’t remember. They know that you know and remember an event that happened and are unsure why they don’t have that memory. It’s as if someone crawled into their head and erased that memory, only to leave your loved one knowing that they can’t remember and, therefore, can’t have a conversation with you around a lost memory. This is one of the reasons why those with dementia act out – because the anxiety and fear of losing your memories take away your control over your own mind, and that is scary and frightening. If your loved one doesn’t remember an activity you did together, change the subject and talk about the weather or a simple subject that is current or is going on around them.

For example, if you’re talking to a parent about a family vacation and he or she is starting to look stressed, change the subject to the current weather or compliment them on their clothing. You can also walk them over to the menu in their memory care community or walk into the kitchen and ask them what they would like for lunch, dinner, or breakfast the following day. Keeping the conversation easy and light makes for a better memory and keeps their stress levels low. The lower you can keep their stress levels, the less anxiety they will experience and the happier they can be.

Dementia Challenges

Imagine that you are conversing with someone, and they can’t finish a sentence with the thought they had a few seconds ago. This is common in people with dementia. Individuals with dementia often experience difficulties with memory, particularly in recalling recent events or information. While some days or times of day may be better than others, don’t stress your parent or loved one by getting them to recall a memory.

When talking to someone with dementia, the most essential aspect to remember is to empathize with the individual and not expect them to make sense or think that you can “jog their memory” by telling them details of a past memory or asking them if they remember a specific event. Pushing them to remember when their brain is being physically changed by their dementia disease only causes anxiety in those living with dementia and will lead them to act out because of their frustration.

In addition to remembering recent events, dementia affects one’s thinking and reasoning abilities. This decline in cognitive function can make it challenging for individuals to solve problems, make decisions, or understand complex information. People with dementia may struggle to express themselves coherently or to understand what others are saying to them, so when talking to a dementia patient, use simple words and easy-to-understand phrases. However, don’t speak to them as if they were a child – they understand when you’re talking to them as if they don’t know what they are doing.

People with dementia understand the world differently than non-dementia persons, and the thought process in their head – although confusing to onlookers – makes perfect sense to them. Talking to them like a child increases their confusion because they feel that they are expressing themselves in a way that everyone understands. Put yourself in their shoes and respond in a thoughtful and straightforward response that doesn’t degrade or show less respect to the person suffering from dementia.

Individuals with dementia may become disoriented in time and space. They may get lost in their memories surrounding past familiar places and people they have lost (and believe they are currently alive) or lose track of time. You’ll need to meet them on their level and talk to them about their thoughts.

For example, if your mom tells you that she talked to your aunt that morning – the same aunt who passed away years ago – don’t try to convince her that your aunt has passed. This will only heighten her confusion and cause anxiety. Ask your mom how the visit was and whether she enjoyed her time with her sister. Reasoning about the facts of reality with a dementia patient is a lost cause and only creates negative feelings.

You want to go along with the conversation at hand, no matter how silly or nonsensical it seems. Remember, the person with dementia is experiencing their past memories in real time. So, telling them that what they are experiencing isn’t real can have horrible effects on your loved one’s mental health. In addition, this will send the signal that they can’t trust you because you don’t believe what they are saying. Be mindful and compassionate when your loved one with dementia distorts time and place; they are only relaying to you what is natural for them at that moment.

Dementia can also affect a person’s ability to complete everyday tasks, such as dressing, cooking, or driving. People with cognitive disabilities easily get confused because their brain isn’t sending the correct signals, so they don’t understand what is going on around them. Have empathy and guide them gently to where they need to be. Sometimes, this may include redirecting the conversation or behavior to a completely different topic or task they can focus on which gives them an outlet to move forward with their day without adding stress.

One of the most heartbreaking changes you may see in your loved one is the changes in behavior, mood, and personality. Individuals may become agitated, anxious, or exhibit socially inappropriate behaviors that seem unrelated or connected to what’s happening around them. However, the person with dementia may be experiencing a past memory in the current time and space, or their brain may have changed enough physically that their old personality traits may not exist any longer.

While hard to watch, remember that your loved one with dementia still has feelings and understands the world in a very different space. Try to view yourself in their situation and see if there’s a reward, pet, or another activity you can use to redirect them. They may also need space and time to express their frustrations or emotions. Whatever the case, ask them if they can tell you what is wrong. Sometimes, they will know they have pain, anxiety, or there is a noise that is bothering them, but they can’t put the words together to tell you why they are distressed. Work with them to eliminate triggers such as noises and objects that may cause anxious behavior.

Logical reasoning and problem-solving skills can be significantly impaired in individuals with dementia, so don’t expect your spouse or partner to answer your question logically. Again, you want to roll with their point of view and conversation. If you’re asking them how they feel and they tell you that their cat is sick, go with it. Either their cat is sick, or they are reliving a memory of their cat being sick. Either way, it’s a topic that is currently creating stress for them, so try your best to resolve the situation – even if they don’t have a cat (but they believe that they do), offer to take their “cat” to the vet so they don’t have to worry about their pet.

Do You Suspect Your Loved One Has Dementia?

If you believe someone you know and love is experiencing symptoms of dementia, encourage them to seek medical attention for a proper diagnosis. The sooner you can diagnose dementia, the earlier medication can start, which can significantly slow down the disease and give the person suffering from dementia a better quality of life. Early diagnosis gives individuals and their families more time to plan for the future, especially if you find dementia in its early stages, because the person with dementia can have enough cognitive ability to make their choices and preferences known, making this demanding lifestyle transition easier for everyone involved.

Human Rights Month

Universal Human Rights Month: December 2023

Celebrating Human Rights Awareness Month! 

This December let’s unite to honor Human Rights Awareness Month. It’s a time to reflect on the progress we’ve made and the journey ahead to ensure dignity, freedom, and respect for all.Together, we can create a world where everyone’s rights are recognized and protected. Let’s embrace diversity, stand against injustice, and be the voice for those who can’t speak out.

This month we want you to raise awareness, and let’s make a difference. Let’s remember, human rights are not just words in declarations; they are the principles we live by every day.

Other notable celebrations in the month of December include…

  • December 7 – Pearl Harbor Day
  • December 10 – Human Rights day
  • December 15 – Hanukkah 
  • December 25 – Christmas Day 
  • December 26 – Kwanzaa 
Incapacity and Power of Attorney

Incapacity and Power of Attorney

To sign legal documents such as a Power of Attorney, a person must have legal capacity. In law, the term “capacity” has a specific meaning that is different from how it is used colloquially. When someone is incapacitated, it means they cannot make personal or legal decisions. They likely cannot pay their own bills, manage their money, or understand legal and healthcare issues because they are mentally incapable. 

Capacity is the opposite of incapacity. When a person has capacity, they can fully understand and evaluate risks and rewards. If a court finds that a person signed a will while incapacitated, the court can invalidate the will.

Incapacity Determination

Whether someone is incapacitated or not may be difficult to determine. It is important to note that just because a person is diagnosed with memory loss, does not per se mean they are incapacitated.  However, when cognitive decline is an issue, attorneys will take great measures to ensure a client has capacity before having them sign legal documents.

Adult children will often call an attorney to schedule an appointment for their parents to assist them with getting their legal planning done. To protect the elderly person from undue influence, the attorney will often ask if the parent (the potential client) can call them and schedule the appointment and on the day of the appointment, ask any family members to sit outside while the attorney establishes the attorney-client relationship and assess capacity. 

The attorney may also ask the client to provide a letter of medical capacity from their doctor in which the doctor will state that despite some memory loss, the client has the ability to make their own legal and financial decisions. Whether a doctor will provide such a letter will be based on their own medical assessment.

Power of Attorney

A power of attorney is a legal document that allows the person signing the document (the “Principal”) to appoint someone else (the “Agent”) to make decisions for them. 

  • With a power of attorney for property, the principal can give the agent authority to handle their financial affairs, such as paying bills, managing accounts, selling property, etc. The Power of Attorney must be in writing and witnessed by a notary to be effective. 
  • In Oregon, a health care power of attorney is called an Advance Directive. This document allows the principal to select an agent (also known as the Healthcare Representative) to make health care decisions for them. The principal can also give the agent instructions for the type of care they would like to receive, including end-of-life care. 

The power granted in a power of attorney can be dangerous in the wrong hands. Therefore, creating a valid power of attorney requires the principal to have the mental capacity to understand the contents of the power of attorney and to whom they are giving that power. When creating a power of attorney for yourself, you should only nominate an agent that you trust will protect you and your assets. Such a power of attorney then allows you to preserve your autonomy, as you have selected a surrogate decision-maker to make decisions according to your wishes and not be subject to a court appointed guardian.

A power of attorney can be structured so that it takes effect only after a physician determines that you cannot make decisions for yourself. This is called a “Springing Power of Attorney.” The power comes to life only after you have been deemed to be incapacitated. A springing power of attorney can be problematic because physicians are often reluctant to declare a patient to be incapacitated, thus leaving the family without means of protecting the incapacitated person. In such circumstances, it may become necessary to have a court appoint a guardian and or a conservator.

If you trust the person you are giving the power to, it is often best to give the authority as soon as they create a power of attorney, as this avoids having to wait for a physician’s determination of incapacity.

The court may appoint a guardian and or a conservator for those who become incapacitated without a power of attorney.

Guardianship of an Adult

Incapacity is a central concept in the guardianship of an adult. Typically, an adult will need a guardian when they are deemed incapacitated by a judge and have not created a power of attorney for themselves. A Guardian is not what most people want because having a guardian appointed essentially strips the individual of their rights and autonomy. They are no longer able to make life decisions for themselves. The court takes this very seriously, and therefore, it is normally quite difficult to have a guardian appointed. 

When a petition is filed to request a guardian be appointed for an individual (the “Respondent”), the Respondent is entitled to due process of law. This means the Respondent will be notified of the petition and have an opportunity to object. If they object to the petition, the judge will order a hearing at which the Respondent may hire an attorney to represent them. During the hearing, the judge must determine whether the Respondent is incapacitated and whether that incapacity is likely to lead to severe injury or death.  The court will rely on evidence from the individual’s physician, family members, friends, and the Respondent’s own testimony. When a judge deems the Respondent to be incapacitated, they will appoint a qualified individual to be their guardian (protector of the person) and possibly a conservator (protector of the assets).

Guardianships and conservatorships are expensive and will cost on average $5,000.00 to establish and thousands of dollars each year to maintain. 

When an individual neglects or refuses to do estate planning, the likelihood of needing a Guardianship goes up significantly.

Wills and Estate Planning

Making a will or any estate planning documents that need your signature, such as a trust or transfer on death deed, requires you to have capacity. You must understand what documents you are signing. As this pertains to a Last Will and Testament, the person executing the will (the “Testator”) must be able to understand the nature of the act (making a will) and its effects; understand the extent of the property of which he or she is disposing; know without prompting the claims, if any, of those who should or might be, the natural objects or their bounty; and be cognizant of the scope and reach of the provisions of the document. 

A will is only valid if you had the required mental capacity when you signed it. The court can invalidate your will if it finds that you were incapacitated when you signed it. For those clients struggling with capacity, it is imperative for the attorney to understand the nature and extent of the cognitive decline, work closely with the client to determine whether the requisite capacity is there and document those conversations thoroughly. If a contest is brought, the attorney will need ample evidence to show that the client knew and understood what they were signing. 

Do Not Wait to Plan

Having a good estate plan can save tens of thousands of dollars in legal fees alone, not to mention the heart ache and stress this will place upon loved ones. As we get older, it becomes more and more imperative to have a good plan in place. All too often, clients wait until the last minute to contact an attorney to get an estate plan in place. Some clients mistakenly believe they are protecting their rights by not signing a power of attorney when in fact, the opposite is true.