Episode 117
Person-Centered Approach to Alzheimer’s Part 1 - Encore
We’re revisiting this episode because its insights remain as powerful and relevant today as when it first aired.
In this episode of Truth, Lies & Alzheimer's, host Lisa Skinner discusses the person-centered approach to Alzheimer's and dementia caregiving. The person-centered approach allows loved ones to retain dignity and autonomy by focusing care plans on the individual's needs rather than on the symptoms of the disease.
Lisa covers the four principles of a person-centered approach which were developed to help caregivers see beyond the disease and to help loved ones live independent and fulfilling lives. Lisa also discusses a story from her book Truth, Lies & Alzheimer's: Its Secret Faces, and examines how a person-centered approach would apply.
About the Host:
Author Lisa Skinner is a behavioral specialist with expertise in Alzheimer’s disease and related dementia. In her 30+year career working with family members and caregivers, Lisa has taught them how to successfully navigate the many challenges that accompany this heartbreaking disease. Lisa is both a Certified Dementia Practitioner and is also a certified dementia care trainer through the Alzheimer’s Association. She also holds a degree in Human Behavior.
Her latest book, “Truth, Lies & Alzheimer’s – Its Secret Faces” continues Lisa’s quest of working with dementia-related illnesses and teaching families and caregivers how to better understand the daunting challenges of brain disease. Her #1 Best-seller book “Not All Who Wander Need Be Lost,” was written at their urging. As someone who has had eight family members diagnosed with dementia, Lisa Skinner has found her calling in helping others through the struggle so they can have a better-quality relationship with their loved ones through education and through her workshops on counter-intuitive solutions and tools to help people effectively manage the symptoms of brain disease. Lisa Skinner has appeared on many national and regional media broadcasts. Lisa helps explain behaviors caused by dementia, encourages those who feel burdened, and gives practical advice for how to respond.
So many people today are heavily impacted by Alzheimer's disease and related dementia. The Alzheimer's Association and the World Health Organization have projected that the number of people who will develop Alzheimer's disease by the year 2050 worldwide will triple if a treatment or cure is not found. Society is not prepared to care for the projected increase of people who will develop this devastating disease. In her 30 years of working with family members and caregivers who suffer from dementia, Lisa has recognized how little people really understand the complexities of what living with this disease is really like. For Lisa, it starts with knowledge, education, and training.
Thanks for listening!
Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page.
Do you have some feedback or questions about this episode? Leave a comment in the section below!
Subscribe to the podcast
If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app.
Leave us an Apple Podcasts review
Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.
Transcript
Hello to all of you who have tuned in to listen
Lisa Skinner:to this episode of the truth, lies and Alzheimer's show. I'm
Lisa Skinner:Lisa Skinner, your host, and I'd like to shout out a very warm
Lisa Skinner:welcome to all of you who have joined us here today. I really
Lisa Skinner:appreciate you taking the time to listen. The purpose of this
Lisa Skinner:show is to talk about every aspect of Alzheimer's disease
Lisa Skinner:and dementia that's going to include the good, the bad and,
Lisa Skinner:yes, the ugly. My goal is to get to the truth, dispel the lies in
Lisa Skinner:this and unveil what I call the secret faces of Alzheimer's
Lisa Skinner:disease. This way you'll have a better understanding of what
Lisa Skinner:it's truly like to live with a brain disease like Alzheimer's.
Lisa Skinner:My hope is to zoom outside the paradigm of people believing
Lisa Skinner:that it's exclusively a memory loss condition, and to shift
Lisa Skinner:their understanding of just how dramatically this disease
Lisa Skinner:impacts the lives of those who have it, as well as their
Lisa Skinner:caregivers and family members. Well, for that matter, anybody
Lisa Skinner:who is involved in the life of a person living with dementia. My
Lisa Skinner:story started almost 50 years ago when my grandmother began
Lisa Skinner:displaying some very strange behaviors. She insisted that
Lisa Skinner:there were birds living in her mattress, and that they would
Lisa Skinner:come out at night and peck her face. She insisted that she saw
Lisa Skinner:rats running along her walls and that they were going to invade
Lisa Skinner:her house. She talked about the men who were trying to break
Lisa Skinner:into her home to not only steal her belongings, but they were
Lisa Skinner:there to harm her. Well, it turned out that this was the
Lisa Skinner:beginning of our 20 year journey with my grandmother and her
Lisa Skinner:Alzheimer's disease. So fast forwarding, a few years I became
Lisa Skinner:a behavioral specialist, and I have spent the last 30 years
Lisa Skinner:helping family members and caregivers understand the
Lisa Skinner:devastating effects of this disease so they too, could learn
Lisa Skinner:how to best live with the unexpected surprises that emerge
Lisa Skinner:day to day. That way, they can spend time focusing on what
Lisa Skinner:truly matters, which, of course, is spending quality time with
Lisa Skinner:their loved ones. And I am here for you now. I've also authored
Lisa Skinner:several books on the subject, written a training program, and
Lisa Skinner:believe it or not, have painfully watched eight of my
Lisa Skinner:own family members fall prey to one of the brain diseases that
Lisa Skinner:causes dementia. I'm also a certified Dementia Care trainer
Lisa Skinner:through the Alzheimer's Association, and I'm a certified
Lisa Skinner:dementia practitioner. I have come to realize, and you
Lisa Skinner:probably do, too, if you're on this Alzheimer's disease
Lisa Skinner:journey, that there are so many aspects of living with dementia
Lisa Skinner:that are unexpected and they surface out of nowhere at any
Lisa Skinner:time. Well, these are what I call the hidden or secret faces
Lisa Skinner:of Alzheimer's disease, and as many of you know, they do show
Lisa Skinner:up unannounced and are completely unpredictable, and
Lisa Skinner:that's why it's so important to be prepared for anything that
Lisa Skinner:emerges on this journey. I believe that knowledge is power,
Lisa Skinner:and I am here to arm you with that knowledge, so you too will
Lisa Skinner:have the power to negotiate the many challenges you will face
Lisa Skinner:having a loved one or while caring for someone with
Lisa Skinner:dementia. You know, living with dementia is unlike anything
Lisa Skinner:anybody could ever imagine. Think of it like falling into a
Lisa Skinner:rabbit hole, like Alice in Wonderland, and entering a world
Lisa Skinner:unlike anything you've ever known, one that is completely
Lisa Skinner:unfamiliar to you. Well, that said it's equally important to
Lisa Skinner:not only understand what will occur on a day to day basis, but
Lisa Skinner:why these things occur, what is happening to the person's
Lisa Skinner:changing brain as they progress through the various stages of
Lisa Skinner:Alzheimer's disease, and that is what I'm here. To offer you a
Lisa Skinner:better understanding about what living with Alzheimer's disease
Lisa Skinner:is really like, and only then will you be prepared to for what
Lisa Skinner:challenges lie ahead. And you know what that is the key to
Lisa Skinner:being prepared and to not being caught off guard. So on today's
Lisa Skinner:episode, I want to talk to you about what is called the person
Lisa Skinner:centered approach to care what exactly is it and why is it
Lisa Skinner:important? I've been practicing the person centered approach to
Lisa Skinner:care for decades now, and I want to tell you that I feel very,
Lisa Skinner:very, very fortunate that I was introduced to it and learned
Lisa Skinner:about it and implemented it early on in my career as an
Lisa Skinner:elder care counselor. It is so important, and it really, from
Lisa Skinner:what I've seen and personally witnessed, it has made a huge
Lisa Skinner:difference in the quality of life that people experience
Lisa Skinner:living with Alzheimer's disease and related dementia. So relax
Lisa Skinner:and sit up in your chair, and I am going to explain to you why I
Lisa Skinner:firmly believe in this approach to care and why it's important
Lisa Skinner:what I've discovered practicing the person centered approach to
Lisa Skinner:care. So it means that knowing what is important to an
Lisa Skinner:individual and working their life and care plan around the
Lisa Skinner:individual's wants and needs, instead of focusing exclusively
Lisa Skinner:on the disease, in other words, just to focus exclusively on the
Lisa Skinner:symptoms that they're displaying, but get to know the
Lisa Skinner:individual person in a very detailed and personal level.
Lisa Skinner:This includes offering choices and benefits as well as care
Lisa Skinner:options and strategies based on a person's personal wants,
Lisa Skinner:needs, likes and dislikes. This approach has shown to fulfill a
Lisa Skinner:patient's needs beyond their disability or ailment, as well
Lisa Skinner:as improve their quality of life, and extremely important
Lisa Skinner:when caring or communicating with a person living with
Lisa Skinner:dementia, for them, it demonstrates respect that they
Lisa Skinner:have their own views on what's best for them, that they have
Lisa Skinner:their own values and priorities in life, and that maintains
Lisa Skinner:familiarity that is such a crucial part of their everyday
Lisa Skinner:lives, these care plans and strategies are adapted to their
Lisa Skinner:expectations and preferences and not the other way around. By
Lisa Skinner:doing so, it enables the patients to retain their dignity
Lisa Skinner:and autonomy during an already challenging time. So these are
Lisa Skinner:the four principles of person centered care, to treat people
Lisa Skinner:with dignity, compassion and respect.
Lisa Skinner:The patients often lose their independence when they enter
Lisa Skinner:care, which puts their dignity at risk. However, person
Lisa Skinner:centered care enables a person to maintain their dignity by
Lisa Skinner:respecting their wishes and treating them with compassion
Lisa Skinner:and empathy. To fulfill this principle, patients must be
Lisa Skinner:allowed to own their own thoughts, feelings, opinions,
Lisa Skinner:beliefs and values, because they don't just suddenly become
Lisa Skinner:invalidated by their care needs. Respecting their personal
Lisa Skinner:qualities helps them feel validated and cared for much
Lisa Skinner:more wholly, both physically and mentally. The second principle
Lisa Skinner:is providing them with coordinated care, support and
Lisa Skinner:treatment. So it's very important to record their
Lisa Skinner:personal information into a journal or care plan and share
Lisa Skinner:it with other caregivers, the caregivers or family members
Lisa Skinner:should communicate this information with one another to
Lisa Skinner:build a shared understanding of how to deliver this person
Lisa Skinner:centered care. The third principle is to offer
Lisa Skinner:personalized care, support and treatment. This. This principle
Lisa Skinner:is truly at the heart of a person centered approach to
Lisa Skinner:care, and it will enable caregivers to understand what
Lisa Skinner:works for each individual person based on specific situations.
Lisa Skinner:You've heard me say in previous episodes that if you've met one
Lisa Skinner:person with Alzheimer's disease. Guess what? You've met one
Lisa Skinner:person with Alzheimer's disease, and as I've stated before, it's
Lisa Skinner:because every single person experiences the stages of the
Lisa Skinner:disease and progresses through the disease in a little
Lisa Skinner:different way. So if we have detailed information about the
Lisa Skinner:people, we can avoid so many stressful situations by being
Lisa Skinner:prepared with the tools in our toolbox that we will have ready
Lisa Skinner:based on their personal information. The last principle
Lisa Skinner:is to enable caregivers to recognize and develop a person's
Lisa Skinner:strengths and abilities so they can live independent and
Lisa Skinner:fulfilling lives. And trust me, I have seen this principle do
Lisa Skinner:exactly that, providing Person Centered Care involved to
Lisa Skinner:patients in decisions and helps them take action to support
Lisa Skinner:themselves whenever possible. This helps them to develop their
Lisa Skinner:own capabilities and an understanding of how to look
Lisa Skinner:after themselves and to stay as independent as possible through
Lisa Skinner:each stage of their disease. Now this definitely becomes a
Lisa Skinner:challenging fine balancing act as they continue to decline, but
Lisa Skinner:trying to force patients to do more on their own can surely
Lisa Skinner:cause anxiety and frustration. On the other hand, too much
Lisa Skinner:involvement makes them feel irrelevant and useless and can
Lisa Skinner:literally turn them into an invalid so why is this important
Lisa Skinner:in providing a more meaningful life? Well, the people suffering
Lisa Skinner:from Alzheimer's disease and related dementia will feel more
Lisa Skinner:comfortable and confident. They'll have more trust in you
Lisa Skinner:that you're doing what's best for them, and therefore they
Lisa Skinner:will be less resistant to your help. This, of course, will make
Lisa Skinner:any situation easier for both of you. You will meet their
Lisa Skinner:emotional their social and practical needs, which ensures
Lisa Skinner:that they maintain a higher quality of life. You can support
Lisa Skinner:those who may not be able to directly communicate their wants
Lisa Skinner:and needs. Person Centered Care helps you find suitable ways to
Lisa Skinner:communicate with them and to help them to communicate with
Lisa Skinner:you, especially when they can no longer articulate their wants
Lisa Skinner:and their needs and that will maximize their quality of care.
Lisa Skinner:Now, family members, caregivers and people living with dementia
Lisa Skinner:deserve to live a fulfilling life and feel positively despite
Lisa Skinner:the challenges and stresses that accompany living with this
Lisa Skinner:disease. I want to go over a few things that would be helpful for
Lisa Skinner:everybody to gather this type of information. It's a behavioral
Lisa Skinner:history and social assessment. So obtaining this information,
Lisa Skinner:you can provide very important information. You can design
Lisa Skinner:activities around what you know they like to do in the past
Lisa Skinner:about each individual person, the history questions elicit
Lisa Skinner:information about their history of such behaviors as wandering,
Lisa Skinner:agitation, assault, sexual behaviors, elopement, and many
Lisa Skinner:others. The history can be obtained from the resident and
Lisa Skinner:family at the same time you conduct your social assessment
Lisa Skinner:and gather requested information from you know, hospitals and
Lisa Skinner:nursing facilities, daycare caregivers, spouses, family
Lisa Skinner:members, friends, because every little nugget that you gather
Lisa Skinner:about a person is going to come. Come in handy when different
Lisa Skinner:situations arise, and I will explain that in detail over the
Lisa Skinner:many episodes that we're going to cover this information moving
Lisa Skinner:forward. So a social assessment provides valuable information
Lisa Skinner:about a person in their social context, examples of information
Lisa Skinner:obtained in the social assessment include their customs
Lisa Skinner:and practices, their beliefs, their fears and joys, their
Lisa Skinner:family history, things that they may be attached to, and how well
Lisa Skinner:they socialize and availability of family and friends to provide
Lisa Skinner:support. Now, obtaining detailed information about the person,
Lisa Skinner:their background, their personality, their likes, their
Lisa Skinner:dislikes, etc, helps us provide optimal care. It also helps us
Lisa Skinner:to design appropriate activities, and it enhances
Lisa Skinner:communication. So let's take a look in more detail about what
Lisa Skinner:information you want to try to gather from the social
Lisa Skinner:assessment. Is the resident outgoing? Are they social? Are
Lisa Skinner:they quiet? Are they physically active? Do they have a favorite
Lisa Skinner:food, hobby or sport? How do they respond to stimuli? How do
Lisa Skinner:they respond to assistance? How does the resident relate to the
Lisa Skinner:family? Do they have children? Do they practice a religion, and
Lisa Skinner:if they do, what religion do they practice? How do they like
Lisa Skinner:to celebrate the various holidays? What do they like to
Lisa Skinner:wear? Are there any significant life events that the family can
Lisa Skinner:share that might trigger behaviors at any time. How do
Lisa Skinner:they respond to stress? How do they display their emotions?
Lisa Skinner:What is their general demeanor? Or at least, what was their
Lisa Skinner:general demeanor prior to their brain disease? How do they react
Lisa Skinner:to discomfort and pain? What type of entertainment Do they
Lisa Skinner:like? What type of music do they enjoy? What level of education
Lisa Skinner:did they complete? That's actually an important question.
Lisa Skinner:How do they respond to animals? I'll give you an example. My
Lisa Skinner:mother couldn't stand pet so that's one thing I would never
Lisa Skinner:have introduced to her pet therapy. So that's an important
Lisa Skinner:piece of information to gather. Would the resident strike in a
Lisa Skinner:given situation? In other words, become combative and try to hit
Lisa Skinner:or strike out. And are you aware of whether or not they're able
Lisa Skinner:to make their needs known? These are just a few of the very
Lisa Skinner:important information or nuggets for you to gather, have ready in
Lisa Skinner:your toolbox to you in many, many, many of the situations
Lisa Skinner:that you will inevitably encounter throughout this
Lisa Skinner:journey with your loved one.
Lisa Skinner:And as we continue with these informational episodes, you will
Lisa Skinner:understand why, in the stories I'm going to tell you and the
Lisa Skinner:examples I'm going to give you, and in the very detailed
Lisa Skinner:information that I will provide so you will be able to connect
Lisa Skinner:all the dots and see the big picture of Just how this disease
Lisa Skinner:impacts people who suffer from it. Next, I want to just give
Lisa Skinner:you a little background of how things changed and have changed
Lisa Skinner:and continue to change since my grandmother's diagnosis 50 years
Lisa Skinner:ago, back then, when people started displaying the types of
Lisa Skinner:symptoms that I described to you, that she did with me,
Lisa Skinner:people were medicated. People were over medicated. That was
Lisa Skinner:customary, and to the point where they were almost like a
Lisa Skinner:zombie or in a comatose state. This was very, very common. They
Lisa Skinner:also used restraints on people who suffered from well at that
Lisa Skinner:time, I told you, they called it senile dementia, but it is
Lisa Skinner:synonymous. With today's Alzheimer's disease and the
Lisa Skinner:other brain diseases that cause dementia, then we move to what
Lisa Skinner:was called reality therapy, or I'm going to explain to you what
Lisa Skinner:that means, but it simply did not work. Then a woman by the
Lisa Skinner:name of Naomi file introduced what is currently called
Lisa Skinner:validation therapy, also known as joining their reality
Lisa Skinner:therapy, adapting our world to theirs, and also using
Lisa Skinner:reminiscence therapy and life stations, and I will explain all
Lisa Skinner:of these to you between this episode and upcoming episodes.
Lisa Skinner:So let me start with what is reality orientation therapy?
Lisa Skinner:Well, reality orientation therapy also known as RO, is a
Lisa Skinner:treatment strategy. Was a treatment strategy, but it is
Lisa Skinner:still used. First described in 1966 as a rehabilitation method
Lisa Skinner:for confused elderly patients. The therapist would present the
Lisa Skinner:patient with continuous reminders about the date, where
Lisa Skinner:they are, where they exist, personal details about them,
Lisa Skinner:about their life, about their likes and dislikes. A therapist
Lisa Skinner:and a patient would discuss recent events and their daily
Lisa Skinner:routine. The goal in this was to ground the patient in the
Lisa Skinner:presence, while also fostering social interaction. For example,
Lisa Skinner:if they were wondering where their parents are because their
Lisa Skinner:short term memory switch flipped off, and they're now pulling
Lisa Skinner:from their lungs to memories and believe that they're a child
Lisa Skinner:living with their parents, they would be told under reality
Lisa Skinner:orientation therapy that their parents are no longer living if
Lisa Skinner:they weren't or that they can't go home because they no longer
Lisa Skinner:live in that childhood home with reality orientation therapy, the
Lisa Skinner:goal of the therapist was to reduce confusion and
Lisa Skinner:disorientation in dementia patients. They believed that the
Lisa Skinner:patients would gain a stronger understanding of their
Lisa Skinner:surroundings and their place within them, and would lead to a
Lisa Skinner:greater sense of control and increased self esteem. But guess
Lisa Skinner:what? It did not work. What it did do was cause anxiety and
Lisa Skinner:even scared people, especially if they didn't remember that a
Lisa Skinner:loved one had passed away. You know, this could be like they
Lisa Skinner:were hearing it for the first time, and could be sent into a
Lisa Skinner:panic. Also, arguing with someone who has dementia is
Lisa Skinner:futile and will often escalate into a more serious situation.
Lisa Skinner:These are what we call catastrophic reactions to them.
Lisa Skinner:We might as well be calling them a liar and taking away any sense
Lisa Skinner:of control they may have in telling their story. Keep in
Lisa Skinner:mind, they believe 100% that what they are telling you is not
Lisa Skinner:true, even if it doesn't make sense to you, it makes perfect
Lisa Skinner:sense to them. Reality, orientation, therapy focused on
Lisa Skinner:presenting patients with the current facts about time, the
Lisa Skinner:date and their current environment, so patients who
Lisa Skinner:lived in a dedicated facility, like a memory care unit or
Lisa Skinner:assisted living or a skilled nursing facility couldn't
Lisa Skinner:receive this therapy 24 hours a day. So this meant that during
Lisa Skinner:every interaction, the healthcare workers and
Lisa Skinner:caregivers, when they were interacting with the residents,
Lisa Skinner:those workers were emphatic about reinforcing the current
Lisa Skinner:dates, times, locations and current events with the
Lisa Skinner:residents. The caregivers would even read the newspaper and
Lisa Skinner:watch TV with the patients to reinforce their reality. But
Lisa Skinner:unfortunately, they were reinforcing their. Reality, the
Lisa Skinner:reality of the caregivers with the healthy brains, not the
Lisa Skinner:reality of the patients and the residents who had the damage
Lisa Skinner:changing brain. And that is the difference. There may also be
Lisa Skinner:signs declaring the date they would have multiple clocks in
Lisa Skinner:the room, they would emphasize current events, seasonal
Lisa Skinner:festivals and other ways to do what they considered to be
Lisa Skinner:grounding social interaction with reality. The second therapy
Lisa Skinner:that I talked about is called validation therapy, also known
Lisa Skinner:as join their reality. And that really what it boils down to.
Lisa Skinner:It's the opposite of reality orientation therapy. It is
Lisa Skinner:literally adapting the world of the person with the healthy
Lisa Skinner:brain to the world of the person with the damaged brain. Instead
Lisa Skinner:of doing what reality orientation therapy tried to do
Lisa Skinner:was force them to adapt to ours. And as I said, it did not work.
Lisa Skinner:So validation therapy was developed by Naomi file after
Lisa Skinner:relocating to Cleveland with her parents from Germany, where her
Lisa Skinner:father served as an administrator and her mother as
Lisa Skinner:the head of the social service department at the Montefiore
Lisa Skinner:home for the aged. Naomi followed in her parents
Lisa Skinner:footsteps and began working with the elderly after receiving her
Lisa Skinner:master's degree in social work from Columbia University, after
Lisa Skinner:experiencing dissatisfaction and frustration with traditional
Lisa Skinner:treatment methods used with disoriented elderly dementia
Lisa Skinner:sufferers. File developed what we know today to be validation
Lisa Skinner:therapy. She's written two books on the subject and about the
Lisa Skinner:techniques that she uses. The first book was called validation
Lisa Skinner:the file method, and the second is called the validation
Lisa Skinner:breakthrough.
Lisa Skinner:Validation therapy is a method of therapeutic communication
Lisa Skinner:which can be used to connect with someone who has moderate to
Lisa Skinner:late stage dementia. It places more emphasis on the emotional
Lisa Skinner:aspect of a conversation and less on their feelings and
Lisa Skinner:beliefs. It is a centered approach to care around a
Lisa Skinner:person's needs by employing empathy and respect validation,
Lisa Skinner:therapy helps a person with dementia feel supported and
Lisa Skinner:understood and restores some of the dignity that dementia has
Lisa Skinner:taken away from them. The practice of embracing the
Lisa Skinner:reality of a person living with dementia has multiple uses and
Lisa Skinner:benefits for those living with the disease. It reduces stress.
Lisa Skinner:It reduces pain of loss for both the caregiver, the family
Lisa Skinner:members and the person receiving care. People with dementia do
Lisa Skinner:not need to be grounded in reality, and it does no good
Lisa Skinner:anyway, adapting to their reality, versus forcing them to
Lisa Skinner:adapt to ours makes them feel more safe and secure in the
Lisa Skinner:moment. You're acknowledging them, you're validating them. It
Lisa Skinner:has been successful in redirecting them so they are no
Lisa Skinner:longer concerned about the safety and whereabouts of their
Lisa Skinner:loved ones, so they can, in turn, enjoy the moments with
Lisa Skinner:you. When we engage them in their stories of the past, we
Lisa Skinner:learn and connect with them on their terms, not on ours. You
Lisa Skinner:know, it's not uncommon for individuals who are living with
Lisa Skinner:dementia or Alzheimer's to often speak of their younger years as
Lisa Skinner:if it was their current reality. Think again about that light
Lisa Skinner:functionality that I've demonstrated to you in a
Lisa Skinner:previous episode. They often tell stories of their childhood
Lisa Skinner:home, of their parents, and will even feel the need to go home
Lisa Skinner:and make dinner for their young children. Sometimes the need for
Lisa Skinner:this reality is so great that they become anxious and even
Lisa Skinner:angry when they can't find what in their mind. Should be there.
Lisa Skinner:So imagine how trapped and powerless they must feel in
Lisa Skinner:these moments. How would you feel if you woke up one day and
Lisa Skinner:everything you knew and loved were no longer there, or if your
Lisa Skinner:once routine and purposeful lives was just a distant memory.
Lisa Skinner:That's what it's like for them. So understand that going along
Lisa Skinner:with their current belief offers them comfort, security and peace
Lisa Skinner:of mind. We know that there is nothing we can say that will
Lisa Skinner:alter that current belief until that short term memory switch is
Lisa Skinner:flipped back on. So if they ask you where their mother or father
Lisa Skinner:is, a suggestion is to tell them they're at the store and we'll
Lisa Skinner:be right back. If they ask you or tell you that they need to go
Lisa Skinner:home. Perhaps you can redirect them in that thought by saying
Lisa Skinner:something like, Well, right now it's too cold to go outside. Or
Lisa Skinner:you can ask where their children are, and you can tell them that
Lisa Skinner:they're still at school. Understand that as humans, one
Lisa Skinner:of our very basic needs is to be loved, accepted and to feel
Lisa Skinner:validated. It's an innate need that does not diminish with
Lisa Skinner:dementia. On the contrary, that need for acceptance may be
Lisa Skinner:increased since their worlds have been turned upside down,
Lisa Skinner:and validation therapy has been proven to be successful in being
Lisa Skinner:able to provide a higher quality of life in the lives of those
Lisa Skinner:living with Alzheimer's disease and dementia. Let me share with
Lisa Skinner:you now a real life situational story from my book truth, lies
Lisa Skinner:and Alzheimer's at secret faces that illustrate this concept of
Lisa Skinner:what I have just explained to you. This is the Mary Ann story.
Lisa Skinner:Quite often, people with Alzheimer's disease display
Lisa Skinner:repetitive behavior, such as repeating a word the same
Lisa Skinner:question, a story or an activity, they repeat it over
Lisa Skinner:and over and over again, or they'll do something and then
Lisa Skinner:undo what they just completed and started over and over and
Lisa Skinner:over again. In most cases, they are more than likely looking for
Lisa Skinner:comfort, security, familiarity, or they're just plain bored.
Lisa Skinner:Repetitive behaviors are demonstrated by people with
Lisa Skinner:dementia because they may be unable to remember recent events
Lisa Skinner:or actions due to their short term memory loss. Remember the
Lisa Skinner:short term memory switch is either flipped on or flipped
Lisa Skinner:off. They may also repeat words or gestures as a means to soothe
Lisa Skinner:themselves. The behaviors that you see may also be an attempt
Lisa Skinner:to communicate an unmet need or alert you to a physical
Lisa Skinner:discomfort. Well, Mary Ann happened to be my mother in law,
Lisa Skinner:and she loved to fidget with tissues. She would meticulously
Lisa Skinner:fold those tissues into neat little squares and then put them
Lisa Skinner:in her purse, and then she'd close her purse. Moments later,
Lisa Skinner:she would take out the folded tissue. She would unravel it,
Lisa Skinner:fold it again, and tuck it back into her purse. Fold, tuck,
Lisa Skinner:repeat, fold, tuck, repeat, over and over again. But this
Lisa Skinner:activity would keep her occupied for hours, and she seemed
Lisa Skinner:perfectly content doing it, but one weekend, when it was our
Lisa Skinner:turn to look after my mother in law, she was sitting on the sofa
Lisa Skinner:with me in our living room, and we were watching the nostalgic
Lisa Skinner:Andy Griffith Show. She looked peaceful for a time, folding her
Lisa Skinner:tissues and tucking them away into her purse. But then all of
Lisa Skinner:a sudden, on the turn of a dime, her whole entire demeanor
Lisa Skinner:changed. All of a sudden, she anxiously stood up from her
Lisa Skinner:seated position on the sofa and demanded that I take her home.
Lisa Skinner:She asked me Stern. Me, does Marty know where I am? He's
Lisa Skinner:going to want his dinner. I've got to get home to him. I'm
Lisa Skinner:thinking in my head, did she really just ask me where Marty
Lisa Skinner:was? Oh, my goodness, you see, Marty had passed away four years
Lisa Skinner:earlier. Well, my initial knee jerk response was that I wanted
Lisa Skinner:to remind her that Marty had passed away, and to pull her
Lisa Skinner:back into my reality. After all, she was my mother in law, and I
Lisa Skinner:wanted to correct her false belief because I wanted to make
Lisa Skinner:her better, but I knew better than to react that way. So
Lisa Skinner:joining her reality was really my only option in this scenario.
Lisa Skinner:Yes, he knows you're here. I told her. I just called him, and
Lisa Skinner:he knows I'll bring be bringing you home very soon. Are you
Lisa Skinner:sure? She replied, Yes, Mary Ann, I'm certain. Well, okay, if
Lisa Skinner:you're sure, I just don't want them to be worried about me or
Lisa Skinner:to be hungry. So she sat back down on the sofa, refocused her
Lisa Skinner:attention on the Andy Griffith Show, and within a few minutes,
Lisa Skinner:she was back to
Lisa Skinner:fold, tuck, repeat, fold, tuck, repeat, opening and closing that
Lisa Skinner:purse. But she looked very calm and peaceful again, and although
Lisa Skinner:I felt conflicted by joining her reality and feeling compelled to
Lisa Skinner:reassure her that Marty was okay and waiting for her at home, I
Lisa Skinner:knew that correcting her could have caused her a lot more pain
Lisa Skinner:and grief in her mind, knowing that her husband was okay with
Lisa Skinner:her being over at our house, relieved her concern at the
Lisa Skinner:moment and brought her the relief that she desperately
Lisa Skinner:needed to hear. After all, she believed that what she was
Lisa Skinner:telling me was true at that moment in time, and there was
Lisa Skinner:nothing I could have done that would have relieved that anxiety
Lisa Skinner:she was feeling in response to the false belief she was having
Lisa Skinner:of him still being alive and well and waiting for her at
Lisa Skinner:their home, choosing the other option of trying to correct her
Lisa Skinner:false belief surely could have backfired. And hearing me tell
Lisa Skinner:her that he was no longer living could have shocked her. It could
Lisa Skinner:have been like he didn't know that he had passed on and that
Lisa Skinner:nobody had told her and they had kept it from her. I mean, just
Lisa Skinner:all these ideas going through her mind and creating a panic
Lisa Skinner:for her, seeing her calmness after telling her what I did,
Lisa Skinner:definitely reassured me that I did the right thing. Well, I
Lisa Skinner:knew Mary Ann would never be her normal self again, but at least
Lisa Skinner:the way I knew her before her Alzheimer's disease, this was
Lisa Skinner:her new normal, but somehow I did find comfort in knowing that
Lisa Skinner:she'd never be normal again, but that she would be Okay, as we
Lisa Skinner:heard in our story. Mary Ann, people with dementia can seem
Lisa Skinner:perfectly fine one moment and in the next out of nowhere, they
Lisa Skinner:can be anxious and detached from reality. This can be one of the
Lisa Skinner:most troubling behaviors for families and caregivers to deal,
Lisa Skinner:to deal with. The difficulty stems in part, from not wanting
Lisa Skinner:to see our loved ones uncomfortable, from not knowing
Lisa Skinner:how to handle a problem that only exists in their mind,
Lisa Skinner:watching them lose touch with reality that is a normal
Lisa Skinner:progression of the disease, and again, this is due to the short
Lisa Skinner:term memory diminishing throughout the course of the
Lisa Skinner:illness. Mary Ann believed that her husband was still alive.
Lisa Skinner:Your loved one will likely have a different false belief.
Lisa Skinner:Remember that no matter what you cannot dissuade the person from
Lisa Skinner:the belief that they're having in that moment, therefore,
Lisa Skinner:exploring joining their reality is the most effective approach
Lisa Skinner:to that occurrence. Right? The essence of the approach is to
Lisa Skinner:acknowledge their reality and then divert their concern. In
Lisa Skinner:Mary Ann's case, this meant acknowledging that her husband
Lisa Skinner:was at home, but explaining why there was no reason for her to
Lisa Skinner:be worried. The situation with your loved one may be different,
Lisa Skinner:but you can use the acknowledge and divert approach for many
Lisa Skinner:similar situations. Additionally, what you heard was
Lisa Skinner:Mary Ann exhibited repetitive behaviors, which are also
Lisa Skinner:extremely common with dementia. Hers was fold, tuck and repeat.
Lisa Skinner:Now your loved one may repeat words, activities, questions or
Lisa Skinner:stories in the same conversation. They may also pace
Lisa Skinner:around a room. These types of behaviors are often a coping
Lisa Skinner:mechanism for dealing with stress or fear, but it certainly
Lisa Skinner:can be annoying for caregivers and family members, so do what
Lisa Skinner:you can to redirect them, but as long as the behavior is safe,
Lisa Skinner:eliminating it is not mission critical. Our brains process
Lisa Skinner:information in different ways. We do this through abstract
Lisa Skinner:thought or through concrete thought, and we rely on these
Lisa Skinner:thought processes every day. Now this ability is lost in this
Lisa Skinner:Alzheimer's disease and other related dementia. This means
Lisa Skinner:that the many concepts that we rely on to live in this world no
Lisa Skinner:longer have meaning for a person living with dementia. So in
Lisa Skinner:future episodes, I'm going to discuss ways in which we as
Lisa Skinner:caregivers and family members can help our loved ones make
Lisa Skinner:better sense of the world that they are living in. According to
Lisa Skinner:the Alzheimer's Association, the past and the future are held in
Lisa Skinner:order by the power of abstraction. Time is abstract,
Lisa Skinner:being able to think about the what ifs in our lives relies on
Lisa Skinner:abstraction. How much is a part of abstraction and the
Lisa Skinner:connection among family members and friends are abstract. Like
Lisa Skinner:the other powers of thought, abstraction declines with the
Lisa Skinner:progression of the dementing disease, disability is lost
Lisa Skinner:early in the disease. So this means that many of the concepts
Lisa Skinner:we rely on to live in this world no longer have any meaning for a
Lisa Skinner:person living with dementia. I sure hope you've enjoyed the
Lisa Skinner:information that I've shared with you today, I want to thank
Lisa Skinner:you again for listening. We have so much to cover in our upcoming
Lisa Skinner:episodes, and I do want to provide you with information
Lisa Skinner:that you will find helpful and valuable throughout your
Lisa Skinner:journey. Remember, dementia awareness is every day, and
Lisa Skinner:kindness is the ability to speak with love, listen with
Lisa Skinner:compassion and act with patience. These are all very
Lisa Skinner:necessary attributes to have in order to outlash Alzheimer's
Lisa Skinner:disease. One last note, this show is about you and how my
Lisa Skinner:experiences, expertise and strategies will be able to help
Lisa Skinner:you and your loved one have an easier time while struggling
Lisa Skinner:through this disease. I know how difficult it is, therefore, I'd
Lisa Skinner:love it if you would send me your comments and suggestions on
Lisa Skinner:what topics you'd like me to cover on this weekly show. You
Lisa Skinner:can send them to dementia whisperer one@gmail.com if
Lisa Skinner:you're listening to this on YouTube or if you got here
Lisa Skinner:through our social media page, please leave your comments or
Lisa Skinner:questions, and I promise I will do my best to address them. I
Lisa Skinner:genuinely look forward to receiving your thoughts and
Lisa Skinner:ideas, and in the meantime, always take care of you. Talk to
Lisa Skinner:you next week.