When Kenneth L. was diagnosed with early-stage Alzheimer’s he began a journey all too familiar to people with dementia. “They tell you…all these negative things, all these things you can’t do now that you have Alzheimer’s.” Mr. L. was lucky; he found a group of people like him who met monthly to socialize and “challenge ourselves to continue to grow.” The focus was on what people with early-stage dementia can do – dance, write poetry, yoga, visit museums – not what is no longer within their reach (NYT: The New Old Age, Judith Graham, March 29, 2013).
I read this today, right after I read another article about depression in the old-old. “Frail elderly, in particular, express depression through physical symptoms such as headaches, backaches, stomach distress, and constipation; often after medical evaluation has determined there is no organic cause for these symptoms” (ElderCare Online). The article goes on to say, “Depression causes preoccupation with self…. For whatever reason, depressed persons feel a very strong need for a predictable, lawful, orderly world….”
Mama is textbook. She has probably always been depressed, and she has never found a way to cope with it. It is not surprising that now it is manifesting in physical distress. And she has a strong need for others to do everything the way she does them; for her helpers to do only what she tells them to do; for food products to be her familiar brands.
Perhaps it is the dementia, perhaps her age, perhaps her psychological history, but unlike Mr. L. she cannot look at the positive side of life. She is a glass-half-empty kind of person; maybe because she has always seen herself as inadequate. I get weary of the first words out of her mouth when I greet her being negative ones. Always the focus on what she can’t do, though she can usually think of something positive when I ask her to. It makes me want to run screaming from the room.
The ElderCare website article about geriatric depression is helpful. Well, theoretically helpful. Suggestions of how to talk to depressed elderly people include:
- Listen. Depressed elderly need an opportunity to put their feelings into words, to hear themselves explain the problem and to know that you are hearing them and attempting to understand. [It seems counter intuitive to let Mama “get away with” ridiculousness, but perhaps not. The current strategy isn’t working for sure.]
- Don’t tell your own stories or the stories of people you know. Every elderly person’s depression is different. Your stories won’t help. [I expect this includes not pointing out to her how much worse off she could be.]
- Don’t change the subject when your loved one pauses. Instead, try echoing his/her words.
- Acknowledge the sadness, irritability, or withdrawal. This means that you should respond to the feelings as much as to the words spoken. Don’t observe a feeling and just leave. Distressed feelings need to be addressed when they are identified.
- Do not judge your loved one’s feelings. Avoid saying, “You shouldn’t feel that way.” [Even if it is true, I suppose.]
- Resist giving advice. The solutions that “take” are the ones that the elderly person “owns.” If he/she thought of it, or believes that to be the case, the more likely it is that a change will be made. We all dislike thinking that someone else is running our lives. Ask him/her what might be done to feel better or improve the situation that is problematic. Do discuss alternative solutions to problems and adopt an approach that encourages self-generated solutions. [This is absolutely spot on. Mama will only follow through on what is her idea. Remember a previous blogpost concerning the vitamin crusher she got for Christmas? I was astounded that she was using it. This week she is back to pounding the pestle into the mortar. I don’t know why.]
- Be patient and don’t push. Depression slows many processes and oftentimes the elderly person needs time to formulate a response.
It sounds so easy. It is so not. As one of my sisters says: Mama has judged our feelings, given advice, and told her own stories instead of listening to ours for a lifetime. It can be difficult to overcome behavior that has been modeled by the one you are caring for – one of the many reasons it is harder to care for a parent than for a stranger…so many hot buttons.
But I do not have dementia, I am a glass-half-full person, and I have a degree in counseling for goodness sake. Surely I can do this. Right? What I try to remember is that I am not trying to change her – I can’t change her, she is 96.75 years old. My objective is my own quest for self-actualization; and if I drag her along in spite of herself, so much the better. But oh those buttons.