By Amy Neu, MSW, LCSW

“I think he just wants to disagree with me, no matter the subject.  The only safe thing to talk about is the weather…but wait – he argues about that too!  We end up going at it, and then I feel guilty.  He’s able to forget the argument, but I’m left stuck with it in my mind.  It’s the same thing over and over.  I know he can’t help it, but I am just getting so angry all the time.”

– Frustrated spousal caregiver

I hear this issue from many family caregivers – spouses, adult children, siblings – who care for their loved ones with dementia.  They often feel like they no longer can carry a “normal” conversation along with their loved ones.  Heightened emotions arise seemingly out of nowhere; a once simple question about what a person wants for breakfast can escalate into a heated spat about burnt toast from 30 years ago.  Attempts to reminisce about a first date can turn sour when an argument ensues about the color of the dress the wife wore during their first meal.

The daily grind of dealing with the communication issues (in addition to of course the physical, mental and emotional stressors) for weeks, months, and years for families of loved ones with dementia is grueling.  Below are several tips for guiding your conversations with your loved ones:

Plan ahead whenever possible.  Try not to start an important conversation if you do not have the time or patience to carry it out.  Minimize distractions – for example, go to a private space; turn down the volume on the television.

Take a break if you feel yourself becoming angry, agitated, or argumentative.  When you are frustrated, your loved one will feed off your heightened emotions, and their behaviors will escalate too.  An easy way to get a break is to say, “Let’s hold on for a minute.  I need to use the restroom.”  Go into the restroom, take a few deep breaths, and give yourself time to regroup.

Sidestep arguments about facts.   For example, I worked with a client who lived with her mother with dementia who would worry constantly about storms coming.  The family would try to ease her fears and reassure her that in fact no storms were in the area.  They would show her the forecast online and watch weather reports on TV to convince her that she was safe.  This seemed to agitate her mother even more.  After talking through this issue with me in session, the next day when her mother said, “There’s a storm coming!  We need to be downstairs!” my client calmly said, “Okay, we’ll keep an eye on the weather today.  Thanks, Mom.  I’ll let you know if I see any clouds or raindrops and then we can go downstairs if we think that’s best.”  Her mom relaxed and they were then able to move onto other things that morning.  While her mother would continue to bring up storms, now my client felt that she could handle the issue.  This made both my client and her mother feel less anxious and more capable in the situation overall.

Use “Yes, And…”   Don’t correct – redirect!  Nobody likes to be told when they are wrong, forgetful, or have inaccurate information.  For our loved ones with dementia, when we point out that their words, memories, or logic is faulty, it has a profound effect on them.  They often will either lash out and escalate an argument or withdraw and become embarrassed and quiet.  Either way, their brain is not receptive to new information in this state, and interactions become increasingly difficult.  I tell my clients to remember the cardinal rule of improvisation: Don’t Deny. Take out words like “No” and “But” and replace them with “Yes” and “And…”  This same principal holds true for us and our loved ones with dementia.  For example, I worked with a family where the father with dementia told his son, “I have a doctor’s appointment on Tuesday.”  The son responded, “No dad, your appointment is Thursday,” and they started bickering back and forth.  The son showed his dad his appointment written on the calendar for Thursday, and the dad insisted someone wrote it in on the wrong day.  Take this same situation and apply the improv rule:  The father says, “I have a doctor’s appointment on Tuesday.”  The son responds, “Yes, you do see the doctor this week, and we’ll be sure you get there.”  The conversation ends, and they move onto other things.

Be compassionate with yourself and seek professional guidance when needed.  Make an appointment for yourself with an experienced professional such as a clinical social worker, counselor, or geriatric care manager.  They will be able to give you information on communication strategies, supports, and resources, and will help you care for your own needs as a caregiver.  Regularly use your personal and professional resources for respite care.  Even a few hours to yourself or out with friends can make a big difference for your own well-being.

Many of these strategies aim to reduce fear and anxiety for your loved one and increase their sense of security and well-being.  As family caregivers work toward achieving these goals, as a result, they often report their own sense of security and well-being increases because of these more productive, less confrontational interactions.

Amy Neu, MSW, LCSW

received her Masters in Social Work from the Brown School of Social Work at Washington University. Amy provides private therapy for adults, families, and seniors who are facing a variety of issues including depression, anxiety, grief, coping with medical issues, and end of life.
She has significant experience counseling seniors, caregivers, and families within medical systems and during transitional periods from home to alternate levels of care.

In addition to Amy’s clinical practice, she provides on-site counseling and education to staff throughout the continuum of senior living communities.

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