Whatever you accept completely will take you to peace, including the acceptance that you cannot accept, that you are in resistance… E. Tolle (Stillness Speaks)
Apraxia is the loss of ability to initiate purposeful movement. Individuals with apraxia may also have trouble understanding terms such as back, front, up, down. As a result of these losses, it becomes difficult to do things such as tying shoelaces, doing up buttons and zippers, and any activity involving co-ordination. When we lose our abilities to remember the sequences and patterns of movement, it results in the eventual inability to co-ordinate hand and leg movement necessary for specific activities, such as driving. Apraxia definition from http://www.alzheimer.ca/en/on/About-dementia/Dementias/what-is-dementia/Seven-A-s-of-dementia
There is a sequence when we complete a task or chore – a natural order. Unfortunately, persons with a dementia lose the ability to remember and to understand the sequence and order of things – they become unable to discern the steps or sequence of a task.
They also are unable to attend to the task because they lack focus. This lack of focus (and lack of understanding the steps or sequence when doing a task) will upset or anger the person with a dementia. Frustration follows. Often the person will refuse to do the task or interrupt or walk away from the chore while in the middle of it, simply because of their frustration. Frustration sets in because they cannot understand why they cannot do the task or remember how to do it. Often the person with a dementia just wants to “save face,” so they walk away or they begin to exhibit aggression, combativeness, anger, etc. We wrongly assume (especially in the middle and later stages of dementia) that a person with Alzheimer’s doesn’t feel embarrassment when they make mistakes – wrong! They are embarrassed and often will feel shame. They are aware that something is wrong, but they do not recognize what is wrong or how to fix it. Often this is the underlying reason that they become aggressive or angry.
My mother would often rail at us when we tried to help her dress or brush her teeth. She would insist, loudly and persistently, “I can do it myself!” Many times when we took her to the bathroom, she argued that she didn’t need our help, when so many times, she clearly did!
In time we learned to step away and just allow her space. Often she forgot in the middle of attempting to find her day clothes in the dresser, why she was rummaging through the drawers. She would move away from the dresser (and leave the drawer wide open) and begin to do something else. Other times I would put her jacket on the bed and she would just stare at me. She clearly was unsure of what to do with the jacket.
Or, we would take her into the bathroom and step aside – she would turn the faucets on, let the water run, and run, and run. Without either brushing her teeth or washing her face, water still gushing, she would turn her wheelchair away from the sink and announce, “I’m ready.” Brain cell damage prevented her from following through these simple tasks. She would be completely unfocused.
Behaviour management strategies should include space and dignity, but unfortunately most staffs are too busy and short-handed to allow this. Instead, they hurry through their daily tasks and residents become anxious. When we allow the resident with a dementia, time and space (without the sense of urgency), we allow the person to maintain his dignity. When the person with dementia becomes distracted or forgets the task, we simply step in and continue to complete it for them, without any judgment on our part.
When my sister and I cared for our parents, we learned many tricks to ease the day-to-day care. My parents shunned our help and support, especially with the daily tasks such as dressing and bathing. Instead of arguing each day over simple tasks, such as dressing, we tried to simplify things. We learned to arrange clothing items in the order of getting dressed: underwear (first), top or sweater, pants, socks; lastly, shoes or slippers placed next to the bed. Otherwise, you will notice that the person with a dementia will attempt to put on socks over the shoes, or simply not wear socks. Or, you might notice that they will put on slippers to go outside. Or, the shoes are on the wrong feet. Or, not wear a coat or warm clothing for cold weather. We need to understand that someone who has apraxia may recognize the item, but really have no idea what to do with the item. I once gave my mother a Kleenex when she was sneezing, and she took it, stared at it blankly and then threw it up into the air and watched as it fell to the floor. She then continued to stare at it as if she had never seen a Kleenex before. (I remember watching her face with total fascination.)
So how can we help when we recognize our loved one is unsure of completing a task? Calmly (without any judgmental commentary, please) step in and begin to give how-to instructions – one step at a time. Slowly introduce the next step in sequence, but only once the previous step is completed. Keep in mind that persons with dementia can focus better in a calm, quiet space; therefore, distractions, noise, or too much chatter (your running commentary) are not helpful.
“Mom, here is your sweater…put one arm into this sleeve first.”
My mother liked to talk and would often become distracted as soon as a second person came into her room. It didn’t matter if she was drinking her beloved tea, eating a cookie, combing her hair or putting on a warmer sweater. The moment she noticed another person in her room, she reacted. She became curious and completely forgot what she was doing, or she became angry and confused,”Why is that person in my room?”
Before my father died, and while I cared for them both full-time, I once was in a grocery store with my mother, helping her shop. (This was before we realized that she had any dementia.) She did not have a shopping list. (That was a clue, my friends. It takes planning and thought to prepare a grocery list.) When we walked into the store, I explained that we would probably need fruit, vegetables, bread, rolls, and cereal.
Since the fresh produce was in the first aisle that we approached, we began to shop. I asked her what fruit did she want to buy. She didn’t answer. Instead, she perused the fruit bins, picking up item after item. After I realized that we had spent nearly five minutes in the store, and had yet to choose an item, I suggested bananas and peaches. She agreed. We went to the vegetable bins and she just stood there. I suggested a cabbage, some carrots, onions and lettuce. She agreed. This hesitancy continued in each aisle. Finally she announced she would like cereal and that she didn’t need my help, so I left her in the cereal aisle and continued shopping. After ten minutes I realized that she had not met me at the front of the store. I went looking for her and she was still in the cereal aisle – and had yet to make her choice.
Now that I know what I know (when you know better, you do better – Maya Angelou) I know that she wasn’t just fatigued or stressed (and that is why she took so long to make her decisions), but that my mother was showing one of the many early signs of dementia – lack of focus and inability to follow the steps or sequence of a task. She no longer made grocery lists because she couldn’t focus on how to complete them. She couldn’t make a decision, because that was a skill that she had lost.
Not all persons with Alzheimer’s exhibit all the seven A’s of dementia. In fact, without a brain scan, it is difficult to determine which areas of the brain are damaged. Different areas of the brain cause different symptoms of the disease.
For me, I did not care if my mother exhibited any of the A’s of dementia, as it only mattered how I reacted to her behaviours. If I gave my mother her lipstick and she smeared lipstick across her cheek instead of her lips (which she did on multiple occasions), or if I handed her a hairbrush and she used it upside-down, well, I tried not to over-react and correct her actions. (I wanted to! God knows, the first time that she smeared lipstick (bright red!) across her face, I nearly gasped out loud.) Instead, I learned to calmly take the brush out of her hands, re-position it in her hands, and say, “Let’s try combing your hair this way.”
I tell you this story so that caregivers can understand that persons with dementia will exhibit different symptoms, but that these symptoms should not scare us. Because in understanding their behaviours and the reasons behind their actions, we allow the seeds of compassion to take root. Compassion changes everything.
At the end of the day, when caring for someone who has Alzheimer’s or any dementia-related disease, we all need to let go of our need to control, and we need to let go of our expectations.
We all need to show more kindness and compassion and allow our loved ones to just be – allow them dignity and space.
I believe that compassion, dignity and space will transform our own personal energy because our energy will be based on acceptance. Persons with Alzheimer’s or a dementia-related disease will feel our loving energy, in spite of the disease, and they will understand that they matter to us, disease or not.
The disease may diminish their quality of life, but our actions and our reactions to this disease will determine how we (together) spend our remaining days.
Let our journey with our loved one be one of peace and acceptance, not struggle and judgement.
Apraxia definition is taken from http://www.alzheimer.ca/en/on/About-dementia/Dementias/what-is-dementia/Seven-A-s-of-dementia