March 19, 2017

Caring for Elderly Dementia: Understanding the World A Dementia Lives in

Grandma insist on using a chopper to chop mushrooms to prove that she is still useful.
Our domestic foreign worker, Ati, is a widower. Her husband died a few years back and her daughter is relying on her income to working in a foreign land for her education and daily expenses. Ati has a sweet disposition, hard working and is mature enough to understand how dementia has taken hold of Grandma's mind. Even though she has worked with another dementia patient in Taiwan, the initial acclimatization was still a shock to her and often drive her to tears in the first few weeks.

Grandma is able to curse fluently in 4 different languages (Mandarin, Hakka, Hokkien and Cantonese) and can go on for hours once the dementia demon took hold of her.

I have heard of stories from my friends whereby the dementia patient will always have a number one enemy which causes all the ills and confusion in the parallel universe of a dementia patient. In our household, poor Ati bore the brunt of the verbal and physical attacks when Grandma becomes agitated. We often sat down with Ati and work her through Grandma's history and why she behaves this way to help her understand better.


In order to take care of a dementia patient, we often have to step into their dementia world and see from their point of view. In my Grandma's demented world, Ati is seen as:

1) A threat to Grandma's usefulness
Grandma's greatest joy is to cook, clean the house and sew new clothes for the rest of the family. With her incapacitated by both a stroke and dementia, she is no longer able to perform these tasks without putting herself in risk. She already had a couple of hospitalization due to her insistence to perform these tasks as a results of falls. The feel of being useless and Ati replacing her role puts her in the crosshairs

2) Waste of Money
Grandma's brought up two sons after WWII and she is proud of her ability to be frugal. When Ati first came on board, she was angry that we are wasting money and she is well enough to do whatever is Ati can do, Many a times, she will try to convince us that Ati is expensive and a waste of money in order to chase her away. A few months later, she gave up on that idea and turned to more aggressive ways to try to get rid of her

3) Thief
A dementia patient will often forget where she places her valuables. Dementia patientw may also think that they still have old possessions which no longer exist today, and start looking for them. When they are unable to find the missing objects, and believing that their mind and memory is still sound, the only explanation is that someone stole her valuable possessions. Being the only outside in the family, Grandma often accuse Ati of stealing her bra, underwear, dentures, soap box, money, earrings, pillow and many other things which does not make any sense. Showing her the missing objects will not convince her that the items were not stolen. Rather, she will choose to believe that Ati took it out of hiding after she exposed her. The solution to this is to try to distract her, or if she is in an ugly mood, let her rant and hopes that she forgets about this the next day.
 
4) Husband Stealer
As Grandma desperate attempts to convince us that Ati is a thief did not convince us to chase her away, she came to one conclusion: That she is sleeping with me and my Dad, which made us took her side rather than hers. No amount of convincing and arguing can convince her of otherwise. We also have no idea how to resolve this situation and the doctor advise us to continue to assure her, even if its not working.

5) Torturer
"She is starving me to death!"
"She is trying to boil me alive by turning the heater to the maximum!"
"She is trying to freeze me to death by turning off the heater!"
"She is giving me smelly clothes to wear!"
"She is trying to kill me by locking me up in the bathroom!"

All these allegations are often as an indirect results of Grandma's actions, such as forgetting how the heater works or forgetting how to open the lock after locking herself up in the toilet. In her demented world, her mind thinks that she never had such a problem before and all these occurrences only started when Ati came aboard after her hospital stay. Grandma thinks Ati is trying to kill her and usurp her place as the head of the house hold.

Do we have solutions to many of the misunderstanding and parallel universe thinking of a dementia patient? Frankly speaking, we don't have any perfect solutions and we try to cope with a combination of coaxing, walking off and letting her rant and sometimes, force to prevent her from hurting herself and others. However, the first step is which any caregivers need to do, is to forgive the dementia patient as we have to understand that it is the illness that made her this way, or not herself. The only way to forgive them is to stand from the angle of a dementia patient and try to empathize as much as we can, and laugh about the various curses and insults which are thrown at us. Also, it is important to help each other out as care-givers, whether we are employers or foreign domestic worker.

It is an illness that we not only have to care for the patient, but also for the care-giver.  

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