After 25 years in dementia care, Laura Herman has facilitated stunning changes in the behavior and functioning of thousands of people with dementia. Now, though her ABC Dementia Course & Community, she shows others how to do so too.
Laura has kindly agreed to share one of her tales of transformation here.
Can Dementia Get Better?
by Laura Herman
Years ago, I was a caregiver in a memory care community. We had a resident named Margaret. She came to us when her husband could no longer meet her needs at home.
She’d had severe mood swings since developing dementia. She could be so sweet and appreciative sometimes. Other times she was… not.
Her confusion and disorientation would worsen.
She’d start to ask about her mother, and would then look for her, pacing anxiously.
She’d grow more tense and crabby.
Her face would flush.
She began to disagree angrily with anything she heard, and soon started to lash out with cutting comments and impossible demands – “You’re such an idiot! Shut up!… Leave me alone! Get me out of here!”
Poor Margaret. And her poor husband!
His heart ached with helplessness. And honestly, he was really embarrassed by her behavior.
We tried to reassure him. We knew this behavior wasn’t her. We didn’t take it personally. We didn’t want him to either.
The doctor, too, tried to help him feel better. Nothing could be done, he told him. It’s just what happens in dementia.
So Margaret’s husband did his best to accept the changes. And over time, we saw less and less of her sweet side. We all assumed that it was her dementia that was getting worse.
One afternoon, Margaret was looking for Mother. Red-faced, angry, pacing, she wasn’t watching where she was going and she fell, hard, landing on her knee. She didn’t break it, but it was badly swollen, black and blue.
Honestly, it hurt even to look at.
The doctor prescribed medication for complaints of pain… But Margaret never complained of pain. Ever.
And when we asked if she was hurting she’d answer in a tense, crabby voice, “No!”
…But we could see her limping. Grimacing. Wincing when she tried to bear weight. We knew she had to be hurting with a knee that looked like that.
So we talked again with the doctor and got permission to give Margaret medication for “signs of pain”, instead of “requests for pain medication.”
We stopped asking if she was hurting. Instead, when we saw her limping, grimacing, or wincing we’d just give her some pain medicine.
It made a HUGE difference. She was sweet and happy again! Not sedated, sleepy, or high. She was more alert and functional than ever!
We were astounded at the transformation when her pain was controlled. And her husband was ecstatic to see the warm, loving side of his wife again, and hear her tell him kind words.
We learned to recognize Margaret’s specific signs of pain –
Increased confusion
Looking for Mother
Anxiety
Tense, crabby voice
Hurtful comments
Once we did, we could identify and treat her pain earlier and earlier. Her quality of life improved a million-fold.
We learned that Margaret had been telling us for a long time that something was wrong. But we kept missing her message.
So she was stuck in a painful body without a way to tell us so. But now, without the pain adding excess disability, Margaret could feel and function better. She was finally able to return to her true baseline – something no one had seen in a long time.
She still had dementia. She still had forgetfulness, confusion, and other symptoms.
But the extreme disorientation, crankiness, and hurtful statements were gone.
Those were NOT “just the dementia”.
Those were the only way Margaret had to tell us something was wrong. Once we deciphered the message in her behavior we could finally meet her need for comfort.
I’ve learned a lot about how people with dementia communicate. When we can’t communicate using words, behavior speaks.
I’ve seen transformations like this countless times because I’ve learned how to translate the message hidden in behavior to uncover what a person needs to return to their true baseline.
And even though it’s not technically the dementia that’s getting better… it sure looks and feels like it is.
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