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Decision Making & Dementia: Supporting Your Loved One To Make Independent Choices

By Kathryn Cherkas, MIPH
Program Manager, Friendship Center Montecito

In caring for someone with cognitive impairment, it’s hard not to go into “control” mode and do everything for them. It could be because we are not used to watching our spouse, parent, or other loved one make less-than-perfect decisions and we want them to have what we think is best. Or it could be because our patience is running low while waiting for them to make up their mind. Whatever the reason, it is important that you learn how to help your loved one make their own decisions again.

These steps can help!

Get down to eye-level. Do not hover over them, do not look up from below. This is particularly important for people with Alzheimer’s, as their peripheral vision is often significantly reduced, allowing them to see only what is directly in front of them. (Snow, n.d).

Say their name. Address them by name and repeat it throughout the conversation (unless this becomes annoying to them, of course). Hearing their name helps your loved one know they have your attention, and continuing to hear it can help maintain their attention.

Touch to stay on track. Gentle, mindful touch—a hand on the arm or shoulder—has been shown to decrease agitation behaviors in people with dementia and can actually help calm them and focus their attention.

Say it again. If you need to repeat a question, use the same wording the second time. If that doesn’t work, wait a moment and try it with different wording. For example: “Would you like water, or milk?”…ask again, then wait a bit, and ask, “Do you like to drink milk or water more?”

Stick to multiple choice. Avoid open-ended option questions such as, “What do you like to drink?”

Keep it simple. Reduce options to two, unless your loved one seems overwhelmed by even two options. In that case, just ask Yes/No questions, such as “Do you want something to drink?”  If yes, then, “Do you want some water to drink?”

Confirm and repeat. Thank your loved one for their answer and repeat the answer back to them, confirming to them that you heard and understand what they want. Respond with consistent reassurance and affection.

It is okay to laugh! Our members often ask for water with their lunch but when I serve it I might say, “Here is your gin and tonic, sir.” We are all in this together, and keeping it light can help everyone retain their good nature.

Don’t Forget to Breathe! Remember—it is okay if you lose your patience. Caregiving is hard and can be frustrating at times. In these tougher moments, take a breath and give yourself space. Backwards t-shirts and mismatched socks might be your loved one’s new normal and the sooner you can embrace that, the easier life will be!

Snow, T. (n.d) The Art of Caregiving. [Video] Florida: Pines Education Institute of Southwest Florida.

Woods, DL et al (2005) US National Library of Medicine: The effect of therapeutic touch on behavioral symptoms of persons with dementia.

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