Aging Well

Being Mindful of the Feelings Beneath Behaviors

Challenging behaviors often come with cognitive decline. Finding the most effective response can be an evolving art. Movies, documentaries and podcasts can help loved ones better understand what's going on.

Posted Updated
Dick Johnson is Dead
By
Liisa Ogburn

“I’m not letting a stranger in,” a client with cognitive impairment recently insisted after an emotional afternoon.

I had been brought in by family who lived far away because her physician had informed the DMV that she was unsafe to drive. Though the physician spoke with her compassionately about this, she had forgotten. My task was to remind her, to get her car keys and to introduce her to the kind woman we had found who would visit her daily and drive her wherever she wanted.

“You can’t take my keys,” she stated vehemently.

I expected this response. (I, myself, may have the same response one day.) Taking away driving privileges and bringing in help are among the most difficult moments along the dementia journey. This tension was aptly portrayed in the recently-released movie, The Father, in which Anthony Hopkins plays an 80-year-old obstreperous father who refuses all attempts his daughter, played by Olivia Colman, to bring in help so he can continue to live at home safely.
Temperament, personality, family and power dynamics certainly influence how families navigate the delicate territory of dementia and changing family roles. While it is not always rife with conflict, as we see in another recent movie (a documentary), Dick Johnson is Dead, which shares how a filmmaker and her psychologist-father navigate similar territory differently, conflict is more often part of the journey than not.

Whatever each family's situation, are there things to keep in mind when handling delicate and emotionally-charged situations?

  1. Enlist the help of the primary care physician
To assess the situation, check whether any tests or referrals might be needed, speak compassionately and directly with their patient about what's going on, and review medications and see if any changes are warranted. If the patient may forget the visit, see if the physician might write their recommendations down on letterhead so that loved ones can use this to gently remind the family member of the visit later.
  • Learn ways to calm your loved one down
  • Whether it be by putting on a particular song, assigning them a familiar task (like sorting mail or folding laundry), sitting them down for a sweet treat, or taking them on a drive, being flexible and ready to switch gears when needed is necessary.
  • Watch films and documentaries or listen to podcasts which can help you better understand what your loved one is experiencing.
  • I mention three excellent new ones in this post.
  • Try to discern and respond to the emotion that might be behind the behavior.
  • Fear, feeling overwhelmed, or frustration over not being able to communicate, are frequently at the root of anger and emotional outbursts.

    In the case of the client who refused to give up driving, we read the note from her doctor together mentioning it was not safe for her to drive and he did not want her to get in an accident.

    I said, "It must be hard to lose your independence."

    She nodded.

    I assured her that her new aide Betty was there to take her wherever she wanted to go whenever she wanted to go. The following week, she called to tell me she was so glad to have regular company in the form of her new "friend" and didn't even mention the car.

    In another instant, when I met an elder orphan (someone without family) with cognitive impairment in the hospital, they were in the middle of an angry outburst. When I calmly asked what was going on for them, they said, "I'm scared. I don't know where I am or why I'm here."

    Dr. Emma Seppula, a psychologist and faculty member at Yale and Stanford, said when emotions are high, we can’t self regulate.

    I would add that dementia will often amplify the situation.

    If your regular ways of helping your loved one settle and recover from a heightened agitated state are not working, see if addressing the underlying need might. Family caregivers have said it can help to remember what their loved one is experiencing. Another good source that provides insight into the mind of someone with Alzheimers is the wisely-produced podcast, The Forgetting, which features vulnerable conversations between David Shenk author of, "The Forgetting: Alzheimer's, Portrait of an Epidemic;" and Greg O'Brien, author of, "On Pluto: Inside the Mind of Alzheimer's." O'Brien was diagnosed with early-onset Alzheimer's disease in 2009, at age 59. The podcast highlights the friendship Shenk and O'Brien share, while also documenting O'Brien's experience with the disease as its symptoms become more pronounced.

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