Monday, February 20, 2017

MCI and Confusing Communication



Caregivers of aging family members have many challenges. There are medical, social, psychological, financial and daily living challenges to name a few which all involve an expanded awareness of the elements of time. Physical limitations and  neuro-degenerative changes can directly impact communication. And this communication can be simple such as expressing immediate needs: “I’m hungry, I’m tired, I’m agitated, I’m lonely, I’m frightened, I’m bored, I’m confused, I want my mother, I want to go home!” These simple needs can many times be challenging to translate because they are not always direct and can be non-verbal. Other challenges include undiagnosed cognitive conditions which can cause massive breaches in communications and in personal and working relationships.

 There is a desire by most care-givers to fill whatever need is being expressed by their loved one. This is a universal drive for most caregivers along with empathy and compassion that a caregiver carries in their heart and hands when they are blessed by God to help another human being. However, there is also a feeling of helplessness at times that goes with the territory along with utter panic in not knowing exactly what is needed because those simple sentences listed above which directly communicate what is needed and when the help is needed are not always conveyed at the right time and place to fill the need.  This can lead to frustration, depression and feelings of hopelessness because the caregiver wants to help, but does not know how to respond. This is a huge problem that elder caregivers face every day! Many times, where short term memory is diminished or is lost, and/ or mild cognitive impairment, (which according to the Alzheimer’s Association 15-20 percent of people 65 years old and older may have), is just beginning to show itself . 

Three things can possibly happen in situations where communication gets garbled due to lack of memory or delusional thinking and these three things are important considerations for caregivers and family members to wear in their hats.  1) Nothing is expressed with regards to immediate needs. 2)  The request for the need will be uttered at exactly the wrong time or forgotten altogether by the person requesting it in the first place, and the care-giver ends up relying on intuition and common sense to give rise to assistive action. 3)The elder loved one refuses help, acts out with anger demonizing the caregiver criminalizing them with ill intent and labeling anyone who attempts to help him/her as an enemy. 

Here are some examples:
  Lori’s mother came to breakfast with a huge toothless smile on her face. She walked slower than usual, but Lori had a cold (no sense of smell), and wasn’t feeling well. “How did you sleep, Mom? Do you need to be changed? “Lori’s mother told Lori she was fine, didn’t need to change her Depends and was just hungry so Lori made her some breakfast and the two women sat together for an hour.  When Lori’s husband entered the room, he was in shock. He didn’t have a cold and could smell a very powerful odor. Lori then from her husband’s cue noticed that her mother had been wearing a soiled diaper for over an hour and immediately changed and bathed her. Even though Lori followed through like she did every morning to fill her mother’s needs, Lori’s mother communicated to Lori that she had a dry diaper when she didn’t have a dry diaper. Her mother had forgotten that she soiled her diaper and in her mind, she didn’t want or need any assistance.  This example shows number 1 and 2 above.

Here is another example:
  John at 80 was unknowingly experiencing mild cognitive impairment, (MCI.)  He had some physical symptoms which he considered minor. He prided himself on being self-sufficient, independent and mentally competent.  But his close family members noticed delusional behavior and repeated episodes of anger which he never had before.  John had a cleaning lady who came to his house every Thursday.  One day after she cleaned the house, John couldn’t find his checkbook and was convinced his cleaning lady was a thief.  He told all his family members terrible stories about this woman and they unknowingly believed him and told John to fire her.  Then, on Saturday John’s eldest son found his father’s checkbook behind the kitchen table. It appeared to have fallen off the table and landed behind the radiator where it almost melted the cover before being found.  After John’s son resolved the issue, John continued telling false stories about his cleaning lady convinced she could not be trusted and was out to get his money. They finally had to replace this lady with a new cleaning lady. 

  Both examples above can lead to confusion for the caregiver. One caregiver had to depend on her senses to fill the need, but when her senses were diminished, she had to rely on a 3rd party to give her cues about the facts that were happening so that she could be of assistance to her loved one who was no longer able to verbalize her needs herself.  The second example of delusional behavior is not as easy to spot because many times the individual has not been evaluated for MCI. This can lead to many problems for a caregiver. Many caregiver’s or family members helping loved ones with undiagnosed M.C.I. will be accused to all sorts of things that are not happening.  However, since the person with M.C.I. will act normal in most situations, the family members will believe the delusions which are not based on reality and will put the blame on the caregiver, or the cleaning lady, the doctor, the dentist, the spouse, or even the person delivering the mail!
For more information on M.C.I. go to: http://www.alz.org/dementia/mild-cognitive-impairment-mci.asp

Positive Communication methods for people living with dementia:  We recommend seminars by Teepa Snow,M.S., OTR/L.FAOTA www.teepasnow.com, Naomi Feil, MSW, www.vfvalidation.org, and her books, all of them. And the life changing, ground breaking books, "Contented Dementia," by Dr. Oliver James, "The Mindful Caregiver," by Nancy L. Kriseman, and "Deeper Into The Soul," by Nader Robert Shabahangi, Ph.D, and Bogna Szymkiewicz, Ph.D

Copyright 2015 Caregivers Get Fit! Mama  Nicey

 DISCLAIMER:  The information in this blog is information only for educational purposes. It is not meant to be a replacement for getting medical advice from your own health professional regarding your own individual health challenge or condition. It is advised that before starting an exercise program, or making dietary changes of any kind, to seek out the advise of your own individual health care provider first.  Dr. Denise will not diagnose, treat, or give direct personal consultations/advice to you on this blog for any medical condition, but will give general examples, and scientific research on many different health topics.  How you decide to use the information is between you and your own medical/ health professional.




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