Friday 13 July 2018

St Wendy of Dementia

I've now finished Wendy Mitchell and Anna Wharton's book about the walking demented Somebody I Used to Know. I wrote an interim report ten days ago.  There are 55,000 people living with dementia in Ireland; that's about 14/1000 of the adult population. If you don't know someone with dementia, then you're deliberately looking the other way. As a public service, and as an aide-memoire for me lest I forget, I here-and-now capture some ideas, mostly culled from Mitchell's book, but also from her youtube presence, which will make living with dementia easier for everyone.
♫You might, waggishly, choose to have Iris Dement singing along in the background♫
  • Finding the lights. Shortly after we bought, serviced and moved into our farrrm, my parents came to stay for a few days. In the middle of their visit, we had to go overnight to a funeral and took the girls with us. My Dad volunteered to feed Flossy the orphan lamb and the chickens if we made up sufficient Lamlac formula for the 24 hours and showed him where the layer's pellets were kept. When we came back, he reported that the kitchen lights didn't work. Or rather, he confessed that he hadn't been able to find the light-switch, in any of the obvious places where a light-switch should be. Certainly not at knee-level [see R]where we had been constrained to put it by the door-side window and the solid stone wall. [I've polished up this tale before] Wendy also had trouble finding the lights in the new place - muscle-memory and habituation had taken care of that in her old home. Indeed light-switches are, by default, white in colour so they don't intrude on the decor.  Her solution was to paint a coloured border round each switch to remind her that lights existed.
  • Returning home. A couple of years after he retired my old and undemented Head of Department drove into town for a bit of light shopping. Returning home, he opened the front door, and was disconcerted to find that the hall table was missing and somebody had changed the carpets . . . until he twigged that he'd driven to his home of 30 years from which he and his wife had down-sized on his retirement. Wendy also, I suggest foolishly, thought she'd move to a new house in the country when she retired due to her dementia. A couple of times she tried to open the front door of her neighbour's gaff when she returned on auto-pilot from a day in town. Her solution was to bracket her door with a couple of distinctive tiles featuring forget-me-nots Myosotis spp. 
  • Finding the clothes. Wendy's younger daughter came to visit twice in a week shortly after the move and noted that her Mum was wearing the same clobber both times. She didn't smell or anything, she just looked atypically ward-robe challenged. And that was the problem: Wendy had 'lost' her new fitted ward-robes designed to be neutral w.r.t. the decor and so invisible. She solved that, and the related problem about the contents of her kitchen cupboards, by taking photos of the interior and printing them A4-size on the outside of each door.
  • Finding the jacks. For the demented, the doors are all closed; if they are seen at all, it is likely to promote anxiety about what is on The Other Side. Wendy could have put a show-it-inside photograph on the outside of the downstairs toilet. But that would be a bit in-your-face for visitors; so she made a big T sign and put that on the door instead. She removed both doors in her kitchen to ease her mind and minimise anxiety-inducing decision making: "Which door?" and "Is that a door?" and "Are there dragons beyond that door?" were all nulled with a few turns of her screw-driver.
As I say above, the standard advice is to move to your final destination before you lose your marbles. A lot of these tricks would be unnecessary if longer familiarity had embedded the location of switches, cupboards and rooms. Here's a bit more cogent advice on interpersonal relationships between the demented and their carers.
  • Don't argue with your demented. You don't have to be right; and disagreement is more like to promote anxiety, distress and difficult behaviour. Trying to establish your own innocence is going to wrong-foot your demented and crank up the anger and anxiety.
  • There is no future in catching your demented in a lie. It is their truth.
  • Don't bother using your powers of logic and reason with your demented. They are demented! You might just as well speak to them in Latin.
It's not easy dealing with the demented but you can make it a whole lot harder on yourself if you play your cards wrong. otoh OTOH if you are totally hands-off with engagement and challenge as these diktats seem to recommend, then you may precipitate the persistent vacant state/stare that is the cliché of dementia. Keeping fit is an important predictor of better life quality; keeping fit is exhausting; someone needs to be the trainer here and probably take some flak. A cross Mammy is better than one with weeping bed-sores.

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