Since I wrote A New Routine, I’ve been thinking about some of the strategies our family and therapists used in dealing with cognitive issues.
From the beginning:
- Use normal tone of voice, staying calm and reassuring.
- Talk to the person as if they understand everything you’re saying. Never discuss subjects that may be upsetting in front of the person.
- Keep comments and questions short and simple.
- Let them know what you’re going to do before you do it.
- Allow the person extra time to respond.
- It’s okay if responses are inconsistent or don’t occur.
- Have only one person speak at a time.
- Tell the person who you are if you’re not sure they know.
- Remind the person of the day, date, name and location of where they are.
To stimulate memory:
- If they’re in the hospital, bring favorite belongings, pictures of family members and friends.
- Play their favorite music.
- Read familiar books and magazines to them.
- Watch their favorite TV shows or movies.
- Talk to them about family, friends and activities they previously enjoyed.
- Keep a notebook nearby for family and friends to sign so the person can read and remember who visited. If they can’t read, you can use it to remind them of who had been there.
- Write down improvements so they can read it or you can remind them of the changes.
- Don’t assume the person will remember what you tell them. Frequent repetition is often required.
To stimulate senses:
- Gently massage lotion on their arms, hands, legs, feet, face, back and stomach. It also helps prevent skin breakdown.
- Use a variety of soaps and lotions to stimulate smell. Talk about what they smell like.
If the person is agitated:
- Make sure they are getting the rest they need.
- Keep the room calm and quiet.
- Limit the number of visitors to two or three at a time.
- Allow them to move as much as safely possible.
- Moving them to a different location might help.
- Take them for a ride if permitted.
- Don’t force the person into activities.
- Listen to them and follow their lead if safely possible.
- Don’t laugh at, play into or reward inappropriate behavior.
- If reasoning is not successful, try redirection and distraction to stop inappropriate behavior.
If conversation is confused, unusual, insistent or bizarre:
- Tell them where they are and reassure them they are safe.
- Help the person get organized for tasks and activities.
- Provide a rest time.
- Be careful with humor, teasing, or using slang. Sometimes it works and other times it’s misunderstood.
Other useful hints:
- Expect the person to be unaware of their deficits and the need for increased supervision and/or rehabilitation.
- They may insist nothing is wrong with them and that they can resume their usual activities.
- Realize that redirection is not always effective and arguments can be frequent and prolonged.
- Encourage the person to participate in activities. Help with starting and continuing.
- Treat the person with respect while providing guidance and assistance in decision making.
- Talk through problems about the person’s thinking skills, problem solving or memory challenges without criticizing.
- Encourage the person to improve cognitive skills with games and/or therapy.
- Check with the physician regarding any restrictions such as driving, sports or drinking. Let them be the bad guy.
- Encourage the person to use note taking and recorders to help with memory deficits.
- Discuss situations where the person may have had difficulty controlling emotions.
- Talk with the person about yours and their feelings and offer outside support such as counseling and/or support groups.
- Make sure you have the help, support and respite care you need.
What ideas can you add to this list? Please share what has or hasn’t worked for you.