Responding to Repetitive Questions from Alzheimer's Patients
Throughout the stages of Alzheimer’s and other forms of dementia, caregivers are bombarded with repetitive questions from the patients. The questions have to do with the time of day, past events, future events, people who have died, stories they have told and have been told. The questions may be simple, but consider the quote below.
“Having to answer the same question over and over and over saps morale like few other aspects of the illness.” -- DementiaGuide
Based on studies done on the topic, DementiaGuide also mentions some important facts that caregivers should know:
- Repetitive questions from patients are not always to seek information, but more often to seek reassurance.
- Repetitive questions result not only from problems with memory, but also from problems with planning (example upcoming doctor’s visit or taking a trip).
- People with dementia become upset when they are told about repeating themselves; and the repetition increases when they become upset.
With this knowledge, consider the following options as we discuss appropriate responses to repetitive questions. The Alzheimer’s TalkTactics is good to remember whether responding to or initiating the questions.
The Alzheimer's Talk Tactics
(1) Speak Simple Statements
For a start, the caregiver helps the situation by responding with calm voice, pleasant facial expressions and positive body language. These dispositions may not lessen the questions, but they help to keep the mood manageable.
Speak a simple, clear answer. If the patient asks "Do you see my cane?" A simple answer is "It is leaning on your chair." There is no need to preface your statement with a reminder of how many times the patient has asked, or add instructions about putting it in the same place every time. Alzheimer's patients cannot handle information overload.
(2) Respond to the Emotion
The caregiver who connects closely with the patient soon learns to read between the lines. For example:
- Repeating the question, “Is my brother outside?” may mean that there is a longing to see the brother. Some comfort may be derived from an answer like, “Your brother misses you too; he is planning to come.”
- “Where are my clothes?” may suggest fear that the patient’s personal belongings are being stolen. A good response is that the clothes are in a safe place where no one can steal them.
(3) Change the Subject
Another way to deal with repetitive questions is to distract the patient by changing the topic or introducing an activity. For example, when the patient asks for the brother, talk about something the patient likes that the brother brought on a previous visit. If the patient keeps asking for a brother who never comes, find a pleasant way to introduce one of the patient's favorite topics.
(4) Avoid Visual Triggers
Sometimes the presence of an object in the room may trigger a question. In my mother’s case, it was her bag that she kept packed for years in case of a medical emergency.
Day after day, she asked, “Could you let me see what is in that bag?” At first, I complied, but after it got tiring for me to take it down from the top of the cupboard, stand and watch her unfold and then fold everything again, I moved the bag out of her view. Out of sight, out of mind.
(5) Avoid Correcting the Patient
If the patient keeps asking for baked chicken, there is no need to convince her how often she eats it. The question may be her cue to you that she is hungry, and she asks for it because it is her favorite food. The facts do not really matter if the caregiver will respond to the need underlying the question.
(6) Avoid Using Negatives
Negative words do not always get noticed, not even in sound minds. It takes extra effort for the subconscious to process them.
- Question: " When are we going to have breakfast?"
- Answer: "We never have breakfast before we shower." (The listener may hear, "We have breakfast before we shower.")
- Next question: "We have breakfast before we shower?"
The confusion could be avoided with a simple, positive answer to the first question. "We will have breakfast after we shower."
(7) Post Signs and Pictures
Every day my mother asks "Where is the bathroom?" With a bathroom sign on the door, sometimes I may get the opportunity to point to it before she even asks.
In the early stages of the disease, while the patient can still read and follow some directions, words as well as signs can be used effectively. The Alzheimer's Association also recommends a schedule (not too many details) which the patient can follow.
Both the caregiver and the patient benefit. Sometimes, the caregiver may want to carry on an activity instead of stopping to give a verbal answer; for the patient, it is a mental exercise to interpret the word or sign.
Common Response vs Recommend Response
(8) Repeat the Answer
Sometimes, the challenge is to practice patience and repeat the answer to the repetitive question. Carefully observing the patient may help the caregiver perceive that it is not always the same reason that motivates the question every time.
For example, it is possible for anxiety, boredom or curiosity to produce the same question, "When are we going to the party?". Repeating the answer with a different slant may satisfy different needs.
- "We are going to the party at six o'clock and I will be with you the whole time."
- "We are going to the party at six o'clock and they will play games that you like."
(9) Excuse Yourself
No matter how kind the caregiver is, workplace stress can takes its toll. When the questions become overwhelming, it is better to excuse one's self from the room, than answer with disgust. “Excuse me, please,” gives the caregiver permission to avoid further irritation of repetitive questions. After a brief break to exhale, the questions may have subsided; if not there may be renewed energy to cope.
Alzheimer's Association®: Training and Education Center, (Copyright 2016)
DementiaGuide Symptom Library: Repetitive Questions/Stories (Updated 02/23/2016)
(10) Respond to the Five Senses
People communicate through the five senses. When the Alzheimer's patient loses the memory, the senses are still pathways to the satisfaction of his physical, emotional and social needs.
Repetitive questions about the time to go home, and about siblings and deceased loved ones may indicate a longing for a familiar environment. Such longings may be satisfied with the sight and fragrance of familiar flowers; the taste and scent of a familiar food; the sound of familiar music; or the touch of arms around the shoulders, brushing of hair, or a long hug.
Through the caregiver's efforts to make the patient happy, many questions--some not even asked--may be answered with satisfaction.
© 2016 Dora Isaac Weithers
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