Anosognosia is the term for this phenomenon and approximately 80% of people with dementia have it to some degree.
It is very hard to convince someone to accept a companion, driver, cleaner, home care aide or relocation if they truly believe there is nothing wrong with them.
This condition can be very destructive to relationship’s as the person with memory loss starts to get angry with family members and loses trust in them and family members get frustrated with their loved one who is being so resistant to help.
Tips for managing this:
- Stay in their good books, don’t become the bad guy who is always telling them that something is wrong and that they can’t do this or that. You want to retain their trust in you so you have more sway over their decisions. To do this, you can make someone else the bad guy. Saying “I know you are able to shower and dress yourself mom. You always dress so nicely. However, your doctor has instructed that you need help in the shower because he is concerned that a slip would result in a broken hip.” Or, “I know you are a good driver dad but your license has not been renewed for some reason and so the insurance company requires you to put your keys away until we can get this sorted out.” Don’t argue with them, don’t disagree with them, don’t correct them. It won’t change things and will just make you the person they don’t trust anymore.
- Use the terms ‘temporary’ and ‘trial’. If they need help in the home, or a care setting. Say it is “short term”. Nothing is set in stone, whether getting help in to the home or moving to a care location, these actions can always be reversed. The idea that something is permanent makes it very hard to agree too. You can use a reason for the short-term change such as, “I know you don’t need home care but the doctor wants to have someone monitor this new medication for two weeks. So the caregiver will be coming daily for that reason until the doctor is satisfied the medication is working as it should.” Or, “your blood pressure was a bit higher on this last appointment so typically that results in close monitoring for a few weeks until things settle down. While the caregiver is here, they can help out with other things because they have to stay for a minimum amount of time.” Or, “I have found a really great place that is willing to make an exception for this situation and allow you to have a temporary stay while I am on holiday, this will allow me to relax and know that you won’t need any help if something fails in the house while I’m gone.” Or, “while dad is having his surgery you can stay at this seniors residence for a couple of weeks so that he can focus on his rehab and recovery.” Hopefully your loved one will start to accept the extra help and then it can be carried on for a longer duration.
- Someone else needs the help. The desire to help others is deeply rooted and can often override the resistance to change. You can try to use the ‘reason’ for getting help as that it is ‘helping’ someone else. For example you could say “my friends daughter is learning to be a cleaner and needs work hours, can she come clean for you once a week?” Ot, “a newcomer from my church doesn’t have anywhere to live and you have a lot of room. Can she live with you for a couple of months and in return she is happy to help you with chores around the house?” Or, “Dad, could you help me out by staying at a seniors residence for a month while I get some trades in to work on some house maintenance. It would be easier on me to be able to schedule a bunch of work at a time but you’d need to be out of the house.” Or, for spouses, you can put the need for help on to the other person. If Dad needs the care but is refusing, you could say “Mom is feeling really tired and run down these days for some reason, she would like to have someone come in and help with her daily tasks so she can work on her health. While she goes to the gym or for a walk her helper is around and can help you with your exercises and get you lunch.”
The idea of fibbing to a loved one can be very challenging to reconcile but if you can find some truthful reasons to justify your requests that is helpful. Also keep in mind that achieving a safe solution at the expense of the full truth may be justified if it preserves the relationship and results in your loved one having the appropriate care.
People with anosognosia have a much higher incidence or injury because they are more likely to engage in dangerous or disinhibited behaviours related to their lack of insight on their limitations and the poor judgement that comes with the dementia presentation. The incidence of caregiver burnout is significantly higher when the person being cared for has anosognosia.
For help with dementia caregiver tips and strategies, feel free to reach out to us at Proactive Seniors, our team is happy to listen to the challenges that you are facing and help problem solve some solutions or ideas to make your role as the caregiver a little easier.
