The Ten Absolutes

Absolute Four: Never Lecture, Instead Reassure!

Stephanie, a family caregiver I had been working closely with, called me frantically one evening. She relayed the conversation she had earlier with her dad. “He promised me he would wait right here while I parked the car! It was only a few minutes, and now we can’t find him anywhere! Please, Jo, come right away and help us find him!” She had been looking for him for 15 minutes and she had no idea where he could have gone in such a short time. Luckily, I was only ten minutes away and by the time I got there, security was walking up with her dad in tow.

Just as I reached them, she hugged her dad with relief - and began her by-then-hysterical tirade. “Dad, how could you have left when you promised to stay until I parked the car! We have been looking all over for you. I called Jo and even the police to come and help! Dad, you promised not to go anywhere! You have got to stop doing these things! I just can’t keep running after you every minute. This is just driving me totally out of my mind!” His response to these accusations was, “Well young lady, you had better stop yelling at me or you’ll get one of these!” as he raised his fist. “What are you talking about anyway? I wasn’t lost. Of course I waited for you. After all, I’m right here!”

 Absolute #4 says, Never Lecture, Instead Reassure. Of course, the normal reaction to worry, as in this situation, consistently results in caregivers exploding at their loved one with Alzheimer’s - and not without good reason. We would respond this way to a teenager who has run away from home, after all! However, as much as we would like them to, our loved ones with Alzheimer’s do not have selective memory; they truly do not remember that they made a promise. Therefore they cannot keep promises - though it may appear that they can, because they might agree to them and perhaps even repeat them back to us when we are trying to extract such promises.

The most important point for you to remember is that even if you are worried or frantic, you must learn to not get in your loved one’s face. First of all, this can lead them to strike - remember they are reacting based on their emotions, not the complicated and socially constructed etiquette that would tell them it would be wrong to strike you. Secondly, what they really need is reassurance (as do we) if there is a serious concern or sense of discord.

One must learn to let go of the broken promise or fear for our loved ones’ safety, and to focus on being glad they are safe. Keep accusations and frustrations out of your response in these types of situations. While this is clearly difficult to do, we all know the best way to get better at a difficult task. You guessed it: just like anything else, this is going to take practice! Your job as caregiver is going to give you more than ample opportunity to practice, so you’re going to get really good! All jokes aside, it is imperative that one learn early on not to lecture, as it may create an unmanageable response. This way, we can prevent the aggressive and combative stage of the disease process. Remember that when Alzheimer’s strikes, it strikes not only the memory, but also the frontal lobe of the brain, where we “store our manners.” You must act in a way that dissipates fright, embarrassment, and other negative feelings, not in a way that escalates them. You can and will become better at this, and it’s the best way to stay out of the danger zone.