The Ten Absolutes

Absolute Three: Never Shame, Instead Distract!

Sarah and Anna were two little ladies that lived in one of the Alzheimer’s facilities I ran. They were both beautiful and well-groomed, and had been very regal ladies in their families and communities. And in the Alzheimer’s unit, they managed to uphold this image quite well - except when they saw each other. It was as if they were magnets - and they always believed that the other had stolen their purse! They both carried purses, but somehow when they passed by one another, a battle would always occur whenever they met.

One day, I saw Sarah and Anna getting dangerously close to one another. As the two ladies approached, I ran over and quickly placed my arm around Sarah’s shoulder. “Sarah!” I said, “come with me, I have M & M’s!” She was delighted to see me, forgot all about Anna, and came with me. As we were walking away, I heard one lady sitting on a couch nearby say to the other, “Get the big one!” (That was apparently me.) “That old lady was about to clobber the other one and now the big one is giving her candy!” Don’t forget that this was an all-dementia facility, so the lady on the couch had a dementia diagnosis as well.

I tell this story often, as it is an excellent example of why one naturally resists the third Absolute. I have so often heard people say, “If I let my loved one get by with their bad habits, they will just do it again!” It won’t take long to learn that there are behaviors that the person with Alzheimer’s will just do again and again, no matter what. Cause and effect are not good indicators with a progressive disease, and are totally ineffective in altering behaviors when one is, by disease process, incapable of relating one thing to the next. What the caregiver does have some control over is the outcome of these situations - but it is by changing the caregiver’s behavior that the outcome can be changed, not by changing the behavior of the person with dementia.

Absolute #3 says, Never Shame - Always Distract. Obviously, distract is yet another term for divert, which we learned about in Absolute #2. The real difference is that when someone feels shamed, embarrassed, or gets their feelings hurt, it’s a lot more difficult to change the outcome of a situation. These emotions make the Alzheimer’s patient feel out of control, and when that happens there can be serious consequences as behaviors escalate and the situation can easily get out of hand. The goal here is to prevent that escalation, and the phrase you need to remember is bribery works!

My example with Sarah and Anna is classic. I didn’t want Sarah and Anna to reach one another as I knew from their past altercations that there would be dire consequences. In this case (and many others), the best way to avoid those consequences was to use bribery as I knew Sarah loved M&M’s (who doesn’t?) which I actually did have in my office. This process is seems to go against certain principles we teach in society, particularly in relation to behavior. Especially for those of us who have been parents, we think that if a child is about to disobey, we can’t reinforce that behavior by rewarding them! This principle is so ingrained, and was being so blatantly being ignored, that even someone afflicted with dementia observed it and commented! The point is that when we are looking only at the behavior it seems wrong to use this technique. However, if we step back and view the disease as it is, then we can accept this as a tool that prevents problems for someone who is unable to control their feelings and actions because of the damage the disease has done to their brain.