by Rich O’Boyle, Publisher
More About Rich…How many times has your mother refused to change her clothes? Has your father
resisted getting out of bed? Has your wife pushed you away when you tried to brush her
teeth? Many times a caregiver will be particularly frustrated by her loved one’s
refusal to help himself. At times she can’t help but think that the person she cares
for "36 hours a day" is going out of his way to make her miserable! The
increasing irrationality of individuals with dementia makes it even harder on the
caregiver.
Individuals who resist care and assistance are trying to
communicate to you. If dementia, stroke, vision loss, hearing loss or other illness limits
one’s ability to speak and convey information effectively, body language and physical
actions take on a greater role in communication. Refusal to accept care, physical contact
or participation in an activity is the individual’s way of telling you something.
When your loved one resists care, step back calmly and think:
- Are there any environmental factors such as lighting, shadows,
noise, commotion or other external influences that are causing the problem now?
- Before you say something, think about what you are going to
say. Check your emotions and frustration before you speak. Your increased frustration can
contribute to your loved one’s agitation.
- Put yourself in her shoes. Use your knowledge of her personal
background to pinpoint patterns and reasons for her reaction.
- Is this confrontation worth escalating? Choose your battles
wisely. A head-to-toe bath is not necessary every day or even more than once each week.
Similarly, clothes do not have to be changed every day if they are not soiled.
Refusal to accept care or engage in once-pleasurable
activities is a sign that something is amiss. The caregiver can assess the situation for
specific complicating factor and make adjustments if necessary:
- Refusal to get out of bed: illness – Assess physical
factors such as injury from a fall, bruises, temperature/fever, urinary tract infection,
or oral infection. Keep a thermometer handy and know how to use it. Make a point every day
or so of inspecting skin for dryness, sores or bruises. Catching skin or mouth sores early
on will limit long-term damage and illness.
- Refusal to join family or participate in even small
activities: environmental – Assess for too much noise, harsh lighting, or specific
individuals who cause distress. Correct these distractions and integrate positive factors
such as music, aroma, comfortable fabrics and warmer room temperatures.
- Refusal to perform tasks and activities: depression – The
inability to fully perform tasks for oneself can cause an individual to avoid those
situations. Assist them as much as possible while encouraging them to do as much for
themselves without embarrassment. This is time-consuming, but it is the best route for
enhancing self-esteem and independence.
- Refusal to take medication: physical side effects –
Sometimes side effects result from medication that are unbearable to the recipient. Learn
what possible side effects can occur from the drugs your loved one takes. Consult with the
doctor to see if over-the-counter anti-nausea, anti-diarrhea, or anti-dizziness products
can be taken with prescription medications. Perhaps the medication can be taken at bedtime
or mealtime to reduce side effects. When administering the medication, tell your loved one
how it will help them and use distraction if side effects occur.
- Refusal to bathe or change clothes: embarrassment – Limit
other people’s presence (even their voices), approach in a non-threatening way,
undress/bathe one area at a time and keep the rest covered, speak calmly and tell your
loved one what you are doing each step of the process. Talk about pleasant memories and
stories as you are bathing/dressing.
- Refusal to eat or clean teeth: illness, incapacity – Oral
hygiene is essential for elderly persons since poor hygiene can make eating painful and
compromise nutrition. Don’t let oral health get to a point where it is a problem. The
sense of taste declines with age, so make efforts to improve the flavor of food, make it
appear appetizing, and ensure that portions are of the right size and consistency. You may
need to provide pre-cut portions or thickened liquids. See if better shaped utensils and
plates help your loved one feed herself.
You may have to use your own creative ideas to get around
resistance. One caregiver’s mother often refused to settle down for dinner. So the
caregiver helped her mother get dressed up a bit with a nice sweater, a brooch and her
purse. The two dined out on the patio without incident.
If your loved one still resists care even after adjusting for
other factors, remember that confronting your loved one at that time of heightened
emotions may make both of you more agitated. Take a time-out and attempt the task later.
Additional Resources:
- Communicating With Impaired
Elderly Persons
- Management of Agitation Behaviors
- Using Validation
Therapy to Manage Difficult Behaviors
- Reflections on Reflections: Bathing and
Alzheimer’s Disease
- Tips on… Bathing
- Skill Builders: Bathing and Grooming
- Skill Builders: Dressing
- Skill Builders: Eating and Nutrition
Recommended Reading:
- Therapeutic Caregiving by Barbara Bridges
- Elder
Rage or Take My Father...Please! by Jacqueline Marcell
- The
36-Hour Day by Nancy Mace and Peter Rabins
- Caregiver’s
Handbook by the Visiting Nurses Association of America
- More Selections in
the ElderCare Bookstore...
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