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.
Dan Lynch is the President of Tender Hearts at Home, a Cincinnati, Ohio elder care company. Dan and his wife Jody found themselves in the challenging situation of caring for their ailing elder parents. Neither parent wanted to move to a nursing home, but Jody and Dan experienced difficulty in finding dependable in elder care. After falling in her home and remaining unfound for five hours, Jody's Father eventually transferred to a nursing home where his health steadily declined until his passing. This experience ultimately led Dan and Jody to form their company, Tender Hearts at Home, providing personalized senior care for the elderly and those in need who wish to remain independent in their own homes for as long as possible. Their company offers service in Cincinnati and Southwest Ohio in the counties of Warren, Butler, Hamilton, & Clermont.
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