Expert: Mary Gordon - 1/16/2011

Question
Hello Mary,
My father is 84, diagnosed with AD and lives in an ALF.  We had to take his beloved dog away the other day because the dog was defecating all over his apartment d/t Dad was neglecting to feed the dog dog food and instead feeding him food off his plate, thus the diarrhea, and just unable to properly care for his pet. This has been very difficult for all of us siblings because we know how he loves his pet. He has been calling over 25 times a day inquiring about his dog never remembering what we've told him. I and my siblings tell him many times every day that the dog went to the vet and that we plan to bring him back ASAP knowing that the dog will not be allowed back into the facility.  Dad can be very difficult and unreasonable.  We were wondering if maybe we should tell him that the dog has passed or just tell him the truth that he can no longer take care of him. He won't agree with that for sure and will insist that he takes care of his dog.  Any suggestions will be appreciated.  Thanks

Answer
Hi Patty,

Here is a great link to help you understand what your father is going through. It's worth printing out and reading a few times. It also has some great ideas for ways to look at what he does, and for dealing with him. He's really not being difficult and unreasonable. He's doing the best his poor injured brain will let him do.
http://www.alzheimer.guelph.org/downloads/12%20pt%20Understanding%20the%20Dement...

Because his short term memory is damaged, no matter what you tell him, he isn't going to remember. So you achieve nothing by telling him that the dog has died, or that he can't take care of one properly, other than to upset him. He can't follow reason, so even the best logic you can come up with regarding the dog will be lost on him.

I'll give you an example. When my mother in law was in mid Alzheimer's, her sister Kay passed away. Dolli got taken for visits to the hospital prior to Kay's death, and she was fully involved in everything afterwards. She was at the visitation, the funeral, and the family gatherings at various homes. However, in short order, she'd forgotten everything about it. She would ask where Kay was and why Kay hadn't come over to visit.  She wanted to call her on the phone. She wanted to go see her. Initially, we tried to remind her what had happened, thinking that she might be able to recall with prompting that Kay had passed away.

However, what happened was every time she was told Kay was gone, it was like the first time she'd heard the news. She would burst into tears and be overcome with grief. She would get angry and be convinced we had cruelly hidden Kay's illness and death from her and excluded her from the funeral. She'd get all stirred up and then 20 minutes later,  she'd have forgotten that Kay was gone again, and start asking all over.

Finally, we figured out that it was much better to tell her something comforting and reassure her. We'd try to deal with the emotions underlying the question, rather than the factual content of the question. She was asking because she loved Kay, she missed her, and she was worried about her. So we'd comment on that, and reassure her that everyone was fine. We'd say Kay was with her parents (which from a religious perspective, we hoped was true!). We'd give her a big hug, and try to distract her and divert her onto new subject.

Keep in mind, he can't see what is apparent to you - he is oblivious to his deficits, even when his problems are screamingly obvious to everyone around him. He also can't remember any problems with the dog. It's part of the disease. He has a damaged brain. No amount of arguing, reasoning, confronting, persuading is going to work. His logic processor is broken. Even if you could get him to understand five minutes later he would have forgotten the whole conversation. The funny thing is sometimes they stay really agitated and upset about an argument even when they can't remember what they were upset about, so its better not to wind the person up. They will feel all unsettled but they won't remember why. Keep telling yourself that this may look like him, but he is profoundly changed by his illness. He is NOT doing this on purpose - he can't help himself. It's the disease. He's doing the best he can with what his brain will allow, so try not to take it personally. Being difficult and unreasonable, annoying, stubborn,  - all those labels require an intact brain to plan out the results of your behavior. He is not capable of that. He really is like a little kid. He is living in the now, and he can't see the consequences of what he does. You pat, you soothe, you reassure, you commiserate, you hug and cajole - and then you distract and divert.

When he's asking the same thing over and over, he's looking for reassurance. Be patient and calm; it doesn't do any good to point out how many times he's asked the same question because he can't prevent it from happening again. One way to distract and divert a person is to use "bridge phrases" to turn the conversation in a fresh direction: "Dad, I know you love your dog so much. That reminds me of the time ...." Other bridge phrases: "What I'd really like to know more about is . . . " "Your childhood was so interesting. Did you also . . . ?"

Here are 10 fabulous rules for dealing with a person with Alzheimer's, as collected by Dr. Robert Stall.

1. Never argue, instead, agree
2. Never reason, instead, divert
3. Never shame, instead, distract
4. Never lecture, instead, reassure
5. Never say remember, instead, reminisce
6. Never say "I told you", instead, repeat
7. Never say "You can't", instead, "Do what you can"
8. Never command, instead, ask or model
9. Never condescend, instead, encourage and praise
10. Never force, instead, reinforce

Hope this helps

Mary G.