My elderly relative has not been diagnosed with dementia but clearly has it. Sundowning is very prominent. We have good days & bad days, as far as cognitive function. There is a subtle downward trajectory for sure, but we still have many lucid times & meaningful conversations. My question is how do you differentiate between a person's actual challenges, and learned helplessness? Examples:
* rarely initiates eating and does zero food prep (will not make a sandwich, or toast, doesn't serve a portion from a larger dish of something, rarely will heat up a plate left in the fridge) but eats when it is served.
* doesn't put clean laundry away...just takes from the pile which inevitably ends up strewn around/tipped over.
* doesn't carry dishes to the kitchen or put things in the dishwasher
* doesn't cover food appropriately
* misplaces mail or doesn't open at all
* stops and starts tasks without finishing them, often
I'm curious if it sounds like this person has become overly dependent on their caregiver, or if they are suffering from age-related decline and just need additional support.
To the OP - when supporting clients, we record their abilities in broad categories, thus:
I - independent, the client is able to carry out a task without assistance; not necessarily to a high standard, mind, but well enough that it does get done.
P - the client is able to carry out a task once prompted, encouraged, or verbally assisted. For example, we might ask whether a client has taken her medication; we might do a spot of cheerleading to give her confidence to stand up by herself; or we might confirm that a client has read the instructions on a packet correctly.
M - the client needs minimal physical assistance to complete a task. For example, the client can mostly dress himself but needs support to get his underpants over his feet. The key point here is that without the "M" support the task would not actually get done, even if the help required is nothing much. In this case we'll be looking for techniques or gadgets that will enable the person to manage alone.
F - full support. The client can't currently perform a task such as preparing a meal or washing himself in the shower. This category is further divided into AO1 and AO2 - assistance of 1 or 2 people respectively. I always record how far the client is able to engage in the task, though, because this gives us something to build on, and reablement principles can benefit all care receivers no matter what their level of disability - it stops people feeling like passive objects and reminds everyone present that this is an individual person we're dealing with.
If you suspect that your aunt can do more than she currently is doing, the best way to find out is to ask her. You mention meal prep as an example: I have a client who claims that he can't remember how to make toast, but if you make the toast and sit him down at the table with the butter and the marmalade he's perfectly happy to spread it himself and has no difficulty with it. Next time I'll hand him the bread and see if he makes his way unthinkingly to the toaster - I'd almost put money it. However, if we weren't there I doubt he'd even enter the kitchen. So, can he make his own breakfast? Probably. Will he, left to his own devices? Almost certainly not. Should he be encouraged to engage in meal prep? Absolutely!
Every task has component steps, and usually far more of them than we're conscious of in the everyday. Breaking tasks down and spotting where the hitches are can be a very interesting and revealing exercise.
Caregivers, by nature, want to care, help, ease burdens, but can sometimes unknowingly trigger an enabling loop for the Senior to establish expectations based around their Caregivers’ support style.
Now, if the caregiver(s) is receptive to feedback - I would challenge them to take a more inclusive approach to your loved one’s abilities in the day to day.
Some examples of this could be,
-“Let’s do this _______(task) together”.
-“Can you remind me/help me/show me how to to this [task]?”
-“I wonder what’s in the mail today! Let’s find out!”
With engaging the Client and including them in these day to day tasks, you may quickly find your answer of whether it’s a true decline or dementia disease progression vs. the learned helplessness cited.
I also would not rule out depression as a root cause of what you explained.
This is an under-asked question.
Many families will make the assumption of physical/cognitive decline and fail to consider other factors as you did.
I hope you find answers here that best serve your loved one’s needs!
She was starving herself to death. She managed a bowl of cereal, and a dish of ice cream per day, and that was it.
Her condo became filthy.
One of the effects of dementia is lack of initiative.
Besides the “want to” that can disappear, the “how to”, can leave as well.
In some dementias a person can seem to be fine in other ways but they've lost their executive function: the ability to put together what is happening now and the consequences of that action/inaction and the ability to make plans and execute them.
See All Answers