Don’t argue with or say no to the person with dementia. Use diversion and distraction instead.
I would never lie; I willfully participate in a campaign of misinformation.
The X Files
It is never a good idea to say no to a person who has dementia. First of all, you can’t win, and second, it will probably upset her or even make her angry. When a person with cognitive loss wants something, he is only concerned with his own needs and desires. Dementia takes away the ability to reason why the request is denied. She doesn’t have the ability to see both sides of an argument.
↪ Think about the last time you said no to or argued with a person who had dementia. Did you stop the behavior or win the argument?
Every morning Obie took possession of a large recliner near the nursing station, and it immediately became “his.” This is where he read his paper, all day long. If the chair was not available, he would yell loudly and belittle anyone who dared to sit in his favorite spot. Eventually, it was rare that anyone but Obie could be found in it.
A 76-year-old man who had multi-infarct dementia, Obie had also suffered a mild stroke. Because of this he used a wheelchair and a cane to get around. Obie was able to push himself from one place to another, scooting along with his feet. The cane came in handy to help with balance when he transferred from the wheelchair to the recliner and back again. Once Obie was comfortably seated in his recliner, the nursing assistants would move the wheelchair next to him, so it was waiting when he was ready to return to his room.
↪ Imagine yourself in the place of Obie. How important is your wheelchair? What if it disappeared?
Sometimes, in an emergency, we do whatever it takes to keep people safe. A nurse had caught a resident who became dizzy and was about to fall. This happened just a few feet down the hall from where Obie was sitting. Ordinarily the staff would never think of taking Obie’s wheelchair away, but upon hearing the nurse call for help, a nursing assistant grabbed the wheelchair and slipped it under the resident. The two women then took her to her room.
A few minutes later, the nursing assistant brought the wheelchair back to an angry looking Obie, who took one look at it and said “That’s not my wheelchair. I want my own wheelchair back!”
One of the nurses tried to assure Obie it was his, but he raised his voice again, and his anger was obvious.
“That is not my wheelchair you ninny! I want my wheelchair back!”
↪ What was the appropriate response? What should the staff have said to Obie at that point?
The staff had been taught not to argue with residents who suffer from dementia because people who have cognitive deficits can’t reason or understand a situation. Nonetheless, the staff tried to reason with Obie. They explained to him that the wheelchair was only borrowed for a few minutes and was brought right back. They showed him his name painted on the back of the chair.
“That is not my wheelchair. Give it back to me!” Obie yelled, calling them some not-so-nice names.
Once again they tried to convince him but they only succeeded in irritating him more. He picked up his cane and threatened the aides with it.
↪ Why was Obie so upset?
The staff finally realized they were not following the advice they had been given in training. There was no way they could change Obie’s mind and had no business arguing with him. They had to think of something different. Finally, common sense kicked in. Give him what he wants.
The staff made a quick phone call and asked the maintenance department for a favor. They were happy to help and few minutes later a young man came through the doors at the front entrance to the unit. He smiled at Obie and said, “I was fixing your wheelchair, and I have it in the back. Someone brought you the wrong one.”
Taking Obie’s wheelchair from beside the recliner, he wheeled it down the unit and out the back exit. A few minutes later, the front entrance doors opened and once again the young man appeared with the same wheelchair in tow.
“Here’s your wheelchair, Obie. Sorry about the mix-up,” he said.
Obie took one look and said “Now that’s my wheelchair! Thank you!” and went back to his paper.
↪ What did the staff learn from this situation?
When Obie denied the wheelchair was his the staff learned once again that it’s fruitless to argue with people who have dementia. Arguing or disagreeing infuriates them and makes the situation worse. Obie and other people with dementia simply do not have the cognitive ability to see both sides of an issue. It is extremely difficult to change their minds and its far better to try to understand how they feel and find a better solution.
Nurses and nursing assistants are often faced with situations such as having to quickly remove an object a resident is trying to eat, or stop a resident from pushing or hitting someone else. Saying no could escalate the situation. The idea is to figure out how to best work around the problem.
↪ What would you do in this situation?
Whenever you have to take an item away from someone with dementia, offer something in its place. A resident trying to put something inedible in their mouth has to let go of it when offered an item that is edible. However, if there is no acceptable alternative to offer, try distraction. This can include such things as telling the resident they have a phone call, telling them to look at something, or asking a question.
The same applies to residents who are arguing or threatening each other. First, distract the least aggressive person and remove them to a safe area. Then diffuse the situation by offering something the aggressive person likes, such as a treat or a walk.
It’s important to figure out why the aggression occurred in the first place so you can prevent it from happening again. For instance, Obie would threaten people who tried to sit in “his” chair by the nurse’s station. Since the staff was aware of his habits, they would encourage the other residents to sit in nearby chairs before an argument could start.
Good communication skills were covered in Module 3. Following them will have a positive effect. Here are some things you should avoid because they will cause a negative response:
- Don’t try to explain the situation.
- Don’t argue.
- Don’t say no.
- Don’t question recent memory.
- Don’t take it personally.