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Choosing a Long-Term Care, Nursing Home, or Retirement Residence for a Loved one living with Dementia: What is Anosognosia? Tip of the Day

Posted Apr 3rd, 2015 in Long-Term Care, Retirement, Tips, Dementia

Choosing a Long-Term Care, Nursing Home, or Retirement Residence for a Loved one living with Dementia: What is Anosognosia?  Tip of the Day

Asking questions about the capabilities of a Long-Term Care or Retirement Residence, to effectively provide care for individuals living with dementia, is a fundamental question when searching for  a new home.  

Consider one of the possible "A's" of Dementia: Anosognosia.  An educated, compassionate member of the care team, will be able to problem solve best practices when it comes to responding to an individual affected with this loss.

What is Anosognosia?

A simple way to define this rather complex word, is a lack of awareness or recognition, that there is a health concern or change in well being.  In Alzheimer disease, as cell damage is sustained and cognition changes, the inability to process information can cause a loss of certain aspects of self awareness.  In other words, as memory fails, the individual may "lose insight into the fact", that "they have in fact lost insight."  A bit of a tongue twister, but really just a way to appreciate that when brain damage occurs, this is a loss based on physiology, rather than conscious denial.

When someone experiences anosognosia, this can impact their recognition that personal care, the ability to manage household administrative duties, or other activities impacting daily living have been affected.

Are you caring for a loved one living with Dementia, that "Doesn't know" that they "Don't know"?  Imagine how this must feel... 

From the individual living with dementia's perspective...

Why Can't you Just Leave things be?

Today you took my keys I think,
I just can’t figure why.
Yesterday the mail was gone,
Denials I defy.

You said I did not bathe today,
But this is far from fact.
Lost for words I must admit,
The cause of your attack.

The bills were paid a month ago,
Yet companies pursue,
With notices of unpaid notes,
What do I have to do?

My clothes have moved to other drawers,
Not sure if done in jest.
I can’t quite figure out the point…
Deter me from my quest?

For all I seek is clear to me,
To be just who I am.
So why the pointless gaming ploys,
Is this a complex scam?

From the Care Partner's perspective, this is how the scenario may have unfolded...

Why Can’t things be Like before?

The keys are in the dish my love,
Beside the kitchen door.
The mail is right beside the bed,
Just like it was before.

The towels stacked await your use,
The soap and razor too,
Bathing now seems quite the chore,
I’m not sure what to do.

The Creditors call often now,
The bills are in a mess.
I’m not sure of the rationale, 
To free me from distress.

Your pants and shirts are third drawer down,
Just like they were before.
This hasn’t changed in thirty years,
A move would be a chore.

For all I seek is clear to me,
To be just who I am.
I wish I could turn back the clock,
To start where we began.

So what practical strategies may help both the individual living with dementia and their care partner alleviate some of the stressors that can be a result of anosognosia?

Here are a few thoughts for your consideration

Think about tools to help with memory reminders and ways to simplify life in general:
a)    Calendars with marked appointments: Big, clear, not too many pictures.  A simple desk calendar is a great idea.  Be sure to mark off each day that passes, to avoid confusion.  This may become the "go to" place to answer questions about the day when information is forgotten.  What about a clock that displays day, date and time?
b)   Magnetic white boards: Place on the fridge listing the day’s date and plans:  Today is… Visit Doctor X at….
c)    Speak to your bank about possible automatic payments for regularly reoccurring bills.
d)   Keep routines intact as much as possible: What does your day to day schedule look like?  Remember changes to the fundamental daily flow may cause aggravation, as the ability to adapt is impaired.
e)   Offer "controlled choices" that lead to the same outcome: Example: If hygiene is a concern:  Would you like to bathe before breakfast or after breakfast?  Choices  foster a sense of independence and self esteem. Limiting the variables when making choices reduces stress.
f)    Keep directions simple: step, by step.  With memory loss, tasks with more than a couple of steps may be forgotten, and cause frustration.
g)    If things are, or seem lost, offer to help in the search to reduce stress.
h)   Try to find places where items can be routinely placed: Example: A wall key hanger may help reduce loss, and always keep a spare set of keys in a safe place.
i)    Be a good listener: Remember the experience related by the individual living with dementia, is an account to their best recollection.
j)     Is there a way to simplify frequently used items: TV remotes etc.?  (Imagine the frustration of dependency.)  Also think about automatic shut offs when purchasing small appliances.

When a person is unaware that they don't know, arguing is a fruitless and upsetting endeavour.  Strategizing ways to remove the roadblocks to success takes time, practice, and patience.  

I am hoping that after reviewing these strategies, perhaps the poem will be written as such;

Let’s Just find some Common Ground

The missing keys must give you grief,
Here let me help you seek.
I’m sure we’ll find them soon enough,
I’ll help you have a peek.

I want to have a spa like soak,
From stress I’d like to flee.
So would you like to have your bath
Before or after me?

Those bill collectors aren’t quite fair,
We can’t be that behind.
We’ll get the bank to watch those cads,
And keep those blokes in line.

Perhaps when cleaning just last week,
I moved your clothes a bit,
To remind me of the drawer locale,
I pinned a note to it.

For all you seek is clear to me,
For now I have a plan,
When memory blips cause you duress,
I’ll help because I can.

Download the free Elderpilot: Long Term care or Elderpilot: Retirement mobile tour apps (iPhones and Androids) for more information. The resource section is full of tips and strategies including things to think about re care needs of individuals living with dementia.. The apps will guide you on your tours, providing prompts, recording your observations and creating a report to share with others. Looking for more help? Visit us at www.elderpilot.com. and read my blogs.


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