ANOSOGNOSIA in DEMENTIA - Six ways to help someone who doesn't recognize they are ill.
Why do some people not believe they have dementia?
Damage to the brain can cause people with Alzheimer's, dementia, stroke, brain tumours and other cognitive impairments to believe there is nothing wrong with them. When this happens it is called anosognosia (ah-no-sog-NOH-zee-uh), meaning "to not know a disease", important to not be confused with being in denial.
Anosognosia is a condition that causes someone to be unaware of their mental health impairments and how it affects them. The unawareness can be related to memory, general thinking skills, emotions or physical abilities.
However, anosognosia symptoms may vary significantly from person to person, change over time and can even fluctuate within a day. That person may sometimes understand what is happening and other times firmly believe they are completely fine. On the other hand, an affected person might only be partially aware that something is wrong. Like dementia in general is is best to remain flexible with the cognitive changes.
Anosognosia in dementia is not denial - when someone is in denial, they are aware of a fact but refuse to accept it. With anosognia the damage that dementia causes in their brain make it impossible for the person to be fully aware of what is happening to them.
It is important to distinguish between someone in denial and someone who has anosognosia in dementia. Those with anosognosia are not just being difficult, so what to do? Read on for 6 top tips for managing these difficult symptoms;
1. Do not try to convince them they have dementia
Using reason and evidence to explain or attempt to have them recognize the symptoms is not going to help. It will only upset them and will likely make them even more convinced that they are right and you are attempting to discredit them.
A far more effective strategy is to discreetly make changes that will help them live safely. Stay calm above all else, focus on their feelings keeping your comments subtle and as positive as possible.
2. Work with their care team
When your older loved ones dementia symptoms are interfering with their daily lives it is important to start working with their care team - including doctors, relatives, friends, caregivers.
Do not wait for a crisis to occur! We cannot stress this enough, it is one of the most frequent problems we see. Family/friends do not want to make waves - tragically a crisis occurs often resulting in being too late to make the necessary adjustments to live safely. When a crisis occurs your options are minimized or gone all together.
3. Discreetly make their life as safe as possible
Making your older adult's life simpler and safer can prevent someone with anosognosia in dementia from hurting themselves or others. Some try to drive, manage money, cook, forget their medication, walk out doors alone or perform other activities that are dangerous and exposes their vulnerability because of their cognitive impairment.
Use positive approaches without mentioning dementia as a justification to prevent problems in making their lives safer. Finding ways to preserve their pride will be most effective. Perhaps you might say you dislike eating alone or you would like to spend more time together so you want to eat dinner with them. Or that you have some great recipes you would like their opinion on, so you can leave prepared meals in the fridge during the week. (Be careful here, as many often forget to check in the fridge, don't remember how to put on the incontinence garments, or what to eat to remain healthy. These are indicators your loved one needs more assistance at home)
How to introduce a caregiver- maintain their dignity & Independence.
Start slowly with gradual increases
Say it is for you rather than because they need the help.
Use a doctors authority saying Dr's orders
Use housekeeping needs as an excuse
Pretend it is a free service
Tell them it is temporary
Introduce the caregiver as a friend who needs work and you want to help
4. Avoid correcting them & having confrontations - pick you battles
When someone has dementia, their brain may experience a different version of reality because of the damage the disease has caused.
Dementia care experts recommend stepping into their reality rather than trying to correct them. Their brain looses the ability to process information and attempting to force them to join the real world will only cause confusion, anxiety, fear, and anger.
Try to solve as much as you can without them knowing - stress only makes challenging dementia symptoms worse.
5. Present solutions subtly and positively
The less the older adult feels they are being limited for reasons they can not comprehend, the less likely they are to become angry and defensive to resisting help.
For example for a positive spin you might say; "let's go for a walk together I need the exercise" rather than "you can't go for a walk alone, I have to go with you".
Provide incentives; "Lets clean the house together so we will be done twice as fast in time to watch your favourite movie."
Reminding them about medication can also be done in a positive way. You can say "it's time for me to take my medicine" and you take a M&M or something of the like just to keep the focus off of them needing help and reminders.
6. Learn more about dementia & dementia care techniques
The most effective dementia care and communication techniques are not always easily figured out. Learning these techniques can prevent frustration and stress for both you and your older adult. Skilled dementia care can provide you with necessary relief and safety for your loved one to improve the quality of life for both of you.