“She’s ALWAYS been stubborn and it’s only gotten worse with age!”  When families care for their aging loved one a tug of war can quickly start over installing grab bars in the shower, keeping feet elevated or accepting the help of caregivers. Assumptions flare up without shedding useful light on the distinction between “will not” and “can not”. The lightning flash of judgment can blind clinicians and other care providers as well.

The elder in question may or may not have a diagnosis of dementia. Even mildly diminished mental function can derail every day tasks and stall cooperation.

Some folks have spent a lifetime resisting change and fending off help. Frustrated family members involved with such a person quickly take up their historic positions and either wage war or throw up their hands in disgust. As understandable as that may be, aging itself erodes the elder’s very foundation. It’s a new game now.  Wise and effective  families consider normal mental aging, physical/medical health and learn about dementia in an effort to find a fresh approach.

Normal mental aging introduces a new set of obstacles for the aging adult. Complex tasks take longer to understand and produce a response, the elder is more easily distracted, and hearing and vision may scramble input. Given all of these changes, errors are common; those errors are alarming to everyone.

Underlying medical disorders and pain can introduce additional corrosive factors that undermine cooperation. Shortness of breath, episodes of dizziness or fatigue as well as the ongoing fear of losing control of their bladder or bowels can be unrecognized distractions that further stall the elder’s ability to accept new equipment, learn a new task or make changes to their routine.

With the onset of dementia the very bedrock of mental function gives way. In some cases there is a slow decline; in others, as with a stroke for example, the damage can be sudden. That battle over grab bars or accepting a caregiver is fueled by much more than simple stubbornness. It requires a fresh approach.

It can be helpful to take an inventory of the physical, medical and emotional challenges the elder has to face each day. What kind of “vehicle” is the elder trying to “drive”?

A person who battles infection, medication side effects, sleep loss and pain has very specific and variable needs. A person who can’t hear, can’t see and can’t feel things accurately will, at the very least, be distracted and will certainly have problems with daily tasks. Poor vision and hearing result in poor memory – regardless of any underlying dementing process – junk in is junk out.

Consider emotional health next. Hopefully elders who have lived with schizophrenia, bi-polar disorders and the like will receive appropriate services. Depression has a serious impact on cognition and may respond well to medication and non-pharmaceutical treatment. Elders who have experienced the loss of their home, a life partner or pet may be aching and distracted with grief.

So the “car” the elder is “driving” may be quite a clunker! The emotional state of the “driver” may at times feel like they are locked in a cell with a blaring radio and screaming kids or at other times imprisoned inside chilling darkness.

What about the mental resources of this imagined “driver”? How well is their cognitive equipment working? Most people associate dementia with memory loss, but impaired cognition involves so much more: perception, attention, judgment, problem solving, use of numbers, language and learning. Dementia damages all of these mental tools.

Even before dementia is diagnosed many elements of cognition may not be working well. The elder may always have had trouble with judgment, impulse control, problem solving and learning. Age, along with years of alcohol/drug abuse and injury, will strain already weak systems.

Perceptual damage often lurks unrecognized. Perception, the meaning the brain makes of sensory input, is an essential foundation to attention and memory. This delicate network of brain function requires specific testing; simple observation does not reliably detect impairments.

When perception is healthy, we can tell the difference between wet and icy and the difference between a motor and a bell. We can reach into our pocket and find our keys, leaving the coins behind. When perception is damaged, the very foundation of every experience falls apart in unpredictable ways.

Is the demented elder faced with “driving” an unpredictable and temperamental “wreck” of a body? Is that task complicated by episodes of fear, grief, voices, energy highs and lows? Do they know what is going on around them? Can they follow verbal instructions? Do they recognize hazards? Can they solve problems or get help? No doubt the answers to these questions will change with dementia’s inevitable decline.

The elder’s previous history and current challenges may dishearten even the most intrepid helper. Don’t be discouraged. Here is an important key: don’t introduce anything new by talking about it. Just bring the new bathroom grab bar or new foot rest or new caregiver and put it in place with the invitation to “try it for a week and then we can take it out if you don’t like it”. Plant the seed and nurture its growth.

A special grace comes with using something or someone that meets a need – you just have to get it planted so it can take root and flourish.