Loss of short-term memory is often one of the first changes that affect people with Alzheimer’s and other dementias—and the resulting repetitive behavior can be among the most difficult to handle. I tend to break repetitive behavior into four categories:
- Questions regarding the schedule: “What are we doing today?”
- Questions related to whether something was done: “Did we feed the dog?”
- Questions about future events: “When is Anna visiting?”
- The fourth category is not always a question, but a common behavior—repeating the same story: “Did I tell you about the time Laura hurt me?”
Coping with repetitive behavior in any of these categories can be frustrating, but keep in mind that your loved one truly does not remember. So reminding them that you just told them won’t help—and may lead to anger, confusion, or depression.
How, then, can we deal with this annoying pattern in a way that promotes the best quality of life for our loved ones, and for us?
Here are some strategies that have helped families I work with.
A strategy I recommend that applies to most types of repetitive behavior is to keep your answers short. “Our doctor’s appointment is at 2 pm.” A few words are much easier to say, and for your loved one to remember, than a long explanation. And the longer the explanation, the more chance it may trigger other anxieties.
On a purely practical level, purchasing a whiteboard and placing it where your loved one can see it may pre-empt the questions. Use it to list times for activities, daily tasks such as feeding the dog, and special visits. For example: 10 am breakfast, 12 pm Susan visit, 3 pm afternoon walk, 6 pm feed the dog. Knowing what’s happening and when is very comforting. When I used this tactic in an adult day care program, even folks with moderate dementia were able to learn fairly quickly to refer to the whiteboard when they wanted to know what was happening next.
How you introduce the board can make a difference. Try not to say, “Mom, I bought this for you because of your memory.” Too much information! And certain to create defensiveness. A good way to introduce the board is to say gently, “I got the board for us to keep track of what’s going on.” If she says, “I don’t need that,” tell her, “Well, it’s helpful for me.” Then change the subject.
Another approach is to remove things that might trigger repetitive questions. Before her dementia, one mom and son’s pattern was to start preparing dinner at 5 and sit down to eat by 6. During that hour they would feed the dog. But the mom couldn’t remember if the dog had been fed, and asked over and over, every two minutes, “Did we feed the dog?” This was driving her son crazy, so in addition to the whiteboard, I asked him to make a few small changes in the environment—and it helped: remove or cover the clock, remove the empty dog dish, put the dog out of sight for an hour or so. Out of sight, out of mind. For some folks this can make things worse as they are now constantly asking for the dog. After these changes the son reported that his mom only asked about the dog twice, and didn’t ask about the food at all. When she did ask, he told her the dog was outside doing his business. She didn’t feel the need to investigate. Asking twice in the span of an hour was an acceptable win.
The third repetitive behavior scenario stems from anxiety over future events. If your dad frets over future events, even pleasant ones, I recommend not telling him until the last possible moment. Reducing his anxiety is a kindness well worth a white lie. As I often say, if you can’t be truthful, choose kindness. For example, “Anna just called and said she’s coming over to visit. Yay, let’s get ready.” If that backfires, you can ask forgiveness: “Did I forget to tell you? I’m sorry.” Telling Dad that you’ve been talking about Anna’s visit all day may be truthful, but it is not kind or productive. Kindness, sometimes at the expense of truth, can be a comforting way of connecting with positive emotions, and a detour out of anxiety.
Repeating the same story is a common behavior that arises because your loved one simply cannot remember. If your husband repeatedly asks, “Did I tell you I met the new neighbor?” you can gently reply, “Yes, and she sounds like fun. I can’t wait to meet her.” This is a kind approach that ends on a high note. If he doesn’t react well to that, then the next time say, “I’m not sure. Tell me.” This approach will reduce confrontations and hurt feelings. When you have heard the story enough times, gently change the subject, start an activity, or excuse yourself from the room for a few minutes.
Sometimes, it is important to get some time away, and schedule for someone else to be the listener, rather than cut off communication and connection—which are important. Reminiscing and storytelling is not only gratifying, but a developmental need that’s common to many older people, even those without dementia. And diverting to stories about the past can be a comforting way of relieving anxiety.
But problems may arise when these repeated stories cause anxiety or depression. For example, suppose your mother often turns to stories about her sister, Laura, which make her angry, anxious, and out of control. How do you break the pattern? The moment she starts with something like, “Did I tell you what my sister did?” you quickly interrupt with something pleasant by saying, “Oh, before I forget,” then launch into positive topics, and have two or three things in mind ahead of time.
You can talk about family vacations (“Remember the hot air balloon festival? We had so much fun. Let’s look at the photos…”), beloved family members or friends (“Aunt Stephanie called, and wow is she interesting. Did you know…?”), or pleasant events (“I loved watching the dogs at the dog park yesterday. So many different breeds…”). You can offer praise (“I sure admire your knitting. Everyone just loved getting those beautiful scarves from you last year…”). Follow up with a pleasant activity, like a favorite nature show, recorded concert, reading together, or putting up seasonal decorations. Some people want to feel useful and want to do chores. As they can, encourage and enable them to do so. Come up with a list of things they can do, with little or no help.
If Mom still goes back to her evil sister, try getting her moving. Movement and a change of scenery are powerful and effective diversions. Getting outside and exercising, when possible, are often feel-good strategies that help everyone.
Also think about the triggers in your environment—some might not be obvious. Maybe your mother’s easy chair faces family photos. Even if they don’t include her offending sister, they could still be a trigger. In a similar situation, I asked the family to take the photos down. Their mother didn’t notice, and the subject of the sister rarely came up after that.
I’ve suggested ways to deal with repetitive behavior—but the forms they take are as unique as the individuals we care for. Few people know your loved one better than you. Trust your instincts, and those of others who care for your loved one, in finding ways to redirect repetitive behaviors, and reduce the stress of living with Alzheimer’s disease.
Geriatric Care Manager