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Senior Living

1969-12-31 18:00:00

Reversing roles with aging parents

: My father is losing his memory but how do you convince your parent that you know what you're talking about and they don't.  It hasn't become a safety issue yet but I feel that is the next step, what can I do?

ANSWER: The transformation or reversal of roles with a parent whereby the relationship with them moves to mirroring the relationship you have with your children of care and protection, is very difficult at best with most parents.  It just goes against all natural instincts for you to be in a position of correcting, directing or arguing with a parent about what the reality of a particular situation is.  Not only is it unnatural for your father to be told by you that he is wrong, but it is very frustrating for the children in this situation because in reality you so desperately want your parent to be back in a place that they never will be.   There are many causes behind loss of memory and gaining some understanding of the root cause behind the disease process may go a long way in helping you understand how to deal with your father, or if nothing else, relieve some of your frustration.  What needs to be understood first is that memory loss is not a normal process of aging.  It is diseased aging.  For those 65 and above approximately 10- 15% of the population suffers from some form of memory loss or dementia.  For those 85 and older the number climbs to 47.5%.   Alzheimer's disease (AD) is the leading cause accounting for 50 - 70% of those afflicted with dementia, but as I said earlier there are certainly other causes as well.     Without getting into a lot of complicated detail because the physiological changes that take place in a diseased brain are many, there is a little horseshoe area in the center of the brain known as the hippocampus.   And again, speaking in generalities the memory process starts in the hippocampus and other surrounding and closely related areas of the brain.  All input travels through this area where in the disease free brain associations are attached to specific events along with processing and forming the emotional components of memory.    Unfortunately this area is particularly ravaged by AD, consequently the formation of new thoughts or keeping track of current events becomes very difficult and at some point in the process, are virtually impossible.  When you combine this 'short circuiting' if you will where new information just never gets sent to the appropriate area of the brain for storage and future retrieval and combine it with the many other physiological changes taking place, the bottom line of how do you convince your father that you are right,  is that you need to come to the reality that at some point you can't.  Its not that your father just wants to be right or argue with you, he just can't engage in a logical discussion with a brain that is no longer processing information logically.   Between the hippocampus not processing the new information along with declines in other areas of the brain that affect reasoning, executive functioning, and many times their emotional state, you are fighting a loosing battle.  This as I said earlier is so frustrating because you feel that if you only approached it differently or said it another way, then surely he will understand.  It becomes even more frustrating when much of their memory of old events is still intact.  In the earlier stages of the disease process memory of the farm in Oklahoma from 50 years ago usually remains.  Remember, it is new memory (or often referred to as short-term memory) that is lost first.     In caring for the memory impaired as we do in our homes, there are two fundamental concepts, reality orientation and validation.  The basic idea behind reality orientation is that when dealing with someone that is confused about something, if by correcting them clears up their confusion and brings them at ease then you have help by essentially rescuing the individual by bringing them back to reality.  For example if your dad were to be getting ready for Sunday church and it is only Thursday, if through a simple correction of what day it is he is able to process the information, understand and thank you for setting him straight, then you continue to use reality orientation.  On the other hand for the reasons laid out above, at some point in the disease process logical discussions are not possible.     Validation therapy kicks in at this point whereby you validate what is going on in the mind of the memory impaired.  You simply can't bring them to your world because they are no longer able to process the information.  As you continue to try to make them understand they can get more agitated because the two of you are simply not on the same page, which can lead to an argument, raised voices, hurt feelings, etc.  The fact of the matter is that the problem lies with the cognitive individual trying to force a demented individual to understand!  They can't.  An example of validation therapy would be if one of our 85 year old Residents begins a search for their mother (which is a fairly common occurrence) our approach would be to engage them in a discussion about their mother, explore with them the love and feelings they had for their mother and not try to bring them to the reality that mom passed away a long time ago.  At some point what is in the minds-eye of an individual with dementia is their reality.  We cannot bring them to ours so we move to theirs by validating their feelings and knowing full well that they will most likely move on to another thought or subject soon.   As far as the issue of safety and what should you do, first I would suggest that you become educated about the disease process and what lies ahead.  A call into the Alzheimer's Association and a conversation with one of the four very informed individuals there at 267-7333 is a good start.  They have a family counselor by the name of Celia who can meet with you and discuss your particular situation, and they also have a library of books and videos regarding memory loss. The best advice I can give you if you think you are heading down the road of needing placement for your loved-one in a long-term care setting some day, it is always best to do your 'homework' early.  Many times facing a crisis situation is not the best time to start looking at your options.