Overcoming Resistance

The most important thing to remember in this situation is that there are different underlying reasons for the resistance. The following are common causes of resistance and suggestions for how to handle them. More causes and suggestions will follow in next month’s issue.

Denial

Denial is a defense mechanism that everyone uses, and your loved one is no exception. Some dementia patients deny that there is any problem. When confronted with resistance based on denial, try to rephrase your demand.
“I agree that you feel great and don’t need to go to the doctor. But isn’t Dr. X such a good doctor? Last time you went he was so nice! I would feel so good if we could go see him, just to make sure that your blood pressure is okay. I would feel good knowing that your health is perfect.”

Fear

Fear is often the cause of resistance, but may often look like anger or frustration. When dealing with someone who is resisting out of anxiety or fear, try first of all to empathize with their feelings and then express your own. “Are you worried the doctor might find something wrong? You must be afraid she’ll say something you don’t want to hear. I love you and just want you to go in and get checked out, so we can be sure that everything is okay.”

Pride

Pride is very important to your impaired loved one, and you must be sensitive to the fact that dementia leads to an incredible loss of control for your family member. Try to find small ways to let the person have control. “I know you don’t enjoy going to the doctor’s, but let’s go out to lunch afterwards. Would you like to go to Restaurant A or Restaurant B after your appointment?”

Timing

Sometimes certain changes can just be too much too soon for your loved one, even if it’s something as simple as having an in-home worker come each day. If your loved one is simply not ready, consider waiting on, but not giving up on, your idea. “I can see you’re not ready to have someone come every day to visit. But let’s just have Sandy over today for coffee and we can get to know her a bit. You and I will talk about having her come over more regularly next week.”

Disagreement

Like everybody else, a person with dementia will sometimes simply disagree with your idea. It is important to address their refusal, whether they express it with body language, behavior, or an emphatic “no!” As most caregivers have already discovered, trying to change an impaired person’s mind by arguing, reasoning, or citing evidence is a lost cause. All you will accomplish is to upset the person, escalate the conflict, and cause stress for yourself. An important first step in dealing with simple disagreement is for you as caregiver to take a moment to stop and reflect on how you’re going to proceed. Stay calm and respond to the person’s refusal by acknowledging and validating their feelings. “Oh, you don’t like that idea at all, do you?” Next, agree on something—anything! The goal is not to have the person agree with your initial suggestion, but to establish common ground to build upon.

Loss

A person with Alzheimer’s has experienced many losses, and continues to do so throughout the course of their disease. One of the most major losses is the ability to clearly communicate about their feelings. Any event may trigger overwhelming feelings of loss and grief. Unable to deal with these feelings, the impaired person may respond by resistance. The best way to handle this is validate the person’s emotions and show caring with love, a soft voice, warm feelings, and a gentle touch. After giving the person some emotional comfort, offer them some control over the situation they were resisting. “I know it’s hard for you to give up driving, but I’ll drive you to your appointment today. Afterwards, we’ll go out for a snack. Do you want an ice cream cone or a piece of pie?”

Stubborn Personality

It is common for family members and other caregivers to dismiss an impaired person’s refusal as a result of “stubbornness.” This may be perfectly true, but it is not productive to focus on it. If there is a pattern of family dynamics or other behavior patterns which might come between you and your loved one, consider having a third person intervene in the situation, such as another family member, a paid caregiver, or a physician. And don’t blame yourself! You are doing a great job and should be proud of yourself.

Adapted from materials produced by the Alzheimer’s Association.