*Resident names and any identifying details have been changed for privacy.

July 10, 2020

Behavioral communication is not exclusive to dementia

We all do it.

- When we're "hangry".

- When we're cranky because we feel unwell or stressed out.

- When we're irritable because we haven't been sleeping right.

- When we overreact and yell in a situation we normally wouldn't.

- When we’re catastrophically upset and slam a door or throw something.

- When we're feeling frustration, disappointment, shame – or any other emotion that might feel too painful or too scary to deal with in the moment.

We try to ignore the feelings. We resist them.

And then they go away…. Ha! Nope.

When we can't or won't deal with feelings consciously, they often come out behaviorally

We may snap or pick fights. We may behave passive aggressively. We may spiral into feelings of anxiety, depression or overwhelm.

We may not think clearly. We may get tired, forgetful, accident prone or otherwise become "lower functioning".

When we can recognize our own behavior as clues to our own feelings - and importantly, our own needs - we can be on our way to functioning at our best.

We'll be better poised to:

- be observant

- say the right things

- NOT say the wrong things

- recognize others' needs

- help others feel better

- be productive

- be happy

- be well

- be wise

Self-care is essential for people working with or caring for people with dementia.

In many cases, people who are drawn to caregiving-type roles professionally are used to putting others' needs before their own. We may be better at seeing and meeting others' needs than our own.

But this isn't healthy or sustainable – it's a recipe for compassion fatigue. 

Self-care can be a challenge

One reason that self-care can be difficult is that it takes a good deal of mental and physical energy to notice what is needed, make a decision and take action. The good news is that by developing or changing our habits we can save 40% of that energy.

Self-care has been all the buzz lately. The term has been used to describe a huge range of activities from taking a nap to learning a new language. Many of us don't see how we could possibly indulge in a massage or a mental health day when some days we can barely squeeze in a shower.

However, a lot of self-care isn't about cramming ever more into an already packed day, but rather making deliberate decisions about how to budget the time we have wisely. This can mean a number of things: establishing or reinforcing boundaries, saying no more often, or talking with a trusted friend or counselor about the situation. Someone else just might have some helpful insight into how you can handle the situation, juggle your responsibilities differently, or make some positive changes in your life.

It's interesting to look at why self-care may be so hard for some of us, and why true self-care goes beyond a massage and a mani-pedi. It's a pattern of treating ourselves with compassion and accepting our human imperfections. 

True self care entails paying attention to our own needs and taking deliberate action to fulfill them - just like we do for people with dementia. 

So, what would we do if we were taking care of someone with dementia who was acting cranky, irritable, emotional, snappy, argumentative, anxious, depressed or overwhelmed?

And no, I'm NOT talking about psychotropic medication! (haha)

We would look for what is bothering them and try to fix it. 

We'd remove or minimize environmental stressors. We might take the person to a different setting or make changes to the situation or environment accordingly. 

We'd look for any needs that may be unmet and try to fill them.

Essentially, we would figure out the root cause of the problem by asking ourselves why we're seeing the behavior.

(And anyone who's studied root cause analysis will ask themselves "why" 5 times of course! 😆)

The dimensions of wellness 

When considering potential unmet needs, first we run through the basics: hunger, bathroom needs, pain, discomfort, thirst, medical conditions. 

But it's important to remember that our human needs extend beyond basic physical wellness.

In fact, depending on exactly who you ask, there are four to eight (or even more!) dimensions of health that must be maintained for wellness. Here are the six that most generally agree upon.

The six dimensions of wellness include:

Physical health

Do we have a healthy diet, regular exercise and practice healthy habits?

Do we get sick frequently?

Emotional health

Are we able to feel our emotions, label them and express them appropriately? 

Can we laugh and have fun?

Social health

How do we communicate, resolve conflict and get along with others?

What is the quality of our relationships?

Are we able to maintain healthy boundaries with others?

Can we recognize emotions in others and respond to them appropriately?

Spiritual health

What gives our lives meaning and purpose? 

How "at peace" do we generally feel?

What guides our sense of morality?

Occupational health

Can we maintain a healthy work/life balance?

Is our work meaningful, fulfilling and satisfying?

Do we have opportunities to feel productive and useful?

Do we balance our finances without excessive spending, hoarding or gambling?

Intellectual health

Are we continuing to learn, grow and enjoy mental stimulation?

Do we think critically?

Are we curious? Creative?

Each aspect of health should be observed, honored and maintained whether we're talking about ourselves or someone with dementia. 

Appreciate our own Behavioral Communication

We can appreciate our own behavioral communication if we pay attention to it. We can use our feelings to give us information about our own unmet needs. From there we can seek to fulfill them the way we would do for someone with dementia.

The world would be a much better place if we treated each other, and ourselves, the way many of us strive to treat people with dementia.

- Be patient and calm

- "Listen" with your ears, eyes and heart to their verbal and non-verbal communication

- Maintain eye contact, speak clearly and allow time for them to respond

- Reduce distractions and pay them your full attention

- Don't argue

- Seek to see their reality... recognize that their really is as true to them as yours is to you

- Take seriously the things that are important to them

- Keep a sense of humor

- Be heartfelt and trustworthy

- Respect, appreciate and value their time and contributions

What do you do for self care? How and when do you communicate behaviorally?

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