Alzheimer’s Disease and Refusing Care

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At times, your loved one may not want to take a bath or get dressed, or they may refuse to take medicine or just not cooperate. A person with Alzheimer’s disease might do this for many reasons. They may feel ashamed when they need help with things or stressed by not being in control. They may not understand what you’re asking them to do.

This can be frustrating, but it’s important to remember that they’re not trying to make things harder for you.

Find Possible Causes

It can help to think about what was happening right before the problem started:

  • Does it happen with personal care, such as bathing or changing?
  • Could they be responding to your emotions, such as anger or frustration in your face or voice?
  • Could they feel hurried or rushed?
  • Are they being asked to do too much?
  • Might they not understand what’s happening or what’s being said?

It could be that they think something’s happening that isn’t (a delusion). For example, do they accuse you of things that aren’t true?

They could also be hungry, thirsty, hot, cold, tired, or in need of the bathroom. People with Alzheimer’s disease may seem to be refusing help when they’re actually sick. They may seem to be weaker, less hungry, or more tired than usual. They won’t seem like their normal self. If you see these signs, talk with their doctor.

Ways to Work With Your Loved One

Once you think you’ve figured out the cause, make a plan and see if it helps. You can try a few simple things right away that might make a difference:

  • Try to distract them. You might go for a walk or have a snack. Once they’ve calmed down, try the activity again.
  • Make sure they aren’t uncomfortable or in need of the bathroom.
  • Speak as softly and as calmly as you can, even if you feel frustrated, angry, or sad. Step away for a few minutes if you can, and take some deep breaths. Your loved one can tell by your voice and body when you feel stressed.
  • If they’re upset, give them space and try again later. Don’t force them to do something they don’t want to do.
  • Give them simple choices if possible.
  • Use short, simple sentences to tell them what they should do and why. Don’t tell them what not to do.
  • Break tasks into simple steps and give instructions that are 1 or 2 steps only. Go slowly and don't rush them. Tell them what you’ll do before you do it, especially before you touch them.
  • Talk to them like an adult, not as if they were a child.

Continued

You may need to try several of these things. If none of them seem to help, talk with a doctor.

If your loved one thinks something’s happening that isn’t, don’t argue with them. You might:

  • Talk to them calmly to comfort them. If they’ll let you, give them a gentle touch.
  • See if you can tell what’s making them think the way they do. It’s often because they see or hear something real and draw an unreal conclusion. For example, they might tell you the police are coming, but that thought was triggered by a car driving by or a neighbor walking on the sidewalk.
  • For some people, it's best to be honest. You might say, “I know you see something, but I don’t see it.” For others, it might help to react to what they think they see or what they think is happening. For instance, if they see snakes, pretend to kill them.
  • Distract them with a favorite activity: listen to music, draw, or look at a photo album.
  • See if you can get them to come away from that place with you.
  • Change the things that are causing them to see or hear things. For example, if they see a face in the kitchen curtains, change the curtains or take them away.

 

If They Lash Out

Sometimes when someone with Alzheimer’s disease doesn’t want help, they may do things like hit, push, curse, or scream. If you can’t calm your loved one down when they get upset, stop what you’re doing and back away.

Keep dangerous things like guns, knives, glass, and sharp or heavy objects out of the house or locked away. Ask someone nearby, like a neighbor, to be ready to help if you need them.

Tell the doctor if they’re often agitated or likely to lash out.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Melinda Ratini, DO, MS on July 18, 2018

Sources

SOURCES:

Alzheimer’s Disease and Associated Disorder: “Undiagnosed Illness and Neuropsychiatric Behaviors in Community-Residing Older Adults with Dementia.”

International Journal of Nursing Studies: “Interventions Used by Nursing Staff Members with Psychogeriatric Patients Resisting Care.”

International Review of Psychiatry: “Motor Subtypes of Delirium: Past, Present and Future.” 

Journal of the American Geriatrics Society: “Nursing Assistants Detect Behavior Changes in Nursing Home Residents that Precede Acute Illness: Development and Validation of an Illness Warning Instrument,” “Predictive Value of Nonspecific Symptoms for Acute Illness in Nursing Home Residents.”

JAMA: The Journal of the American Medical Association: “Nonpharmacologic Management of Behavioral Symptoms in Dementia.”

Journal of the American Medical Directors Association: “Agitation and Resistiveness to Care are Two Separate Behavioral Syndromes of Dementia.”

Journal of Gerontological Nursing: “Assaultive Behavior in Alzheimer's Disease: Identifying Immediate Antecedents During Bathing.”

Mace, N. & Rabins, P. 36 Hour Day: A Family Guide to Caring for People Who Have Alzheimer’s Disease, Related Dementias, and Memory Loss, John’s Hopkins University Press, 1981.

Alzheimer’s Association: “Medication Safety and Alzheimer’s.”

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