BEHAVIOR MODIFICATION

by Jacqueline Marcell

How Do I Handle My Elderly Loved One Who:

Set reasonable but strict limits of when you can be available and when you can’t. Never allow yourself to be manipulated. If you never give in to demands, your parent will learn that moaning and groaning doesn’t work and will eventually stop trying. If you give in to extreme begging, they will continue to push harder and harder, knowing that you will eventually cave in.

Always use an answering machine to screen your calls and never pick up and respond if your parent is being nasty or negative. When they ask for your help in a more reasonable way, respond positively to reinforce the good behavior, telling them how proud of them you are, and how much you appreciate the way they have approached you this time. Reinforce good behavior.

Getting your loved one involved in activities will be the best thing for both of you. Call the nearest “Area Agency on Aging” to find the Senior Centers and Senior Day Care Centers nearby, and learn about enrollment and schedules. It may take a lot of coaxing and compassion to get your parent to step out of their comfort zone of being at home and to consent to go to Day Care where they don’t know anyone. Remember that any type of change can be extremely frightening for elders. The Day Care professionals are very familiar with this problem and will help you. Ask one of the administrators to call and talk to your parent a few times to develop a relationship before going.

Take your parent out for lunch and when they are in a good mood, casually stop by the Day Care to say hello to that administrator. Have an appointment set up so you can take a tour, meet the other seniors and staff, and reduce some of the anxiety. Encourage your loved one to attend no matter how much they protest. They may hate it at first, saying that everyone is too old, it’s too much effort, or they just don’t like it-but don’t give up. Eventually they’ll make new friends and look forward to all the activities. The pressure on you to entertain them will be drastically reduced.

If they cannot physically attend a Senior Center, you can hire a companion to come in and visit with them on a regular basis. This person can read to them, watch a movie, take them out for a walk or a ride, play a game, or talk about the old days, etc.

Call your local public libraries to find out about their volunteer programs. These volunteers can be very helpful by bringing printed books, audio books, movies and travel videos to the home regularly. These deliveries also provide a visitor whom your parent may enjoy talking with. Call the Eldercare Locator (800-677-1116) to find other programs for the elderly in your area.

Focus on the positive things you can do for your parent and don’t emphasize the things that you can’t. If you continue to eventually give in to their extreme demands these behaviors will get worse. Assertively set your boundaries of what you will and won’t do ahead of time and stand firm, giving sympathy and empathy where appropriate. Don’t let your better judgment be swayed by your sense of responsibility. If their demand strikes you as illogical or irrational, BIG FLAG-it is! Call the Alzheimer’s Association to find out where your loved one can be tested for dementia. If the bad behavior stops, give positive reinforcement by acknowledging their ability to control their conduct. You may want to give a specific reward to further encourage them. If the negative behavior continues, give three warnings, use the silent treatment, then walk away.

First, use empathy and sympathy within reasonable limits. Your parent may just need a hug or kiss at the moment and be too embarrassed to ask for the affection they crave. Instead of arguing, agree with them about how terrible something is for a short moaning session. Practice using positive phrases like, “I’m sorry you’re feeling so lousy... What can we do to cheer you up?... Let’s put on some uplifting music and talk about good things.” Resolve within yourself not to let their negative energy and insulting comments get to you. Focus on anything positive that they say, redirecting their attention to change the subject.

If the negativity continues after you’ve tried repeatedly to change the subject, tell them that you will not engage in any more negative conversation for the day. Their “negativity quotient” is used up. If you allow it to go on, giving too much sympathy, you are teaching them that the more they complain, the more attention they will get. Don’t be an enabler.

Never respond positively to any negative behavior. For example, if your loved one screams at you to hand them something, do not do it until you are asked properly. Never respond to any demanding orders, telling them that you will be happy to accommodate their request if asked nicely. If the bad behavior continues, give three warnings, use the silent treatment, and then walk away.

Set a time limit for these health “complaint” sessions. Listen, be sympathetic, and offer solutions. Then, declare the complaint time over and divert their attention to a different topic or activity. If the moaning and groaning doesn’t stop, give three warnings, use the silent treatment, then walk away.

Try a simple test to see if their symptoms might be psychosomatic or just for attention. The next time they complain of a minor ache or pain, quickly put a vitamin pill in their mouth, pretending the pill is an aspirin. See if the mysterious pain immediately goes away. Don’t tell them that their pains are not real, but privately let their doctor know what you discover.

Together, write down their symptoms in order of what bothers them the most. When you go to the doctor, see which symptoms they actually end up complaining about. Have the doctor address each issue, take notes, and cross each item off the list as they are reviewed. If your loved one is embarrassed to complain to the doctor, take charge and make sure the doctor knows all symptoms including: sleep, appetite, energy changes, memory problems, alterations in mood, inability to do basic things, incontinence, depression, anxiety and anger. Speak with the doctor in private if necessary.

Frequently bring all medications (prescriptions and all over the counter vitamins, etc.) to the doctor’s to make sure there are no interactions. When a new medicine is prescribed, ask if any specific foods and alcohol should be avoided while taking this drug. Should this drug be taken with or without food? Should this drug be taken at a certain time of day? Is it all right to continue normal activities, such as driving? All drugs have side effects, and can interact with each other and produce further complications.

Get a lock box for their medications if you have any suspicions that they are not being taking appropriately. Hide a spare key someplace in their home in case you forget or lose your key, or if someone else has to give the medications if you cannot get there.

Bizarre or unusual behavior that is out of character is one of the first signs of dementia. Be aware and don’t dismiss these early warnings signals. Seeking help at this early stage will greatly help your loved one and reduce your frustrations.

You can still set your limits of acceptable behavior. Correct them every time inappropriate behavior occurs and when foul or embarrassing language is used. Never resort to bad language yourself as that just perpetuates it. Keep your temper under control, or walk away until you can regain it.

Role-playing can be used to teach appropriate behavior. Make it simple with specific dialogue showing them the proper way to ask for your help. “I’d appreciate it if you could hand me the television remote... I’m glad you came to see me today... Could I please have a glass of milk?”

If you are being verbally abused (“I hate you... I never want to see you again.”) never respond. Don’t let your emotions get the better of you. Change your perception and don’t escalate the problem into a screaming match or expect a rational discussion. When you are being called offensive names, do not respond. Acknowledge them only when you are being called by you correct name. Give three warnings, use the silent treatment, walk away immediately if the behavior does not stop.

Don’t make light of it, argue, or tell them that their fears are irrational. Calmly acknowledge how awful it must be to feel that way and assure them you don’t think they are crazy. Make them feel safe, loved, and assured of your continued support. Report these symptoms with examples to their doctor. If you get an unconcerned attitude from their doctor that it’s just part of the aging process, insist on taking them to a geriatric psychiatrist for evaluation. With the proper medication, these fears may be greatly reduced.

Call the Alzheimer’s Association and find out where you can take your loved one for evaluation right away. They are the experts at this-don’t waste time with doctors who are not. Inquire about the drugs: Aricept, Exelon and Reminyl, and Vitamin E therapy.

Display large “direction” signs with easy-to-follow instructions. “Brush Your Teeth... Turn off Stove... Keep Door Locked.” Get a large wall calendar so that they can check off the days. To help insure that medications are not forgotten or doubled, make a chart that they can check off each time they take their pills. An erasable board can work well too. It will help them remember people if you label pictures of everyone they know and put them up where they will see them. (The larger the better.) For their telephone, get one that has one-button dialing with a photo and name of the person next to the number. The use of lists, tape recorders, crossword puzzles, trivia and computer games can help exercise the memory also.

These may all be efforts to get attention and sympathy. Understand that these actions are desperate attempts to hold onto control or a need for assurance of your continued support. They may also be craving physical affection and don’t know how to ask for it. When you recognize an obvious lie, carefully evaluate the motive behind it. Don’t get hooked into confronting them on unimportant issues. Instead, switch your perspective and let these tall tales roll off your back. Even though they are exasperating, you don’t want to become a victim yourself. It takes two to play a game, so just don’t play it.

There are times, however, when some of their attempts to control the situation cannot be overlooked. When these behaviors are constant and disruptive try behavior modification. Never respond with positive action to what you know is a manipulative lie or the lying will persist. Calmly let them know that you’re aware that they are just trying to get more attention and that you will not let it upset you. Set strict limits of what you will and won’t tolerate and let them know that you cannot be manipulated.

This could be an ulterior motive to get more attention, or it may be a sign of depression. Carefully evaluate what’s going on. Drop in unexpectedly a few times and observe their level of activity. If you suspect depression, ask their doctor to consider prescribing an anti-depressant. There is such a wide range of effective medications available today that there may be no need for them to suffer.

Then, get your parent enrolled in Senior Day Care to create a life outside of lying in bed all day. They have to have something to look forward to, friends to see, varied activities to do. You cannot supply all this stimulation yourself day after day. Go with them a few times, have lunch and introduce them to everyone to encourage the making of new friends. Additionally, many centers have a shuttle service to pick them up and bring them home.

If your parent is a “Sundowner” who wants to sleep all day and be up all night, there are a few things you can do to alter this pattern. In the morning, open all the windows and drapes to let in fresh air and sunlight; make lots of noise by turning on the radio and television, running the vacuum cleaner, dishwasher, etc.; plan activities, exercise and visitors. Getting an hour or two of sunlight daily can help regulate their circadian rhythm. Ask your doctor about Melatonin that may help them sleep at night. Make sure they are not getting any caffeine from coffee or chocolate in the evening. Also, have their doctor regularly review all of their medications to see if any may be causing daytime drowsiness. If possible, switch them to be taken at night.

If you arrive to find their home in a deplorable condition, don’t rush to clean it. First, call Adult Protective Services and have them “drop in” to examine the condition of the home. Their report will automatically go to the local police department, so you will be visited by a police officer soon. This puts you on record with them in case you need to prove that your parent can no longer take proper care of things. Have APS say that the home must be cleaned immediately for health and safety reasons. This way, you aren’t the bad guy making changes your loved one doesn’t want.

Avoid telling them a definite time of when you will do something, or when something will happen. Give a broad window, be vague, and say that you will try to handle their request soon. Never commit to a specific time because they may tend to obsess over it. This way, it will be a pleasant thing to tell them that you have accomplished what they asked for, rather than disappointing them that you didn’t have time. Don’t lock yourself into a time frame that you may not be able to meet. You will build their trust if you don’t have to disappoint them.

Avoid responding with a flat-out “No” to their request. Let them know that you have considered the issue and understand their viewpoint, but explain that it’s not a good idea right now. Indicate that maybe next time, or at a later date, you will be able to handle their request. Cheerfully distract their attention to something else more positive. Most of the time, they will completely forget about this request and have a different one by the next day.

Just like some children, the more some elders are told “No” they can’t do something, the more they will keep fighting to do it. It can become a test of wills for power and control. In some instances, it may be best to just let them have their way (if there is no danger). Usually they will come to the conclusion on their own that it really wasn’t such a good idea after all.