Broken Record Syndrome

By Kelly K. James

Kelly K. James is a longtime freelancer who covers health, fitness and wellness topics from Downers Grove, where she lives with her family.

www.kellykjames.net

How to gently redirect the conversation when someone has dementia

“Where do you live?”

“Did you eat lunch?”

“How are the kids?”

If your loved one has dementia, you likely hear these sorts of questions, repeated over and over in an endless loop. People with dementia commonly repeat behaviors, known as perseveration — the medical term for asking the same questions or performing the same behaviors, for no apparent reason.

Downers Grove resident Brenda Hodgson experienced this with her mom, Betty Tenorio, when she had Alzheimer’s. “She would ask repeatedly, ‘Where is my cell phone?’, or ‘Where is my purse?’” Hodgson says. Tenorio also asked about people, like Hodgson’s husband and children, over and over without realizing she was doing so.

Repetitive speech is a symptom of dementia, which can be caused by Alzheimer’s disease, Parkinson’s disease, stroke, or other conditions.

“Simply put, dementia is a set of symptoms — it’s not really the diagnosis,” says Melanie Adams, senior director of education and community volunteers at the Alzheimer’s Association’s Illinois chapter. “If you have dementia, you’re having changes in the way you’re thinking and behaving, and in your memory.”

Connect, then redirect

While caregiving comes with many challenges, repetitive questioning “is one of the things that wears down the caregiver more than anything else,” says Beverly Sanborn, social worker and vice president of program development at Belmont Village Senior Living. “It’s the constant questioning, especially when it comes at you every five minutes.”

However, the person asking isn’t aware of the repetition. They’re just looking for answers. “It is completely new to them. You really have to answer it as if the question is new to you rather than getting exasperated. But we’re all human, and we all have our limits,” Sanborn says.

Try to respond in a way that comforts the person and minimizes their frustration. “Focus on the feelings and not the facts,” Adams says. “Say something like, ‘I know that feeling — it’s awful. I hate it when I misplace my purse.’”

Pay attention to the person’s emotions. “Some people move right to the redirect, but you have to reassure the person that you feel what they’re saying,” Adams says.

Body language helps, too. Many people with dementia experience sensory overload. “They feel anxious or overloaded or crabby,” Adams says. “So you want to sit in front of them and give good eye contact.”

The best thing to do is before that [repetitive questioning] starts, have a topic. Instead of answering the question, interject with a question of your own.”

You may hold the person’s hand or rub a shoulder as you reassure them. Then, you can redirect them by saying something like, “We haven’t been shopping for a while. Would you like to go shopping this week?” The idea: to connect and show empathy before you redirect the conversation.

Stay patient, and seek support

As you navigate these conversations, try not to get visibly frustrated. “All it will do is produce a catastrophic reaction,” Sanborn says.

Have a favorite topic to bring up to change the subject. Knowing what your loved one likes to reminisce about — a much-beloved relative, favorite car, their childhood on a farm — is key. When you know the person’s pattern, you can more easily interject.

“The best thing to do is before that [repetitive questioning] starts, have a topic. Instead of answering the question, interject with a question of your own.”

Sometimes you want to give the gift of a therapeutic story or white lie, Adams says. “If the person’s husband is in hospice, dying, and she’s asking about him every few hours, how cruel would that be to make her go through that pain over and over?”

Instead, you might acknowledge and reassure her by saying something kind about her husband before redirecting the conversation.

Finally, don’t underestimate the value of support. Hodgson says she and her family attended dementia education classes that helped them navigate caregiving.

“It took a while to get there because instinctively you want to correct them and point out the obvious, but you’re not dealing with the same person you thought you were,” she says. “You need to have patience — and remember that the person isn’t the same as before.”

They may have changed, but your love doesn’t have to.