Demystifying Resistance to Care in Loved Ones with Dementia

As a caregiver of a loved one with Alzheimer’s disease or another form of dementia, you work hard to constantly learn new ways of offering support and assistance with their daily struggles and challenges. But what do you do when they refuse your help? The best laid plans of a caregiver can derail quickly when your loved one resists care or refuses to cooperate.

As frustrating as it is for a caregiver, loved one’s resistance always has a reason behind it. Once you understand the cause of their behavior, then you can begin to work around it in order to bring about the best care results. Sometimes, the solution is as simple as coming back to a task later. Or, it can be complicated by severe symptoms of their disease. Regardless, once you demystify their resistance, you’ll find that the path to cooperative dementia care becomes much clearer.

Reasons Those with Dementia Resist and Refuse Help

When older adults without memory problems refuse care or assistance, we can usually infer their behavior is caused by embarrassment, fear of losing independence, guilt from feeling like a burden or simple stubbornness. Adding dementia to the mix, and the loss of cognitive abilities it causes, the reasons for resistive behavior become more complex. Experts from the Social Care Institute for Excellence summarize several reasons why dementia causes loved ones to refuse care, including:

• Confusion – Your loved one doesn’t understand what you are asking them to do or why they need to do it. Their dementia may cause them to misinterpret or misunderstand your requests or make it hard to think logically.

• Changes in Preferences or Routine – What you’re asking your loved one to do doesn’t fit with what they would normally do on their own. For example, your loved one might resist your suggestion to go to bed at 9 p.m. when they normally stay up late.

• Sense of Control – Your loved one feels as though your interference is threatening their independence, or they feel as if they are being bossed around. Or, their dementia makes them feel out of control of their own mind, and they are refusing to cooperate as a way of maintaining control however they can.

• Environmental Perception – Your loved one is overwhelmed by sensory information (e.g., too loud or too much noise, harsh lighting, movement) or the sensory changes caused by dementia make it difficult to see things as they are. For example, they might perceive water from the shower head to be falling pieces of shattered glass.

• Depression – Poor mental health is common in loved ones with dementia. Depression makes it hard for someone to accomplish tasks, feel excited or maintain energy, so your loved one may refuse to do something because they feel miserable.

• Distrust – Your loved one’s dementia symptoms cause them to forget who you are or why you’re asking them to do something. Hallucinations, delusions and suspicion are all common symptoms of dementia, and these could make your loved one defensive when you approach them.

In many cases, your loved one’s dementia won’t allow them to explain the reason for their resistance. They may refuse to eat because they have trouble using utensils and the process is frustrating. They might resist taking medication because of a side effect they don’t tell you about. Determining the cause of your loved one’s challenging behavior will often require you to be open-minded and creative in your problem-solving.

Tips for Encouraging Cooperation

Depending on the situation and how determined your loved one is, you can encourage them to accept the assistance and care you offer. Consider the following suggestions:

• Stay Calm and Positive – Loved ones with dementia easily pick up on and respond to the body language and stress of their caregiver. When they refuse help, remain calm and speak clearly as you explain the benefits of what you are asking them to do.

• Be Patient – If your loved one is confused about your request, you may have to speak slower or repeat what you’ve said. Try speaking in short, simple sentences that are easy for those with dementia to understand.

• Promote Independence – If your loved one is resisting as a response to their loss of dignity or privacy, reassure them that you’re only trying to help them so they can continue to do things on their own. For example, if they need help bathing, offer to help wash their back and their hair while allowing them to wash the rest of their body.

• Show Respect – In all you do, be respectful to your loved one. They will be more likely to cooperate if they feel respected than if they feel belittled or bullied because of their dementia.

• Be Flexible – Adjust your plans if you need to. Your loved one may be resisting because of bad timing. If they are adamant about refusing a task, try again later when they might be feeling better.

Another important strategy for dealing with your loved one’s resistance is to reassess your perspective. When your loved one refuses to comply, ask yourself these three questions: What will happen if my loved one doesn’t cooperate right now? Will they be harmed? Will others be at risk? If immediate health risks are absent, perhaps your expectations for compliance are unreasonable. In the case where your loved one would rather eat oatmeal for dinner, your insistence on fish and vegetables may be unnecessary. Stay humble in your caregiving, and always evaluate your actions according to the best interests of your loved one.

Dignified Memory Care and Support

If you could use some guidance and support for caring for a loved one and managing difficult behaviors such as resistance and refusals, contact the dementia care experts at Tuscan Gardens. Our community offers dignified, compassionate memory care for loved ones with dementia and other cognitive impairments. Our devoted care team understands the challenges you face as a caregiver, and we’re glad to lend a hand to make life easier for you and your loved one.