When memory is a problem, many people feel challenged in social situations, and tend to avoid socialising. Your relative or friend will feel more comfortable with some people than others, depending on how people react to their memory difficulties. For them, keeping track in conversation can be a challenge, and talking in smaller groups or even just with one other person is often easier. At large noisy gatherings, arrange for different people to take turns spending time with the person in a quieter location, having a one-to-one conversation. Encourage your family member or friend to wear their glasses or hearing aids, if they use them. Avoid asking questions that rely on memory, such as, ‘What did you do yesterday?’ Instead, keep conversation in the here and now. If a person asks you the same question or tells you the same thing repeatedly, it may be best to try distracting them with another topic of conversation, rather than pointing out to them that they have already asked or said the same thing before.
You might need to talk more slowly and allow extra time for people with memory difficulties to respond. If they have difficulty finding the word that they want to say, you can help out by getting them to describe what they mean in other words, or asking them to show you or point to the thing they are talking about. If finding words is a regular problem, you might want to talk to each other about how it suits you both to handle this situation. Some people like to be told the word, whereas others like to try and think of the word themselves. People with memory difficulties can find it easier to socialise if they are doing things that don’t involve as much conversation, such as watching sport, a film or a show, listening to singing or music, going for a walk or attending a group exercise session.
Play to the person’s strengths
You might find that a relative or friend with memory difficulties talks a lot about things that happened in their past. These old memories are much stronger than memories of things that have happened recently (see Chapter 1 for more information about ‘lifetime memories’). It’s a good idea to make the most of these stronger memories, and help a person ‘play to their strengths’ to enhance their self-esteem and confidence. Encourage your family member or friend to keep up activities based on previous interests—these could be cooking, playing a musical instrument, gardening, playing golf, sewing, home maintenance, knitting, dancing, singing in a choir or painting. You may even want to ask them to teach you or others some of their well-learned skills.
Dad has pruned my roses with me every winter since I have had my own garden. He might have a few difficulties remembering where he has put things, and what people have said to him, but he is still an expert rose pruner! Each year I ask him to teach me more about pruning—it’s a complicated process that he has learned over many years of experience.
Pam, 54
Mum was diagnosed with Alzheimer’s disease a few months ago, but she can still play the piano. I’ve been tidying up our lounge room so that she can get to the piano easily. It brings us all so much joy when she plays, and she seems more relaxed when she is at the piano than she does at any other time.
Bruce, 51
I love watching Mum bake with my children, teaching them the same recipes that she taught me all those years ago. She radiates warmth and confidence, and delights in watching the kids tasting the goodies that they bake.
Mihiri, 55
Conversation with a person who has memory difficulties tends to flow more freely if the focus is on older memories. You can trigger reminiscence by putting on familiar music, or getting out some well-loved memorabilia or old photos. Some people like to research their family tree, or work on writing stories from their past that will be valued by generations to come.
For Dad’s 70th we collected photos and had them made into a large album that we keep on the coffee table. There are photos from almost every year of his life. He loves it, and often looks through it with the grandchildren, telling them stories from when he was younger. For Christmas I thought I would ask the older grandchildren to write down some of these stories, and we could add them to the photo album.
Eve, 49
Everyday memory strategies
We all use memory strategies in our own ways throughout our lives. When our memory becomes inefficient, we usually become more reliant on reminder systems to serve as a back-up for our memory and make us feel more confident that we will remember important information. These systems reduce the demand on memory. The aim of developing everyday memory strategies for a person with memory difficulties is to promote their continued independence.
It may be difficult to know how to talk about memory strategies with your friend or family member. It is important that they do not feel patronised, ‘put down’ or embarrassed. You could empower them by saying that they have already adapted positively to many aspects of their memory problem. You could draw attention to any reminder systems that the person is already using, and highlight how useful these strategies have been. You can also share the techniques that you find useful as a way of introducing new options for better memory management. Perhaps read through some of the suggestions for strategies in this book together to see if any ideas appeal to your relative or friend.
Deidre introduced systems to support her husband John’s memory whilst at the same time showing that she values him. She has always used a notebook for reminders, and she encouraged John to use one too, saying that it is normal to use a notebook, because she has done so for most of her life. Each day she shows John her own ‘to do’ list, and asks him to write things into his notebook, like she does. She also fills out a dosette box for both her and John, so he doesn’t feel that he is alone in needing a reminder system for his medication. She gently guides him at the same time as appreciating his strengths. She regularly praises him for having built their house on his own, and for being such a good listener. John feels valued for his strengths, and his weaknesses are normalised and minimised.
Anne
The approach you use will be strongly influenced by the nature of your existing relationship, and the demands on your family member or friend’s memory. You need to find out the typical things that he or she tends to forget, and develop strategies which will suit those specific situations, and work for that person.
Mandula was often confused about which night she would go to each adult child’s house for dinner. Her family didn’t want to talk directly to her about this because they thought she would take offence. In the end Mandula’s children worked out a good way to get around the problem. They devised a weekly routine, so that dinner at each particular house was on a particular day of the week: Tuesday night was Suzie’s house, and Thursday night was Trevor’s house. This lessened the demand on their mother’s memory, and achieved the desired result in a subtle and respectful way.
Anne
We all have different preferences when it comes to reminder systems. Some people like to have appointments written on a digital or paper-based calendar, while others prefer that someone reminds them about the appointment the day before. When someone’s memory is unreliable, assume that they will need a reminder, and develop a system that works for everyone.
I don’t think Dad likes it when I remind him about things he forgets, like appointments and remembering to bring certain things with him. I’ve found that an indirect approach works well. I phone him and work the reminder into the conversation. I might say, ‘I am looking forward to our lunch at twelve o’clock today’, or, ‘I want to check if I did ask you to bring …?’ These tactful reminders have helped to safeguard the quality of our relationship.
Miki, 61
When I arrange something with Mum over the phone, I tell her to write it down on her calendar while I am talking to her. I say, ‘Okay, Mum, go to your calendar now, find Thursday 12 October, and now write down family dinner for Callum’s birthday at Rhonda’s house at 7 p.m.’ I have to get her to write it down while I am talking to her because she will forget to write it down after we have finished talking on the phone.
Rhonda, 57
&n
bsp; Last week I didn’t write down about seeing a film with my friends. I forgot to go and they called me to ask where I was. My friend asked me what she could do to help me remember for next time. I told her to remind me to write it in on my calendar and she said she will also call me the day before to remind me.
Eleanor, 69, has early Alzheimer’s disease
I write things down, but I forget to look at them.
Jake, 76, has vascular dementia
Jake may have never used written reminders when he was younger. It can be hard to develop a new routine. He will probably need help with setting up and maintaining his reminder system, and encouragement to check his notes at regular intervals during the day. People are more likely to look at their reminder notes if the notes are put in a visible location, such as the kitchen bench. This spot can serve as the ‘memory centre’ in the house. (See Chapter 8 for information about setting up a memory centre.)
If you leave a reminder note, make sure that what you write is specific. For example, a note saying ‘back in 5 minutes’ does not provide enough information. Write today’s day and date on the note, where you are going, and the time that you expect to be back. You could even add your phone number so you can be called easily if necessary.
On our recent holiday my wife, Ilsa, didn’t want to come on an early morning tour, so I planned to go on my own. She knew about the tour, as we had discussed it the day before. I left at 5.30 a.m. and said goodbye to her, but she was half asleep. When I got back a few hours later, she was all upset, and said, ‘I didn’t know where you were.’ Next time, I’ll leave a note for her, saying where I am and when I’ll be back.
Johan, 72
Setting up a ‘communication book’ or a shared diary can be helpful, especially when people live on their own. The idea is to have information shared and updated by family and friends. This shared information system can be digital or paper-based, and enables a team-based approach to maintaining a reminder system.
Written reminders can be used for remembering a whole range of things. Some people like to have their cupboards labelled so they know what is in them; others like to have step-by-step instructions stuck on household appliances, such as the television remote control or a new microwave oven, so that they can be sure they will use the appliance correctly.
Remembering to take medications can be a challenge when a person has memory difficulties, and it may take time to develop a medication reminder system that works for your relative or friend. You could try a combination of the following ideas:
• Keep a list of your relative or friend’s daily medication regime somewhere accessible. You could also keep an updated list on a digital shared communication app.
• Keep the medication organised and in a visible location. People often have their own personalised methods of organising their tablets that they have used for many years. Some like to leave tablets in their original boxes, others have little jars or containers that they sort them into. Others prefer to use a purchased dosette box, or get the pharmacist to make up a personalised blister pack containing the tablets separated into labelled compartments for specific times of the day.
• Some people keep their tablets stored near something else as a reminder—for example, next to your toothpaste if you have to take it in the morning and at night, or on the kitchen bench if tablets are to be taken with meals.
• Most people with memory difficulties require additional reminders to ensure that they have taken their medication. Audio and visual reminders can be programmed into smartphones, or you can phone your relative each day to remind them to take their tablets. Another option is to arrange for a nurse to visit each day to dispense the medication.
There are an increasing number of technological devices being created to assist people who have memory difficulties. While younger adults are usually familiar with new technology, many older adults who have not grown up with such devices can find them confronting. Be extra patient, and adopt a trial-and-error approach when introducing new technological aids to your relative or friend with memory problems.
My wife, Parveen, is 68 and has been diagnosed with early dementia. She has always been one to lose things, especially her keys, but now she loses them at least twice a day. As a birthday present, our well-meaning son gave her a location tracking device. He attached the device to her keys and programmed it to sound an alarm every time her keys were more than a certain distance from her wallet. He was upset when he found out that his mother had taken the device off her keys. Parveen said she removed it because she didn’t like the noise it made. I noticed that she seemed embarrassed when the alarm sounded when we were in company, and she couldn’t remember how to turn the noise off. I also think the alarm kept reminding her about her memory problem, and she didn’t like that.
Saji, 71
My wife, Sylvia, and I have been using smartphones for several years, but we only use them for phone calls and texting. Our son said that we could set up a calendar reminder system for Sylvia to remember her medical appointments, but I decided to keep things familiar for her, and send her text messages as reminders instead. This involves more work on my part, but it means Sylvia doesn’t have to try to learn a new system, which I think would be difficult for her now that her memory is giving her so much trouble.
Warwick, 76
The thing that bothers my mother the most about her memory at the moment is that she forgets what day it is. We came up with a simple solution for this. Whenever she wants to know the day, she quickly looks at her phone, and there it is for her, along with the date, month and time of day!
Wang, 58
When memory becomes a problem, many people wonder if memory exercises will help to build up the memory function again.
I have always done the family finances. Should I get him to start doing them now to stimulate his memory?
Leona, 78
Should we teach Dad how to do Sudoku puzzles?
William, 55
Our brains need stimulation and we can feel good when we challenge ourselves. When someone has memory problems related to a memory illness, such as dementia, it is important to get the balance right when it comes to learning new things. If your dad has always enjoyed Sudoku puzzles and he is not feeling overwhelmed by them, then they are to be encouraged. On the other hand, if trying to learn how to do these puzzles makes him feel anxious, then it would be better to find a different activity for providing stimulation. It is important to stay mentally stimulated, but we have to be careful not to put people off by making the activities too confronting or too difficult.
My husband, Viktor, is 71, and last month he was diagnosed with Alzheimer’s disease. He only retired from his work as a lawyer a year ago. I think he forgets things because he’s not paying attention, and I’m worried that he’s not using his brain enough. In his job he used to keep his mind active all the time, and I think he needs to try harder to pay attention, and do some brain training to get his memory going again.
Iris, 69
Memory stimulation exercises and apps are readily available, and many people enjoy completing regular sessions of ‘brain training’ (Chapter 5 has more information about brain stimulation). When a person has memory loss related to changes in the brain from dementia, like Viktor, mental stimulation can involve more effort than it would have done prior to the dementia. Viktor may be more comfortable taking part in mentally stimulating activities that have already been part of his routine, such as attending a music concert, playing golf or spending time with his grandchildren. Activities that involve doing exercise and spending time with others give the added bonus of social and physical stimulation.
Extra support when life gets complicated
Memory problems often first become noticeable when people are trying to handle something that is unfamiliar, like arranging an overseas holiday or moving house. You might notice that your relative or friend with memory difficulties struggles with managing complex jobs, such as overseeing their financ
ial affairs like they used to, and you need to provide assistance with these tasks, or take them on yourself.
Memory thrives on routine, but life is complex, and when you have a memory illness it can be difficult to manage situations that are out of your usual routine. Memory difficulties can be exaggerated when a person is physically unwell, or has physical discomfort or pain. Anxiety, distress and depression can lead to increased memory inefficiency (see Chapter 8 for more information about anxiety and depression), as can fatigue, excess alcohol and some medications. It is important to arrange a medical review if you think your relative has additional physical or mental health issues. Organising and attending a big family event, going on holiday, being admitted to hospital or even attending a medical appointment can all provide a challenge. The demand on memory becomes much heavier at these times, and you might notice that your relative seems more confused, and you need to provide more support than usual.
At various times of our lives we have to manage the often complex medical system. It is usually not just one medical appointment that we need to attend, but several, including blood tests and X-rays. When we get on this medical merry-go-round, it is often at a time when we are stressed or unwell. Add to that the complication of a memory illness, and you have a challenge on your hands! If you can go to the appointment with your family member or friend, then you will be able to provide the doctor with information that might otherwise be forgotten. It also helps if you:
• Write the appointment details down on your relative’s calendar. Include the name of the health professional and their role.
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