Don’t be afraid, I’m not a tiger- strategies for managing a state of alert in people with Dementia

The brain is a complex yet magnificent organ that functions as the hub of our sensations, intellect, and nervous activity. A specific part of the brain called the hypothalamus is responsible for a human’s fight-or-flight response—sometimes referred to as hyperarousal or acute-stress-response.

The hypothalamus protects us by alerting us and responding to dangers without the need for a thought process. It’s an automatic built-in reaction. Different parts of the brain allow us to assess vulnerability and decide on the best course of action. When a brain is affected by dementia, the hypothalamus is not able to effectively evaluate whether something is a threat, or whether an individual is in danger, and so the well-functioning part of the brain assumes it’s at risk and instigates a fight-or-flight response.

Depending on the type of dementia and the speed in which it progresses, people with dementia can repeatedly face the mind-triggered fight-or-flight response for 8-to-12 years—it’s exhausting for those with dementia, and can be hard to watch for those that love and care for them.

Something as simple as misplacing their glasses can lead a person with dementia to feel stressed, anxious, agitated, panicked, or threatened. The acute-stress-response is then activated within their brain. The person may quickly progress through thoughts of ‘I have lost my glasses’ to, ‘Where are my glasses,’ to, ‘You find my glasses,’ and then as their stress-response calms, ‘What glasses?’

When an object such as their glasses are lost, it’s helpful if we can train ourselves to breathe, breathe in, and breathe out. If we show signs of stress, it will likely impact on the person with dementia and inhibit their coping strategies. They may quickly become irritated, panicked or angry, desperately trying to find a way to escape their feelings.

Similarly, it is not uncommon for a person with dementia to repeatedly ask the same question. When being asked the same question multiple times, our coping strategy might be to avoid the question for fear of not knowing how best to answer it time after time.

Being on the receiving end of this can make us tense our bodies, and as a result, we notice a feeling of stress; we over breathe, reducing the level of carbon dioxide in our blood, which, in turn, reduces blood-flow to our brain and increases levels of cortisone in our bodies. We expect a high level of cortisone when being chased by a tiger, but this stress response is unhelpful when caring for someone with dementia.

Those that love and care for people with dementia can seek coping strategies that teach us how to worry less, communicate better, and minimise the risk of us sparking our fight-or-flight in response to dealing with some of the challenging situations that naturally arise when supporting a person with dementia. Slow, calm breathing can work wonders in re-setting our state of mind, helping us to get alongside the person with dementia and support them in managing their responses to perceived stress.

Once we have rebalanced, there are some effective methods in soothing a person with dementia through a stressful situation, some I have included below. Let’s be mindful of the fact that people with dementia are not tigers; we don’t need to go a long way around to avoid them, but instead, we must equip ourselves better to manage our stress-response.

  • Aid communication with your hands and fingers—

Using hand-gestures to guide to the left, for example, or to help explain a shape can be helpful.

  • Don’t be afraid to lean on others for support—

If a  person with dementia is upset or unsettled, and you are running out of ways to calm them, don’t be afraid to let someone else try; a fresh face or different approach is often successful.

  • Give simple directions—

Explain things using single commands, allowing the person with dementia to process what you are saying entirely.

  • Don’t underestimate the power of distraction—

Sometimes a change in focus for the person with dementia can be helpful. Methods such a singing, looking at trees or birds from a window, or sitting down with a warm mug of tea can be useful in calming a state-of-mind.

  • Move to a quiet environment—

If the environment that you are in is active, noisy, or unnerving, consider moving to a quieter, calmer space where there are no competing sounds.

  • Smile or pay a compliment—

We all respond positively to a smile, and a compliment can inevitably alter the way that a person is feeling. You could try ‘Wow, you look great today’, or complement an outfit or their hair.

  • Give them the contact that they crave—

We all want human connection, don’t be afraid to take their hand across the kitchen table or to ask them if they would like a hug.

The brain is responsible for processing sensory information, releasing hormones, and regulating both breathing and blood pressure. While the affected brain cannot be cured of dementia, by following the above methods, we can help in soothing a person with dementia when experiencing acute-stress response; we can help to reduce the intensity of their fight-or-flight.

Evidence suggests that the more we use our brain—diseased or not—the better it functions. Leaf Care supports this suggestion by encouraging activities and daily routines—such as reading, learning, exercising, and interacting—that stimulate nerve cells to the brain.

The mind is remarkable; it decodes information derived from our many senses, smell, touch, sight, taste, and hearing. Living in a care-environment that plans events and activities and that encourages routines that stimulate those senses has to be a good thing.

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