Keep it flexible restructuring caregiving approaches
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Keep it Flexible – Restructuring Caregiving Approaches. Alexandra Morris March 2009. Objectives. Cognitive Changes in PWD Goals of Caregiving Roots of Caregiver Stress Caregiver Cognitive Restructuring Understanding Dynamics of Typical Dementia Related Behavior Challenges

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Keep it flexible restructuring caregiving approaches

Keep it Flexible –Restructuring Caregiving Approaches

Alexandra Morris

March 2009


  • Cognitive Changes in PWD

  • Goals of Caregiving

  • Roots of Caregiver Stress

  • Caregiver Cognitive Restructuring

  • Understanding Dynamics of Typical Dementia Related Behavior Challenges

  • Dementia and Living in the Moment


  • Global, progressive deterioration

    • Memory

    • Language

    • Executive Functioning

    • Behavior

    • Visual/ Spatial

Pet scans normal ad
PET ScansNormal AD

Keep it flexible restructuring caregiving approaches

Manage Behavior: Help

Person Remain Calm

and in Control

Manage Daily Life: Keep

Person Enjoyably Involved

The Main Work of

the Caregiver

Manage Own Well-Being:

Caregiver Self-Care

Manage Resources --

Including Family Resources

for Care

Roots of caregiver stress burden
Roots of Caregiver Stress & Burden

  • Level of functional disability, cognitive impairment, and problem behaviors of PWD

  • Lack of social support

  • Lack of resources: $, respite, time

  • Caregivers own ill-health

  • Lack of caregiver skills

  • Difficulty recognizing the effects of the disease and to accept the effects are real


Caregiver cognitive restructuring in others words letting go
Caregiver Cognitive Restructuring : In Others Words “Letting Go”

If something is bothering you move toward it rather than away from it
If something is bothering you, move toward it rather than away from it

“…feelings like disappointment, embarrassment, irritation, resentment, anger, jealousy, and fear, instead of being bad news, are actually very clear moments that teach us where it is that we’re holding back. They teach us to perk up and lean in when we feel we’d rather collapse and back away. They’re like messengers that show us, with terrifying clarity, exactly where we’re stuck. This very moment is the perfect teacher, and, lucky for us, it’s with us wherever we are.”

Buddhist nun , PemaChodron

Letting go of unhelpful thoughts
Letting Go of Unhelpful Thoughts away from it

  • “Should”ing Yourself: “I should have known better.” “I should do more.” “I shouldn’t get upset.” Should statements can also be directed at others or external events. “He should be able to do that.” “It shouldn’t be this way.”

  • Black and White Thinking: When things do not work out as well as you had hoped, think about the experience as a partial success (shades of grey) and learn from it.

  • Identify the Distortion: Write down your thoughts and look for distortions. i.e. All or nothing thinking, overgeneralization, & labeling

Cognitive dissonance
Cognitive Dissonance away from it

  • Letting go of PWD/ Staying Connected

  • Taking care of PWD/ Taking Care of Self

  • PWD is Gone/ But Not Gone

Understanding dynamics of dementia behavior
Understanding Dynamics away from itof Dementia Behavior

  • Confusion

  • PWD is responding to cues as they understand them.

  • PWD is doing the very best that they can.

Emotions away from it

  • Emotional reaction depends on perception & understanding

  • As confusion increases, emotions become more confused

  • Emotional expressions are messages

  • Difficult behaviors can come from difficulty expressing emotions

Practical examples
Practical Examples away from it

  • Repetitive Questions. Who owns the problem?

  • Other Than Health or Safety Issues:

    Practice the “So What” Principle

  • Bathing, Personal Grooming, “I Won’t Go”

    Take Gentle but Firm Control

Living in the moment

Living in the Moment away from it

Wrinkles should merely indicate where the smiles have been.

Mark Twain

Sit beside me
Sit beside me away from it

  • Life story: example: Talk about their interests in dog shows, baseball, reading the local newspaper or playing a hand of cards or game of dominos

  • Sensory: Hold hands or apply hand lotion

  • Reminisce: What was it like when you were growing up in New Orleans?

  • Appreciate What is All Around You: Nature, Music, Poetry

Keep it flexible restructuring caregiving approaches

The Summer Day away from it

Who made the world?

Who made the swan, and the black bear?

Who made the grasshopper?

This grasshopper, I mean –

this one who has flung herself out of the grass,

the one who is eating sugar out of my hand,

who is moving her jaws back and forth instead of up and down–

who is gazing around with her enormous complicated eyes.

Now she lifts her pale forearms and thoroughly washes her face.

Now she snaps her wings open, and floats away.

I don't know exactly what a prayer is.

I do know how to pay attention, how to fall down

into the grass, how to kneel down in the grass,

how to be idle and blessed, how to stroll through the fields,

which is what I have been doing all day.

Tell me, what else should I have done?

Doesn't everything die at last, and too soon?

Tell me, what is it you plan to do

with your one wild and precious life?

Mary Oliver

Keep it flexible restructuring caregiving approaches

Never refuse to do a kindness unless the act would work great injury to yourself, and never refuse to take a drink- under any circumstances.Mark Twain