Today, we are going to be talking about what to do when your loved one stops recognizing you. We’ll discuss at what stage someone with Alzheimer’s typically forgets who their loved ones are, as well as methods to prompt memory, connect without memory, and communicate. Now let’s move on to the rest of the show.
According to the National Institute on Aging, Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks. The disease begins making changes in the brain years before symptoms show. Over many years, the disease steals pieces of a person, but when will your loved one no longer recognize you? Let’s take a look at the seven stages of Alzheimer’s to find out.
During stage one, someone with Alzheimer’s will have no impairment due to the disease and will only be diagnosed through brain scans. Stages two and three are where symptoms begin to show. Someone with Alzheimer’s will begin to have mild cognitive decline. They may forget where they put the keys or struggle with paying their bills. During these first three stages, the symptoms all appear as the normal signs of aging, and many people go undiagnosed.
Stage four is where many are diagnosed. During this stage, someone with dementia will experience increased forgetfulness and may have difficulties in social situations. Those close to someone with dementia can usually see the early signs of dementia during this stage, as well. Your loved one may forget your name during this stage, but they can usually recall it after some time. They normally recognize you even if they can’t remember your name.
Stage five shows a moderately severe cognitive decline. Individuals in this stage often need help doing daily living activities, such as cooking, cleaning, and even possibly using the bathroom. At this stage, many people with dementia are unable to live on their own and need some level of care throughout the day and night. During this stage, your loved one will need help with daily living activities, but Alzheimer’s.net says that they will still maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.
According to Seniorlink, stage six marks a period in which a person requires substantial assistance to carry out day-to-day activities. They may have little memory of recent events and forget the names of close friends or family members. Many people in stage six have limited memory of their earlier lives and will also have difficulty completing tasks or successfully exhibiting cognitive skills such as counting backward from 10.
People in stage six may also begin to experience incontinence of bowel or bladder, and speech ability is often diminished. Significant personality changes may also be noticeable at this stage, as individuals may suffer from delusions, anxiety, or agitation.
Alzheimer’s.net tells us that stage seven is the final stage of Alzheimer’s. Because the disease is a terminal illness, people in stage seven are nearing death, and will ultimately succumb to the disease. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living.
For more information about the seven stages of Alzheimer’s, you can listen to our recent series on the Seven Stages. Don’t have time for all 5 episodes? We also released a recap episode on the Seven Stages of Alzheimer’s, as well. You can find it on our website, our Dementia and Alzheimer’s playlist on our Official YouTube channel, and wherever you get your podcasts.
It isn’t until the last three stages that your loved one will have trouble recognizing you. If your loved one is in the early stages of the disease, now is the perfect time to learn best practices and techniques to communicate and connect with your loved one. If your loved one is in the later stages, now is still the perfect time to learn, too! It’s never too late to try new ways to connect with your loved one. Your loved one can sense that you are making an effort to connect with them and feel the sentiments behind it even if they do not recognize you.
VeryWell Health says that sometimes people write off visiting loved ones with dementia by saying that since they won’t remember the visit a few minutes from now, it’s pointless to visit.
Research has demonstrated that it’s not just the memory that matters here; it’s also the emotion created by a positive visit. What’s important to note is that the positive emotion from an encouraging and supportive visit can last much longer than the specific memory of that visit.
You may have impacted that person’s whole day by changing her feelings and behavior. Although she might not be able to recall that you visited her, the feelings you created in her can change how she interacts with others and improve her mood.
Next time you think it doesn’t matter, think again. The benefit of your visit might last long after you’ve gone.
Your loved one may become confused at times, which as you know, is to be expected with this disease. According to Dementia UK, some people with dementia appear to ‘travel back in time’, reliving memories from when they were younger. They might expect grown-up children to be small again, or expect their parents to still be alive, or even revert back in their mind to previous marriages or relationships. Whenever your loved one is experiencing problems with their memory, there are a few memory cues you can provide to help them back into the present.
Dementia UK suggests putting up photos around the house of important times you were together, such as weddings, birthdays, and children’s parties. You should show the progression of time in these photos, so that they show a spouse or partner when young, but also throughout time and how they appear now. You can also keep a photo album on display with the photos clearly marked with people’s names, the year, and the event in chronological order.
What you wear can be a clue as to who you are in relation to your loved one. You can wear clothes around the house that your loved one would associate with you; these could include a favorite item of clothing, like a flannel or a piece of jewelry, or popular styles from when you were younger.
You should also make use of the other senses. Sight on its own can be a good enough memory cue, but combining it with the other senses can be an even greater help to your loved one. If you have a signature scent, such as an aftershave, perfume, or even deodorant, wear it around your loved one. Encourage your loved one to wear their favorite scents, as well. Often the sense of smell can evoke positive memories when words cannot.
Similarly, cooking aromatic foods your loved one likes can bring back memories. Cooking together, as long as you are taking all the necessary safety precautions, can be a fun activity to do together and if it is something you have regularly done together in the past, it can be a great example of a creative method of prompting your loved one’s memory.
Listening to music or watching a favorite movie or tv show together can also help your loved one remember who you are. It is important to note that you should not try to have a conversation while listening to music or watching television. It is hard for your loved one to concentrate on one thing and multitasking can confuse them more.
If your loved one doesn’t recognize you, no matter if you are coming for a visit or if they live with you full-time, do not ask them if they know who you are. This question will make them uncomfortable and they may also feel like you are belittling them if they don’t know the answer.
Whenever your loved one doesn’t know you, try to move past that and distract them with small talk. You can say it’s a beautiful day out, isn’t it? After they respond to you, you can then try one of the methods we just discussed to see if their memory will return. If they still don’t recognize you just move on. Your loved one doesn’t have to recognize you to still enjoy spending time with you.
Watching your loved one lose themselves and constantly interacting with the disease through them is draining. The Alzheimer’s Society says to give yourself permission to be human. You have good and bad days too. If you need to shorten, or even skip a visit from time to time to replenish yourself – that’s OK. You can alert a staff member or a friend and see if they can possibly arrange a visitor in your absence. It’s important to take care of yourself while caring for a loved one. For more information on preventing caregiver burnout, you can find resources, episodes, and more on our website and you can watch our playlist on caregiver support on our official YouTube Channel.
According to the Alzheimer’s Society, people with memory problems have suggested some of the following aids to help someone with dementia or other memory-related problems remember things. You might think of them as different tools for tackling different problems. You may have already used some of them.
Look for aids that fit with the skills you already have. For example, if you have never used a reminder function on your mobile phone, you may find it difficult to start using it now. Whatever aids you use, people around you can support you to use them.
A calendar or daily agenda can help your loved one know what to expect for the day. If you are on their calendar and they are expecting you to come for a visit, they may be more inclined to remember you. Similarly, sticky notes can help your loved one know to expect you for a visit. The bright, eye-catching color may stick out better than a calendar, too.
If your loved one is used to using technology, using a phone, tablet, or computer can also help them recall memories and people. They can browse Facebook and look at photos and names as a name and face recall exercise. Video calls can also help your loved one feel comfortable visiting with someone they may not recognize. Video calls usually have a person’s name on the screen, along with their face. Having a name on the screen can be helpful to your loved one when they are having trouble recognizing people.
We’ve discussed several methods of prompting a loved one’s memory, now let’s move on to finding other ways to connect with someone with dementia when they do not recognize you.
Dementia UK says it can be very difficult when someone with dementia stops recognizing you. But there are things you can do to keep your connection with the person, and your relationship with them, warm and open.
If you can, try ‘entering into their world’, and asking the person diagnosed with dementia about the memories they mention. Encouraging them to talk about what feels familiar will help them to feel at ease. Try not to remind the person with dementia of more recent realities that they’re having trouble grasping, such as the death of their parents, as this can cause distress and confusion. Instead, talk about happy memories and events that are important to them.
Taking part in activities together can be a good way to reconnect with a person with dementia. Anything you both enjoy can help you feel closer, such as playing familiar music, watching a favorite film, drawing pictures, going for a walk and talking about the things you see on the way, gardening or arranging flowers, or even doing a jigsaw puzzle if your loved one is able.
According to Next Avenue, remembering the past is often a soothing and affirming activity. Many people with dementia may not remember what happened 45 minutes ago, but they can clearly recall their lives 45 years earlier. Therefore, avoid asking questions that rely on short-term memory, like asking the person what they had for lunch. Instead, try asking general questions about the person’s distant past — this information is more likely to be retained.
You can also connect with your loved one through humor. Next Avenue also says that you should use humor whenever possible, though not at the person's expense. People with dementia tend to retain their social skills and are usually delighted to laugh along with you. Laughing with them during your visit can help improve their mood throughout the rest of the day, too.
As dementia progresses, memory loss will no doubt change the connection that you have with a parent – but that doesn’t mean you still can’t have a meaningful connection with your senior loved one.
Learn more about how to build a meaningful connection with a loved one who has dementia and how to maintain that connection throughout the progression of the disease.
Nancy Kriesmen shared a wonderful story about connecting with her mom during the late stages of Alzheimer’s in an article for Alzheimer’s.net. About a year before Nancy Kriseman’s mother Doris died, the two sat outside in the garden at her mom’s skilled nursing residence. By that time, Alzheimer’s disease had diminished most of Doris’ cognitive abilities, along with skills such as mobility and speech. Their time together wasn’t without meaning, though.
Doris, who was diagnosed with Alzheimer’s at age 71, had always loved going for walks. Years earlier, the daughter and mother often strolled to a nearby pond, where they enjoyed sighting butterflies alighting on flowers and dragonflies hovering above the water. Sometimes, the women enjoyed picnics at local parks.
By now, Doris could no longer pack a picnic lunch, but her love of fresh air and greenery remained intact. Kriseman would have loved to engage with her mom as she once did, laughing and talking, even dancing with her to Judy Garland and Tony Bennett songs. Instead, that day, she and her mom ate outdoors from a picnic basket that Kriseman brought along. Kriseman still sang to her mom and reminisced about those singers with Doris, who could still respond by listening.
Nancy Kriseman, a geriatric clinical social worker and owner of Geriatric Consulting Services in Atlanta, Georgia, and author of “Meaningful Connections: Positive Ways to Be Together When a Loved One Has Dementia” offers a few ways to build a meaningful connection with a loved one with dementia.
First, she says to ask another person to join you. Invite a family member or another resident to visit with you and your loved one. This takes the focus off just the two of you. It can also foster new relationships. Next, Kriseman suggests that you keep crafts age-appropriate. Although your senior loved one’s cognitive abilities are impaired, he or she is still an adult. Avoid things like children’s coloring books, opting for adult coloring books instead.
You should also notice how your mood impacts your visits with your loved one. Avoid visiting when you’re ambivalent, irritable, or tired of being there. Like we have talked about earlier in the episode, Kriseman also suggests that you tap into different senses. Stimulating hearing, sight, smell, taste, and touch can lift your parent or senior loved one’s spirit and reinforce the connection.
Finally, you should visit when your loved one is at their best. If they are in an assisted living facility or skilled nursing community, ask staff to recommend the best time to visit.
Now that we’ve covered a few ways you can connect with your loved one when they don’t recognize who you are, let’s move on to the part of today’s episode, which is methods for communicating with someone with dementia.
We have done several episodes on communicating with a loved one with Alzheimer’s and other dementias, so we won’t be talking about this in length, but it is still important to discuss. And as always, if you are interested in learning more about communicating with a loved one with dementia, please visit our website for more information.
Dementia UK has a few suggestions for effective communication with a loved one with dementia. They suggest that you keep yourself in your loved one’s eye line and try not to suddenly appear from the side or from behind. Speak clearly to them and use short sentences. Make sure that you give them time to respond, too. It may take them longer to figure out a response, even to a simple question like it’s a nice day out, isn’t it?
If your loved one is struggling to recognize you, introduce yourself and tell them about the connection between you, for instance: “Hello mom, it’s Julie and I have little Danny, your grandson with me.” If your loved one doesn’t recognize you after this, don’t try to repeat your relationship as it can upset your loved one. If your loved one regularly doesn’t recognize you, don’t ask them “do you know who I am?” Introduce yourself by your name and leave out your relationship.
While talking to them, be reassuring. Look your loved one in the eye and smile. Being reassuring may not always prevent your loved one from becoming agitated or upset. If your loved one is getting agitated, take yourself to another room for a few minutes before coming back in, calmly, and saying something like: “Hello, I’m back now, how lovely to see you.”
Lastly, Dementia UK says to not try not to correct your loved one if they get your name wrong or say something that isn’t true; this can lead to distress and frustration on all sides. Try to imagine how the person with dementia is feeling. They are stressed out, confused, and possibly frightened. Reassure your loved one that you are here to support them and enjoy the time you get to spend with your loved one. And know that even if they don’t remember you they will still remember the sentiments they felt while you were around.
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Sources:
https://www.nia.nih.gov/health/what-alzheimers-disease
https://www.alzheimers.net/stages-of-alzheimers-disease
https://www.seniorlink.com/blog/the-7-stages-of-alzheimers
https://www.verywellhealth.com/tips-visiting-people-dementia-97960
https://www.alz.org/media/greatermissouri/visiting_loved_ones_with_dementia.pdf
https://www.alzheimers.org.uk/get-support/staying-independent/memory-aids-and-tools
https://www.nextavenue.org/10-tips-connecting-someone-dementia/
https://www.alzheimers.net/build-a-meaningful-connection-with-a-loved-one-who-has-dementia
https://www.dementiauk.org/get-support/understanding-changes-in-behaviour/things-to-try-when-someone-with-dementia-stops-recognising-you/