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Dealing with Fixations

Alzheimer’s patients can get fixated on certain thoughts or actions. Many times the thoughts or actions cause no harm either physically or psychologically, so there is no real need to redirect or change the thought and/or behavior. But when the thought or action causes distress or physical harm there needs to be an intervention.

If a thought or behavior is causing anxiety, fear, or anger it is best to redirect at the first sign of those types of emotions. Signs of emotional distress can be seen in facial expressions, heard in tone of voice or words, and change in activity or personality. Excessive fidgeting, pacing, pulling at hair, or clothing, are all signs of distress. It is much harder to intervene as these emotions escalate. Intervention may be as simple as changing the subject to guide the focus to something more pleasant.

Redirect your loved one to something they enjoy or towards pleasant memories in their earlier years.

Engaging the person in a physical task surrounding the conversation typically has a better outcome.

• For instance, if the person traveled, you can begin talking about a specific geographic area they loved and ask them to show you the souvenirs, or get the photo albums out.

Conversational redirection may not be enough, and in that case it is important to guide the person to another physical location with a positive and calm approach.

• Never tell them to stop talking about it, or try to reason with the thoughts they have. This only causes more problems.
• Do not ask yes or no questions, such as would you like to go into the kitchen or would you like to go for a walk. (You will almost definitely get a no response).
• Using language like “it’s time to” go for our walk, or providing choices such as “do you want to eat lunch or go for our walk first?” will initiate a more positive response.
• It is important that you understand the background of the person to be able to quickly divert their attention to a conversation or task that brings them joy.
  

When your loved one is fixated on behaviors that are dangerous or detrimental to their well being or another or pet, you have to take control of the situation. The best advise I can give as a caregiver is "Don't Panic ... remember in most situations its the disease not the person." In order to find a solution you have to put yourself in the person shoes and think 'Outside the Box'

An Example from Our Experience

My mother was fixated on helping you cook the evening meal ... She often would point out that "I have been cooking the meals for all five of you kids for longer than I care to mention". Each night I nervously watched my mother grab one of the knives from the block on the counter and try to cut something. As the disease progressed she started to hold the knife by the blade rather than the handle. Initially, the use of excuses worked ... “It's OK, remember the doctor  said you need to give that wrist a rest until it heals from that break you had.” ... BUT when a behavior puts the person in imminent danger you must stop it immediately.

PLEASE NOTE ... I am not a proponent of lying but sometimes you can make the person believe a person of authority made the decision, and not you.

After numerous moments of panic followed by raised voices we had to find a different solutionIn our case, there was another and better solution that caused less argument and distress.

Thinking 'outside the box" ... I took the block of knives to the workshop ground the blades to squares, then placed the block back on the counter .... when she fixated on helping ... we were able to give my mother a tomato and the cutting board and she would attempt to cut the tomato. We would then just take the squished tomato and tell her to go take a seat while we finish the dinner. BTW ... We purchased new carving knives and placed them in a drawer out of sight.

REMEMBER ... When you are stressed, angry and anxious, your loved one will also be stressed, angry and anxious.

They need you to be calm, soothing, patient and relaxed to feel safe, loved and cared for.

Although I don’t really like the comparison to children, no one would allow a child to run in the street and put their child in harm’s way of being hit by a car. The same goes for a person with dementia. You will have to do what is necessary to remove the imminent danger. The outcome may be difficult but as long as the danger is removed you will have to utilize other approaches to deal with the difficulty at hand.

Any time you attempt to intervene in a negative thought pattern or behavior, be as calm, gentle, and as reassuring as possible.

Keep your side of the conversation as simple as possible with short statements or questions. Keep noise and stimulation to a minimum because noisy, chaotic, anxious environments and people will only add to the problem.

If a repeated thought, action or behavior is not causing the person any emotional or physical harm, don’t worry about it. Caregiving is very difficult, so it is important to let the little things go and work on getting excellent at developing a positive routine, and intervention techniques for the real problems. It takes practice, trial and error to understand what will work and what won't.

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