Caregiving and repetitive questioning in dementia
During COVID-19, many of us are asking what day it is
With COVID 19 social distancing directives, I have been isolating and staying at home safely for many weeks. I find myself not knowing which day of the week it is, the date or even the month. I definitely related to a recent online meme listing the days of a quarantine week as ‘thisday’, ‘thatday’, ‘otherday’, someday, yesterday, today and ‘nextday’. But here’s the thing, I am now asking my family, “Oh hey, what day is it today?” or “Anyone know the date?”.
Later in the very same day, I unknowingly asked about the date again. I received a sarcastic response: “You asked about the date earlier! Did you forget already”. I curtly replied back; “OOPS! Sorry to have bothered you.” Not wanting to feel any future embarrassment, I turned to asking Alexa (my smart speaker device) about the date–at least my smart device did not give me any sass. The difference between me and someone with dementia not knowing the date, and asking again, is I have the awareness and the ability to problem solve where they may not.
Repetitive questioning and dementia
Verbal repetition, as with any behaviour, has a cause. This repetition behaviour often begins in the early stages and increases significantly as the dementia progresses. Changes in the brain can lead to verbal perseveration. Verbal perseveration is the persistent repeating of a phrase or word; a behaviour that Mom or Dad likely has neither the awareness nor the ability to control or stop.
Verbal repetitions can take the form of repetitive questions, storytelling, repeated statements or conversation topics told over and over again. To illustrate, the person’s mind is stuck in a repetitive loop it cannot release, like a skipping music CD (or for baby boomers, the needle stuck in a vinyl record groove). As another example, the mind is stuck like a car that is stuck in the mud. The wheels are turning and spinning and getting no traction, just as the mind is unable to move forward with new thoughts.
How can I respond?
Answer the question
Your parent’s short-term memory is affected, and they may not even remember they already asked the question. Your parent is attempting to engage in conversation and trying to track things. They may feel embarrassed or even defensive if the repetition is pointed out. The best scenario is to provide the answer the question even if you have to repeat it several times.
Feelings and repetition
A frequently asked question might be triggered by anxiety, boredom, fear of the environment or to gain a sense of comfort, security or familiarity. For example, the repetitive asking of “when are we leaving?” is not only because Dad needs more information about the time when he is leaving, but also perhaps because he is feeling uncomfortable or sensing he is not welcome. Try being alert to the feelings behind the words of what your parent is expressing.
Less is more
Keep your answers brief. Offering lengthy answers with loads of information will not stick and will simply overwhelm your parent. Sometimes we mistakenly feel if we just take our time to explain with more detail, the repetition will hopefully stop. Keeping your answers simple and short is what will actually reduce time and frustration.
Redirect with a task or activity
Avoid reminding them that they just asked the same question. Instead involve your parent in an activity such as looking through old photos, singing, dancing, or doing a helping task like tending to plants, sorting and folding laundry, preparing a snack, dusting furniture.
Discussing plans too far in advance can create anxiety and intensify repeated questioning. You may want to inform your parent of your plans closer to, or immediately prior to an event to pre-empt the repeating behaviour.
Write it down
Writing things down on calendar can help. It may have more of an impact for your parent (if capable) to write it down for themselves. It gives them an added sense of control and they are receiving the information by doing, seeing and hearing. Then, when Mom/Dad asks what day it is or when something is happening, you say, “Look. You have it right here on your calendar.”
As the disease progresses, posting a daily schedule for example, on a whiteboard can be helpful as well as sticky notes or reminder signs placed around their living space. You may want to try placing a sign on the kitchen table, such as, “Supper is at 5:30” or “John comes home at 5:00”. This can remove uncertainty about daily happenings.
Time orientation can be a struggle and may lead to repetitive questions. Dementia-friendly clocks were created for people with the need to be reminded of the day, month, time, time of day. These clocks were also designed to be read easily even from a distance.
You tell your mother: “I am coming over at noon”. She repeats “when are you coming over” and you reply “Noon”. Again the question, and again you say “Noon” and so on. Simply saying “Noon” doesn’t always lead to a resolution. What can you say instead?
- Say “Mom you want to know when I am coming over. Well, I will be over at noon”. This answer will be comforting to her at an emotional level, that you heard her concern. This is better than robotically saying “noon”. Yes “Noon” answers the question, but this statement responds to the emotional need.
- After giving the answer several times to the repeated question, consider returning the question: “Hey mom, can you tell me what time I am coming over?” She may hesitantly yet pleasantly surprise you with the correct answer. Sincerely praise your parent with: “That’s right mom, Good for you!”
- Apologize with a genuine response even if you did not do anything wrong. An apology shows empathy and offers reassurance. Try “Sorry Mom, I thought I said the time, but maybe I didn’t. I will be over at noon.”
- Use distraction to momentarily interrupt the loop by inserting a simple question or diversion of your own, “Mom, come to the window, tell me what you see.” Comment on the sun shining, the children playing, the flowers in the garden, birds in the sky, the cars on the road…
- If your parent is in the earlier stages of dementia, consider using the message feature of a smart speaker like Alexa to remind Mom that you will be over at noon.
An opportunity to practice patience (even if you didn’t ask for it!)
Admittedly, these tips and techniques do require a great deal of patience and a calm approach. It can be exasperating when you have heard the same question for the 10th time and have answered it 10 times in an interval of 30 minutes. You may need to pause, breathe or walk away. You can do a quick relaxing exercise, listen to a favourite tune, pray, get outside for fresh air or whatever you may need. You and your parent will both benefit from the timeout.
Tell us what ways you have tried to deal with repeated questioning?