Rumination

I meant to post this article months ago when I was still trying to figure out what was going with my mother's mental health. While this post is out of sequence in the saga of my mother’s recent health, I found this information very interesting and thought I would pass it on. The term RUMINATION was new to me although I now realize that my mother has been ruminating for 30 years, maybe longer.

Rumination is defined as the compulsively focused attention on the symptoms of one's distress, and on its possible causes and consequences, as opposed to its solutions. Rumination is similar to worry except rumination focuses on bad feelings and experiences from the past, whereas worry is concerned with potential bad events in the future.

Probing the depression-rumination cycle:

WHY CHEWING ON PROBLEMS JUST MAKES THEM HARDER TO SWALLOW

By BRIDGET MURRAY LAW

The word "ruminate" derives from the Latin for chewing cud, a less than gentile process in which cattle grind up, swallow, then regurgitate and re-chew their feed. Similarly, human ruminators mull an issue at length.

But while the approach might ease cows' digestion, it doesn't do the same for people's mental health: Ruminating about the darker side of life can fuel depression, said Yale University psychologist Susan Nolen-Hoeksema, PhD, in a Board of Scientific Affairs invited address at APA's 2005 Annual Convention.

What's more, rumination can impair thinking and problem solving, and drive away critical social support, she said.

In work published in APA's Journal of Personality and Social Psychology, JPSP (Vol. 77, No. 4, pages 801-814), Nolen-Hoeksema and Christopher Davis, PhD, found that although ruminators report reaching for others' aid more than nonruminators, they receive less of it. In fact, many of them report more social friction--"things like people telling them to buck up and get on with their lives," said Nolen-Hoeksema.

People might respond to a ruminator compassionately at first, but their compassion can wear thin if the rumination persists.

"After a while they get frustrated, and even hostile, and start pulling away, which of course as a ruminator gives you a whole lot more to ruminate about: 'Why are they abandoning me, why are they being so critical of me?'" said Nolen-Hoeksema.

In her talk, she explored the roots of this cycle of rumination and depression, and what can be done to break it.

THE RUMINATION-DEPRESSION LINK

Numerous longitudinal studies point to rumination's negative effects: For example, research Nolen-Hoeksema conducted on Bay Area residents who experienced the 1989 San Francisco earthquake found that those who self-identified as ruminators afterward showed more symptoms of depression and post-traumatic stress disorder.

Another of her studies, conducted with Judith Parker, PhD, and Louise Parker, PhD, found rumination predicted major depression among 455 18- to 84-year-olds who had lost family members to terminal illnesses. Those who ruminated more often became depressed, and stayed depressed in follow-ups through 18 months later, according to the study, published in 1994 in JPSP (Vol. 67, No. 1, pages 92-104).

In addition, a community survey Nolen-Hoeksema conducted on 1,300 adults, ages 25 to 75, backed those results. It found that ruminators develop major depression four times as often as nonruminators: 20 percent versus 5 percent. (The results were significant even for ruminators who weren't depressed at baseline.)

Many ruminators stay in their depressive rut because their negative outlook hurts their problem-solving ability, said Nolen-Hoeksema. According to her research, they often struggle to find good solutions to hypothetical problems. For example, if a friend is avoiding them, they might say, "Well, I guess I'll just avoid them too."

In addition, ruminators express low confidence in their solutions and often fail to enact them--for example, failing to join a bereavement support group despite intending to, said Nolen-Hoeksema.

"Even when a person prone to rumination comes up with a potential solution to a significant problem, the rumination itself may induce a level of uncertainty and immobilization that makes it hard for them to move forward," she said.

WHY PEOPLE RUMINATE

Such depressive rumination most often occurs in women as a reaction to sadness, according to research Nolen-Hoeksema conducted with Lisa Butler, PhD, of Stanford University. Men, by comparison, more often focus on their emotions when they're angry, rather than sad, she said.

The reason, Nolen-Hoeksema speculated, is largely cultural.

"There are differences between what it's OK for women versus men to focus on emotionally," she said.

Gender aside, ruminators share some common characteristics. They often:

•               Believe they're gaining insight through it.

•               Have a history of trauma.

•               Perceive that they face chronic, uncontrollable stressors.

•               Exhibit personality characteristics such as perfectionism, neuroticism and excessive relational focus--"a tendency to so overvalue your relationships with others that you will sacrifice yourself to maintain them, no matter what the costs," Nolen-Hoeksema explained.

Bucking rumination

It's hard to divert depressive ruminators from their negative thoughts, Nolen-Hoeksema's research indicates. However, distracting them by directing them to think about, for example, a plane flying overhead, the layout of their local mall or a fan slowly rotating, does appear to decrease their rumination. Her studies with Sonja Lyubomirsky, PhD, of Stanford University--many of them published in JPSP--have found that distracted ruminators less often recall negative events, such as being dumped by a significant other, than non-distracted ruminators. Distraction also helps mitigate ruminators' tendency to focus on problems--and express self-blame and low confidence--when discussing their lives, the research suggests.

Practically speaking, people can use such distraction techniques as meditation and prayer to help break the rumination cycle, said Nolen-Hoeksema.

Other cycle breakers she suggested include:

·     Taking small actions to begin solving problems.

·     Reappraising negative perceptions of events and high expectations of others.

·     Letting go of unhealthy or unattainable goals and developing multiple sources of self-esteem.

"For example, women who build their identity solely around family are rumination-prone" because they've got all of their self-esteem and social support in one basket, said Nolen-Hoeksema. "So helping them to develop multiple sources of gratification and social support can be helpful buffers against stressful events in any one of those domains."

RUMINATION explains a lot of my mother’s previous behaviors. I think it caused and exacerbated her depression and contributed significantly to her dementia.

I worry that in trying to figure her out that I, too, am ruminating!

So, moving on…(!)

The Friends Are Calling

The friends are calling. This is nice because it means the friends are thinking of my mother. Some are visiting. One is flying across the country to see her and to help. Some call her. Others call Alice. Everyone wants to be kept, ‘up to date.’ This is caring and nice of them. But it’s also demanding for me, and for Alice. The best friends are supportive and say, ‘follow your instincts, listen to your gut.’ The less best ones need comforting and lengthy explanations. They are sad and they feel bad. Those folks tire me out and leave me feeling inadequate and drained. It’s not helpful to tell me what I should be doing, or what the doctor should be doing or what Alice should be doing. We all are doing the best that we can. And so is my mom.

How do you know when it is time for hospice?

The behavior nurse from VNS, Jolene, called me today to inform me that she believes that it is time for my mother to begin Hospice care. I really don’t know what that would entail, but I agreed to have my mother assessed. I know that Alice does not believe that my mother needs hospice at this time and my gut tells me that it is not yet time. We will see what my mother’s doctor says and we will see what the assessment reveals. Even though we have spoken about this in the past, and Alice warned me that Jolene was going to call, it was still kind of a shock to receive this news today.

I read several great and informative articles about hospice tonight and I will post the links below.

Letting Go, a New Yorker article about hospice and death

My Son's Birthday

July 24^th of this year was the 19^th anniversary of the day of my son was born. It would be impossible to forget that day because on that day, I received the greatest gift possible: a beautiful, healthy, baby boy. The love I feel for my baby son is unlike any other that I have ever experienced. I still remember the moment when I first saw his tiny face, a carbon copy of my dad’s. The thrill, the joy, the excitement, the relief, the exhaustion-mothers feel many things right after birth. It’s indescribable. My son is my joy, my life, my gift to the world.

The days surrounding Jeremy’s birth were also the days of the beginnings of my mother’s journey into her new worlds, the worlds of epilepsy and, I now believe, dementia. What should have been, for me, a wondrous, restful time of bonding with my newborn was suddenly the opposite. Instead of snuggling with and gazing at my baby at home, I was forced to turn my attention to my mother to address her needs and offer her support.

Jeremy was born on a Monday. The Friday before, my mother experienced her first seizure and was wandering around Greenwich Village, trying to find her way to St. Vincent’s Hospital, the same place I would give birth a few days later. I was home drinking castor oil, trying to hasten the onset of my labor. I was ten days past my due date and the midwives were eager for Jeremy to be born. My mother found her way back to her doctor’s office on 11^th Street and revealed that she could not remember his instructions, where to go and whom to see at the hospital. Her kind doctor then walked her to the ER himself where she was seen and released with an appointment to see a neurologist. Post dictal, (bewildered and dysfunctional) she was in no condition to care for two year-old Elsa, which had been our plan. My cousin and her nurse-friend, Carla, reluctantly called me and together we arranged for my mother’s cousin, Evelyn, a retired physician, to come to NY from Philadelphia to care for both Elsa and my mother.

I remember my astonishment upon hearing the news that my mother was confused and disoriented at the same time that I was about to give birth. I have to admit, I was furious with her ruining my delivery, for causing me stress, and for once again upstaging me and channeling everyone’s support and attention from me to her at this very special time. I was angry with her for allowing her nerves to get the better of her to the point where she literally fell apart. She was engulfed in worry about my baby and me and all of the many things that she feared could go wrong with my delivery rather than believing that all things could and would go well and that she could, instead, be confident and supportive of me, my capacity to take care of myself, my ability to give birth for a second time, my midwives’ ability to deliver one more healthy baby and the ability of my husband to make sure that everything went smoothly.

During the weekend, Evelyn came, Elsa was cared for, my mother began to recover and Jeremy was born naturally in the early afternoon on Monday. We were discharged from the hospital on Wednesday morning.

Thursday afternoon, I sat in the office of my mother’s first neurologist, Dr. Garafolo, with my mother, cradling three-day old Jeremy in my arms. No one could believe we were there, how young he was and how crazy it was to have him out so soon.

This was the beginning of my dual caregiver role: mother and daughter. Since that time, I have felt I have had to split my energy and concern between my children and my mother. It didn’t feel good to me. My job, as a mother, I believed, was to give my kids my full attention and energy. But, with my mother, that has never been possible. To be honest, I felt that my mother took advantage of me, manipulated me and allowed me to feel guilty if I wasn’t attentive enough. Ever since that day in Dr. Garafolo’s office, I feel I have had the life sucked out of me (the Dementor effect) because of my overwhelming sense of obligation to fill the role that my father’s sudden death in 1983 left vacant. My mother was never able to recover, restart, reboot and re-gather in her hands of the reins of her life. She grieved continuously, she was chronically depressed, she was lost and she couldn’t get back on track. Plus, I always felt the eyes of her sister and two cousins on my shoulder, peering disapprovingly at me from long distances, because I didn’t do enough, visit enough, care for enough or fulfill enough my mother’s emotional needs.

It was not until much later, much too much later really, that I figured out that it was not my job to make my mother happy. For one, I was failing miserably and she was always unhappy regardless, and, at the same time, I was miserable and I was making my husband and children miserable, too.  Gradually, I decided that I would like to be happy, that life is good and I have a lot to be grateful for. I began trying to see the bright side of things and face each challenge or setback as an opportunity to learn and grow.

Eventually, I began the work of detaching from my mother, little by little. I called less frequently, I visited less often, and I began making family decisions without consulting her and began doing things with my family that she did not approve of, like traveling to Africa. I stopped allowing her negativity affect my life and my choices. Feeling freer of her, I began to notice little fun and beautiful things in the world that I appreciated and which made me happy. I saw large ladies doing yoga in Prospect Park one morning, I noticed the color of the lake water against the sky, and I observed flocks of birds calling as they flew in formation. It sounds really corny, but I began to feel a rebirth in a sense, a feeling of being released from an emotional prison, separated from someone who only saw doom and gloom, and I began to feel a new sense of glee and appreciation for life. Of course, guilt is often sprinkled in and among my new feelings, but I guess, being me, a female, that is unavoidable. In some ways, we are programmed to experience guilty feelings whenever we take the initiative to take care of ourselves before someone else.

I am embarrassed to say how very recently my detachment occurred.

I long to retrieve the many evenings I spent on the phone with my mother, listening to her drone on and on, dwelling on the impossible-ness of her situation and sadness, evenings I could have and should have been helping with homework, snuggling with my kids, reading stories or singing bedtime songs. But dwelling on those choices and mistakes would mean repeating her pattern-obsessing over my regrets. Hey, I did the best I could to be a good daughter and a great mother. In my next life, I’ll do better.

And, with all of these recent posts about my mother and her dementia, how detached am I really?

The Ah Ha's are Coming

Neither of my mother’s two doctors, her internist nor her neurologist, have diagnosed her with dementia. Regardless, the diagnosis fits. There are so many symptoms and behaviors that she exhibits for which there is no other explanation and the disease explains SO much about what is going on with her that has been a mystery to me and to other family members, now and for a while.

If we accept that my mother not only has dementia, but is currently at the end stages of the disease, then it only follows that she has had dementia for a very long time. In the past, my cousin and I have made passing comments, almost jokes, about the fact that my mother acted demented, often, but I never really considered dementia a possibility that her doctors should investigate. I do remember insisting that she go to NYU for cognitive testing. The tests required a series of visits during which she had to complete puzzles and other tasks. The tasks were hard and she didn’t like them and, frustrated, she aborted the testing process and claimed the whole thing was “pointless”. Later, in 1995, when she was first diagnosed with epilepsy after a series of small seizures or mini strokes, the epilepsy became our main focus. I should have realized that my mother could have both epilepsy and dementia simultaneously. But, in my defense, I am not a doctor! We attributed a lot of my mother’s behavioral issues to untreated chronic depression, which I’m sure was also a huge factor.

Now, thinking back, the dementia explains a lot. We have had so many baffling issues, fights, arguments and misunderstandings in the past that were so illogical and irrational that I often doubted my own sanity.

Dementia explains my mother’s increasing forgetfulness over the years. Often, she would generalize her conversations and once she had shared information with one relative, she would become frustrated when another relative would not understand what she was talking about because she believed that she had shared the information with that person as well. This happened often.

Dementia explains why, on a day when we were gathered at my mother’s house for brunch to help my daughter gather seed ideas for her college essay, my mother was frustrated at being left out of the conversation because she was unable to follow the threads of ideas as Elsa’s topic began to materialize and gel.

Dementia explains why my mother could never remember or learn how to solve simple issues with her computer and email (such as closing open windows) even after repeated tutoring sessions will all of my family members and carefully written notes and reminders nearby. She simply could not take in  and make sense of this new information.

Dementia also explains my mother’s gradual growing distasteful and hurtful mistrust of me, her only child, which was completely unfounded and caused me to doubt my loyalty and performance as her child. Was I not attentive enough? Respectful enough?

Dementia explains why my mother accused both her devoted former aid of five years as well as her own niece who volunteered to be a caregiver one weekend of hunting for and stealing her cash supply.

Dementia explains why in 2010, her lawyer called me in tears because a three page will that was supposed to take two office visits and no more than three hours to execute ended up taking weeks because my mother refused to accept the limits of NY State laws.

Dementia explains why my mother complained that her balance was off several weeks ago when she could still walk, a prior side effect of her epilepsy medication. Her nurse thought she was misunderstanding a feeling of weakness, but dementia interferes with balance as well.

Dementia explains why now, my mother can no longer walk and spends most all of her time sitting in a chair. She needs pillows to hold her head up as she sits.

Dementia explains why recently she asked me how horses are mounted prior to being exercised at the racetrack, thinking about a series of jobs I had as an exercise rider 30 years ago.

Dementia explains why some days my mother has no speech, no words-just facial expressions. Other days she speaks normally and with a complex vocabulary. Yesterday, she was using nonsensical words and jumbling up her sentences.

Dementia explains why my mother’s sleep cycle is off, and how she is often awake during the night and sleeping most of the day.

Dementia explains why my mother panics and pleads for help, calling neighbors on her cell phone, not understanding that her brain and her body are ‘trapping’ her, not some outside person. It explains why she called the police at 4 am.

Dementia explains why my mother accused me of dropping a kitten off in her apartment and later, why she accused the sub nurse of smothering the kitten.

Dementia explains why my mother can no longer take care of her own hygiene. It explains why on many days, she refuses to bathe.

Dementia explains why my mother feels that she needs to use the toilet every five minutes, or, fails to feel the need to use the toilet.

Dementia explains why my mother cannot feed herself any longer. Her arms are too weak to lift her fork. Her hands are too rigid to curl around the stem of a utensil. She cannot control the movements of her arms and fingers.

Dementia explains my mother’s sudden and rapid decline, beyond her IPF diagnosis in January of this year. At Christmas, she was so different.

Always Go to the Funeral?

I have been following an amazing blog called MY DEMENTED MOM written by Kathy Ritchie. From the ABOUT ME section I learned that Kathy moved to Phoenix with an infant to be her mother’s caregiver. Her mother seems young and has Frontotemporal Alzheimer’s disease. She has been asked to leave more than three facilities because of her behavior, and I’m not sure where her mother is now.

Kathy has written many interesting and reflective posts. I read one yesterday in response to an NPR segment, a This I Believe, essay I remember hearing years ago while on vacation in Maine. The piece was called something like “Always Go to the Funeral” and was about the importance of showing respect for the deceased and the family by attending a funeral, regardless of how awkward or inconvenient it may be.

At the time, I thought it was a great piece because my mother and I often argued about this very subject. My mother proudly and stubbornly refused to attend funerals and memorials, even for close family members. My mother’s sister’s husband died after a long illness and my mother refused to attend his funeral in Detroit. “He was an old drunk!” she exclaimed. “I have theater tickets.” I now wonder if her reaction was an early sign of dementia-it was so irrational. It was also so inconsiderate of her poor sister, who, although she had a difficult marriage, was parting with her life partner and the father of her children. I was ashamed of my mother’s behavior and went to Detroit alone. I was very glad I did, because at the funeral, I learned so many good things about my uncle that I didn’t know and never would have known about his accomplishments and how he helped people, etc.

It was also important to support my aunt and cousins-it was just important to go. I don’t know why my mother couldn’t. My dear friend Sugar says that fear dictates the actions of many people. Maybe that was it-my mother is afraid of death and afraid of sadness. Maybe she is that selfish and couldn’t give her sister and family what they needed at the time. Maybe she didn’t know what to do or how to comfort. Interestingly, when my father died, years before, even though there was no service or funeral, all of my mother’s relatives, her sister and her two cousins, came to be with her…

Regardless, Kathy’s point is that she feels very differently. When her mother dies, she will feel resentment for folks who show up to the funeral who have not been supportive to Kathy and her mother during her mother’s tortuous illness and slow decline.

I can completely understand her feelings. On the other hand, my mother is much older and feebler, and she has a great nurse who has support from two other aids and from my family and me. I feel protective of my mother and her vanity and I don’t want casual visitors to come over and see her in her present condition. Close friends, yes, but not distant friends and acquaintances. I know that she wouldn’t want to be seen, either. She will not be pushed outside in her wheelchair because she doesn’t want people that she knows to see her unable to walk and dependent. I think she’s being ridiculous, but I respect her feelings. So, even though my mother has expressed that she doesn’t want a funeral service of any kind, if we had one, I would appreciate people who know her and respect her attending, even if they have not been on the scene lately.

10 Things People With Alzheimer's Have Taught Me by Marie Marley

A Nice Article from The Huffington Post

The Speech Therapist

During the extended wait for the hospital bed, my mother’s speech therapist, Alecia, called to report on my mother’s progress during her placement on my mother’s care team of visiting nurses from the Visiting Nurse Service.

Alecia was mostly suggesting activities and things we can do as part of a routine for my mother to help reduce her confusion and disorientation, especially upon waking in the mornings when she is most confused.

One suggestion she made is to make a poster that is visible from a distance instructing my mother about what to do when she wakes up. It will say something like: GOOD MORNING, MARY. PLEASE CALL ALICE AND TELL HER THAT YOU ARE AWAKE. It can also have a slot for the day and date to be written-perhaps a dry erase board will be helpful.

Another suggestion is to have a calendar by her bed. Every night, Alice can point to and say the day and date and review the activities of the day. She can also indicate what the day and date will be the next day and discuss the plans or visitors that will come.

The third suggestion is to make a special photo album of the faces of people she knows, one person per page. The album should be small, 4x6 prints, so that she can hold it easily and leaf through it. Alice, or someone, can quiz her to help her identify family and friends.

I will work on to make these things available to my mother as soon as possible.

I asked Alecia what her thinking is about my mother’s condition. Amazingly, she too, is not thinking dementia. (I MUST be crazy!) Her reasoning is that although my mother says Lulu is not her cat, for example, she recognizes Lulu and knows her name. I find this reasoning somewhat flawed. When I described some of the other dementia-like behaviors we have observed and experienced, such as loss of executive functioning long ago, she agreed that there may be some dementia going on, in that case.

Alecia has noticed a decline in my mother’s performance and cognitive abilities over the last two weeks. Still, her time is done. She told me that if my mother improves over the next few weeks, to ask my mother’s doctor to call her back. On the other hand, if my mother gets worse, we can call her back as well. Okay, but why not just continue? I don’t understand this system.

I did appreciate Alecia’s ideas for how to help. She stressed that the purpose of the calendar work and looking at the photo album is not to make my mother remember, but to establish a routine that supports her and can have a calming effect on her demeanor.

A Day of Waiting

Alice told me yesterday that the hospital bed would be delivered today at 1. I knew it would take a substantial amount of time to take down my mother’s existing bed, so Jonathan, my husband, and I thought we’d arrive at her house to begin the process at 12.

Of course, we were delayed and didn’t arrive until 1:15.

Jonathan dismantled the bed and had it tied to the top of our car by 3:30. No hospital bed arrived.

Jonathan left my mother’s house to bring the old bed home to store it. My mother, Maria ( a sub nurse) and I waited.

3:38-no hospital bed. The company closed their offices at 5. I called, got voice mail. I left a message for my rep. She didn’t call back. We heard from no one.

4:30-no hospital bed. No deliveries are allowed at my mother’s house after 6. I began to panic. I called again and spoke to Susan. The bed will arrive between 6 and 9, she informs me. 6 and 9? WHAT? That’s unacceptable! But, my mother has no other bed!

4:45-I left to get to my hair salon before 6:30, (long story). I stopped by the management office at my mother’s building. I informed them of the 6 to 9 window for delivery. This is a ‘big problem,’ Orlando says. I have no idea who he is, but he seems important. I plea. I explain that her bed has gone. We need this new bed. They made an ‘exception’ for my mother, because she’s such a ‘wonderful’ person.

We wait. We wait. We wait.

8:45-text from Alice, “Finally they are here!”

They set it up. The sheets don’t fit. Alice finds something bigger to spread over the mattress. The bed takes up more space than we anticipated. The men help Alice move more stuff out of the way. I should have been there-but I wasn’t. We should have been there.

My mother is sleepy. She gets in her new bed.

Alice calls me and we FaceTime-a first for both my mom and me!

Any Harry Potter Fans Out There?

I'm thinking about dementia and DEMENTORS…

From Wikipedia:

Dementors

The dementors are "soulless creatures among the foulest beings on Earth": a phantom species who, as their name suggests, gradually deprive human minds of intelligence. They are the guards of the wizard prison, Azkaban, until after the return of antagonist Lord Voldemort.

In the books, dementors have a generally human shape, approximately 3 metres (10 feet) in height, covered in dark, hooded cloaks that reveal only their decayed-looking hands. Beneath the cloak, dementors are eyeless, and the only feature of note is the perpetually-indrawn breath, by which they consume the emotions and good memories of human beings, forcing the victim to relive its worst memories alone. According to the author, dementors grow like fungi in dark, moist places, creating a dense, chilly fog. Although they are implied to be sentient, this is left ambiguous. The presence of a dementor makes the surrounding atmosphere grow cold and dark, and the effects are cumulative with the number of dementors present. The culmination of their power is the 'Dementor's Kiss', wherein the dementor latches its mouth onto a victim's lips and consumes its psyche, presumably to leave the victim in a vegetative state. Dementors are invisible to Muggles, but affect them otherwise identically.

JK Rowling's play on words is, I think, very revealing. Dementia sucks the psyche of it's victims. Dementia patients have their lives sucked out of them by the disease.  

More Sundowning

This evening, just before the sundowning hour, I spoke to my mom on the phone. When I asked how she is, I got the usual answer. "Not good. Today was distressing." She went on to explain that she woke up to the news that her cat was dead. I asked how the cat died and she replied that "Bobo" was smothered to death by someone in the house, hinting that either Alice or the visiting speech therapist must be responsible. Yesterday she was distressed about a lost kitten. Today she was remembering a cat that I had as a child, a gray half Siamese with green eyes who was born the night that Nixon was inaugurated. She went on the explain that the cat in the house now, her cat Lulu, is the wrong color because Bobo had blue eyes. Interestingly, Lulu has blue eyes, but whatever.

How do you speak to someone so obviously confused? In the past, I have tried to straighten her out and remind her of what has actually taken place. This evening, I tried a new approach and just went along with her story, agreeing that it was indeed awful and upsetting that Bobo was dead and resting in a little plastic box in her house.

My friend, Katherine, who's mother has been diagnosed with Alzheimer's disease, agrees with this soothing approach. She has been dealing with this for years. She says never correct, never reason, just listen and try to understand. It feels wrong to me, to patronize, especially when my mother is not always confused. It's hard to know when to have a normal conversation, and when to shut up. This is a real learning process…

Screaming and Wailing, A New Experience

This morning began for me at 7:30 when Alice texted me: Your mother got up at 5:30 screaming for help because she thinks she is being robbed and someone wants to kill her so that they can take her job. Poor Alice, her morning began at 5:30. My poor mother, she is in another reality!

So I immediately got online and began researching reasons why dementia patients scream and wail. I read four articles for which I will post the links below.

I learned that there are many reasons why dementia patients cry out. It may be that they are in pain, it may be that they are bored, it may be that they are hungry, it may be that they are over tired or over stimulated, it may be that they are frustrated, it may be that they are confused and disoriented, and it may be that they are scared out of their wits and do not understand what is happening to them.

http://www.fightdementia.org.au/services/agitated-behaviours.aspx

http://www.stacommunications.com/customcomm/Back-issue_pages/AD_Review/adPDFs/january2004/11.pdf

http://www.stacommunications.com/customcomm/Back-issue_pages/AD_Review/adPDFs/2005/january2005e/07.pdf

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=159

http://www.nytimes.com/2009/10/20/health/20well.html?pagewanted=print