When dealing with Alzheimer’s and dementia, especially advanced cases with combative tendencies, it’s important to take extra precaution in your approach, positioning, and communication when caring for your loved one.


First, your approach to your loved one should be announced a few feet away when they cannot see you coming.  Their peripheral vision is diminishing and when you suddenly appear in their face with no warning, they can easily be frightened and may startle, become very upset, or even hit you.  Let them know you are there and approach them from the front.  If that’s not possible, tell them you are there and gently touch their shoulder or arm before slowly coming into view.


Next, while providing care or speaking to them, stand on their dominant side.  Standing in front of them will likely be perceived as a threat because you are blocking them.  The fight-or-flight response will kick in and they may become physically combative to either get away from you or to defend themselves.  Instead, stand at their side.  Seeing that there is a way out if they need to get away can prevent this natural response that tells them there is danger.


Finally, words aren’t always the best way to communicate with someone with Alzheimer’s or dementia.  We are taught to clearly state what we are doing or about to do, but when our words can’t be understood by our loved ones or cause confusion, we need to be prepared to communicate with body language and gestures.  For example, if I tell a client with advanced Alzheimer’s that it’s time to brush their teeth, they may stand there and nod to me like they understand but won’t move the toothbrush to their mouth.  But, by showing them with gestures or assisting them with moving their hand to their mouth, they may understand the task.



by Elizabeth Wooten