How can I be a good houseguest to someone with mild dementia?

July 6, 2015 7:27 AM

At the end of the week I'll be staying overnight at the home of someone who is clearly exhibiting some early dementia symptoms. I've been incredibly lucky that no one in my family has ever had to deal with this before firsthand and I just want some tips so I don't accidentally be a jerk.

My grandmother, who usually lives flying distance away from me, is visiting her hometown and staying with a very dear lifelong friend (we'll call her Vera) this week somewhere a reasonable driving distance away. It's been probably 5-7 years since my grandma has last seen Vera in person, and apparently she's suffered some cognitive decline since then that she's been hiding from my grandma. (This has been a complete surprise. They've been emailing, facebooking, and talking on the phone about the visit (Vera invited my grandma to stay with her in her home) and when my grandma showed up at her door Vera said, "it's so nice to see you! Where are you staying while you're in town?") I spoke on the phone with Gram yesterday morning while Vera was at church (so Gram could speak freely) and apparently Vera is "really struggling," repeating things a lot, asking the same things over and over, has to write checklists for herself for basic things like putting on clothes before leaving the house and bathing daily...it's not a great scene.

Anyway, Vera has graciously invited me and my dog to stay overnight with her in a few days so I can spend some time with my grandma, and I want to make sure it's as un-stressful as possible for her while I'm there.

I'm not exactly the most patient and charitable person, but I can make it work for two days.

What do I need to know? What do I need to be careful about? I know she's embarrassed by this (hiding it from one of her best friends), so are there tips for gently handling the awkward moments?

Also, is there anything I can do for her or bring to her house that would make her life a small bit easier after I leave? I know I'm only going to be staying overnight, but if you have something like "my grandfather has dementia and lives alone, this One Weird Trick made it a lot easier for him to ___" I want to hear about it! Vera has been a very good friend to my grandma since they were in their 30s and I know my grandma feels helpless and sad right now. Even a small gesture would do a lot of good.

If it matters, Vera is 90 and still physically mobile/capable.

Assume I am competent enough to be a good houseguest in general (i.e. be respectful of the house, clean up after myself, practice good dog guest management, etc) and a good houseguest to the elderly (I already intend to spend my two days there lifting heavy things, reaching high shelves, and doing helpful chores). I am looking for advice specific to this situation re: Vera's cognitive decline. Thanks!

posted by phunniemee to Human Relations (26 answers total)

I assume if this was a possibility you would have already considered it, but could Grandma come stay with you overnight (or longer?) to give Vera some time off?
posted by Rock Steady at 7:34 AM on July 6, 2015 [1 favorite]

Best answer: Call your grandma and Vera right before you leave the house to let them know you'll be there in X hours. This also gives your grandmother a chance to remind Vera again that you're staying.

Ask questions about Vera's family and local friends, and maybe her faith community if she has one. See if there's anyone that your grandma could get in touch with if she's feeling like she needs to do something more after this visit.
posted by deludingmyself at 7:36 AM on July 6, 2015 [5 favorites]

Best answer: If Vera asserts something factually incorrect where her error just isn't a big deal, roll with it instead of correcting her. It makes conversation a lot less stressful.

Vera's mobility notwithstanding, if her housekeeping has lagged, don't make a big deal of it and, if necessary, step in and do it yourself in a low-key manner.
posted by mchorn at 7:37 AM on July 6, 2015 [14 favorites]

Response by poster: I assume if this was a possibility you would have already considered it, but could Grandma come stay with you overnight (or longer?) to give Vera some time off?

For myriad reasons no, unfortunately this is not a possibility.
posted by phunniemee at 7:39 AM on July 6, 2015

Best answer: If Vera asserts something factually incorrect where her error just isn't a big deal, roll with it instead of correcting her. It makes conversation a lot less stressful.

Yes. With a family member, you'd have some harder choices to make, but in the current moment I have taken advice to treat conversation like a tennis ball, just trying to return the ball. Other than that, it varies by the person and they will still have preferences. A friend who worked with demented elders told me to avoid talking about the past and to do things like point to a current news article and start a discussion about the content. My father wasn't into that at all; he wanted to talk about the past because his memory of that was more reliable. My advice is just take your cues from Vera but try to make sure she doesn't bear too much of the conversational burden. She will probably try hard; the list making and stuff suggests that, but she is likely already experiencing strain so try to reduce it unobtrusively.
posted by BibiRose at 7:47 AM on July 6, 2015 [2 favorites]

The biggest thing we encountered with my grandfather the past few years was the repeated questions, especially about my grandmother, his "bride" as he always referred to her - and she died 7 years ago. Just answer things noncommittally, and do not disagree with too many things.

Who is taking care of Vera in general? If possible, it's much better for the elderly to be in their home, but somebody needs to be checking in on her regularly. This, of course, is not your job, but it would be helpful for you to know if a child or friend or neighbor is coming by every other day or so.
posted by Ms Vegetable at 7:50 AM on July 6, 2015 [1 favorite]

Best answer: Talk about things you are experiencing in the now rather than the past. Avoid questions about events that took place in the past that she might have forgotten. For example, avoid "When did you move here? Where did you buy that dress? Where did you two go for dinner last night?" She may not remember and get flustered. Remark on the things you all are doing together (going for a walk, watching a particular tv show, things you are seeing at the museum, the food you're eating etc.) because she can comment on those more reliably. She may want to talk about things happened in the distant past, but you won't know what those will be until they pop up. She may have some great stories to tell!
posted by Mouse Army at 7:52 AM on July 6, 2015 [3 favorites]

Best answer: Strongly seconding mchorn's advice: choose your conversational battles. Answer repeat questions as though they're being asked for the first time; if she tells you something don't entirely understand, just take your best guess at what she means and then reply, instead of asking a bunch of clarifying (and potentially stressful) follow-up questions; if she asks you to do, or not do, things that are harmless but don't make a lot of sense, just do them. Keep on chattering to her and let her chatter back. Wherever possible, make your goal "A pleasant interaction that lasts for X minutes" instead of task-oriented, so that you're not setting her up for failure.

Depending on the stage of dementia, I've found that older people can be very charmed by toys that offer up a mix of cuteness and novelty - I brought my grandma a bear that danced and sang when you squeezed its paw and she loved it. I think the Furby is the kind of gold standard for this; if you brought a hostess gift that was a little schlocky but entertaining and introduced it without condescension "I know this is silly but I thought it was really adorable!" she might get quite a bit of pleasure out of it. Similarly, people with mild dementia can really enjoy simple and visually appealing iPad apps; obviously you can't give her an ipad, but you might download a few and see if you can get her interested in them.
posted by pretentious illiterate at 7:54 AM on July 6, 2015 [4 favorites]

Best answer: Just be calm and patient and pretty much react to every statement at face value as though it's meaningful. As noted above, don't correct or argue; if necessary, redirect with a question about the view out the window or a comment about how lovely it is for her to invite you to visit while your Gran is there. If the stove is left on, turn it off, don't ask if she meant to do it. If the dishes are put away dirty, take them out of the cupboard, re-load and re-run the dishwasher. Don't explain, just do it. If Vera asks, say "I noticed these dirty dishes and thought I'd help."

My Nonnie spent the last few years of her life in this decline. I stopped by to my parents on the way to a wedding once (Nonnie lived with my parents) and she patted me on the cheek and said "That's an odd choice of dress to get married in but you're beautiful, dear. Have fun" and I just said "Thanks." When Guy & I announced we were getting married, she said "What a lovely new haircut you have!" and I just said "Thanks" For months after Nonnie's brother died, mom had the same "I wonder how my brother is doing? It's been a while since we've heard from him." "I'm sure he's fine" conversation because the "Mom, he died last month" conversation made no more impression her than the "Oh, you know how he gets with the phone" conversation. Nonnie was much better talking about memories and things from her past than the present or things from yesterday. It may be hard for you to pick up on that with a stranger, though.

How's your Gran's level of distress with this? A lot of dealing with my Grandmother entailed being sympathetic to mom, so maybe be prepared to go for a short walk with your Gran or something to give her a break too.

Nonnie did have fits of anger--she accused me of stealing her house and forcing her to live in my parents' house. I would just walk away and let her yell at the back of me. I'd walk back in five minutes later and she'd have forgotten. Be prepared to leave early, take the dog, get back in your car and go home, if something about your visit seems to really be distressing her.
posted by crush-onastick at 7:54 AM on July 6, 2015 [12 favorites]

Best answer: My biggest piece of advice is to act like it's totally normal for her to forget things you just told her, cheerfully answer the same question as many times as you need to, and not get irritated. Be your best-est, chipper-est, understanding-est self. Vera clearly is aware enough to be self-conscious - do whatever you can to put her at ease. Also know that deviations from the routine bring out the worst symptoms of cognitive decline - you're not ingrained in her being the way her church routine is, for example.

Embrace the checklists. If you're going out, write her a note about when you'll be back. Ask your grandma to write a note of when you'll be arriving. Subtly do little things around the house that need doing, and play it down if she catches you.
posted by telepanda at 7:57 AM on July 6, 2015 [3 favorites]

Response by poster: How's your Gran's level of distress with this?

High. She's really upset and I can tell talking to her that she's watching Vera and worried that the same thing will happen to her soon.
posted by phunniemee at 8:00 AM on July 6, 2015

My grandmother had some form of memory loss like this and we did many of the things recommended already - just roll with it if she asks the same question a dozen times or tells the same story a few times in a row. If she still has long-term memory and likes to tell stories, encourage that! In my experience, 90 year old ladies have some pretty cool stories to tell, and if you can be a patient listener, that can be very good and pleasant for them.
posted by bedhead at 8:50 AM on July 6, 2015

Best answer: The show Dementiaville (you may be able to find it on the interwebs if you so desire) shows what happens when staff let the residents with dementia live in whatever time they get stuck. There's some evidence that approaching dementia in that way reduces stress and anxiety for the patient, though it's often harder on the families who are left behind and want to have the person be who they remember.

Practically, I think that means going along with what ever Vera says and showing interest without expecting her to be able to answer all questions. But it sounds like your grandmother probably needs more support and someone to talk to about it. Focus on that.
posted by guster4lovers at 9:07 AM on July 6, 2015 [1 favorite]

Best answer: It might not be a bad idea to have a backup plan. My grandmother just hit this stage of dementia and it makes her very unpredictable. Often she seems perfectly fine, but then something comes out of left field. She recently invited some family members to stay with her for a week. Apparently she got the dates mixed up and when they showed up a day later than she expected (on the correct date) she refused to let them in the house and they had to stay in a hotel.
posted by galvanized unicorn at 9:17 AM on July 6, 2015 [4 favorites]

Best answer: In my experience, people with dementia seem to remember the distant past better than they remember the recent past (probably something to do with the way long-term and short-term memory works). So if you can ask her about things she and your grandmother used to do together, etc, then it will probably be an easier conversation for her than asking her what she's been up to recently. Also, be prepared for a lot of repeat questions, and try to respond cheerfully to them even if you feel like you're stuck in Groundhog Day.
posted by colfax at 9:22 AM on July 6, 2015 [1 favorite]

Best answer: Talking can be very taxing, so if she seems to be blending into the woodwork, don't try to engage her the way you might with someone else. Sometimes, they'll bow out just because it's too much work to talk. A lot of the rules for social engagement get turned around, really. Don't ask open ended questions. Instead of asking her what she wants to eat, for example, ask her if she'd like tamales. Keep smiling at her and making eye contact unless she seems uncomfortable, and listen attentively if she does say something, but she might be happier just soaking in the conversation as an observer.

Patience is so important. Early stage dementia seems to usually involve language issues, so it might take her ten times as long to form a simple sentence just because she's trying to remember specific words. Take your cues from her. Maybe she appreciates help looking for the word, and maybe she wants time to work it out on her own. Work hard on creative listening. Sometimes, someone will be saying something but using weird phrasing or terminology. There is no simple trick to this, though. It's just sort of a lateral thinking thing, like she's forgotten the names for cutlery and is substituting garden tools or something like that. A lot of the time, it's just that she's digging into personal associations, calling people by other people's names or something.

Oh, man. And gender. I have seen the concept of gender go, and some people get really upset being misgendered. If she does that, don't correct her. She's not doing it on purpose, and it doesn't mean anything about the person she's addressing.

Abstract concepts are often pretty rough. Time, numbers, seasons, distances, things like that. So instead of "at 9:00" or something, say, "when it's dark outside" or "when you wake up," and instead of saying something's x miles away, say it's too far to walk. Things like that.

Try your best not to disrupt her normal schedule more than necessary. That's one stable thing they sometimes have. When they get up, when or maybe what they eat, when they go to bed, things like that. Disruptions like people coming and going a lot can be confusing. Try your best not to be darting in and out more than necessary, because each exit and entrance could be a whole new thing.

From the cases I've seen (unfortunately several), people retain different time frames. Some might be better remembering recent events, some start talking about childhood events like they just happened, or go over and over some other specific period. Just roll with that as best you can. You'll only be there for a little bit, and it sounds like you don't know her well enough probably, but if you do have any familiarity with her life story, do the best you can to engage with her about those things, rather than trying to time shift the discussion. So don't bring up some similar event from another period. It can be very distressing for someone to suddenly be hit with these realizations that they've lost big portions of their life story.

I don't know what to say to your grandmother beyond just telling her this doesn't happen to everyone, and there's not much sense worrying about it too much ahead of time. Don't be patronizing or dismissive about it, though. It really is a horrible thing to happen, and it does happen to a lot of people.
posted by ernielundquist at 9:24 AM on July 6, 2015 [4 favorites]

Best answer: Since your grandmother is very stressed, I think it's good for you to go for moral support. I don't have advice for specific moral support--empathy is always a good position and I think you've got a strong kill things with humor vibe in your family, right? There's just no way to know for sure how your Grandmother will age--Nonnie ended up a lot like her father in terms of demetia, but neither of her two older brothers experienced the same dementia and anxiety. But Nonnie was fine until a rapid skid 3-4 years before she died.
posted by crush-onastick at 9:30 AM on July 6, 2015 [1 favorite]

Best answer: DARE - Don't Argue, Reason or Explain. This is the essence of what a couple of the above commenters were suggesting. Depending on the level of dementia, arguing that you cleaned up the bathroom, explaining that you told her you would be there at 3 p.m. and/or reasoning with her about making your bed (as examples) is a waste of your time and energy. In my lengthy experience. Just go with the flow. "Oh! I'm sorry I didn't clean up the bathroom! Let me do that right now!" and go into the bathroom, take a few deep breaths and come out ready to distract.

Distractions that have worked for me:
"Let's grab some ice cream!"
"I'm going to put on some music."
"That shirt you're wearing is beautiful. Is it new?"
posted by Sophie1 at 9:31 AM on July 6, 2015 [7 favorites]

Best answer: My brother and I had a really good afternoon at my grandmother's house, even though she had fallen into the pattern of cycling through the same 4 polite questions on infinite loop. (oh, how nice that you're here, when did you get in? how long are you staying? how's school been? (graduated 2 years ago), are you staying at your mother's? when did you get in?) Instead of politely relying on her to drive the conversation by asking questions, or asking her questions she wouldn't be able to reply to without getting stressed, my brother created a question-and-answer session between the two of us for her to listen to. He included the kind of information that she liked to ask about, the news we had, frequent recaps of what we were talking about, explanations of who people were, and let her feel included in the conversation without having to take responsibility for holding up her end of it.

example - So you've been home at Mom's for just a day, right?
That's right, I'm spending a week here with Mom, I'm on vacation from my job.
How great, a whole week here, all the way from Michigan huh, that's where your job is?
Yes, I'm living in Michigan but only for the last two years since I finished college, it's good to be back with the family for a week.
It sure is.
I only got in yesterday but I wanted to come right over and spend time with gran. It's great you can be here too, you're staying with mom all week just like I am, right?
Yes I'm staying at Mom's till Sunday, too, I wanted to stay because we're going to all have dinner on Saturday for her birthday.
I came down from Michigan to see everybody for Mom's birthday dinner, too, but yes, I'll be leaving on Sunday. Is that when you go back to Atlanta?
Yes, I'm visiting from Atlanta, staying at Mom's all week, with you. We're both going home on Sunday.
etc.

Instead of her asking the same questions over and over, we supplied a lot of variations on the same information, repeatedly, but slowly moved the conversation along. I could see this (a conversation between you and your grandmother) being a pleasant way for her to share news about her life with Vera, without Vera needing to process all the information in the moment, and without your grandmother feeling upset that Vera isn't hearing/remembering what she tells her.
posted by aimedwander at 10:03 AM on July 6, 2015 [6 favorites]

repeating things a lot, asking the same things over and over, has to write checklists for herself for basic things like putting on clothes before leaving the house and bathing daily

This sounds like fairly advanced dementia symptoms to me. One thing I would do is look for obvious risks of harm - are newspapers stacked near the oven? Is there rotting food in the fridge? However, even if you don't see fire hazards or indications that Vera is not attending to basic self-care, what you have described sounds like the kind of financial risks previously discussed on the Blue.

Also, is there anything I can do for her or bring to her house that would make her life a small bit easier after I leave?

You can call the local Area Agency on Aging and/or Adult Protective Services to ask for referrals to local services that can help support Vera living at home. The U.S. Administration on Aging (AoA) offers a searchable online directory of state and local Area Agencies on Aging and a telephone referral service at [phone] for a variety of resources, including supportive and caretaker services, elder justice and health promotion programs. The Department of Health & Human Services (HHS) offers a searchable online Eldercare locator that includes legal assistance and Elder Abuse Prevention resources. There are services that Medicare may cover that could help Vera remain independent and protected from risks to her financial and physical health, and an Elder Law attorney may be able to help with the planning and any necessary documents related to the usual legal protections for situations like this.

_{via the MeFi Wiki Get a lawyer page}
posted by Little Dawn at 10:04 AM on July 6, 2015 [2 favorites]

Response by poster: Lots of good advice here, thanks guys.

I had already scouted out a local motel that's cool with pets just in case things go south when I arrive and I need to bail. I'm going to try to pull Gram away for some 1:1 time but I expect she wouldn't feel comfortable doing that for politeness' sake. Gonna try under the guise of doing a tour of the old family homes.

Mostly we're just going to play cards and meet other friends of hers for lunch, so I don't anticipate anything more complex than light conversation spectating, I just want to be prepared.

I love the suggestion of a weird little toy gizmo. My grandma has one of those solar powered dancing daisies in her kitchen that she just loves. I found a funny little solar powered dancing monkey. Even if everything else about the visit is a cluster, the monkey will still have a good time.
posted by phunniemee at 10:11 AM on July 6, 2015 [13 favorites]

I forgot something really important: Unless she has clearly regressed and believes she's a kid, or you somehow know she likes this, try really hard to avoid talking her like she's a child.

For many older people, especially women, especially ones who are becoming dependent on others, being babytalked and called patronizing names (honey, sweetie, dear) is just one more indignity piled on an already heaping pile of indignities they're already dealing with.

She is a grown woman worthy of respect. So even if you're talking about the same sort of thing you would with a child, try really hard not to do it in a high pitched or cutesy voice, to avoid baby words, avoid that kind of overdramatic expressiveness people use with kids, and try to address her like you would any other older adult.

This is a very tough balance! You may need to slow down and use smaller, simpler words sometimes, but just remember that she is still an adult, and you don't know how much of her is really left in there. And even if you find yourself slipping up a little, just by trying, you'll be doing better than a lot of people.
posted by ernielundquist at 12:17 PM on July 6, 2015 [6 favorites]

Best answer: Phunniemee, I also think you and your gran should have a serious conversation about making sure Vera is OK after you two leave (which you sort of asked about). Whether that's her family, or setting up a local support network to check in on her every other day, or the local county elderly care services.

Your grandma may have been the first to have realized the problem - someone had to notice first!
posted by amaire at 10:18 PM on July 6, 2015 [1 favorite]

Response by poster: So far so good. I leave tomorrow morning so I called my grandma to go over some last minute things. After my grandma answered I could hear Vera hollering from another room, "is that Jennifer? Tell her we can't wait to see her!"
posted by phunniemee at 6:50 PM on July 8, 2015 [1 favorite]

Response by poster: Welp, I just got home. Vera is doing pretty ok, actually! My grandma blew things way out of proportion, which, knowing my grandma and her tendency to catastrophize literally every other thing in her life, I should probably have seen coming. Vera repeats questions but that's about it. All this business with the notes to herself? Either my grandma made it up (entirely possible) or she's getting Vera confused (ironic) with some other friend of hers (even more possible).

But this question and all of your wonderful answers were great (and will I'm sure be useful to me at some point in the future), even if the only direct result of this thread was that silly swinging solar powered monkey, which let me tell you, went over like gangbusters and moved from window to window in Vera's house trying to find the best light to make him swing back in forth. Vera named the monkey Truman, after my dog, who she quickly fell in love with even though (and maybe this would have been a nice warning to have before thrusting a dog into her life) she kind of hates all pets and has her entire life. But of course she loved my dog, I mean just look at him.

tl;dr My grandma is very silly and +10 points to pretentious illiterate for the excellent suggestion to bring a little toy.
posted by phunniemee at 6:54 PM on July 10, 2015 [6 favorites]

YAY! I am so glad the toy went over well and that you had such a nice visit! :) :) :) Made my afternoon.
posted by pretentious illiterate at 10:19 AM on July 11, 2015 [1 favorite]