Thursday, 11 June 2020

Pray for people I don't know, when I'm asked

For example, if someone is asking about the whereabouts of her purse, inform her that the purse is in her handbag, show her the purse in the bag and encourage her to touch and feel it. Immediately, before the Zeigarnik effect arises again, try to redirect the person on to another topic. The new topic, with its new goal, must grab the person's attention such that they forget the original query (`Hi John, you're a big strong man, will you please help me put this box on the shelf? Ask the person for advice. Asking the person for advice is another strategy for getting her to focus on some other issue. However, ensure the person is not going to be overtaxed by your query. A helpful series of case studies on how to deal with repetitive questions have been published by Hamdy and colleagues (2018a; Their case studies indicate that the phenomenon is highly frustrating for carers, but it is important for the carer to remain calm because emotional reactions can increase the frequency of the questions. I have always thought that whether or not food is addictive is a lesser question, subordinate to a more important one: why does addiction exist at all? Why are we humans capable of becoming addicted to anything? The answer is survival. Our nervous system and endocrine system evolved to reward us most robustly for behaviors that require real effort, can conceivably be avoided, and are essential for survival. Heartbeats are essential for survival but involve no conscious effort; Accordingly, we are glad for every one of them to be sure, but don't receive a pleasurable reward each time. In contrast, breathing can involve conscious effort, but is not conceivably avoidable. We can't actually choose to stop breathing, for at the extreme, we would pass out and start breathing again unconsciously. So here, too, evolution skipped the addition of a reward in the form of acute pleasure (although breathing in the context of meditation and centering can, of course, be soothing and pleasurable) . Getting food is different. I've been miserable for so long. I need to get a divorce.

I don't know where to begin. Can you help me? For us, navigating our changing social status in a couples-only scene of intact family units felt isolating and lonely. We developed strategies for showing up solo to social events and defusing tension, and found much-needed comfort spending time with our friends in the Maplewood Divorce Club. You will want to keep some easy phrases on hand, such as, It's awkward because you know us both, but we don't have to talk about the separation. I was just looking forward to having a fun evening together. This can do wonders for deflating the pink elephant in the room with your ex-husband's face on it. Socializing, whether with friends, acquaintances, or our extended families, brought its share of challenges. Once a problem behaviour (BtC) has occurred it will then require an interaction in the form of an intervention to resolve the difficulty and minimise the risk. In such scenarios, we are often required to act persuasively to get the PWD to either stop some problematic behaviour or to start a behaviour aimed at enhancing the person's wellbeing. We suggest that training to communicate effectively around these common daily activities is essential to delivering good dementia care. Furthermore, knowing these sorts of activities are likely to be the triggers for BtC, we are in a good position to develop skills for such interactions. When dealing with situations when someone is already engaging in a BtC, it is often the carer's role to de-escalate the situation, calm the person and deal with any potential risk. Research suggests that there are number of things not to do in order not to inflame the situation, and we already have seen the Verbal Judo technique in article 3 that addresses some of these issues. If one sees a resident undressing in a communal room, approach her calmly and guide her to a more private area, rather than shouting `Stop' and rushing towards her. When one witnesses an unusual behaviour, one should ask whether it requires any kind of immediate intervention. Are there any immediate risks to the person or others? If there are no concerns, one may be able to simply tolerate the actions. We can conceivably avoid it, although most of us prefer not to for very long. And until quite recently, securing plenty has required real effort.

Finally, food is of course required for personal survival. When it comes to inducing a reward from the pleasure center in our brains, food has all the right stuff. So, of course, does sex. Finding a mate is avoidable, often a labor-intensive undertaking, and key to the survival not of ourselves but of our selfish genes and their claim to a place in the next generation. Genes and adaptation have been running this show all along. The humans who happened to have genes that rewarded them most robustly for eating and mating were most apt to eat, mate and survive long enough to pass on the chance to their progeny. Those humans who were blase about eating and mating never got to progeny. Food and sex are the reasons variations on the theme of addiction are physiologically possible in the first place. We learned how to adapt to the changing landscape, and you can, too. When you were first going through your divorce, your instinct was likely to circle the wagons--to communicate only with your nearest and dearest, perhaps your sister, mom, and best friends, and otherwise retreat. You will likely find that the world has been waiting for you to come back. Many people would love to hear from you, and a lot of people have missed seeing you around. As you start stepping out into the social scene and doing things alone that you used to do as a couple--attending block parties, dinners, holiday cocktails, weddings, and school events--you may find yourself having to act outside your comfort zone. You may want to make some adjustments to ease your transition. Approaches that worked for us and our friends include letting the host of the party know that you're separated, practicing conversation starters, and even bringing another separated or divorced friend as your date. Be sure to have your stock answer for questions about your divorce in place to sidestep any uncomfortable queries. Learn from our stories about how we found a balance between socializing with other divorced women and everyone else, made face-to-face connections versus relying on social media, and ventured out even when we felt brokenhearted. Getting out of your comfort zone . Residents have regular patterns to their behaviours (time of day, triggers). If one can anticipate when a behaviour is likely to happen, one can intervene in a way prior to any problems emerging.

For example, if John always gets upset after his wife leaves the home, spending a few minutes with him until he forgets she's left may reduce his desire to leave the care facility. When communicating with PWD there can be situations where the most appropriate action is to accept their perspectives, even if their views are inconsistent with reality (eg a person living with dementia incorrectly accusing her daughter of taking her purse). Susan Macaulay, a family carer, developed the acronym BANGS to describe such an `acceptance' method (Macaulay, 2015). BANGS highlights the following six features. When you recognise that a confrontation is likely to arise in which you will be required to intervene, before doing anything else take time to `centre' yourself. A good way of centring yourself is to stop and take a deep breath. This technique is also used by many athletes just before doing something important, such as taking a penalty kick in football. Try to make a logical assessment of the current situation, and attempt to understand what is going on. Almost anything else that happens to be addictive is circumstantially hijacking reward systems built for food and sex. Opiate drugs -- like morphine and heroin -- that figure so prominently in our nation's ills as I write this, are similar to our own endorphins and bind to receptors that figure in our intrinsic system of reward and reinforcement. Cocaine binds to receptors fashioned for our own endogenous stimulant compounds. Common pathways We have some deep insights into the shared pathways of addiction thanks to the ill-fated history of what was, for a time, among the more promising of weight-loss drugs, rimonabant (marketed, albeit briefly, as Accomplia). Rimonabant is an endocannabinoid receptor blocker. Look carefully at that long and clumsy word, and you will see something resembling cannabis in the middle. That's no mistake. Rimonabant helped curtail over-eating (and thus facilitated weight loss), and also appeared to be effective at curtailing use of pot, tobacco, and possibly even alcohol. The same receptors were playing a role in a whole panoply of addictions. If going out alone isn't generally your cup of tea, you may want to consider adopting a new mind-set to become a star at solocializing (solo socializing). Start with going out for breakfast.

Take a newspaper or a article for company, which can help you feel less self-conscious. A few bites into your bran muffin, you may be thinking, This is fantastic. I'm great company. Next, you can venture out to a movie by yourself. Start with a matinee. No need to share your Milk Duds or sit through another smash-'em-up car chase film. The Notearticle 2 (dare to dream) might be just the ticket. With those experiences under your belt, why not aim for the bleachers? Listen to what the person is saying and try to clarify the situation. If there is no immediate danger for the person or others, be prepared to accept the person's statements and her views wholeheartedly. Positively agree with the person's view, confirming that she is correct and thereby validating her perspective and making her feel good. The `go' element refers to `going with the flow' of the person living with dementia, and not letting the carer's ego get in the way. In terms of the latter, the carer must be prepared to `let go' of being correct and not try to direct the person. The `go' also refers to the fact that once people are no longer feeling agitated they can shift their concentration onto a different topic. To complete the protocol it is necessary to apologise. By saying sorry the episode is ended and PWD are likely to feel their needs have been met, so potential resentment has been dissipated. Hence, it should be a proper sorry that is conveyed in terms of both body language and tone of voice. BANGS is a useful technique to use in situations where PWD are expressing an opinion or making an accusation, such as a person claiming she is still working or misidentifing you as someone else. Alas for rimonabant and those who took it, its effects were not entirely benign. Its use was associated with a significant increase in suicides.

No comments:

Post a comment

Note: only a member of this blog may post a comment.