WEBVTT 00:00:06.719 --> 00:00:07.909 Still working on that book? 00:00:08.000 --> 00:00:08.550 What? 00:00:08.800 --> 00:00:09.310 Oh, 00:00:09.880 --> 00:00:11.109 you startled me. 00:00:11.640 --> 00:00:12.189 Yes, 00:00:12.359 --> 00:00:13.279 it's wonderful. 00:00:14.489 --> 00:00:16.209 He reminds me of my father. 00:00:16.500 --> 00:00:17.500 He was a salesman. 00:00:17.579 --> 00:00:18.180 I didn't know that. 00:00:18.219 --> 00:00:19.079 That's interesting. 00:00:19.250 --> 00:00:20.309 And you want to get ready for bed? 00:00:20.969 --> 00:00:21.500 OK. 00:00:24.600 --> 00:00:24.930 OK, 00:00:25.090 --> 00:00:27.129 so brush your teeth, and try using the toilet, and then 00:00:27.129 --> 00:00:28.690 we'll get your slippers off and get you in the bed, 00:00:28.729 --> 00:00:29.159 OK? 00:00:29.489 --> 00:00:29.569 No, 00:00:29.610 --> 00:00:29.690 no, 00:00:29.770 --> 00:00:29.809 no, 00:00:29.930 --> 00:00:30.319 no, 00:00:30.569 --> 00:00:31.090 no, teeth first, 00:00:31.170 --> 00:00:31.969 then slippers. 00:00:32.689 --> 00:00:32.700 OK. 00:00:32.979 --> 00:00:32.990 Oh, 00:00:33.000 --> 00:00:33.889 OK. 00:00:34.150 --> 00:00:35.240 OK. 00:00:40.540 --> 00:00:41.900 Don't forget to floss. 00:00:47.159 --> 00:00:49.889 Middle-stage dementia is a more severe memory 00:00:49.889 --> 00:00:52.709 loss where some distant memory is retained, 00:00:52.840 --> 00:00:55.029 but new material is quickly forgotten. 00:00:55.680 --> 00:59:00.990 This stage is typically the longest and can last for several years. 00:01:00.279 --> 00:01:01.709 In middle-stage dementia, 00:01:01.959 --> 00:01:03.950 damage to the brain can make it difficult 00:01:03.950 --> 00:01:07.419 to express thoughts and perform routine tasks. 00:01:07.599 --> 00:01:10.040 You may notice the person jumbling words, 00:01:10.160 --> 00:01:11.410 having trouble dressing, 00:01:11.480 --> 00:01:12.599 or refusing to bathe. 00:01:13.349 --> 00:01:15.779 There may be personality changes like getting 00:01:15.779 --> 00:01:19.330 frustrated or angry, or acting unexpectedly. 00:01:19.940 --> 00:01:21.860 Being a caregiver for someone in the middle 00:01:21.860 --> 00:01:25.260 stages of dementia demands flexibility and patience. 00:01:25.739 --> 00:01:30.010 As their ability changes and functioning independently becomes more difficult, 00:01:30.260 --> 00:01:32.690 you'll have to take on greater responsibility. 00:01:33.949 --> 00:01:38.540 Daily routines will need to be adapted, and structure will become more important. 00:01:39.209 --> 00:01:41.400 Here are a few additional tips. 00:01:41.650 --> 00:01:44.839 Prepare yourself for the challenges of middle-stage dementia 00:01:45.089 --> 00:01:47.889 by familiarizing yourself with its symptoms. 00:01:48.089 --> 00:01:51.160 When your client asks the same questions repeatedly, 00:01:51.690 --> 00:01:54.199 respond with patience and a calm voice. 00:01:54.489 --> 00:01:57.199 Your client may really be looking for reassurance, 00:01:57.330 --> 00:01:58.400 not answers. 00:01:58.769 --> 00:02:01.860 So, don't necessarily respond to the question itself 00:02:01.860 --> 00:02:04.209 so much as the emotion behind the question. 00:02:04.870 --> 00:02:06.629 If your client can still read, 00:02:06.809 --> 00:02:11.149 help them by providing written reminders, so they can handle some tasks on their own. 00:02:11.800 --> 00:02:14.839 Tell your supervisor and the decision-making family member 00:02:14.839 --> 00:02:17.830 if you're seeing changes in behavior or ability. 00:02:18.320 --> 00:02:22.600 A doctor's visit might be needed to rule out illness or side effects for medication. 00:02:28.589 --> 00:02:29.210 Hi, 00:02:29.369 --> 00:02:30.190 just checking in. 00:02:30.369 --> 00:02:31.759 Do you need to use the restroom? 00:02:32.369 --> 00:02:32.880 No. 00:02:33.130 --> 00:02:33.639 Are you sure? 00:02:33.649 --> 00:02:34.839 It's been a while. 00:02:35.089 --> 00:02:36.479 I'm not a child. 00:02:36.699 --> 00:02:38.000 Of course, I'm sure. 00:02:38.169 --> 00:02:38.850 I understand, 00:02:38.889 --> 00:02:40.080 but I have to check. 00:02:40.330 --> 00:02:42.080 It's time to wash up for dinner now anyway, 00:02:42.289 --> 00:02:43.490 so let's take care of that, 00:02:43.529 --> 00:02:44.070 OK? 00:02:44.210 --> 00:02:44.509 Oh, 00:02:44.649 --> 00:02:45.169 OK. 00:02:53.240 --> 00:02:53.949 Maybe we'll, 00:02:53.960 --> 00:02:54.520 um, 00:02:55.000 --> 00:02:55.960 change your pants too, 00:02:56.000 --> 00:02:57.119 just to freshen up a little. 00:02:57.220 --> 00:02:58.279 I didn't. 00:02:58.360 --> 00:02:58.490 Oh, 00:02:58.559 --> 00:02:59.720 it's OK. Darn it. 00:02:59.880 --> 00:03:02.050 You must feel like you're babysitting a child. 00:03:02.320 --> 00:03:02.490 No, 00:03:02.600 --> 00:03:03.779 it's not a problem, 00:03:03.919 --> 00:03:04.149 really. 00:03:04.360 --> 00:03:05.270 We'll take care of it. 00:03:05.399 --> 00:03:06.119 It's no problem. 00:03:06.240 --> 00:03:12.639 Let's go. OK, let's sit. 00:03:14.619 --> 00:03:15.110 OK. 00:03:18.270 --> 00:03:19.149 There you go. 00:03:27.940 --> 00:03:28.690 How's the book? 00:03:32.050 --> 00:03:32.589 What? 00:03:34.589 --> 00:03:35.330 The book. 00:03:35.500 --> 00:03:36.330 Is it good? 00:03:36.580 --> 00:03:38.089 Oh yes, 00:03:38.460 --> 00:03:40.649 he's running from the man with no nose. 00:03:40.860 --> 00:03:41.679 Voldemort? 00:03:41.940 --> 00:03:43.369 Is he the one with no nose? Mmm-hmm. 00:03:44.979 --> 00:03:45.669 Silly. 00:03:46.179 --> 00:03:48.410 I don't know why they couldn't give him a nose. 00:03:49.100 --> 00:03:50.050 Can you imagine? 00:03:50.940 --> 00:03:52.070 No ears either. 00:03:52.949 --> 00:03:55.940 I don't understand how he got those glasses to stay on. (LAUGHING SOUND) 00:03:56.729 --> 00:03:59.729 The kids he went to school with must have been terrible about that. 00:04:01.539 --> 00:04:02.550 No nose, 00:04:02.800 --> 00:04:03.880 no ears, 00:04:04.779 --> 00:04:06.419 scar on his forehead... 00:04:07.009 --> 00:04:10.939 Children can be so cruel. Mmm-hmm. 00:04:11.639 --> 00:04:12.389 My mother, 00:04:12.710 --> 00:04:13.710 she was a school teacher, 00:04:13.839 --> 00:04:14.429 you know? Oh. 00:04:15.449 --> 00:04:18.238 She wouldn't tolerate any of that nonsense in her classroom. 00:04:19.769 --> 00:04:22.480 And we couldn't get away with it either at home, 00:04:22.649 --> 00:04:23.450 I'll tell you. 00:04:24.440 --> 00:04:26.149 Any sass or any back talk, 00:04:26.359 --> 00:04:27.709 and we get into trouble. 00:04:28.589 --> 00:04:30.329 When father got home, he... 00:04:31.410 --> 00:04:32.890 He was a door-to-door salesman, 00:04:32.929 --> 00:04:33.890 you know? Oh. 00:04:34.049 --> 00:04:35.440 He sold those... 00:04:35.980 --> 00:04:36.489 What are they? 00:04:36.619 --> 00:04:36.910 Those, 00:04:36.959 --> 00:04:37.850 those things... 00:04:37.890 --> 00:04:38.480 Oh, 00:04:38.690 --> 00:04:39.029 you know, 00:04:39.089 --> 00:04:39.730 those things, 00:04:39.809 --> 00:04:41.160 they're square, 00:04:41.410 --> 00:04:42.549 you know what I mean? 00:04:42.559 --> 00:04:43.839 They're square. 00:04:45.209 --> 00:04:46.559 Oh. 00:04:47.140 --> 00:04:47.730 That's OK. 00:04:49.010 --> 00:04:51.420 I bet your father was a really good salesman. 00:04:52.149 --> 00:04:53.440 He was wonderful. 00:04:54.630 --> 00:04:56.160 I loved him so. 00:04:56.890 --> 00:04:57.149 Oh, 00:04:57.160 --> 00:04:59.790 I bet you miss your father and mother from time to time. 00:04:59.859 --> 00:05:00.839 They sound lovely. 00:05:12.380 --> 00:05:14.029 Have you seen my glasses? 00:05:19.500 --> 00:05:22.010 Maintain eye contact when communicating, 00:05:22.019 --> 00:05:25.769 and try to approach the older adult from eye level or lower. 00:05:26.179 --> 00:05:29.059 Standing above your client can make them feel threatened. 00:05:30.489 --> 00:05:30.929 Hi, 00:05:30.940 --> 00:05:31.390 Joan. 00:05:32.100 --> 00:05:33.529 It's time for bed now. 00:05:34.489 --> 00:05:36.130 Reduce distractions. 00:05:36.250 --> 00:05:38.489 Use a calm voice and speak clearly, 00:05:38.690 --> 00:05:39.170 slowly, 00:05:39.250 --> 00:05:40.649 and in a friendly tone. 00:05:41.809 --> 00:05:46.829 What? Now? (GESTURES OF BRUSHING TEETH AND GOING TO SLEEP) 00:05:47.339 --> 00:05:48.410 That's ridiculous. 00:05:49.339 --> 00:05:50.399 I just had breakfast, 00:05:50.450 --> 00:05:51.880 it's barely 10 a.m. 00:05:55.619 --> 00:05:57.170 Well, I liked your hearing doctor. 00:05:57.459 --> 00:05:58.450 She seemed nice. 00:06:00.160 --> 00:06:03.350 When did you meet my doctor? This afternoon, at your appointment, 00:06:03.640 --> 00:06:04.000 remember? 00:06:06.220 --> 00:06:06.880 Oh, 00:06:07.049 --> 00:06:08.410 that's right. 00:06:09.850 --> 00:06:11.359 She's really nice. 00:06:11.450 --> 00:06:12.399 I thought so. 00:06:12.890 --> 00:06:15.079 So, are you excited about your new hearing aid? 00:06:15.290 --> 00:06:16.399 It's great. 00:06:16.970 --> 00:06:18.209 I hear everything now. 00:06:18.369 --> 00:06:18.760 Good. 00:06:19.209 --> 00:06:20.640 So, let's go brush your teeth. 00:06:21.290 --> 00:06:21.920 OK. 00:06:22.489 --> 00:06:24.160 Don't argue with your client. 00:06:24.489 --> 00:06:27.100 If they're saying something that you know is incorrect, 00:06:27.450 --> 00:06:29.399 try to move the conversation around the 00:06:29.399 --> 00:06:31.649 issue rather than directly contradicting them. 00:06:34.320 --> 00:06:35.109 OK, 00:06:35.609 --> 00:06:36.670 sit on the bed, 00:06:36.880 --> 00:06:37.630 please. 00:06:40.059 --> 00:06:40.070 Good. 00:06:41.920 --> 00:06:43.399 Now, take your slippers off. 00:06:46.959 --> 00:06:46.970 OK. 00:06:47.769 --> 00:06:48.980 Now we're gonna lie down. 00:06:49.230 --> 00:06:51.910 Give simple directions one step at a time. 00:06:54.510 --> 00:06:55.200 All right. 00:06:56.350 --> 00:06:57.570 Would you like to read a while? 00:06:58.279 --> 00:06:58.589 Yes, 00:06:58.670 --> 00:06:59.140 I would. 00:06:59.260 --> 00:06:59.630 OK. 00:07:00.399 --> 00:07:01.079 There you go. 00:07:01.790 --> 00:07:02.100 All right, 00:07:02.220 --> 00:07:03.339 and I'll be back in 20 minutes, 00:07:03.380 --> 00:07:03.950 OK? 00:07:04.390 --> 00:07:04.829 All right. 00:07:04.899 --> 00:07:05.220 OK. 00:07:06.869 --> 00:07:09.660 Ask yes or no questions whenever possible. 00:07:12.679 --> 00:07:12.690 All 00:07:13.029 --> 00:07:13.489 right, 00:07:13.630 --> 00:07:15.709 let's try to use the bathroom once more before bed. 00:07:29.589 --> 00:07:30.290 All right, 00:07:30.579 --> 00:07:31.170 stand, 00:07:31.179 --> 00:07:33.250 please. Good. 00:07:33.390 --> 00:07:34.260 Where are we going? 00:07:34.369 --> 00:07:35.459 We're going to the bathroom. 00:07:35.910 --> 00:07:36.250 Oh, 00:07:36.399 --> 00:07:37.000 all right, 00:07:37.070 --> 00:07:37.630 OK. 00:07:37.910 --> 00:07:40.790 Your client will need more assistance with ADLs 00:07:40.790 --> 00:07:44.420 and IADLs like choosing proper clothing for the season 00:07:44.589 --> 00:07:46.230 and remembering to use the toilet. 00:07:46.779 --> 00:07:50.049 Your client will also need assistance with regular bathing. 00:07:50.380 --> 00:07:53.769 Communication difficulties can cause your client to withdraw, 00:07:53.980 --> 00:07:55.690 leading to feelings of depression. 00:07:56.059 --> 00:07:56.220 Hey, 00:07:56.260 --> 00:07:57.880 we were just talking about your garden. 00:07:58.220 --> 00:07:59.049 What do you think? 00:07:59.339 --> 00:08:01.049 Should we have someone plant some roses? 00:08:01.220 --> 00:08:02.579 I like roses. 00:08:02.700 --> 00:08:03.339 I know you do. 00:08:03.420 --> 00:08:05.250 I think you'd enjoy having them. 00:08:05.500 --> 00:08:08.179 Actively engage your client in one-on-one 00:08:08.179 --> 00:08:11.500 conversations to avoid feelings of exclusion and isolation. 00:08:12.160 --> 00:08:13.320 Try to be flexible, 00:08:13.559 --> 00:08:13.929 patient, 00:08:14.040 --> 00:08:16.910 and supportive as your client tries to communicate. 00:08:17.239 --> 00:08:21.350 The way you say something is often more important than what you say. 00:08:21.799 --> 00:08:22.549 What do you need? 00:08:24.709 --> 00:08:26.290 Have you seen my glasses? (GESTURES TOWARDS NECK) 00:08:28.480 --> 00:08:29.279 Oh, 00:08:30.450 --> 00:08:32.219 why can't I remember that? 00:08:32.299 --> 00:08:33.210 That's OK. 00:08:33.330 --> 00:08:34.719 That's why I'm here. 00:08:35.058 --> 00:08:37.489 So, what do you think about white roses? 00:08:37.609 --> 00:08:40.039 If your client repeatedly asks a question, 00:08:40.409 --> 00:08:43.340 remember that they can't recall the answer you just provided. 00:08:43.770 --> 00:08:46.679 Instead of answering the same question multiple times, 00:08:47.049 --> 00:08:50.880 try reassuring them that everything is fine and you're there to help. 00:08:51.210 --> 00:08:51.539 Then, 00:08:51.770 --> 00:08:54.729 try to distract them by discussing a new pleasant topic. 00:08:58.909 --> 00:09:00.030 Would you like some help eating? 00:09:04.140 --> 00:09:05.020 Let me help you. 00:09:05.330 --> 00:09:06.510 Be observant. 00:09:06.770 --> 00:09:09.580 You will need to adjust your communication tactics as 00:09:09.580 --> 00:09:12.940 your client's needs increase and change throughout the stage.