0:00:06.719,0:00:07.909
Still working on that book?

0:00:08.000,0:00:08.550
What?

0:00:08.800,0:00:09.310
Oh,

0:00:09.880,0:00:11.109
you startled me.

0:00:11.640,0:00:12.189
Yes,

0:00:12.359,0:00:13.279
it's wonderful.

0:00:14.489,0:00:16.209
He reminds me of my father.

0:00:16.500,0:00:17.500
He was a salesman.

0:00:17.579,0:00:18.180
I didn't know that.

0:00:18.219,0:00:19.079
That's interesting.

0:00:19.250,0:00:20.309
And you want to get ready for bed?

0:00:20.969,0:00:21.500
OK.

0:00:24.600,0:00:24.930
OK,

0:00:25.090,0:00:27.129
so brush your teeth, and try using the toilet, and then

0:00:27.129,0:00:28.690
we'll get your slippers off and get you in the bed,

0:00:28.729,0:00:29.159
OK?

0:00:29.489,0:00:29.569
No,

0:00:29.610,0:00:29.690
no,

0:00:29.770,0:00:29.809
no,

0:00:29.930,0:00:30.319
no,

0:00:30.569,0:00:31.090
no, teeth first,

0:00:31.170,0:00:31.969
then slippers.

0:00:32.689,0:00:32.700
OK.

0:00:32.979,0:00:32.990
Oh,

0:00:33.000,0:00:33.889
OK.

0:00:34.150,0:00:35.240
OK.

0:00:40.540,0:00:41.900
Don't forget to floss.

0:00:47.159,0:00:49.889
Middle-stage dementia is a more severe memory

0:00:49.889,0:00:52.709
loss where some distant memory is retained,

0:00:52.840,0:00:55.029
but new material is quickly forgotten.

0:00:55.680,0:59:00.990
This stage is typically the longest and can last for several years.

0:01:00.279,0:01:01.709
In middle-stage dementia,

0:01:01.959,0:01:03.950
damage to the brain can make it difficult

0:01:03.950,0:01:07.419
to express thoughts and perform routine tasks.

0:01:07.599,0:01:10.040
You may notice the person jumbling words,

0:01:10.160,0:01:11.410
having trouble dressing,

0:01:11.480,0:01:12.599
or refusing to bathe.

0:01:13.349,0:01:15.779
There may be personality changes like getting

0:01:15.779,0:01:19.330
frustrated or angry, or acting unexpectedly.

0:01:19.940,0:01:21.860
Being a caregiver for someone in the middle

0:01:21.860,0:01:25.260
stages of dementia demands flexibility and patience.

0:01:25.739,0:01:30.010
As their ability changes and functioning independently becomes more difficult,

0:01:30.260,0:01:32.690
you'll have to take on greater responsibility.

0:01:33.949,0:01:38.540
Daily routines will need to be adapted, and structure will become more important.

0:01:39.209,0:01:41.400
Here are a few additional tips.

0:01:41.650,0:01:44.839
Prepare yourself for the challenges of middle-stage dementia

0:01:45.089,0:01:47.889
by familiarizing yourself with its symptoms.

0:01:48.089,0:01:51.160
When your client asks the same questions repeatedly,

0:01:51.690,0:01:54.199
respond with patience and a calm voice.

0:01:54.489,0:01:57.199
Your client may really be looking for reassurance,

0:01:57.330,0:01:58.400
not answers.

0:01:58.769,0:02:01.860
So, don't necessarily respond to the question itself

0:02:01.860,0:02:04.209
so much as the emotion behind the question.

0:02:04.870,0:02:06.629
If your client can still read,

0:02:06.809,0:02:11.149
help them by providing written reminders, so they can handle some tasks on their own.

0:02:11.800,0:02:14.839
Tell your supervisor and the decision-making family member

0:02:14.839,0:02:17.830
if you're seeing changes in behavior or ability.

0:02:18.320,0:02:22.600
A doctor's visit might be needed to rule out illness or side effects for medication.

0:02:28.589,0:02:29.210
Hi,

0:02:29.369,0:02:30.190
just checking in.

0:02:30.369,0:02:31.759
Do you need to use the restroom?

0:02:32.369,0:02:32.880
No.

0:02:33.130,0:02:33.639
Are you sure?

0:02:33.649,0:02:34.839
It's been a while.

0:02:35.089,0:02:36.479
I'm not a child.

0:02:36.699,0:02:38.000
Of course, I'm sure.

0:02:38.169,0:02:38.850
I understand,

0:02:38.889,0:02:40.080
but I have to check.

0:02:40.330,0:02:42.080
It's time to wash up for dinner now anyway,

0:02:42.289,0:02:43.490
so let's take care of that,

0:02:43.529,0:02:44.070
OK?

0:02:44.210,0:02:44.509
Oh,

0:02:44.649,0:02:45.169
OK.

0:02:53.240,0:02:53.949
Maybe we'll,

0:02:53.960,0:02:54.520
um,

0:02:55.000,0:02:55.960
change your pants too,

0:02:56.000,0:02:57.119
just to freshen up a little.

0:02:57.220,0:02:58.279
I didn't.

0:02:58.360,0:02:58.490
Oh,

0:02:58.559,0:02:59.720
it's OK. Darn it.

0:02:59.880,0:03:02.050
You must feel like you're babysitting a child.

0:03:02.320,0:03:02.490
No,

0:03:02.600,0:03:03.779
it's not a problem,

0:03:03.919,0:03:04.149
really.

0:03:04.360,0:03:05.270
We'll take care of it.

0:03:05.399,0:03:06.119
It's no problem.

0:03:06.240,0:03:12.639
Let's go. OK, let's sit.

0:03:14.619,0:03:15.110
OK.

0:03:18.270,0:03:19.149
There you go.

0:03:27.940,0:03:28.690
How's the book?

0:03:32.050,0:03:32.589
What?

0:03:34.589,0:03:35.330
The book.

0:03:35.500,0:03:36.330
Is it good?

0:03:36.580,0:03:38.089
Oh yes,

0:03:38.460,0:03:40.649
he's running from the man with no nose.

0:03:40.860,0:03:41.679
Voldemort?

0:03:41.940,0:03:43.369
Is he the one with no nose? Mmm-hmm.

0:03:44.979,0:03:45.669
Silly.

0:03:46.179,0:03:48.410
I don't know why they couldn't give him a nose.

0:03:49.100,0:03:50.050
Can you imagine?

0:03:50.940,0:03:52.070
No ears either.

0:03:52.949,0:03:55.940
I don't understand how he got those glasses to stay on. (LAUGHING SOUND)

0:03:56.729,0:03:59.729
The kids he went to school with must have been terrible about that.

0:04:01.539,0:04:02.550
No nose,

0:04:02.800,0:04:03.880
no ears,

0:04:04.779,0:04:06.419
scar on his forehead...

0:04:07.009,0:04:10.939
Children can be so cruel. Mmm-hmm.

0:04:11.639,0:04:12.389
My mother,

0:04:12.710,0:04:13.710
she was a school teacher,

0:04:13.839,0:04:14.429
you know? Oh.

0:04:15.449,0:04:18.238
She wouldn't tolerate any of that nonsense in her classroom.

0:04:19.769,0:04:22.480
And we couldn't get away with it either at home,

0:04:22.649,0:04:23.450
I'll tell you.

0:04:24.440,0:04:26.149
Any sass or any back talk,

0:04:26.359,0:04:27.709
and we get into trouble.

0:04:28.589,0:04:30.329
When father got home, he...

0:04:31.410,0:04:32.890
He was a door-to-door salesman,

0:04:32.929,0:04:33.890
you know? Oh.

0:04:34.049,0:04:35.440
He sold those...

0:04:35.980,0:04:36.489
What are they?

0:04:36.619,0:04:36.910
Those,

0:04:36.959,0:04:37.850
those things...

0:04:37.890,0:04:38.480
Oh,

0:04:38.690,0:04:39.029
you know,

0:04:39.089,0:04:39.730
those things,

0:04:39.809,0:04:41.160
they're square,

0:04:41.410,0:04:42.549
you know what I mean?

0:04:42.559,0:04:43.839
They're square.

0:04:45.209,0:04:46.559
Oh.

0:04:47.140,0:04:47.730
That's OK.

0:04:49.010,0:04:51.420
I bet your father was a really good salesman.

0:04:52.149,0:04:53.440
He was wonderful.

0:04:54.630,0:04:56.160
I loved him so.

0:04:56.890,0:04:57.149
Oh,

0:04:57.160,0:04:59.790
I bet you miss your father and mother from time to time.

0:04:59.859,0:05:00.839
They sound lovely.

0:05:12.380,0:05:14.029
Have you seen my glasses?

0:05:19.500,0:05:22.010
Maintain eye contact when communicating,

0:05:22.019,0:05:25.769
and try to approach the older adult from eye level or lower.

0:05:26.179,0:05:29.059
Standing above your client can make them feel threatened.

0:05:30.489,0:05:30.929
Hi,

0:05:30.940,0:05:31.390
Joan.

0:05:32.100,0:05:33.529
It's time for bed now.

0:05:34.489,0:05:36.130
Reduce distractions.

0:05:36.250,0:05:38.489
Use a calm voice and speak clearly,

0:05:38.690,0:05:39.170
slowly,

0:05:39.250,0:05:40.649
and in a friendly tone.

0:05:41.809,0:05:46.829
What? Now? (GESTURES OF BRUSHING TEETH AND GOING TO SLEEP)

0:05:47.339,0:05:48.410
That's ridiculous.

0:05:49.339,0:05:50.399
I just had breakfast,

0:05:50.450,0:05:51.880
it's barely 10 a.m.

0:05:55.619,0:05:57.170
Well, I liked your hearing doctor.

0:05:57.459,0:05:58.450
She seemed nice.

0:06:00.160,0:06:03.350
When did you meet my doctor? This afternoon, at your appointment,

0:06:03.640,0:06:04.000
remember?

0:06:06.220,0:06:06.880
Oh,

0:06:07.049,0:06:08.410
that's right.

0:06:09.850,0:06:11.359
She's really nice.

0:06:11.450,0:06:12.399
I thought so.

0:06:12.890,0:06:15.079
So, are you excited about your new hearing aid?

0:06:15.290,0:06:16.399
It's great.

0:06:16.970,0:06:18.209
I hear everything now.

0:06:18.369,0:06:18.760
Good.

0:06:19.209,0:06:20.640
So, let's go brush your teeth.

0:06:21.290,0:06:21.920
OK.

0:06:22.489,0:06:24.160
Don't argue with your client.

0:06:24.489,0:06:27.100
If they're saying something that you know is incorrect,

0:06:27.450,0:06:29.399
try to move the conversation around the

0:06:29.399,0:06:31.649
issue rather than directly contradicting them.

0:06:34.320,0:06:35.109
OK,

0:06:35.609,0:06:36.670
sit on the bed,

0:06:36.880,0:06:37.630
please.

0:06:40.059,0:06:40.070
Good.

0:06:41.920,0:06:43.399
Now, take your slippers off.

0:06:46.959,0:06:46.970
OK.

0:06:47.769,0:06:48.980
Now we're gonna lie down.

0:06:49.230,0:06:51.910
Give simple directions one step at a time.

0:06:54.510,0:06:55.200
All right.

0:06:56.350,0:06:57.570
Would you like to read a while?

0:06:58.279,0:06:58.589
Yes,

0:06:58.670,0:06:59.140
I would.

0:06:59.260,0:06:59.630
OK.

0:07:00.399,0:07:01.079
There you go.

0:07:01.790,0:07:02.100
All right,

0:07:02.220,0:07:03.339
and I'll be back in 20 minutes,

0:07:03.380,0:07:03.950
OK?

0:07:04.390,0:07:04.829
All right.

0:07:04.899,0:07:05.220
OK.

0:07:06.869,0:07:09.660
Ask yes or no questions whenever possible.

0:07:12.679,0:07:12.690
All

0:07:13.029,0:07:13.489
right,

0:07:13.630,0:07:15.709
let's try to use the bathroom once more before bed.

0:07:29.589,0:07:30.290
All right,

0:07:30.579,0:07:31.170
stand,

0:07:31.179,0:07:33.250
please. Good.

0:07:33.390,0:07:34.260
Where are we going?

0:07:34.369,0:07:35.459
We're going to the bathroom.

0:07:35.910,0:07:36.250
Oh,

0:07:36.399,0:07:37.000
all right,

0:07:37.070,0:07:37.630
OK.

0:07:37.910,0:07:40.790
Your client will need more assistance with ADLs

0:07:40.790,0:07:44.420
and IADLs like choosing proper clothing for the season

0:07:44.589,0:07:46.230
and remembering to use the toilet.

0:07:46.779,0:07:50.049
Your client will also need assistance with regular bathing.

0:07:50.380,0:07:53.769
Communication difficulties can cause your client to withdraw,

0:07:53.980,0:07:55.690
leading to feelings of depression.

0:07:56.059,0:07:56.220
Hey,

0:07:56.260,0:07:57.880
we were just talking about your garden.

0:07:58.220,0:07:59.049
What do you think?

0:07:59.339,0:08:01.049
Should we have someone plant some roses?

0:08:01.220,0:08:02.579
I like roses.

0:08:02.700,0:08:03.339
I know you do.

0:08:03.420,0:08:05.250
I think you'd enjoy having them.

0:08:05.500,0:08:08.179
Actively engage your client in one-on-one

0:08:08.179,0:08:11.500
conversations to avoid feelings of exclusion and isolation.

0:08:12.160,0:08:13.320
Try to be flexible,

0:08:13.559,0:08:13.929
patient,

0:08:14.040,0:08:16.910
and supportive as your client tries to communicate.

0:08:17.239,0:08:21.350
The way you say something is often more important than what you say.

0:08:21.799,0:08:22.549
What do you need?

0:08:24.709,0:08:26.290
Have you seen my glasses? (GESTURES TOWARDS NECK)

0:08:28.480,0:08:29.279
Oh,

0:08:30.450,0:08:32.219
why can't I remember that?

0:08:32.299,0:08:33.210
That's OK.

0:08:33.330,0:08:34.719
That's why I'm here.

0:08:35.058,0:08:37.489
So, what do you think about white roses?

0:08:37.609,0:08:40.039
If your client repeatedly asks a question,

0:08:40.409,0:08:43.340
remember that they can't recall the answer you just provided.

0:08:43.770,0:08:46.679
Instead of answering the same question multiple times,

0:08:47.049,0:08:50.880
try reassuring them that everything is fine and you're there to help.

0:08:51.210,0:08:51.539
Then,

0:08:51.770,0:08:54.729
try to distract them by discussing a new pleasant topic.

0:08:58.909,0:09:00.030
Would you like some help eating?

0:09:04.140,0:09:05.020
Let me help you.

0:09:05.330,0:09:06.510
Be observant.

0:09:06.770,0:09:09.580
You will need to adjust your communication tactics as

0:09:09.580,0:09:12.940
your client's needs increase and change throughout the stage.