1
00:00:06,719 --> 00:00:07,909
Still working on that book?

2
00:00:08,000 --> 00:00:08,550
What?

3
00:00:08,800 --> 00:00:09,310
Oh,

4
00:00:09,880 --> 00:00:11,109
you startled me.

5
00:00:11,640 --> 00:00:12,189
Yes,

6
00:00:12,359 --> 00:00:13,279
it's wonderful.

7
00:00:14,489 --> 00:00:16,209
He reminds me of my father.

8
00:00:16,500 --> 00:00:17,500
He was a salesman.

9
00:00:17,579 --> 00:00:18,180
I didn't know that.

10
00:00:18,219 --> 00:00:19,079
That's interesting.

11
00:00:19,250 --> 00:00:20,309
And you want to get ready for bed?

12
00:00:20,969 --> 00:00:21,500
OK.

13
00:00:24,600 --> 00:00:24,930
OK,

14
00:00:25,090 --> 00:00:27,129
so brush your teeth, and try using the toilet, and then

15
00:00:27,129 --> 00:00:28,690
we'll get your slippers off and get you in the bed,

16
00:00:28,729 --> 00:00:29,159
OK?

17
00:00:29,489 --> 00:00:29,569
No,

18
00:00:29,610 --> 00:00:29,690
no,

19
00:00:29,770 --> 00:00:29,809
no,

20
00:00:29,930 --> 00:00:30,319
no,

21
00:00:30,569 --> 00:00:31,090
no, teeth first,

22
00:00:31,170 --> 00:00:31,969
then slippers.

23
00:00:32,689 --> 00:00:32,700
OK.

24
00:00:32,979 --> 00:00:32,990
Oh,

25
00:00:33,000 --> 00:00:33,889
OK.

26
00:00:34,150 --> 00:00:35,240
OK.

27
00:00:40,540 --> 00:00:41,900
Don't forget to floss.

28
00:00:47,159 --> 00:00:49,889
Middle-stage dementia is a more severe memory

29
00:00:49,889 --> 00:00:52,709
loss where some distant memory is retained,

30
00:00:52,840 --> 00:00:55,029
but new material is quickly forgotten.

31
00:00:55,680 --> 00:59:00,990
This stage is typically the longest and can last for several years.

32
00:01:00,279 --> 00:01:01,709
In middle-stage dementia,

33
00:01:01,959 --> 00:01:03,950
damage to the brain can make it difficult

34
00:01:03,950 --> 00:01:07,419
to express thoughts and perform routine tasks.

35
00:01:07,599 --> 00:01:10,040
You may notice the person jumbling words,

36
00:01:10,160 --> 00:01:11,410
having trouble dressing,

37
00:01:11,480 --> 00:01:12,599
or refusing to bathe.

38
00:01:13,349 --> 00:01:15,779
There may be personality changes like getting

39
00:01:15,779 --> 00:01:19,330
frustrated or angry, or acting unexpectedly.

40
00:01:19,940 --> 00:01:21,860
Being a caregiver for someone in the middle

41
00:01:21,860 --> 00:01:25,260
stages of dementia demands flexibility and patience.

42
00:01:25,739 --> 00:01:30,010
As their ability changes and functioning independently becomes more difficult,

43
00:01:30,260 --> 00:01:32,690
you'll have to take on greater responsibility.

44
00:01:33,949 --> 00:01:38,540
Daily routines will need to be adapted, and structure will become more important.

45
00:01:39,209 --> 00:01:41,400
Here are a few additional tips.

46
00:01:41,650 --> 00:01:44,839
Prepare yourself for the challenges of middle-stage dementia

47
00:01:45,089 --> 00:01:47,889
by familiarizing yourself with its symptoms.

48
00:01:48,089 --> 00:01:51,160
When your client asks the same questions repeatedly,

49
00:01:51,690 --> 00:01:54,199
respond with patience and a calm voice.

50
00:01:54,489 --> 00:01:57,199
Your client may really be looking for reassurance,

51
00:01:57,330 --> 00:01:58,400
not answers.

52
00:01:58,769 --> 00:02:01,860
So, don't necessarily respond to the question itself

53
00:02:01,860 --> 00:02:04,209
so much as the emotion behind the question.

54
00:02:04,870 --> 00:02:06,629
If your client can still read,

55
00:02:06,809 --> 00:02:11,149
help them by providing written reminders, so they can handle some tasks on their own.

56
00:02:11,800 --> 00:02:14,839
Tell your supervisor and the decision-making family member

57
00:02:14,839 --> 00:02:17,830
if you're seeing changes in behavior or ability.

58
00:02:18,320 --> 00:02:22,600
A doctor's visit might be needed to rule out illness or side effects for medication.

59
00:02:28,589 --> 00:02:29,210
Hi,

60
00:02:29,369 --> 00:02:30,190
just checking in.

61
00:02:30,369 --> 00:02:31,759
Do you need to use the restroom?

62
00:02:32,369 --> 00:02:32,880
No.

63
00:02:33,130 --> 00:02:33,639
Are you sure?

64
00:02:33,649 --> 00:02:34,839
It's been a while.

65
00:02:35,089 --> 00:02:36,479
I'm not a child.

66
00:02:36,699 --> 00:02:38,000
Of course, I'm sure.

67
00:02:38,169 --> 00:02:38,850
I understand,

68
00:02:38,889 --> 00:02:40,080
but I have to check.

69
00:02:40,330 --> 00:02:42,080
It's time to wash up for dinner now anyway,

70
00:02:42,289 --> 00:02:43,490
so let's take care of that,

71
00:02:43,529 --> 00:02:44,070
OK?

72
00:02:44,210 --> 00:02:44,509
Oh,

73
00:02:44,649 --> 00:02:45,169
OK.

74
00:02:53,240 --> 00:02:53,949
Maybe we'll,

75
00:02:53,960 --> 00:02:54,520
um,

76
00:02:55,000 --> 00:02:55,960
change your pants too,

77
00:02:56,000 --> 00:02:57,119
just to freshen up a little.

78
00:02:57,220 --> 00:02:58,279
I didn't.

79
00:02:58,360 --> 00:02:58,490
Oh,

80
00:02:58,559 --> 00:02:59,720
it's OK. Darn it.

81
00:02:59,880 --> 00:03:02,050
You must feel like you're babysitting a child.

82
00:03:02,320 --> 00:03:02,490
No,

83
00:03:02,600 --> 00:03:03,779
it's not a problem,

84
00:03:03,919 --> 00:03:04,149
really.

85
00:03:04,360 --> 00:03:05,270
We'll take care of it.

86
00:03:05,399 --> 00:03:06,119
It's no problem.

87
00:03:06,240 --> 00:03:12,639
Let's go. OK, let's sit.

88
00:03:14,619 --> 00:03:15,110
OK.

89
00:03:18,270 --> 00:03:19,149
There you go.

90
00:03:27,940 --> 00:03:28,690
How's the book?

91
00:03:32,050 --> 00:03:32,589
What?

92
00:03:34,589 --> 00:03:35,330
The book.

93
00:03:35,500 --> 00:03:36,330
Is it good?

94
00:03:36,580 --> 00:03:38,089
Oh yes,

95
00:03:38,460 --> 00:03:40,649
he's running from the man with no nose.

96
00:03:40,860 --> 00:03:41,679
Voldemort?

97
00:03:41,940 --> 00:03:43,369
Is he the one with no nose? Mmm-hmm.

98
00:03:44,979 --> 00:03:45,669
Silly.

99
00:03:46,179 --> 00:03:48,410
I don't know why they couldn't give him a nose.

100
00:03:49,100 --> 00:03:50,050
Can you imagine?

101
00:03:50,940 --> 00:03:52,070
No ears either.

102
00:03:52,949 --> 00:03:55,940
I don't understand how he got those glasses to stay on. (LAUGHING SOUND)

103
00:03:56,729 --> 00:03:59,729
The kids he went to school with must have been terrible about that.

104
00:04:01,539 --> 00:04:02,550
No nose,

105
00:04:02,800 --> 00:04:03,880
no ears,

106
00:04:04,779 --> 00:04:06,419
scar on his forehead...

107
00:04:07,009 --> 00:04:10,939
Children can be so cruel. Mmm-hmm.

108
00:04:11,639 --> 00:04:12,389
My mother,

109
00:04:12,710 --> 00:04:13,710
she was a school teacher,

110
00:04:13,839 --> 00:04:14,429
you know? Oh.

111
00:04:15,449 --> 00:04:18,238
She wouldn't tolerate any of that nonsense in her classroom.

112
00:04:19,769 --> 00:04:22,480
And we couldn't get away with it either at home,

113
00:04:22,649 --> 00:04:23,450
I'll tell you.

114
00:04:24,440 --> 00:04:26,149
Any sass or any back talk,

115
00:04:26,359 --> 00:04:27,709
and we get into trouble.

116
00:04:28,589 --> 00:04:30,329
When father got home, he...

117
00:04:31,410 --> 00:04:32,890
He was a door-to-door salesman,

118
00:04:32,929 --> 00:04:33,890
you know? Oh.

119
00:04:34,049 --> 00:04:35,440
He sold those...

120
00:04:35,980 --> 00:04:36,489
What are they?

121
00:04:36,619 --> 00:04:36,910
Those,

122
00:04:36,959 --> 00:04:37,850
those things...

123
00:04:37,890 --> 00:04:38,480
Oh,

124
00:04:38,690 --> 00:04:39,029
you know,

125
00:04:39,089 --> 00:04:39,730
those things,

126
00:04:39,809 --> 00:04:41,160
they're square,

127
00:04:41,410 --> 00:04:42,549
you know what I mean?

128
00:04:42,559 --> 00:04:43,839
They're square.

129
00:04:45,209 --> 00:04:46,559
Oh.

130
00:04:47,140 --> 00:04:47,730
That's OK.

131
00:04:49,010 --> 00:04:51,420
I bet your father was a really good salesman.

132
00:04:52,149 --> 00:04:53,440
He was wonderful.

133
00:04:54,630 --> 00:04:56,160
I loved him so.

134
00:04:56,890 --> 00:04:57,149
Oh,

135
00:04:57,160 --> 00:04:59,790
I bet you miss your father and mother from time to time.

136
00:04:59,859 --> 00:05:00,839
They sound lovely.

137
00:05:12,380 --> 00:05:14,029
Have you seen my glasses?

138
00:05:19,500 --> 00:05:22,010
Maintain eye contact when communicating,

139
00:05:22,019 --> 00:05:25,769
and try to approach the older adult from eye level or lower.

140
00:05:26,179 --> 00:05:29,059
Standing above your client can make them feel threatened.

141
00:05:30,489 --> 00:05:30,929
Hi,

142
00:05:30,940 --> 00:05:31,390
Joan.

143
00:05:32,100 --> 00:05:33,529
It's time for bed now.

144
00:05:34,489 --> 00:05:36,130
Reduce distractions.

145
00:05:36,250 --> 00:05:38,489
Use a calm voice and speak clearly,

146
00:05:38,690 --> 00:05:39,170
slowly,

147
00:05:39,250 --> 00:05:40,649
and in a friendly tone.

148
00:05:41,809 --> 00:05:46,829
What? Now? (GESTURES OF BRUSHING TEETH AND GOING TO SLEEP)

149
00:05:47,339 --> 00:05:48,410
That's ridiculous.

150
00:05:49,339 --> 00:05:50,399
I just had breakfast,

151
00:05:50,450 --> 00:05:51,880
it's barely 10 a.m.

152
00:05:55,619 --> 00:05:57,170
Well, I liked your hearing doctor.

153
00:05:57,459 --> 00:05:58,450
She seemed nice.

154
00:06:00,160 --> 00:06:03,350
When did you meet my doctor? This afternoon, at your appointment,

155
00:06:03,640 --> 00:06:04,000
remember?

156
00:06:06,220 --> 00:06:06,880
Oh,

157
00:06:07,049 --> 00:06:08,410
that's right.

158
00:06:09,850 --> 00:06:11,359
She's really nice.

159
00:06:11,450 --> 00:06:12,399
I thought so.

160
00:06:12,890 --> 00:06:15,079
So, are you excited about your new hearing aid?

161
00:06:15,290 --> 00:06:16,399
It's great.

162
00:06:16,970 --> 00:06:18,209
I hear everything now.

163
00:06:18,369 --> 00:06:18,760
Good.

164
00:06:19,209 --> 00:06:20,640
So, let's go brush your teeth.

165
00:06:21,290 --> 00:06:21,920
OK.

166
00:06:22,489 --> 00:06:24,160
Don't argue with your client.

167
00:06:24,489 --> 00:06:27,100
If they're saying something that you know is incorrect,

168
00:06:27,450 --> 00:06:29,399
try to move the conversation around the

169
00:06:29,399 --> 00:06:31,649
issue rather than directly contradicting them.

170
00:06:34,320 --> 00:06:35,109
OK,

171
00:06:35,609 --> 00:06:36,670
sit on the bed,

172
00:06:36,880 --> 00:06:37,630
please.

173
00:06:40,059 --> 00:06:40,070
Good.

174
00:06:41,920 --> 00:06:43,399
Now, take your slippers off.

175
00:06:46,959 --> 00:06:46,970
OK.

176
00:06:47,769 --> 00:06:48,980
Now we're gonna lie down.

177
00:06:49,230 --> 00:06:51,910
Give simple directions one step at a time.

178
00:06:54,510 --> 00:06:55,200
All right.

179
00:06:56,350 --> 00:06:57,570
Would you like to read a while?

180
00:06:58,279 --> 00:06:58,589
Yes,

181
00:06:58,670 --> 00:06:59,140
I would.

182
00:06:59,260 --> 00:06:59,630
OK.

183
00:07:00,399 --> 00:07:01,079
There you go.

184
00:07:01,790 --> 00:07:02,100
All right,

185
00:07:02,220 --> 00:07:03,339
and I'll be back in 20 minutes,

186
00:07:03,380 --> 00:07:03,950
OK?

187
00:07:04,390 --> 00:07:04,829
All right.

188
00:07:04,899 --> 00:07:05,220
OK.

189
00:07:06,869 --> 00:07:09,660
Ask yes or no questions whenever possible.

190
00:07:12,679 --> 00:07:12,690
All

191
00:07:13,029 --> 00:07:13,489
right,

192
00:07:13,630 --> 00:07:15,709
let's try to use the bathroom once more before bed.

193
00:07:29,589 --> 00:07:30,290
All right,

194
00:07:30,579 --> 00:07:31,170
stand,

195
00:07:31,179 --> 00:07:33,250
please. Good.

196
00:07:33,390 --> 00:07:34,260
Where are we going?

197
00:07:34,369 --> 00:07:35,459
We're going to the bathroom.

198
00:07:35,910 --> 00:07:36,250
Oh,

199
00:07:36,399 --> 00:07:37,000
all right,

200
00:07:37,070 --> 00:07:37,630
OK.

201
00:07:37,910 --> 00:07:40,790
Your client will need more assistance with ADLs

202
00:07:40,790 --> 00:07:44,420
and IADLs like choosing proper clothing for the season

203
00:07:44,589 --> 00:07:46,230
and remembering to use the toilet.

204
00:07:46,779 --> 00:07:50,049
Your client will also need assistance with regular bathing.

205
00:07:50,380 --> 00:07:53,769
Communication difficulties can cause your client to withdraw,

206
00:07:53,980 --> 00:07:55,690
leading to feelings of depression.

207
00:07:56,059 --> 00:07:56,220
Hey,

208
00:07:56,260 --> 00:07:57,880
we were just talking about your garden.

209
00:07:58,220 --> 00:07:59,049
What do you think?

210
00:07:59,339 --> 00:08:01,049
Should we have someone plant some roses?

211
00:08:01,220 --> 00:08:02,579
I like roses.

212
00:08:02,700 --> 00:08:03,339
I know you do.

213
00:08:03,420 --> 00:08:05,250
I think you'd enjoy having them.

214
00:08:05,500 --> 00:08:08,179
Actively engage your client in one-on-one

215
00:08:08,179 --> 00:08:11,500
conversations to avoid feelings of exclusion and isolation.

216
00:08:12,160 --> 00:08:13,320
Try to be flexible,

217
00:08:13,559 --> 00:08:13,929
patient,

218
00:08:14,040 --> 00:08:16,910
and supportive as your client tries to communicate.

219
00:08:17,239 --> 00:08:21,350
The way you say something is often more important than what you say.

220
00:08:21,799 --> 00:08:22,549
What do you need?

221
00:08:24,709 --> 00:08:26,290
Have you seen my glasses? (GESTURES TOWARDS NECK)

222
00:08:28,480 --> 00:08:29,279
Oh,

223
00:08:30,450 --> 00:08:32,219
why can't I remember that?

224
00:08:32,299 --> 00:08:33,210
That's OK.

225
00:08:33,330 --> 00:08:34,719
That's why I'm here.

226
00:08:35,058 --> 00:08:37,489
So, what do you think about white roses?

227
00:08:37,609 --> 00:08:40,039
If your client repeatedly asks a question,

228
00:08:40,409 --> 00:08:43,340
remember that they can't recall the answer you just provided.

229
00:08:43,770 --> 00:08:46,679
Instead of answering the same question multiple times,

230
00:08:47,049 --> 00:08:50,880
try reassuring them that everything is fine and you're there to help.

231
00:08:51,210 --> 00:08:51,539
Then,

232
00:08:51,770 --> 00:08:54,729
try to distract them by discussing a new pleasant topic.

233
00:08:58,909 --> 00:09:00,030
Would you like some help eating?

234
00:09:04,140 --> 00:09:05,020
Let me help you.

235
00:09:05,330 --> 00:09:06,510
Be observant.

236
00:09:06,770 --> 00:09:09,580
You will need to adjust your communication tactics as

237
00:09:09,580 --> 00:09:12,940
your client's needs increase and change throughout the stage.