People with Alzheimer’s disease and other dementias face a lot of stressors. They may struggle to remember things, try to cover up their memory problems, or feel frustrated that they can’t do things they used to do easily.
They can also feel more stressed and overwhelmed as time goes on. A framework called Progressively Lowered Stress Threshold (PLST) can give caregivers a frame of reference to help them understand and reduce the challenging behaviors associated with Alzheimer’s disease and other dementias. PLST was identified by Geri Hall, PhD, a retired clinical nurse specialist from Banner Alzheimer’s Institute.
People with dementia can’t always easily communicate how they feel. “You’re probably not going to hear, ‘I’m getting a little overwhelmed right now,’” said Heather Mulder, associate director of outreach programs at Banner Alzheimer’s Institute. “You’re going to have to look for more indirect communication like changes in mood or behavior. If the person you care about starts being more anxious or agitated, that could be your clue that they are getting worn out or reaching capacity.”
Structure can help reduce stress
People with Alzheimer’s or other dementias feel better when they have a consistent, predictable routine. Caregivers can watch for how people’s energy level ebbs and flows through the day and structure a routine that matches.
“Consider the amount of energy or stress the person will need to invest to complete a task,” Mulder said. After a taxing activity, plan a less-intense option so the person can rest and rejuvenate.
The order of activities is important, but you can be more flexible with the timing. “If the morning routine consists of getting dressed, fixing breakfast, and eating while reading the newspaper, always try to do them in that order. It matters less if you start them at 7:30, 8:30 or 9:00,” Mulder said.
Strategies for reducing arguments
Dementia changes how people share what they think and what they need, and it also changes the way they understand what you are saying. As much as possible, don’t correct them or try to convince them of something—you’re likely to get into an argument.
Instead, listen and respond to the emotion behind what they are saying, and offer empathy and reassurance. Mulder offers this script:
“You sound ________. I would feel that way too if this were happening to me. Don’t worry, I’ll take care of ________.”
You can also try to distract the person and draw their attention toward a soothing thought or activity.
Anticipate strong emotions to defuse them
With prevention, you can help people with Alzheimer’s and other dementias manage their emotions. Mulder recommends you:
- Provide a calm, soothing, and comfortable environment for the person to thrive in.
- Structure a consistent routine and avoid change.
- Try to identify the cause of intense emotions. Are they overwhelmed, tired or bored? Eliminate the trigger or help them navigate it.
“These strategies help you to better understand what is going on in the person with dementia’s world. Once you are aware, you can anticipate needs or avoid issues in the future,” Mulder said.
The bottom line
Strategies like managing fatigue and maintaining consistency are mainstays of symptom management for people with Alzheimer’s and dementia. But the model behind them is not well-known. “Understanding progressively lowered stress threshold (PLST) offers a framework to help a person living with dementia have the best quality of life,” Mulder said.
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Are you a caregiver to someone with Alzheimer's or dementia? Listen to our Dementia Untangled podcast for guidance and support to help better navigate this complicated and challenging role.