Coping Strategies for Vascular Dementia Caregivers

Anticipate misinterpretation by your patient. A person with VaD may no longer be able to accurately interpret verbal or non-verbal cues, which can cause anxiety and frustration in both you and your patient. Try to be clear and concise in your communications—repeating things as needed using the same words or message. Reduce extraneous noise and distractions when trying to communicate. Do not use confusing pronouns, such as he, she or it, but rather names and specific titles.

Remember that all behavior has a purpose. Many experts believe that some of the behavioral symptoms that people with VaD exhibit, such as shouting or striking out, are meaningful. Although the person does not generally intend to disrupt things or to hurt someone, they do intend to be noticed and perhaps communicate a need that is not being met. In addition, it is important to remember that while these behaviors are meaningful, they are not intentional and the person is not doing this "on purpose," but more likely trying to convey a message that they can longer explain in words. Slowing down, trying to see the world through their eyes and trying to respond to the "feeling" behind the behavior, rather than the behavior itself, may prevent an emotional crisis.

Enjoy the good times. Many people with VaD remain physically fit and retain their ability to be comfortable and involved in social situations quite late in the disease. Therefore, continue to socialize, travel, be physically active and participate in activities that are enjoyable to both you and your patient. Often, familiar activities will continue to be enjoyable for a person with VaD and should be encouraged. However, trying to learn new tasks or starting new hobbies may be frustrating or overwhelming.

Reminisce about the past and encourage discussions about people and places that are familiar and evoke pleasant feelings for both you and your patient. Memories from the distant past are not usually affected and watching family videos, looking at photographs or reviewing travels from the past can allow you and your patient to continue to share experiences and feelings. Allow your patient to share the history they remember with family members, grandchildren and friends. This is fun for everyone and helps your patient feel connected to their loved ones.

Be flexible. Remember that VaD is a progressive disease. Your patient's symptoms and needs will change over time. If strategies such as notes or reminders are no longer working, don't use them. A successful intervention at one stage may become a frustration and disaster at another. Seek help, ask for advice and learn from others who have had similar experiences. More challenging behavioral symptoms of a patient with VaD, such as resisting care or being aggressive can be particularly difficult for a caregiver and often require a very individualized approach. Talk to your doctor about treatment approaches, both pharmacological and non-pharmacological.

Safety

Your patient's safety is an important priority. As their disease progresses, their memory and judgment becomes impaired and they are often unable to anticipate or avoid dangerous situations. This can be an overwhelming responsibility for a caregiver and requires creative strategies for coping. The following recommendations may help ensure your patient's safety.

Supervision may become a greater need for a person with VaD as they become more forgetful and their judgment decreases. It is best to assess each situation individually and gradually increase your patient's level of supervision as needed. This will help them maintain as much independence and autonomy as possible, in as safe a setting as can be provided. It is often difficult to determine the level of supervision needed and involves evaluating the risks and consequences of your patient's current and potential behavior and the ease/discomfort involved in protecting your patient.

When evaluating your patient's need for supervision, behaviors to review include:

• Ability to handle emergencies when left unsupervised
• Ability to use appliances safely
• Ability to safely answer the phone or door when left alone
• Tendency to wander. This may occur in later stages when patients are confused about where they are or are trying to find a familiar person or place. If there is a concern about this, enrolling your patient in the Safe Return program should be considered. This program, which is administered by the Alzheimer's Association, provides national registration and identification of people with VaD to assist in locating them should they wander away or become lost.

Supervision strategies may include:

• Simple reminder phone calls for medications
• Alarms on doors to prevent exiting
• Personal supervision to prevent physical injury or harm

Modifying the environment to limit your patient's exposure to potentially dangerous situations can allow them to continue to be independent and safe. Especially in the early stages of VaD, reminders and cues in your patient's environment may be enough to ensure their safety. For example, posting the steps involved in a task or labeling where things are kept may be extremely helpful to your patient.

In the later stages of the disease, you may need to employ strategies that limit your patient's exposure to potentially dangerous situations, such as installing childproof handles on cupboards containing potentially dangerous materials.