5 Things to Never Do to a Veteran Living with Dementia (and What to Do Instead)

5 Things to Never Do to a Veteran Living with Dementia (and What to Do Instead) post page

By Valerie FeurichMay 20th, 2021

5 Things to Never Do to a Veteran Living with Dementia (and What to Do Instead)

Strategies for offering compassionate dementia care for veterans with PTSD, TBI, and more
Have you ever heard the saying “If you have met one person with dementia, you have met one person with dementia?” This statement rings true, as it is highly dependent on the individual as to how their Alzheimers disease or other form of dementia will play out. Depending on the type of dementia or other potential health conditions, the journey can vary greatly. If the person living with dementia is a veteran, additional special challenges may arise.

Conditions such as Post-Traumatic Stress Disorder (PTSD), Traumatic Brain Injury (TBI), depression, anxiety, having lost a limb, or other war or disaster-management related conditions can significantly impact the progression and experience of dementia for a person and their care partner.

According to Clifford M. Singer, M.D., there is a high prevalence of dementia risk factors among veterans. In fact, he expected “over 25% of…new cases of dementia will be associated with specific military factors, especially traumatic brain (TBI) and post-traumatic stress disorder (PTSD)” in the decade that ended in 2020. (Source: https://www.aginglifecarejournal.org/dementia-risk-factors-in-veterans/)

You might also include emergency responders such as police officers, search and rescue personnel, emergency medical technicians, and any other similar group that has experienced traumatic events in this category. Because this combined group is so large, the need for dementia care partners that can assist and support veterans living with dementia is significant.

So, if you’re caring for a veteran who is living with dementia, what are some of the unique aspects you’ll need to know? Below is a list of five things you should be aware of if you're caring for or supporting a veteran living with dementia:
1. Avoid war scenes on tv
Imagine having experienced a traumatic life event. How would you feel if someone turned on a program that reenacted a similar scene to what you’ve gone through? Chances are, you wouldn’t care for it. This becomes particularly challenging when a veteran is living with dementia, as the brain undergoes chemical as well as physical changes.

One of the first areas of the brain that gets damaged is the hippocampal region, the area of the brain that helps us keep a timeline of our life’s events and helps us orient ourselves in our surroundings. While the order and location of damage within the hippocampus varies by the type and form of brain change, it is one of the first parts of the brain to be affected in all types of dementia.

When enough of the hippocampal area has been damaged, destroyed, or chemically altered, the person will have a really hard time trying to hold on to the timeline of their life. Things we take for granted, such as knowing where you are or how you got there, are no longer working properly.

Now imagine seeing the scenes of a traumatic event on tv, similar to the ones you’ve experienced. However, also imagine this time you don’t know where you are or what year it is. How would that make you feel? Could this situation trigger negative emotions? Likely, the answer is yes.

So as a care partner of a veteran living with dementia, you’ll want to avoid this type of programming. This may also include the daily news, which could include scenes of war or gruesome accidents. If you have residents asking for the news, you may want to think about recording the news first so you can skip any scenes that may be trigger points. Or, see if you can find a channel that is less likely to include scenes that could create negative associations. Try to think creatively about how you can meet the person’s needs while excluding potential triggers.
2. Avoid loud, sudden noises
While a popping balloon or a group of friends calling Surprise! at their friend that is entering the room may not be a terrifying experience for everyone, veterans that have experienced a war zone with exploding bombs or sudden gunfire are not as likely to appreciate loud and sudden noises.

In the first point above we discussed how damage to the hippocampus creates difficulty in knowing where we are and why we are there. Now, imagine a loud, sudden noise such as a popping balloon. This noise coupled with a traumatic event in one’s past may trigger a very negative emotion and response.

As you set up different activities or events, be mindful and ask yourself if any parts of it could be a trigger for a veteran living with dementia and PTSD. Evaluate whether the value of the experience is worth the possible distress.
3. Don’t approach the person from behind
While it is never a good idea to approach a person living with dementia from behind, it is a particularly bad idea when you’re dealing with a veteran that served in a combat zone.

Not only may the person have experienced traumatic events, but soldiers go through rigorous self-defense training. Pair this with vision changes caused by dementia, including the loss of peripheral vision (how much humans can see on either side without turning their head), and you have a recipe for disaster.

What you’ll want to do instead is use the Positive Physical ApproachTM to approach the person from the front, making sure you’re within their visual field. Go slow, and give them time to register that you’re there.

4. Don’t quietly sneak into their room
When you’re caring for a veteran living with dementia, quietly entering their room with the lights down low to see if they’re awake or need something can end badly. As a person who has been trained in combat and may or may not remember you or where they are, you’ll want to use a different approach.

If the person is sleeping, turn on the lights before you engage. Then, make sure they know you’re there by saying “Knock, knock” (knocking on the door while simultaneously saying the words). “Hey, Mr. Smith! It’s Valerie.”

Once you know they’re aware that you’re there, you can approach slowly from the front, sitting, squatting, or kneeling down so you’re at the person’s level, staying angled to the side to give them additional visual space and make you feel less confrontational.
5. Don’t back them into a corner
Most likely, you don’t enjoy being backed into a corner. Yes, you may be trying to help them take their clothes off, and yes, they may be moving away from you as you try to help. However, backing a veteran living with dementia into a corner likely isn’t a good idea.

Not only do humans have an innate fight or flight mechanism that might set in if we feel threatened, but a veteran’s combination of military training and possible unawareness of time and place can make this a precarious situation.

Instead of making a person living with dementia feel like they’re backed into a corner without a way to escape, allow them some extra visual and physical space. To do this, avoid standing directly in front of them. Instead, ensure that your body is turned to the side in a supportive stance (see the images below for a demonstration). By doing this, you give the person some visual and physical space, which makes it is less likely that they will feel threatened and create a fight or flight reflex.
Confrontational stance
Supportive stance
Confrontational stance
Supportive stance
In addition, if you notice the person is starting to become distressed, back off, give them space, and try another time after everyone has calmed down again. Trying to push through will likely aggravate the situation, negatively impact the relationship you two have, and make it more likely for them to resist in the future. While people living with dementia may not remember what you said, they’re more likely to remember how you’ve made them feel.
Caring for a veteran or emergency-management professional who is living with dementia can include a lot of unique challenges. While we hope the five points above provide you with a starting point to think about the needs of veterans living with dementia a little differently, you’ll likely encounter more situations that you’ll want to think through and approach in a different way.

Try not to make assumptions about people living with dementia. Instead, get curious and do some assessments before moving forward. Remember that having a routine and structure are known to be beneficial for people living with dementia, but are also a type of daily structure the veteran in your care may be used to from their days’ past. Know as much as you can about the person, including their branch of service or rank. Some may even respond well to military phrases, such as “Yes, sir!” or “Yes, Major Smith!” The more you know about a person and what they care about, the better you’ll be able to connect with them.

Interested in learning even more?
Listen to the Dementia Care Partner Talk Show podcast below, where Teepa Snow and Greg Phelps talk about Veterans and Dementia:
Download Print-Version

5 Comments on “5 Things to Never Do to a Veteran Living with Dementia (and What to Do Instead)”

  1. Thank you for this informative information. I’m wondering about people of sexual abuse as a child and developing Alzheimer’s disease later in life. As they regress in age, how can one help them feel safe? What are your thoughts on the use of EMDR as a therapy for those in early to mid stages?

    1. HI Kathy,

      My name is Alejandro and I work as a mentor for Positive Approach to Care. Thank you for taking an interest in the post and for adding in a question. There are many different forms of trauma that people have lived through and it seems that you are curious about how we can make them feel safe. We teach a process called positive physical approach as a way to help build relationships with people that we interact. It is one of the main tools that we use when working with people.

      EMDR seems to be gaining popularity and through some searching I was able to find some studies that were done with people living with dementia. I don’t know anyone personally who has received the therapy. If you would like to have your question explored more you can try adding to the conversation on “Ask Teepa Anything”. Here is a link to to find more information, https://teepasnow.com/services/online-learning__trashed/webinars/.

  2. So helpful is this. And even more subtle exchanges can come about with senior residents. I remember a lady literally counting down the seconds as a flying bomb cut out prior to imminent detonation. That occurred in a normal living room and to this day l cannot say what triggered it. The varied and complexity of such ” triggers ” poses a real challenge for Carers and requires an awareness beyond the general application of dementia Care and all that entails.

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