Why people living with dementia never initiate tasks

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She’d left her father a “to-do” list that included tasks around the house. He was home, by himself, for a good deal of time during the day. When his caregiver was there, Max had the help around the house that he needed. When she left, though, Max was also left to his own devices. Max’s daughter came home to find him, head tilted back, asleep in a chair. The closet was still as she’d left it.

Max’s daughter was frustrated, but she didn’t understand that, while Max wanted to do the task, he couldn’t even get started with it. One could argue that it’s because the instructions weren’t clear enough, but even if they’d been explicitly clear, step-by-step instructions, Max wouldn’t have been able to follow them. He was at a stage in his dementia where accomplishing tasks by himself was impossible.

People with dementia have trouble starting tasks because the “initiation” of a new task is too complicated. You know this if you’ve ever had to help someone with dementia get dressed: what you’ll notice is that you need to “cue” each new task before they start it.

And, the task needs to be cued verbally or physically. This is why notes around the house don’t work. Reading is difficult because it involves two different processes: being able to understand the words and then being able to interpret what they mean in context. These two things are too complicated for someone with a moderate or more advanced stage of dementia. Sometimes, they are even too complicated for someone in early stages.

So, it’s not that Max didn’t WANT to help his daughter: he did! He just couldn’t figure out how to get started with the task.

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Rachael Wonderlin has a Master’s in Gerontology and is the author of two published books with Johns Hopkins University Press. She owns Dementia By Day, a dementia care consulting company.

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